Volume 13 Issue 5

Non-medical prescribing by paramedics in emergency, urgent and critical care

This article considers some of the unique considerations and challenges that are associated with non-medical prescribing in the context of paramedic emergency care. In contrast to primary care, advanced paramedics practicing in emergency settings are more likely to encounter patients who require an immediate supply or administration of medication and access to a range of controlled drugs. Furthermore, access to medical support for prescribing decision-making, restrictions on the prescribing of controlled drugs and potential challenges in obtaining access to patient records, may also impact non-medical prescribing in these settings. Currently, very little empirical evidence has been published on the topic of non-medical prescribing in paramedic practice. Further research is required to understand whether the anticipated benefits are being realised for patients and NHS services. This is particularly the case in the context of prehospital emergency, urgent and critical care settings.

Effectiveness of e-learning to develop the ability to recognise and manage stroke

Background: With stroke continuing to affect people in the UK and around the world, the need to develop health professionals in the management of patients with the condition and ensuring staff can meet the requirements of guidelines is key. Aim: This study aimed to assess the effectiveness of e-learning to develop ambulance staff in the management of acute stroke and stroke mimics by looking at their engagement with the course and knowledge attainment. Method: A small-scale study focused on an e-learning course on stroke management and before and after questionnaires. Results: Participants demonstrated good engagement with the course. However, the before and after questionnaire results were mixed, with 46% of participants demonstrating an increase in their knowledge up to 6 weeks after undertaking the course, 32% remaining the same and 22% showing a decrease. Conclusion: The data suggest more around the general approach to e-learning rather than on the topic of stroke management. Regardless of the course's content and its overall effectiveness, if students do not afford a suitable amount of time to engage with the learning materials, their ability to develop is greatly diminished.

Mental health assessment and triage in an ambulance clinical contact centre

Background: With increasing numbers of emergency calls to ambulance services, exploration of the triage and management of mental health calls is valuable, given their volume and duration. Studies have explored these calls from patient and practitioner perspectives, but few have considered the perspective of the practitioners assessing patients over the phone in terms of clinical capability. Aim: This study aimed to explore the thoughts, feelings and educational requirements of paramedics and nurses working on emergency medical services clinical desks, focusing on mental health-related calls and the triage tools used. Methods: A service evaluation was conducted. A questionnaire was developed and distributed to 41 staff on clinical desks at the Welsh Ambulance Service Trust's (WAST) clinical contact centres in June 2019. Quantitative data was analysed using descriptive statistics and qualitative data by thematic analysis. Findings: Out of the 41 employees, 26 (63%) responded. Low levels of confidence were reported in managing mental health calls, along with inadequate detail in the mental health elements of their triage algorithm and deficiencies in referral pathways. Conclusion: Given the volume and complexity of mental health calls to ambulance services, more attention should be paid to the education and training of clinical desk professionals and the decision support tools available in WAST and other ambulance services. Further research is required with a larger sample size over multiple ambulance services.

Winning in winter with marginal gains: enhancing welfare on the frontline

Winter pressures on the NHS challenge every one of us. Patients may experience delays waiting for emergency ambulances and face extended waiting times at hospital emergency departments (ED). During this season, GPs, hospitals, NHS organisations and staff will face increased demand for services; yet are still required to deliver on agreed performance targets with only a finite availability of resources. Add Brexit and the second wave of COVID-19 wave into the mix and it might appear difficult to make improvements in any of these areas. During the winter of 2019–2020, a large ambulance service in England introduced a ‘welfare van’ to support busy emergency ambulance crews in one of its busy urban areas. It was tasked to see if it could make a positive difference to staff welfare and uphold or improve on ambulance service performance during a period of expected increased demand.

How it's done: search tools and techniques for major bibliographic databases

This article explains how to write an effective search plan using simple steps. The article takes you through the tools and techniques that are widely used in major bibliographic databases such as MEDLINE and CINAHL to conduct searches. These include Boolean logic, truncation and wildcards, in-field searching, proximity operators, limits and subject thesauri. Each process is illustrated with an example to help you apply them to your own searches. The process of using these tools and techniques to either narrow (find fewer results) or broaden (find more results) is described and summarised in an easy-to-use table.

‘Fitting in’ as an NQP

In his second column, Barry Costello reflects on what it was like to start out as an NQP and the lessons he has learned about how he can fit in while making his own mark

Silver linings of COVID

Through personal challenges experienced during the COVID-19 pandemic as an underpriveleged student paramedic, Rhys Sycamore shares his ‘silver linings’ from an unconventional placement to a bolstered drive to advocate for a more inclusive practice.

Teaching in the British Army

In this instalment of Paramedic Roles, Sgt Ty Jewell shares some insight into his role as a paramedic in the British Army and how things operate, reflecting on his own contributions and passion for teaching

Prehospital unfractionated heparin and primary percutaneous coronary intervention

Unfractionated heparin (UFH) is an anticoagulant used by some, but not all, ambulance services in the treatment of patients who will undergo primary percutaneous coronary intervention (PPCI) due to ST-elevation myocardial infarction (STEMI). This study reviews the effectiveness and safety of prehospital unfractionated heparin administration to STEMI patients prior to PPCI, and considers whether it should be used more widely for these purposes across international ambulance services. A literature search was conducted to identify articles relevant to prehospital UFH administration prior to PPCI. The reviewed literature unequivocally demonstrates that early anticoagulant administration is safe, effective and highly appropriate for STEMI patients who subsequently undergo PPCI. This study find that anticoagulants such as UFH or, in some jurisdictions, enoxaparin—should be strongly considered as a standard feature of prehospital treatment regimens for STEMI patients who will subsequently undergo PPCI.

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