Volume 14 Issue 5

Reaching underserved people during the pandemic

Background: As the COVID-19 crisis evolved, many emergency medical technicians (EMTs) and community paramedics (CPs) were already positioned to engage with both the community and the health system. Aim: This project, based in Indiana, USA, aimed to provide resources for EMTs and CPs to build knowledge and skills necessary to use promising practices related to COVID-19 and provide culturally competent care using telehealth to improve access to care for underserved populations during the pandemic. Methods: Between May 2020 and April 2021, EMT and CP participants completed a retrospective pre-test and post-test assessing self-efficacy around best practices related to COVID-19 and culturally competent care using telehealth. Findings: Forty-nine EMTs and CPs completed the project and results demonstrate a significant (P<0.05) improvement in self-reported level of preparedness to demonstrate best practices related to COVID-19 culturally competent care using telehealth. Conclusion: The project identified a potentially effective strategy for increasing practitioner self-efficacy, resulting in a more effective system for caring for vulnerable individuals during a pandemic.

‘Giving a piece of you’: the lecturer experience of aiding student wellbeing

Background: The mental health of ambulance clinicians is a national priority. For student paramedics, the risk and inherent vulnerability to poor mental wellbeing are significant. However, evidence exploring support in universities for paramedic students and the role of academic faculty in this within paramedic preregistration programmes is limited. Aims: To explore the experiences and perceptions of university lecturers towards supporting student paramedic wellbeing. Methods: A qualitative research design was adopted to explore the experiences of six paramedic senior lecturers from three urban universities. Data were collected via semi-structured interviews and thematically analysed using interpretative phenomenological analysis. Findings: Themes of ‘navigating the professional role,’ ‘the whole student’, ‘enabling cultural change’ and ‘supporting resilience and preparedness for practice’ were identified. Conclusions: University lecturers play a crucial role in student paramedic wellbeing and the unique role and identity of paramedic academics should be embraced. Paramedic programmes should consider a proactive approach to emotional health within the curriculum, alongside peer support, student-centred initiatives and tailored trauma support.

The efficacy of the HEART score in prehospital settings

Background: HEART scores are a well-validated tool used to risk stratify patients with chest pain in the emergency department. Currently, no triage or risk stratification tool is available in the UK prehospital arena. Methods: A comprehensive literature search was carried out to determine the effectiveness of HEART score use by paramedics in the prehospital environment. Findings: Prehospital HEART scores completed by paramedics appear to have a high sensitivity and negative predictive value for detecting major adverse cardiac events. The use of high-sensitivity cardiac troponin assays or a prehospital modified HEART Pathway may allow patients to be triaged based on a single point-of-care (POC) cardiac troponin test. As POC devices improve, this is likely to increase the accuracy of paramedic HEART scores. Additionally, there are some differences between HEART scores calculated by doctors and paramedics. Conclusion: The use of HEART scores prehospitally has the potential to improve patient outcomes. However, issues remain over the accuracy of POC devices and with paramedic interpretation of electrocardiograms and cardiac history-taking. Furthermore, the lack of POC testing in current UK paramedic scopes of practice raises questions over the practicality of introducing HEART scores, which would rely on POC testing.

Falls in older people

Paramedic programmes incorporate person-centred approaches to the individualisation of emergency care. Within this context, older patients (aged 65+) pose specific challenges in relation to their ambulatory health and wellbeing. Helping these patients to avoid falling can contribute significantly to reducing their morbidity and mortality and improving their overall health and wellbeing. Alongside this, in times of economic constraint, it is the responsibility of all health professionals to promote ambulatory wellbeing to address the inordinate number of people necessitating paramedic support and intervention because of falls each year in the UK. Understanding the underlying processes of ageing, which are often a mix of the normal processes of physiological senescence, plus the impact of pathology—which is not age specific but occurs more commonly in older people—enables practitioners to build knowledge of how best these people can be supported. This short module affords paramedics the opportunity to learn about these physiological processes and to look at the holistic impact that falls can have on older people.

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