Volume 14 Issue 6
Paramedic decision-making and the influence of bias: a case study
Background:Prehospital clinical decision-making is a complex, evolving skill. Typically, there are multiple possible diagnoses and several potential treatment pathways to be considered, and usually prehospital clinicians have to base their decisions on imperfect information. Biases will inevitably compete to influence clinicians as they attempt to weigh the probabilities of diagnoses, degrees of certainty and permissible risks in their decision-making process. With experience, as intuition and tacit knowledge develop, paramedics will depend less on explicit knowledge and algorithm-based decision-making tools. Paramedics must strive to strike the right balance between the intuitive and analytical aspects of clinical decision-making, while maintaining an awareness of the human factors that will influence them in this process if optimal clinical decisions and therefore patient outcomes are to be achieved. This case study illustrates complex decision-making in the prehospital setting, with a focus on the influence of bias.
Innovations in preoperative control of exsanguination in major trauma
Exsanguination places a considerable strain on trauma systems worldwide, and is estimated to be involved in 20–40% of trauma deaths. This article evaluates innovations in the preoperative care of the injured patient to minimise the impact of bleeding. These include reform of organisations and structure of trauma networks, adoption of objective prehospital triage tools and changes in ambulance crews' approach to on-scene interventions. Developments of methods to mechanically control these bleeds—simple tourniquets, topical haemostatics developed in military settings and endovascular interventions such as resuscitative endovascular balloon occlusion of the aorta—are also analysed. This article has examined advancements in damage control resuscitation, including a possible future shift towards whole-blood transfusion and interventional radiology for primary haemorrhage control. Finally, a potential further development—the uptake of hybrid resuscitation suites—is examined.
Prehospital management of sickle cell crisis: a case report
Sickle cell disease (SCD) covers a group of inherited conditions that affect the red blood cells. It can cause episodes of intense pain called sickle cell crises. This case study outlines a 10-year-old boy's first presentation of sickle cell crisis. The patient presents with typical sickle cell crisis pain in joints that is exacerbated by movement and related to strenuous physical exercise in the cold. This pain is caused by the sickled red blood cells occluding the microvasculature, causing tissue ischaemia. SCD is a serious disease and requires early recognition through robust clinical assessment to reduce the potential for fatality, complications and morbidity. Understanding the pathology of disease ensures paramedics work appropriately, using their knowledge to identify a patient with SCD and using skills to inform practice. Initiating the correct treatment is paramount in reducing the likelihood of fatal complications.
Students' experience and perceived value of a clinical simulation centre
Background: The emergence of new technology and innovation has seen dedicated simulation centres being designed and built to assist with the development of a range of professionals within the ever-changing healthcare setting. Focusing on the university environment, this study examined the extent to which paramedic students perceive these simulation centres as efficient and effective learning spaces. Methods: Using evaluation research, data were collected from 33 students studying paramedic science at a London university. An online questionnaire was used to measure student engagement, perceived value, impact and sustainability of a simulation centre. Findings: Participants primarily perceived the simulation centre as having high value and a good impact on their learning and development, although some concerns were raised regarding its utilisation and general usability. Conclusion: While large-scale simulation centres seem beneficial to learning, they need to be fully integrated into the curriculum to maximise their impact on preparing students for their forthcoming role.
Pacing for a marathon
Mahdiyah Bandali reflects on her NQP journey as she approaches 2 years since qualifying