Respiratory system

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 respiratory system, gives an overview of initial examination considerations.

Accepting a patient's decision

Respecting an autonomous decision to refuse life-saving treatment: a case study

Background: Autonomy is a key ethical principle in healthcare, giving patients the right to be involved in their own care. Allowing patients to make decisions based on their own values and beliefs is a fundamental aspect of evidence-based practice. Professional autonomy allows paramedics to make critical decisions around patient care in an emergency, enabling them to provide life-saving treatment. A patient's autonomy can conflict with that of a paramedic, leading to complex ethical situations which can affect the way a paramedic performs their duty of care. Decision-making is a fundamental skill for paramedics and often in the prehospital setting, paramedics have to manage situations with a certain degree of risk if they are to manage patients effectively and safely, while respecting patients' legal and ethical rights. Case presentation: An ambulance crew were called to attend a 62-year-old woman with a history of chronic obstructive pulmonary disease, respiratory arrest and stage 2 respiratory failure, who had breathing difficulties. She was deemed to have capacity by the ambulance crew under the Mental Capacity Act. The patient refused to be taken to hospital for treatment against paramedic recommendation, as she wished to receive no further treatment or hospital admission and wanted to die at home. The ambulance crew referred her to her GP. Conclusions: Paramedics experience great difficulties in making decisions, as information and alternative treatment options are often limited in the prehospital setting. One major limitation to autonomy is where an autonomous patient is refusing life-saving treatment. This can create ethical dilemmas for paramedics, leaving them to feel a sense of vulnerability and anxiety around performing their duty of care. The law is clear: an autonomous patient's decision to refuse treatment, even if it may seem unwise, must be respected in accordance with the Human Rights Act 1998.

A ‘think aloud’ exercise to develop self-awareness of clinical reasoning in students

Aims: This study aimed to evaluate the ‘think aloud’ teaching exercise's ability to develop clinical reasoning skills of student paramedics, and to ascertain its feasibility as an ongoing method to enhance clinical reasoning teaching and potentially alleviate problems around applying theoretical learning to practice. Methods: A qualitative approach was taken to seek the opinions and experiences of students taking part in the activity to determine levels of enjoyment, how relatable it was to students, and awareness of the skills it was intended to develop. Data collected via an online survey tool were analysed to identify themes and comments. Findings: Student enjoyment and engagement were evident, and the exercise permitted independence of thought and working, promoting self-appraisal among students of the effectiveness of the working strategy. Conclusion: The results of this case study indicate that the think aloud exercise could be effective in developing students' clinical reasoning skills. It complements established teaching strategies, such as core lectures, seminars and supervised practice.

Child public health part 1: strategies for health

Child public health is an area that focuses on child health outcomes that can have an impact through the life course. This article briefly explores some key concepts such as public health strategies and the potential role of paramedics in improving child health. The following articles in this series will delve further into the impact of paramedic practice on the three main elements of child public health: prevention, promotion and protection.

Paramedic emotional labour during COVID-19

Emotional preparedness is required for emergency paramedic practice. Emotional labour underpins the role of paramedics at the frontline of patient care. During the COVID-19 pandemic where patients are at their most vulnerable, it is imperative that paramedics can offer both reassurance to parents and be empowered in the face of the virus. Dealing with COVID-19 has put stress on paramedics, for whom psychological wellbeing is imperative to their capacity to cope in exceptionally challenging circumstances, where death has so frequently characterised the most severe cases of the virus.

Development of V-FAST: a vision screening tool for ambulance staff

Background: About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Methods: The educational package was developed through focus groups. The pilot study screened patients with suspected strokes in prehospital settings; the V-FAST tool was used with 43 of these patients. Each participant was also assessed in hospital using the National Institutes of Health Stroke Scale (NIHSS) and the score compared to V-FAST screening results to determine sensitivity and specificity. Results: The education package includes detailed instructions with video. In the pilot study, V-FAST detected visual impairment in 75.9% of FAST-positive and 80% of FAST-negative strokes. Sensitivity and specificity compared to NIHSS were 85.7% and 42.1% respectively. Conclusion: V-FAST has good sensitivity to detect vision impairment when screening for possible strokes. The added education package facilitates greater knowledge and understanding of potential visual problems caused by stroke.

Spotlight on Research

Principlism in paramedicine: an examination of applied healthcare ethics

Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice.This article examines the theory and practice of principlism, and shows how it is used in daily paramedic practice and decision-making. Practical guidance on applying ethics in paramedicine, illustrated with scenarios, is also provided.This is the first in a series of three articles on paramedic ethics. This series complements the <i>Journal of Paramedic Practice</i>'s concurrent CPD˚series on paramedic law in the UK. Later articles in this series will examine the complex ethical issues that can accompany end-of-life care, and ethical considerations relating to treatment of vulnerable persons including children.