Volume 11 Issue 9

Non-invasive ventilation as a prehospital intervention for acute COPD exacerbation

Chronic obstructive pulmonary disease (COPD) is the second most common respiratory illness in the UK, affecting over 1 million people. Acute exacerbations of COPD are a common presentation to the ambulance service and account for thousands of hospital admissions annually. Acute respiratory failure accompanies approximately 20% of exacerbations. Current prehospital treatment focuses on oxygen and pharmacological therapy to treat the underlying causes. Non-invasive ventilation (NIV) is a method of ventilatory support that does not require endotracheal intubation, avoiding significant risks associated with intubation and sedation. While some UK ambulance services have introduced NIV, UK guidelines primarily focus on hospital use. International trials have shown prehospital NIV to be more effective than standard treatment in terms of reducing the need for intubation and invasive ventilation in hospital. However, further research is necessary before NIV is introduced widely in UK prehospital paramedic practice.

Oxygen titration therapy and hypercapnia risk in COPD

Background: Estimated to be the third leading cause of death in the UK by 2030, chronic obstructive pulmonary disease (COPD) is a common presenting complaint requiring an emergency ambulance. It is recognised that patients with COPD are at high risk of developing hypercapnia with the main theory of causality being high-flow oxygen therapy. Therefore, current guidelines recommend titrating oxygen therapy to maintain oxygen saturation percentage (SpO<sub>2</sub>) of 88–92% to reduce this risk. Aim: The aim of this review is to analyse literature concerning oxygen therapy in patients with COPD and their potential risk of hypercapnia. Methods: Extensive literature searches with strict parameters were carried out in electronic databases. After filtration of results, eight core articles were selected for analysis, from which three themes were identified as particular topics of interest. Findings: Critical analysis of the core articles confirmed the increased risk of hypercapnia in patients with COPD, but it is unclear if the cause is high-flow oxygen therapy, rate of alveolar ventilation or a specific COPD phenotype. Conclusion: Methods of reducing hypercapnia are limited in the prehospital setting with the only method transferable to paramedic practice being air nebulisation. Clinical compliance with study protocols and current national guidelines is low, both in prehospital and in-hospital environments.

Prehospital use of the traction splint for suspected mid-shaft femur fractures

Introduction: A retrospective audit of electronic patient care records (ePCRs) highlighted the infrequent use of the traction splint for the management of femur fractures. The aim of this study was to improve the use of the traction splint for patients presenting with a mid-shaft femur fracture in the absence of contraindications, by means of introducing a purpose-designed trauma CPD training course. Methods: An intervention consisting of a simulation-based mandatory trauma CPD training session for all operational prehospital care providers was implemented over a 3-month period, supported by a pre- and post-implementation staff survey regarding staff perceptions of using a traction splint. Following the intervention period, a repeat retrospective audit of the ePCR database was conducted to identify any improvement in the use of the traction splint. Results: The use of the traction splint for a femur fracture in the pre-intervention stage was found to be underutilised (Median 16%). Following the intervention period, however, traction splint use increased significantly (Median 50%). An improvement was also noted in staff perception and understanding of the management of femur fractures. Conclusion: This study found that focused trauma training is an effective means to improve patient care. Training should be ongoing in order to maintain skills and knowledge needed for management of femur fractures.

Examining the type and frequency of incidents attended by UK paramedics

Various factors have widened the variety of incidents that UK paramedics, practising in a non-specialist role, may be required to attend. This study set out to identify the type and frequency of incidents attended by paramedics, as well as establishing whether geographical location and time of year bear any influence. The study involved a quantitative retrospective review of paramedic-completed patient clinical records, across two locations and the span of 1 year. Results demonstrated the infrequent exposure of paramedics to serious illness/trauma, as well as limited associations of significance in relation to location and time of year. The infrequent nature of certain incidents raises potential issues of skill decay for paramedics; closely aligned to this is their ongoing education, and how learning is best balanced between the infrequent, serious presentations, and those that are frequent but less serious.

The end is near but the learning goes on

Ellie Daubney reflects upon her first 2 years as a student paramedic, and shares her plans for continued learning in her final year and beyond into her career as a paramedic

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