Neurological examination

The clinical examination is an important part of any patient consultation. After the primary survey and taking the patient history, a more in-depth examination is sometimes required to aid making a working diagnosis and help negate other differential diagnoses. The extent of this depends on the stability of the patient and may not be possible in time-critical circumstances. However, clinical examination is an increasing part of paramedic practice owing to the continued expansion of the scope of the paramedic role in both urgent and emergency care. Education on clinical examination concerning each of the main body systems is now an integral part of undergraduate paramedic curricula.This clinical examination series provides a step-by-step overview for each of the main body systems. Continuing professional development (CPD) is an essential requirement for all clinicians to maintain and to demonstrate that they are staying up to date and advancing in their roles.This series gives an overview of each type of examination to support students, newly qualified paramedics and paramedics wishing to use these articles as a CPD development activity and an aide-memoire for clinical practice. This article, which explores the the neurological examination, gives an overview of initial examination considerations, and assessment of the upper limbs.

Colour, culture and conscious caps off

Alcohol/substance use and occupational/post-traumatic stress in paramedics

Background: Paramedics work in high-pressure environments and experience traumatic events, which contribute to high levels of occupational and post-traumatic stress. Such stress can result in alcohol and substance misuse in other health professionals, but this relationship has not been examined in paramedics. This review is the first exploration of the literature on this. Methods: A systematic literature review was conducted using PRISMA guidelines, with databases searched using terms relevant to paramedics and alcohol/substance use. Studies were analysed using descriptive statistics for quantitative data and thematic analysis for qualitative information. Findings: Eleven studies were identified. Nine studies examined alcohol use; seven examined substance use; five examined both. Alcohol and smoking may be linked to occupational stress. Conclusions: The nature and extent of alcohol and substance use in relation to occupational and post-traumatic stress among paramedics need further investigation to facilitate advice and support.

Undergraduate paramedics' understanding of mental health insight placements

Aims: Paramedics are often patients' first point of contact during mental health crises, and are increasingly responding to mental health emergencies. Paramedic training focuses predominantly on trauma and emergency physical healthcare rather than mental health difficulties. A UK-based pilot evaluation study aimed to find out whether providing mental health ‘insight’ placements for paramedic students in a local mental health trust would improve their understanding of patients with mental health issues, particularly from working alongside mental health practitioners. Methods: A pre- and post-experience questionnaire was used to elicit the students' understanding of mental health. Conclusion: The tentative conclusion is that the placement increased students' understanding of mental health services and mental health patients' needs, and they gained a greater understanding of mental health concepts. Being in direct contact with mental health colleagues in practice ensured that they could link mental health theory learned as part of their degree to their experience and gain insight into multiprofessional working.

Racism in the ambulance service: a personal reflection

Changing paramedic students' perception of people who self-harm

Aim: This study aimed to identify whether paramedic students' perceptions of patients who self-harm changed following an educational intervention. Background: Self-harm is a major public health concern with an increasing number of incidents being reported in England. Paramedics are often the first contact for those who self-harm and antipathy to these patients among caregivers, including paramedics, has been reported. Negative attitudes to patients who self-harm from health professionals is a considerable barrier to their care. Education on self-harm for paramedics has been historically inadequate, even though it can potentially improve attitudes and how these practitioners engage with those who self-harm. Method: A pre- and post-survey analysis was undertaken to examine whether any identified unsympathetic perceptions of paramedic students (n=30) towards patients who self-harm would decrease following an educational intervention, using a validated questionnaire measuring attitudes to self-harm. Results: Perceptions of people who self-harm were generally moderately negative prior to the educational intervention, with a significant drop in negative attitudes after it was completed. A survey showed that this drop was also mostly sustained 10 months later. Conclusion: Educational interventions may help to reduce negative perceptions of patients who self-harm in paramedic students.

Child public health part 3: promoting healthy childhood

Child health promotion focuses on individuals and communities adopting healthy behaviours. This article, the third part of four on child public health, explores health promotion strategy and theory, as well as the areas in which paramedics can contribute to improving their own health promotion beyond the clinical setting.

COVID-19 and students from disadvantaged backgrounds

And breathe…

Having just entered his third year, Jolyon Price reflects on his early autonomous experience in clinical practice as a result of COVID-19, and lessons learned to support him as a clinician

Spotlight on Research