PaRamEDIc assessment of laCTate in OHCA and survival to hospital (PREDICT protocol)

Background: Studies suggest that blood lactate differs between survivors and non-survivors of out-of-hospital cardiac arrest who are transported to hospital. The prognostic role of lactate taken during out-of-hospital cardiac arrest remains unexplored. Aims: To measure the association between lactate taken during out-of-hospital cardiac arrest, survival to hospital and 30-day mortality. Methods: This is a feasibility, single-centre, prospective cohort study. Eligible for inclusion are patients aged ≥18 years suffering out-of-hospital cardiac arrest, receiving cardiopulmonary resuscitation, in the catchment of Newcastle or Gateshead hospitals, who are attended to by a study-trained specialist paramedic. Exclusions are known/apparent pregnancy, blunt or penetrating injury as primary cause of out-of-hospital cardiac arrest and an absence of intravenous access. Between February 2020 and March 2021, 100 participants will be enrolled. Primary outcome is survival to hospital; secondary outcomes are return of spontaneous circulation at any time and 30-day mortality.

Frameworks that guide curriculum development in Australian higher education

Background: In Australia, accrediting body competencies reflect paramedic professional practice rather than informing curriculum development for higher education institutions. Purpose: This article will investigate frameworks that can be used to design curriculum development. Method: An initial focused discourse analysis of the grey literature was undertaken followed by a systematic review. Findings: Three of the 18 institutions in Australia and New Zealand that offer paramedic education identified some form of framework. Two theories were identified as applicable in supporting the development of curricula that are focused on the expanded scope of practice of paramedicine. Discussion: The current and future scope in paramedicine will define the development of curricula, especially in relation to a more primary-focused healthcare model. Conclusion: Further research is required to establish a consensus on what constitutes the essential core knowledge and skills required by graduate paramedics so that they are able to deliver patient care proficiently.

Prehospital osmotherapy in isolated traumatic brain injury: a systematic review

Background: Isolated traumatic brain injury (TBI) accounts for 30% of injury-related deaths globally, with significant cost to individual health, lifestyle and the economy. Despite advances in prehospital trauma care, frontline paramedics have limited options to manage cerebral oedema and herniation. Prehospital osmotherapy could limit cerebral oedema and subsequent secondary brain injury, but uncertainties remain of its benefit to patient outcomes. Aim: This study aimed to explore whether prehospital osmotherapy such as hypertonic saline (HTS) could improve mortality and neurological outcomes in adults with severe isolated TBI compared with other products. Methods: Multiple electronic databases (PubMed, MAG Online Library, EMBase and Cochrane Library) were searched to investigate the impact of prehospital osmotherapy on mortality and neurological outcome. Findings: 9005 articles were identified, with six articles fully meeting the research aim. The majority of literature was high quality with an overriding consensus that administration of prehospital HTS or other hyperosmolar products had limited benefit to patient mortality and neurological outcome in isolated TBI. Conclusion: High-quality literature demonstrated that there is no current strong argument to adopt prehospital osmotherapy for isolated TBI. Paramedics should prioritise managing hypoxia and hypotension, which have proven impacts on long-term mortality and neurological outcomes. Future research should focus on the benefits of the expansion of rapid sequence intubation to advanced paramedics and appropriate analgesia (ketamine) for paramedics to enhance isolated TBI management in UK paramedic practice. However, paramedics should not disregard the importance of fundamental basic resuscitation skills in isolated TBI.

Human factors in paramedic practice—not really about the humans but the system

Transition to practice: from student to NQP

In his first column as an NQP, Barry Costello reflects on his transition and ‘student brain’

What is an expedition medic?

In the third instalment of Paramedic Roles, Jakki Owens reflects on the multidisciplinary nature of expedition medicine, and details areas that can be the most far-ranging from a paramedic's natural environment.

SPOTLIGHT ON RESEARCH

COVID recovery

Prescribing for paramedics: pharmacodynamics

In continuing the Prescribing Paramedic series, this article explores the nature of drug actions that occur within the body. An understanding of these principles allows the paramedic to make an informed decision on the medicines that may be offered, the likely outcomes and possible risks. Often considered a complex subject, this article aims to present a set of principles that the reader can apply to almost all drugs that one may encounter. Where appropriate, relevant case studies have been included to support theory and provide contextual examples.

Words used by the breathless patient in COPD and enhancing therapeutic care

Shortness of breath, dyspnoea and breathlessness are collective terms to describe the awareness of inadequate gas exchange within the respiratory system. Varying mechanisms, behavioural and physiological changes are caused by this ventilation–perfusion mismatch. This complex sensation encompasses many diverse concepts. The spectrum of language and words used as a consequence of this sensation vary from quality and intensity to emotions and feelings. Matching the phrases to the cause supports understanding. Studies reviewed produced clusters of verbal descriptors which reflect the multidimensional input as a consequence of being out of breath. Using these clusters has produced a comprehensive list of twelve words known as ‘The Dyspnoea 12’ which, when used, quantifies the severity of this debilitating and extremely distressing symptom. Could these verbal descriptors be used to aid the assessment and treatment of their cause in service users and provide a more holistic view to a widespread problem?