Volume 14 Issue 8
The role of individual factors in the mental health of NHS ambulance personnel
Background: An estimated 27% of ambulance personnel experience general psychological distress. The relationship between work and mental health is complex. Aims: This study aimed to explore whether and to what extent individual factors affect the mental health of ambulance personnel. Methods: Four UK NHS ambulance trusts facilitated recruitment of ambulance personnel (<em>n</em>=160). Well-validated measures were used to collect data on the predictor variables: the Perceived Stress Scale; the Satisfaction with Life Scale; and the Brief Resilience Scale. Mental health, assessed according to response to trauma measured by the Impact of Events Scale Revised (IES-r), and anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS), were the outcome measures. Findings: Regression models demonstrated that all predictor variables accounted for nearly half of the variance in each outcome <em>(P</em><0.01). Conclusions: A significant proportion of variance was accounted for by individual factors. This assists in understanding the impact and role of individual factors in the mental health of this occupational group. Future research could inform intervention development.
Troponin testing in primary care: can it improve diagnosis and prevent admission?
Introduction: With the growing demand on emergency departments, expanses in the clinical capabilities of prehospital healthcare facilities have become a hot topic. The use of point-of-care troponin testing (POCTT) has been greatly debated due to the sensitivity limitations of the current testing machines. The current systematic review will collate the current research and attempt to confirm whether troponin testing in primary care can improve diagnostic capabilities and prevent onward admission where appropriate. Methods: The literature search was carried out using PubMed and Embase databases with MeSH terms derived from the US National Library of Medicine. Key data points were extracted pertaining to areas such as cost, unnecessary admission, incorrect diagnosis and mortality, with a descriptive analysis completed. Results: Cost – An overall improvement in cost of patient care was noted. Unnecessary admission – A reduction in unnecessary admission was reported. Acute coronary syndrome (ACS) exclusion – Improved ACS exclusion was assumed due to improved admission rates. Mortality – No POCTT-associated mortality was reported. Incorrect diagnosis – Misdiagnosis rates between 1.02–5.2% with some associated morbidity. Conclusion: POCTT could be safely used when combined with current risk-stratification tools and delayed testing to mitigate the limitations with low-sensitivity testing.
‘Just little tricks’: an exploration of treating children in pain
Background: Pain is one of the commonest symptoms in patients of all ages presenting to ambulance services. Children in pain make up a relatively small proportion of the number of those attended by prehospital care and pain management is needed in only 40% of cases. This might go some way to explain why the management of paediatric pain is perceived to be poor. Aim: The primary aim of this study was to explore the experiences of UK paramedics in treating children in pain. Methods: A phenomenological study was undertaken using a purposeful sample of UK paramedics (<em>n</em>=12) to explore their experiences and decision-making during the treatment of children in pain. Results: Five themes became apparent through analysis—preparation and education; adaptation and change of approach; organisational and legal factors; support and guidance; familial and carer impact—with some crossover between themes noted. Conclusion: Clinicians are aware of multimodal techniques for managing pain in children but are often less confident in the use of pharmacological than non-pharmacological management methods. Advances in the use of technology in practice have enabled clinicians to use alternative measures to manage children in pain. However, while using these methods, practitioners lack confidence that they are meeting social expectations of their roles.