Beyond blame

Where to look: sources of research in paramedicine

This article explains how to approach searching for paramedicine research, and the order in which you should consider types of sources, from synthesised sources to individual studies. Databases and sources for literature are covered and common issues about the search process are addressed, including when a search is complete and finding a gap in the literature.

A decision theory overview and case-based discussion

Paramedics make decisions as part of their everyday role but often, the theory behind clinical decision-making is not discussed in depth. This article explores the theories of decision-making as they apply to a clinical case. With the increasing use of technology in healthcare, the introduction of human reliability analysis is becoming more pertinent.

Needle decompression in tension pneumothorax: anterior or lateral approach?

Background: For tension pneumothorax, the UK recommendation is to use a 14 g, 5 cm cannula to decompress the chest. Advice around site selection differs between using the second intercostal space (ICS) mid-clavicular line or the fifth ICS near the mid-axillary line. The aim of this literature review is to determine the best approach for needle decompression using a standard 14 g, 5 cm cannula. Methods: A systematic search of multiple databases was conducted, using inclusion and exclusion criteria. Outcomes were tabulated to identify any trends between various criteria including success with a 5 cm cannula. Results: Thirty-one studies were found, of which four were included. Mean chest wall thickness was 35.8 mm at the anterior site and 39.7 mm at the lateral site. Overall success rates with a 5 cm catheter were on average 79.7% at the anterior and 80% at the lateral position. Conclusion: There is no significant difference in success between using the anterior or the lateral approach for needle decompression.

Perceptions of ethical dilemmas in Australian paramedicine

Background: Paramedics experience a range of ethical dilemmas in the course of their work. To date, ethical dilemmas by Australian paramedics have not been documented. With the scope of practice becoming increasingly complex, paramedic education may not have evolved to meet holistic professional demands. Aim: To describe the ethical dilemmas experienced by contemporary Australian paramedics. Methods: An online survey, based on a previous instrument, was used to explore a range of ethical dilemmas. Findings: Paramedics face a range of ethical dilemmas in their everyday practice. While several demographic variables were associated with different perceptions, the results of this study highlight that a paramedic's years of experience is most consistently associated with their perception of ethical dilemmas. Conclusion: Australian paramedics experience a range of ethical dilemmas consistent with previous international findings. Years of experience in the profession features heavily and is relied upon more so than education, suggesting that educational approaches to ethics education in paramedicine need to be reconsidered.

History and experience of a volunteer ambulance first responder scheme in London

Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER crew. Compared to most traditional volunteer first responder schemes, the LAS ER scheme, which was set up in 2008, involves an enhanced skillset, dispatch to medical and traumatic emergencies in addition to cardiac arrest, and the use of blue-light vehicles to reduce response times. Over a period of 13 years, the scheme has grown in scope and size, and now operates with more than 120 volunteers based at seven ambulance stations across London.

The ‘COVID cohort’

With the pandemic having a significant impact on student paramedics, Mahdiyah Bandali reflects on what this means for newly qualified paramedics and how they can be supported

Variety in practice

Finishing off his second year, Samuel Parry reflects on some of his recent challenges while learning during the pandemic, as well as a variety of paramedic placements, as he prepares for his third year as a student paramedic and looks towards qualification

Pioneering retrieval of neonates as a paramedic

In this month's instalment of Paramedic Roles, Josh Eason, one of the first trainee advanced paramedic practitioners in intensive care retrieval medicine, shares a typical day in one of the profession's newest roles

Training to improve responder attitudes and knowledge of opioid overdose

Background: Opioid use is a major public health issue and opioid overdose requires rapid response with naloxone. Aims: This study assesses the impact of a training session on the knowledge and attitudes of first responders and members of the community regarding opioid overdose recognition and naloxone use. Methods: A training session was delivered to 2327 participants between July 2019 and March 2020. The study used a paired, pre-/post-analysis to quantify changes. Findings: Nearly all (99.7%) participants completed a survey before and after training. Statistically significant improvements were observed in nearly all attitude and knowledge items. Conclusion: An education session delivered to an educationally and professionally diverse group can improve trainees' knowledge and attitudes. There were some significant differences between sub-groups, particularly regarding their professional and educational background, and whether the location was urban or rural. Further study is needed to examine whether trainees would benefit from a course tailored toward their education and professional experience.