Point-of-care testing for C-reactive protein in acute cough presentations in primary care

Acute cough is one of the most common illnesses in the UK, with an estimated 48 million cases per annum. The majority of these presentations are thought to be of viral aetiology and self-limiting in nature, yet some studies report antibiotic prescription rates of approximately 65% in the UK. Clincians' decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. This article will consider the feasibility, efficacy, benefits and limitations of using point-of-care testing of C-reactive protein within primary care in the United Kingdom to help inform management of acute cough.

Prehospital amputation: a scoping review

Background: Where limbs or extremities become entrapped and it is not possible to extricate a patient in time to prevent death, or because of a deterioration or scene safety emergency, prehospital amputation is an option to enable extrication. Aims: This study aimed to analyse accounts of prehospital amputation and identify factors that may influence practice as well as areas for further research. Methods: A search of multiple databases (AMED, BNI, CINAHL, EMCARE, Google Scholar and PubMed) and additional literature for accounts of prehospital amputation was carried out. Results: Thirteen sources of evidence describing 20 cases of prehospital amputation (18) or dismemberment (2) in a variety of settings between 1975 and 2019 were identified. Prehospital amputation was reported following structural collapse (8), industrial accidents (6), road traffic crashes (5) and rail incidents (1). The procedure was undertaken for a range of reasons, including unsuccessful traditional extrication attempts (7), time-critical patient condition (6), a risk of further extrication attempts causing structural destabilisation (5) and dismemberment of deceased victims (2). The equipment used to perform the amputation was not reported in 14 cases. Outcomes were reported in 17 accounts, with all patients surviving to hospital. Conclusion: Prehospital amputation is performed extremely rarely and accounts in the literature are limited. The situations and environments in which prehospital amputation is reported vary and specialist teams are often required. Further review of guidance and studies on techniques may be beneficial.

Health promotion in mental illness

Clinical exam: an introduction

The clinical examination is an important part of any patient consultation. After the primary survey and patient history, a more in-depth examination of the patient is required in order to aid the working diagnosis and help negate other differential diagnoses. The extent of this depends on the stability of the patient condition and may not be possible in time-critical circumstances. However, it is becoming an increasing part of paramedic practice due to continued expansion of the scope of the paramedic role, both in urgent and emergency care. Educational delivery of clinical examinations of each of the main body systems is now an integral part of undergraduate paramedic curricula.The forthcoming Clinical Examination series will provide a step-by-step overview for each of the main body systems. Continuing professional development (CPD) is an essential requirement for all clinicians in order to maintain and demonstrate currency and advancement within their roles (Health and Care Professions Council (HCPC) 2018). This series will therefore provide an overview of each examination to support students, newly qualified paramedics, and paramedics wishing to utilise these as a CPD development activity and an aide-memoire for clinical practice. This article will provide an introduction to the series, a guide to the intended use and an overview of initial examination considerations, including first impressions.

Physical health in mental health: considerations for paramedics

Life expectancy for people with a mental illness diagnosis is 15–20 years less than those without, mainly because of poor physical health. Mental ill health affects a significant proportion of paramedics' patients, and practitioners could assess and promote their physical health even though contact time is limited. Factors affecting physical health include substandard and disjointed care, stigma and diagnostic overshadowing—where physical symptoms are dismissed as a feature of mental illness. Diagnostic overshadowing is not discussed in key paramedic literature, although patients with mental health problems are at risk of not having their physical needs being taken seriously. The paramedic's role in health promotion is receiving more attention. Making Every Contact Count (MECC)—a behaviour change model using brief interaction—could be adopted by paramedics to promote physical health, especially when linked to campaigns and local services. Health promotion is in its early days in paramedicine, and paramedics could learn from the experiences of other professions.

Improving post-resuscitation care after out-of-hospital cardiac arrest

Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA post-resuscitation care pathway should be developed to improve the delivery of care and survival.

Thanking our 2019 peer review panel

The importance of non-clinical skills

In the final year of her paramedic education, Ellie Daubney builds upon her clinical skills with new non-clinical or ‘soft’ skills, and discovers how to use these in tandem to become the most effective paramedic she can be once she embarks on her career

Spotlight on Research

Firework celebrations put paramedics at increased risk

Caring for woman and baby: pragmatic advice and evidence-based theory