Integrating research and evidence-based guidance into prescribing practice

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

Paramedic prescribing: implementation in practice

Background: In April 2018, legislation was changed to allow paramedics to prescribe independently. There is limited research regarding how paramedics are implementing their prescribing qualification. Policy papers and other literature were largely written before April 2018 and therefore document expectations regarding prescribing paramedics within the healthcare system. Aim: To explore if paramedic prescribing is being practised as expected. This article reports part of a larger study that explored how paramedics are implementing their prescribing qualification in practice more broadly. Methods: A web-based survey was conducted using convenience sampling. The sample represents 14.65% of the total number of prescribing paramedics. Findings: Paramedics are working in a variety of areas of healthcare. Some paramedics do not have the required amount of experience or the educational background recommended to become a prescribing paramedic. It is unlikely that new pathways to care are being created by prescribing paramedics. It is unclear whether prescribing increases patient access to medications.

Practice education in paramedic science: theories and application

Focused cardiac ultrasound in out-of-hospital cardiac arrest: a literature review

Focused cardiac ultrasound (FoCUS) is emerging in emergency medical systems, particularly in the context of prognostication in out-of-hospital cardiac arrest. However, FoCUS has not been formally incorporated into UK guidelines because of a lack of evidence. Furthermore, concerns have been raised that FoCUS can distract people from providing other essential and evidenced elements of care. This broad literature search aims to shed light on the practice of FoCUS in cardiac arrest by reviewing articles related to in-hospital and out-of-hospital practice. The findings are conspicuous by the lack of high-quality studies, particularly regarding prognostication. Association between ultrasound findings and outcome are asserted, as is the feasibility of paramedic use of FoCUS, although the evidence is from small and non-randomised studies and subject to bias.

Should ascorbic acid be a primary therapy for sepsis in prehospital settings?

Background: Prehospital emergency medical services (EMS) are believed to be responsible for the initial treatment of 68 000 septic patients annually in the UK, 88% of whom have severely low ascorbic acid levels, which can lead to organ dysfunction, increasing the likelihood of mortality. Objective: This review aims to determine if early therapeutic use of ascorbic acid (vitamin C) could reduce the deterioration of septic patients and therefore overall mortality. Method: A literature review was conducted using the mySearch, PubMed and Cochrane Library databases. Each was systematically searched for human studies that addressed the use of ascorbic acid as a primary method of treatment during varying stages of sepsis and whether it reduced associated mortality. Studies not published in English or that were more the 5 years old at the time were excluded. The quality of evidence in the remaining articles were appraised using the GRADE method and further assessed for quality with an adjusted Downs and Black scoring tool. Results: Nineteen articles were found, three of which met the inclusion criteria. All addressed the use of ascorbic acid as a therapy in the treatment of sepsis; none were conducted in a prehospital setting. Conclusion: Intravenous ascorbic acid appears to be a safe and effective therapy in treating septic patients, with the potential to reduce mortality rates if given prophylactically. However, a series of clinical trials would need to be conducted to measure the extent of any improvement and therefore clinical value in the prehospital environment.

My daunting first steps

As Edge Hill University launches its new nurse paramedic programme, new columnist Philipa Duncan reflects on the nerves and responsibility, as well as the excitement and honour that come with being one of its first students—at one of the most challenging times

Life as a locum

Most health professionals are likely to weigh up the pros and cons of becoming a locum at some point in their careers. The prospect of being able to choose where and when you do or do not work is often a big pull. In this first instalment of the JPP Paramedic Roles column, Suki Kaur, who has been a paramedic since 2013, explores why she decided to become a locum emergency care practitioner 3 years ago.

Spotlight on Research

Thanking our 2020 peer review panel

The team at the <i>Journal of Paramedic Practice</i> would like to extend our sincerest thanks to the following people who have generously devoted their time to volunteering as peer reviewers for us in 2020, despite it being an exceptionally challenging and demanding year.For the third consecutive year, we are publishing a list of our peer review panel for the year as a small way of recognising the extremely important work of our referees, without whom we could not produce the high-quality double-blind peer-reviewed content our readers have come to rely upon and rightly expect.Our peer reviewers are highly valued members of the editorial team at the <i>Journal of Paramedic Practice</i> and our international quarterly journal, <i>International Paramedic Practice</i>.We are grateful not only for the dedication of their time, but also their energy, expert knowledge and insight.Peer reviewers strengthen the quality of our authors'research and writing, and help to ensure that we publish only those articles that contribute meaningfully to the evidence base.

Vaccine rollout

The prescribing paramedic: a pharmacology series

Exploring the clinical debrief: benefits and barriers

Paramedics are regularly exposed to traumatic situations in the prehospital environment, which can profoundly affect their emotional resilience. A debrief is a recognised tool that is used to manage the aftermath of such events. Its aims are to unpick the components of the situation, identify any issues or achievements in clinical care, highlight learning points to improve future practice and safeguard the clinician’s emotional wellbeing. This article explores the benefits of and barriers to debriefing in clinical practice as well as the emerging debate around the potential harm or benefit of single-session debriefing.