Musculoskeletal system part 1

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 upper musculoskeletal system, gives an overview of initial examination considerations.

COVID-19 unfolding in higher education

PPE use when attempting prehospital resuscitation during COVID-19: conflicts between science and ethics?

Paramedic use of PPE and testing during the COVID-19 pandemic

COVID-19 is the disease caused by the SARS-CoV-2 virus. Paramedics are at the frontline of healthcare delivery, including during the SARS-CoV-2 pandemic. The virus poses specific problems for paramedics. These involve treating and transporting infected patients, as well as considerations around decontamination and disinfection of ambulances and medical equipment. All respiratory infections should be considered COVID-19 until proven otherwise so paramedics should wear personal protective equipment (PPE). PPE consists of gloves, gowns, aprons, surgical face masks, protective eyewear and face shields. Paramedics should receive training and guidance on PPE so they can select and use it properly. The type and level of PPE used will depend on the level of protection required, and risk should be assessed. Widespread testing will give a clearer picture of the incidence and distribution of the virus.

Paramedics' perceptions and experiences of NHS 111 in the south west of England

Background: NHS 111 is a non-emergency telephone triage service in England, where people with non-urgent health problems or questions can gain access to information and services. However, studies have demonstrated key problems with the burden it places on emergency and ambulance services. Aim: To add to the evidence base, this study explores the perceptions and experiences of paramedics who attend patients referred to the ambulance service by NHS 111. Methods: A qualitative research design was adopted and seven frontline paramedics who work in the south west of England were interviewed. Data were collected using semi-structured interview questions and thematically analysed. Findings: Key overarching themes identified included: non-clinical call handlers making clinical decisions; caution and liability; an unwarranted, increased demand on the ambulance service; inaccurate call prioritisation; and interprofessional conflict. Conclusion: Improvements need to be made to the NHS 111 service to ensure the triage software it uses is triaging and prioritising patients accurately and to minimise inappropriate referrals to the ambulance service, promoting the right care for patients the first time.

Targeted temperature management: beneficial or not?

Targeted temperature management (TTM), formerly known as therapeutic hypothermia, has been shown to improve survival and neurological recovery in patients following cardiac arrest. Following successes with its in-hospital implementation, many guidelines now advocate its use in the prehospital domain for all out-of-hospital cardiac arrests (OHCAs). It has been suggested that patients presenting with shockable rhythms who receive early initiation of TTM have better survival rates. TTM can be initiated in the prehospital setting with minimal equipment. This article discusses and explores the potential benefits and pitfalls of targeted temperature management when initiated in the prehospital environment. Particular focus is given to potential treatment strategies that can be used by paramedics to adequately manage OHCA. It is proposed that prehospital TTM is advantageous to all patients in cardiac arrest and can be efficacious in a variety of prehospital environments, with its implementation requiring only minimal equipment.

Pressure and performance: finding your sweet spot

A qualified perspective: the NQP programme

Speaking up — even when not heard

Decisions made at the end of a patient's life can be some of the most difficult. This month, Abbygail Elsey, shares her most challenging experience yet as a newly qualified paramedic

Anxiety during COVID-19

As student paramedics adjust to online learning and its many challenges, guest student columnist, Rhys Sycamore, reflects on the resulting anxiety and how it can be managed

Spotlight on Research

Gender in medicine (2020)