Musculoskeletal system part 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. This article, which explores the the musculoskeletal system, gives an overview of initial examination considerations.

Are you ‘enhanced’ by your stress?

Letters

COVID-19: experiences of roadside logistics from a UK air ambulance service

The COVID-19 pandemic is so widespread that any patient in the prehospital environment is considered a significant transmission risk. UK charity air ambulances are affected by challenges regarding air equipment decontamination, staff redeployment and acquisition of personal protective equipment. This has led services to change their mode of operation and contribute to other areas of healthcare that have sprung up in response to the pandemic. Implementing adapted processes and assuming a clear clinical approach can help prevent transmission and uphold service integrity.

Prehospital sepsis care in Ireland: an audit

Background: Sepsis is a life-threatening illness that requires early recognition and treatment. In Ireland, mortality, while improving, remains at 17% for adults and in a range of 2–4% in children aged under16 years. Prompt, accurate recognition of severe sepsis in the prehospital period could improve outcomes in patients with severe sepsis. Aim: This study aimed to audit the prehospital care of patients with sepsis against national Irish sepsis clinical practice guidelines and identify areas for improvement. Methods: A retrospective analysis of all Dublin Fire Brigade patient care reports over a 1-week period was carried out and patients with potential sepsis and potential severe sepsis were identified. Care was assessed against the national prehospital clinical practice guidelines. Call-taking and dispatch information were cross-checked. Findings: The incidence of potential sepsis was 3.7%. It is a condition of extremes of age; 8.5% of patients were aged less than 1 year and 58% were aged above 65 years. While 48% of calls were categorised as high priority, about one-third (32%) were put in a low-priority category, and 37% of the latter were potential cases of severe sepsis. The most common chief complaints at the call-taking stage were ‘breathing problems’ and ‘sick person’. Conclusion: Potential sepsis is not infrequent and call-taking information may not capture the potential or severity of sepsis. Education must emphasise the risk in old and young patients. To ensure patients receive timely advanced interventions, call-taking and dispatch systems should ensure that practitioners with the skills to identify and manage sepsis are dispatched to these patients.

Treating sepsis in the emergency prehospital setting with IV antibiotics

Background: The effectiveness of intravenous (IV) antibiotics for the treatment of sepsis in UK prehospital emergency care is not fully understood. In addition, the views of the key clinical decision-makers in ambulance services have not been documented. Aims: This study aimed to provide contemporary, primary data on the opinions of medical directors from across the UK on the use of IV antibiotics to treat sepsis in prehospital emergency care. Methods: A qualitative methodology was used. During semi-structured telephone interviews, participants were encouraged to share their personal and professional views on the use of IV antibiotics to treat sepsis in ambulance services. The interviews were recorded and transcribed, and a thematic content analysis using the principles of grounded theory was carried out. Findings: Five themes emerged: barriers and enablers; early sepsis recognition; accurate and consistent National Early Warning Score (NEWS) scoring; the need for primary evidence; and standardisation of equipment and protocols. A range of opinions were suggested, with an emphasis on rapid transfers and the need for further evidence. Conclusion: There is a drive for early sepsis diagnosis and pre-alerting the receiving hospital. However, there are potential barriers to standardising the approach if paramedics were to collect blood samples and administer IV antibiotics. Additionally, in the absence of UK data on the effectiveness of this treatment, many key decision-makers are reluctant to consider it as a standard approach. Despite this, there is some strong support for using benzylpenicillin for the treatment of suspected sepsis.

The ‘s’ word: a killer, or just a way infection can kill?

999 call-taker insights

As university lectures have moved online, Samuel Parry shares his experiences of becoming an emergency call-taker during the pandemic and his lessons learned about how 999 calls are dealt with before the crews on the road receive them

#BlackLivesMatter (2020)

A virus of the mind (2020)

Spotlight on Research

Exploring the concept of ‘informed consent’ within the context of paramedic practice

The phrase ‘informed consent’ is used widely in healthcare. Practitioners ask their patients for their consent to a treatment or a diagnostic or monitoring procedure and, if consent is given, will document this. There is a general understanding that consent is a prerequisite for care and signifies the patient’s permission for the paramedic to proceed with assessments and other therapeutic interventions. Obtaining the patient’s informed consent is fundamental to contemporary healthcare: what is informed consent and why is it so important? This article explores the meaning of consent in practice and the purpose it serves. It will then go on to consider complex circumstances, including emergencies, young people aged under 18 years, when a patient is unable to give consent or where a person has capacity to consent but refuses.