Volume 14 Issue 2

Prehospital emergency anaesthesia: an introductory guide for paramedics

Prehospital emergency anaesthesia (PHEA) is indicated in a relatively small number of patients. It is a complex procedure that requires an in-depth knowledge of airway management, physiology, pharmacology and human factors and should only be performed judiciously by a competent team. This aim of this article is to provide an overview of the process of PHEA and to describe its indications, practical aspects and potential complications.

Prehospital airway management

The prehospital emergency airway management is a key moderating factor for patient survival and mortality rates. There has been much debate around the optimum method of prehospital emergency airway management. This commentary critically appraises a recent systematic review which assesses the harms and benefits of three different airway management strategies for a range of emergency clinical scenarios.Commentary on: Carney N, Totten AM, Cheney T et al. Prehospital Airway Management: A Systematic Review. Prehosp Emerg Care. 2021;1–12. https://doi.org/10.1080/10903127.2021.1940400

Point-of-care blood testing with secondary care decision support for frail patients

Aim: A service evaluation was conducted to assess the feasibility and impact of a pilot service to facilitate alternatives to hospital admission for frail patients in supportive care settings. Paramedic assessments were enhanced by point-of-care testing and telephone support from senior physicians. Method: A rapid response vehicle, staffed by a specialist paramedic and equipped with the Abbott i-STAT Wireless 1 point-of-care testing platform that could transmit results to hospital electronic patient record (EPR) systems, was dispatched to frail, non-injured patients over a 3-month period. Results were obtained on scene and transmitted to Oxford University Hospitals EPR system. The patient was then discussed over the telephone with a senior acute medical assessment physician at the Trust for advice and decision support and to coordinate referral to secondary care or other services. Results: The analysis included 56 patients, 21 men and 35 women, with a median age of 86 years. Seventeen patients who had significantly deranged blood test results were transferred to hospital, as were another 10 who did not have such results; 27 patients were admitted in total. Twenty-nine patients remained in their usual environment; of these, four presented to hospital within the next 30 days, and no deaths or adverse events were reported. Conclusion: Point-of-care testing by the ambulance services is feasible and, when combined with telephone advice and decision support from secondary care physicians, may be effective in reducing hospital admission for frail patients in supportive care environments. Larger systematic evaluations are warranted to establish the utility and cost-effectiveness of point-of-care testing by ambulance services.

Acute medical condition of patients with femoral neck fracture

The main objective of this study was to analyse the acute medical condition of patients at the earliest possible time after femoral neck fracture. Emergency medical services (EMS) data from five counties and cities in the state of Hesse, Germany, over 2017–2019 were analysed. The highest incidence of fracture was in those aged 80 years or above. Of all patients, 94.57%–95.49% were admitted to hospital for inpatient care, 3.40%–4.41% for outpatient care and 0.25%–0.60% for immediate intervention. Patients' hospital admission priority was significantly correlated with circulatory system impairment and severity of injury and pain. Other correlations were identified, indicating relationships between different organ systems in patients with femoral neck fractures. As expected, patients with femoral neck fracture are mainly treated as inpatients.

Remote-facilitated mental simulation to bridge the theory-practice divide

Remote simulation in education predates the COVID-19 pandemic, and its more widespread contemporary use can help inform future teaching practices. This article outlines the development of a remote-facilitated mental simulation (RFMS) delivered to second-year paramedic science students at a UK university. This was created using Sprick et al's simulation design model: preparation, briefing, simulation activity, debriefing, reflection and evaluation. Mental simulation is a teaching modality where participants mentally rehearse processes rather than practical skills. Speaking thoughts aloud helps learners to reflect on their thought processes and decision-making. While studies on remote simulation involve a facilitator viewing participants interacting with a simulation, in this study the participants were observers and the facilitator interacted with the simulation equipment. This arrangement may increase access to simulation for learners who do not have access to such facilities. Participants were engaged through group activities and psychological fidelity was maintained by providing real-time streaming of patient observations. The RFMS was evaluated positively by respondents.

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