Family Matters

ECG Case Series for Paramedics: April 2023

A previously fit and healthy 35-year-old man presented with a seizure. He was out shopping when he felt cold, clammy and faint. He sat down but was then helped to the floor as he became unresponsive. He was vacant for approximately 1–2 minutes with twitching of his legs

An Evaluation of Practice Supervisor Training for Student Paramedics

Background: Registered health professionals have a responsibility to facilitate learning in the workplace and those who are supporting students should have the skills and knowledge to take on this role. Paramedics are now working in a variety of healthcare settings. Regulatory bodies recognise that students should have opportunities to develop their supervision skills before qualifying, so practice supervisor training was implemented into the final year curriculum at one university. Aim: To explore the value of incorporating practice supervisor training into the curriculum. Methods: Final-year student paramedics were provided with practice supervisor training as part of their degree. This training was delivered over three seminars before the students’ final preregistration placement. Students were invited to provide anonymous feedback via an evaluation form. Findings: A significant number of students felt prepared to take on the practice supervisor role when qualified. Conclusion: Practice supervisor training, when delivered as part of the curriculum, is of benefit to students.

Let them See: Effects of Witnessing Resuscitation on Patients’ Loved Ones

As part of an academic project, the question of witnessed resuscitation and its effects on onlookers was posed and investigated. During resuscitation, a patient’s friends, family or other loved ones may be present and witness the procedure. This literature review was carried out to establish whether seeing this affected their incidence of post-traumatic stress disorder, and the quality of the research around this. Following a search, four studies were identified for review. Synthesis of the data suggests that in many circumstances, patients’ family members and loved ones should be offered the opportunity to be present during resuscitation, and this could have a neutral or positive effect on their wellbeing after the event.

Erratum

Chest Compressions and Defibrillation as Aerosolgenerating Procedures

SARS-CoV-2 is a highly contagious respiratory pathogen associated with significant mortality in certain patient populations. Patients may be asymptomatic, which causes problems regarding infection control and prevention. Health professionals are required to adhere to strict protocols regarding infection control and personal protective equipment (PPE), particularly when engaging in resuscitation activities thought to be aerosol-generating procedures (AGPs). While adherence to enhanced PPE protocols can delay life-saving interventions, non-adherence may put responders at risk. The aim of this scoping literature review was to establish if chest compressions and defibrillation should be classified as AGPs. Following application of systematic literature search criteria, a limited selection of studies was identified in relation to chest compressions and defibrillation as AGPs. An assumption that endotracheal intubation posed a high risk of nosocomial transmission was noted. Emerging evidence suggests that endotracheal intubation produces fewer aerosol particles than coughing so could be classed as a low-risk-procedure. Because of the lack of adequate prospective studies investigating chest compressions and defibrillation as AGPs, there is a clear need to perform further, well-controlled studies to better understand the aerosol-generating potential of chest compressions and defibrillation.

Discussing Values in Paramedic Practice

A case-based discussion around values-based practice illustrates how the elements of values-based practice can be used to: navigate a challenging situation in practice; examine how it intersects with legal considerations; and offer both opportunities and challenges to clinicians.

Power of a Mentor

In their first Student Column, Nathan-Jacques Le Blancq reflects on past experiences with mentors, and the pros and cons of varied or consistent mentorship.

What is a Good Mentor?

From the perspective of an NQP, Derek Ford offers his views of what makes a good mentor.

Spotlight on Research

Previous studies report high success rates of intraosseous (IO) access, with unsuccessful insertion attributed to incorrect site placement and failure to adhere to anatomical landmarks. Berger et al (2023) conducted a prospective observational study assessing the ability of 30 paramedics based in Pennsylvania (USA) to identify the correct locations for both proximal humeral and proximal tibial IO insertion sites.

Managing ambiguity and uncertainty in clinical decision-making

Ambiguity and uncertainty are unavoidable elements of clinical practice. Although they can cause discomfort for both clinicians and patients, they can also be used to positive effect ensuring safer clinical practice that is tailored to individuals. As paramedics generally work in areas of practice where they encounter undifferentiated complaints with limited resources to investigate, diagnostic uncertainty can prove a challenge on a regular basis. Similarly, even when paramedics are fairly confident of the diagnosis, optimal management is frequently unclear or unachievable. This article presents practical short-term strategies to manage both diagnostic and management uncertainty in clinical practice. This article also suggests longer-term tactics that can be developed individually and collectively beginning with developing capability over competence through to changing culture and providing space for supervision. While these strategies may not completely eliminate the discomfort that can arise when faced with ambiguity and uncertainty, they can enable a greater tolerance for it, improve clinical practice, and ultimately benefit patients.