Volume 13 Issue 6
Prescribing in mental health
Mental health disorders such as anxiety and depression are becoming increasingly prevalent and frequently pose some of the greatest challenges for the clinician, both in terms of communication and prescribing. Prescribing appropriately, safely and effectively depends upon the clinician's approach to the consultation and to the patient. This article discusses some methods of improving consultation and communication skills to maximise efficiency and safety of prescribing in mental health and explains some of the rationale for choosing to not prescribe.
Focused ultrasound in out-of-hospital cardiac arrest by advanced paramedics
Background: This study describes and evaluates advanced paramedic practitioner (APP) use of focused cardiac ultrasound (FoCUS) in out-of-hospital cardiac arrest (OHCA), and relates ultrasound findings with decisions to terminate resuscitation. The authors report characteristics of patients who do/do not undergo a FoCUS examination by APPs, ultrasound probe positions used and whether FoCUS findings were associated with decisions to terminate resuscitation or to convey patients to an emergency department (ED) with ongoing resuscitation. Method: A retrospective, observational cohort study of all adult medical OHCA patients attended by APPs in Greater London during 2018 was carried out using data from emergency medical services (EMS) and APP databases. Results: Twenty-eight APPs attended 1444 OHCA patients in 2018, of whom 744 underwent FoCUS. The subcostal probe position was used most frequently (74%), followed by the parasternal long axis (19%), with significantly smaller use of the parasternal short axis and apical windows. Absence of spontaneous cardiac motion (SCM) was associated with resuscitation being terminated (333 out of 391; 85%) and the presence of SCM was associated with conveyance to the emergency department (213 out of 264 patients; 80%). All decisions to terminate resuscitation were within the APP scope of practice. Conclusion: The authors believe this is the largest prehospital study involving FoCUS in OHCA. An association between FoCUS findings and decisions made to either convey patients to hospital or terminate resuscitation was found. The SC window was most used and ROLE decisions were deemed to be in accordance with local guidance and practice.
Paramedic-led acute home visiting services in primary care
Home visiting is traditionally carried out by GPs but it is becoming increasingly difficult for GPs to do, and many doctors want it removed from their contract. This is opening up a space for the paramedic profession, with paramedics carrying out home visits and designing future primary care services. Paramedics working within primary care can possess the knowledge, leadership and complex skills needed for home visiting, and some are independent prescribers; they can lead acute home visiting services (AHVS). AHVS require effective triage and access to electronic patient records, are underpinned by robust clinical governance and engage in clinical audits. Future primary care paramedic services could include online, video and face-to-face consultations, care home ward rounds, remote triage and home visiting. However, paramedics' contribution to general practice has not been fully evaluated and it may take time for this to become a norm. Regardless, primary care paramedicine has an opportunity to be innovative, shaking off risk-averse protocols for more enlightened practices, and lead the profession.
Community paramedicine home visits: patient perceptions and experiences
Background: Community paramedicine (CP) is an emerging model of community-based healthcare delivered around the world by paramedics with additional skills, education and training. There is a lack of qualitative research on patient perceptions and experiences of this phenomenon. Aims: The study aimed to explore patient perceptions and experiences of CP home visits delivered by specialist paramedics (SPs) in a Scottish urban general practice home-visit setting. Patient acceptance and CP primary-care strategic value were examined. Methods: An explorative qualitative study using purposive sampling, semi-structured interviews and thematic analysis. Findings: Five main themes were identified: provide a well-communicated, professional, knowledgeable and comprehensive home visit consultation; SP-patient relationship and continuity of care; acceptance of SP home visits in place of GP home visits; quicker response and an increased possibility of a home visit; and limitations of the SP role. Conclusion: Patient perceptions and experience of CP were positive, with patients accepting this model of care. Opportunities to improve healthcare, including better continuity or care and health monitoring, were found.
License to ‘really’ learn
One year on as an NQP, Mahdiyah Bandali is still realising how much she does not know—and that building up learning gradually is part and parcel of every paramedic's journey
The boost I needed…
As one of Edge Hill University's first students in the nurse paramedic programme, Philipa Duncan reflects on her first months learning during the pandemic, and her experience of her first placement on a hospital ward, which turned out to be exactly what she needed
Getting to grips with neurosciences intensive care
In this month's instalment of Paramedic Roles, Oliver Saddler shares his journey towards becoming a trainee advanced critical care practitioner in neurosciences intensive care, and walks us through a day in his work life
Prehospital clopidogrel use and STEMI management: a review
Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. This study examines and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. According to this review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.