Neurological examination 2

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.The last of the clinical examination series, this article continues exploration of the neurological examination, providing an overview of initial examination considerations, and assessment of the lower limbs.

Clinical courage

The zero point survey and egg-timer model combined for crew management

Managing a complex scene and a critically unwell patient at the same time is a challenge for any paramedic, in terms of both personal preparation and crew resource management. While modern paramedicine requires new solutions to situated challenges, a good starting point is to review existing frameworks to seek ways of maximising the safety of the care delivered by paramedics. This paper provides a synthesis of the theoretical egg-timer model of disparity combined with a practical framework called the zero point survey as cohesive tools for operational paramedics to optimise their performance while experiencing high-stress situations. This synthesis provides a valuable aide mémoire for strategies to improve personal performance, leadership and teamworking in relation to the care of a critically unwell patient. Such models fit within current practice, and have the potential to lead to safer paramedic care through the practical application of human factors theory, with team management skills and psychological interventions to improve patient outcomes.

Challenges of SARS-CoV-2 and conflicting PPE guidelines

During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) has become a contentious issue in healthcare settings, no more so than in the prehospital environment. The current severe acute respiratory syndrome 2 virus (SARS-CoV-2) has pathogenic and transmission similarities to previous coronaviruses, severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). There are differences in global and domestic PPE guidelines concerning SARS-CoV-2.

End-of-life care within the paramedic context

How accurate is the prehospital diagnosis of hyperventilation syndrome?

Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity.

Child public health part 4: paramedics at the forefront of child protection

Paramedics are ideally placed in communities to facilitate screening and promote healthy behaviour in children, as well as identify those who may at risk of abuse or neglect. This last instalment of this four-part series on child public health explores the position of paramedics in the larger picture of child protection.

Theory into practice

After an unconventional first year as a student paramedic during COVID-19, Samuel Parry has now started his second year. In this month's column, he shares his experiences of applying what he has learned out on the road and as a foundation for the year ahead

Spotlight on Research

Legal issues in end-of-life care 2: consent and decision-making

Paramedics are legally and professionally obliged to uphold their patients' right to dignity, respect and autonomy—and this includes the general requirement to obtain their consent before proceeding with any intervention. The first instalment of this two-part article considered the challenges that this might present to the paramedic. This second article develops this theme and further explores the legal framework underpinning the decision-making process when caring for a patient approaching the end of life. It also examines issues around consent and mental capacity in more depth and addresses matters such as such as advance decisions to refuse treatment (ADRT) and do not attempt cardio-pulmonary resuscitation (DNACPR) decisions.