Volume 15 Issue 11

Impact of paramedics carrying just-in-case end-of-life care medication

Background: Early in the COVID-19 pandemic, it was predicted that frail community patients with symptoms of severe COVID-19 infection may need urgent symptom management—and that unless they had already been identified as being in their last weeks of life, they would be unlikely to have just-in-case (JIC) medications at home. The Welsh Ambulance Services NHS Trust therefore placed JIC medications on emergency ambulances to increase symptom management options for paramedics treating patients with symptoms of severe COVID-19 infection and/or associated with advanced end-stage illness. Methods: A review of medications to palliate symptoms of severe COVID-19 infection and advanced and terminal illness was undertaken. A verbal order process was implemented, allowing prescription-only medications to be administered by paramedics. Guidance, training and data capture processes were designed and implemented. Results: Symptoms associated with advanced cancer were the main reason for giving ambulance-based JIC medications, and midazolam and morphine were the most administered medicines. No adverse incidents were reported or recorded. Conclusion: Ambulance-based JIC medications were and continue to be appropriately administered, irrespective of life-limiting illness diagnosis. Although carrying JIC medicines on ambulances was introduced in response to the COVID-19 pandemic, 12 months of data collection indicates this is a safe, cost-effective, patient-centred practice.

Carrying out research, critical appraisal, ethics and stakeholder involvement

Research skills are a requirement under the Health and Care Professions Council (HCPC) standards for paramedic registration. Paramedics must ‘recognise the value of research to the critical evaluation of practice’. Research in the medical field is important in order to improve the knowledge of clinicians and inform evidence-based practice. The purpose of this article is to demonstrate the key components of the research process, use of a PICO [population, intervention, comparison, outcome] tool to search relevant databases and explain the critical appraisal of research in order to establish if research is valid before implementing results into paramedic practice.

Disaster preparedness of health professionals at mass gatherings: a scoping review

Mass gathering disasters involving large numbers of casualties can adversely affect the performance of healthcare systems. This scoping review aims to explore the current literature on the preparedness of health professionals for disasters during mass gathering events. Four databases were searched to identify papers examining health professionals' disaster preparedness during mass gatherings between 2011 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews was applied to undertake this review. A total of 2024 articles were identified, of which 18 qualified for inclusion in the scoping review. Some studies reported the level of professionals' preparedness for disaster management, while others reported strategies to enhance preparedness and challenges associated with disaster preparedness during mass gatherings. More studies are needed in this field to better understand the level of disaster preparedness of health professionals to improve response and management of potential disasters during mass gathering events.

Hyperventilation in cardiac arrest—a systematic review and narrative synthesis

Background: Resuscitation guidelines recommend delivering ventilations at a rate of 10 per minute. However, hyperventilation is commonly reported during out-of-hospital cardiac arrest resuscitation efforts, and the impact of this on patient outcomes is unclear. This review explores the reported rates, causes and patient outcomes of hyperventilation in the management of out-of-hospital cardiac arrest. Methods: A systematic literature review with a narrative synthesis of three databases was carried out. Findings: Thirteen papers met the eligibility criteria. These showed that ventilations were consistently delivered at a higher rate and tidal volume than are internationally recommended. Hyperventilation can occur because of clinician stress, a lack of situational awareness and a focus on other clinical interventions as well as poor leadership. Conclusion: Hyperventilation is common during cardiac arrest management. Currently available human data do not produce sufficient evidence to favour any ventilation strategy; however, a harmful upper limit will exist. This review found no human randomised control studies examining how ventilation rate, tidal volume or pressure affect patient outcomes and this warrants further research.

Recognising the need for support

While coping with a series of difficult life events alongside university commitments, Dan Wyatt reflects on his realisation about the importance of recognising when we may require some additional support and having the humility and courage to ask for it

A new adventure

In her first column, Katy Sofield prepares for her start as a Newly Qualified Paramedic

Spotlight on Research

Data indicate that adult patients suffering from suspected seizures are often conveyed to the emergency department (ED) with no clinical need. In England, ambulance services respond to around 211 000 calls for suspected seizures, so the size of the problem is significant

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