Cognitive biases and their effects on practice: a case study reflection

Clinical decision-making is a key aspect of the student paramedic journey. In particular, it is vital that students can understand the theories that underpin this vital facet of their practice. This article considers a case encountered in practice and the evidence that informs the decision process which was undertaken. The influence of biases, systems of thinking and an appreciation of probability are all considered in this call to a 55-year-old patient with chest pain. In addition, an appreciation of robust history taking is considered as part of this process. As ambulance clinicians can be limited in the tests and scoring systems appropriate to them, consideration is given to the value of traditional ‘in-hospital’ scoring systems and the advantages and limitations they present to the paramedic. These limitations can ultimately result in hospital attendance in many acute presentations such as chest pain incidents, and it may be that our practice is overdue a review of what can be done to address such limitations.

Embracing change

As ambulance strikes continue, patient wait times outside hospital emergency departments continue to rise, and the cost of living becomes ever-more unmanageable, stress is at a high.

ECG case series for paramedics: May 2023

Roles and skill sets

In his second Student Column entry, Dan Wyatt shares his experiences of his most recent placement block in a hospital environment, reflecting on not only the skills and knowledge developed, but an understanding of the entire professional network involved in patient care

Effect of shift length on paramedic anxiety

Introduction: Paramedics frequently experience extremely stressful situations. A combination of the unknown, long shifts and witnessing human distress and tragedy can have lasting effects on the psyche of these individuals. The purpose of this study was to determine if there was a difference between anxiety levels experienced by paramedics who work 12-hour shifts and those working 24-hour shifts. It was hypothesised that those required to work longer shifts would experience higher levels of anxiety. Methods: This survey research study measured anxiety experienced by paramedic practitioners (<em>n</em>=78) at three local emergency medical services using the Beck Anxiety Inventory. A binary logistical regression analysis was used to determine whether any results met criteria for significance and to determine the odds ratio for categories that did reach significance. Results: Paramedics who worked 24-hour shifts were significantly more likely to experience moderate-to-severe anxiety than those working 12-hour shifts (<em>P</em>=0.042; OR 0.002). Age affects the likelihood that participants experienced moderate-to-severe anxiety (<em>P</em>=0.028; OR=0.594); as age increases, the likelihood of experiencing moderate-to-severe anxiety decreases significantly. Conclusion: Paramedics who worked 24-hour shifts were significantly more likely to experience moderate-to-severe anxiety than those working 12-hour shifts. Age also affects whether paramedics experience moderate-to-severe anxiety; the older the individual, the better able they are at moderating their anxiety. Emergency medical service administrators are encouraged to reconsider the use of 24-hour shifts. If not already in place, strategies should be developed to assist paramedics and other prehospital care practitioners to recognise and address anxiety and other mental health disorders.

Demystifying prehospital research in practice

Apps for paramedics

How paramedics apply the spinal immobilisation algorithm in trauma patients

Background: Validated criteria are included in the algorithm used in the UK prehospital setting to safely reduce the number of traumatically injured patients requiring full spinal immobilisation. The criteria improve the sensitivity in selecting patients with spinal injuries but evidence how UK ambulance clinicians apply them is sparse. Aims: This study aimed to identify the knowledge levels and the use of the spinal immobilisation algorithm by ambulance clinicians. Methods: A quantitative survey used a convenience sample of all frontline clinicians in London Ambulance Service NHS Trust. Findings: The algorithm is not routinely used when assessing traumatically injured patients at risk of spinal injury; recognition of the algorithm inclusion criteria is poor, especially regarding patients under the influence of drugs or alcohol. There is a belief that too many patients are immobilised unnecessarily. Conclusion: Research is required on how ambulance clinicians use checklists and paramedic education on spinal immobilisation rules requires review.

Ethics part 3: paramedic distribution, or ‘the good, the quick, the cheap’

The fair distribution of finite resources or ‘goods’ is distributive justice in its simplest form (Campbell, 2017). Rawls is perhaps the most influential contemporary figure who presented a generalised theory that argues for maximising the wellbeing of those worst off (Rawls, 1973).

Use of flumazenil to treat poisoning in prehospital care

A discussion exploring antidotes available for drug toxicity is presented, focusing specifically on flumazenil, within the prehospital setting. This critical review was carried out to establish whether this antidote would be useful in prehospital care and details the potential for practice development for the role of the ambulance-based paramedic. Analysis suggests that further research is required in order to determine the requisite of this antidote.

Spotlight on Research

Many paramedics will have raised their eyebrows upon entering the scene of a cardiac arrest to find bystanders performing chest compressions while the patient is lying supine on a springy mattress.

The age of artificial intelligence

Artificial intelligence (AI) is gradually integrating into various sectors such as finance, transportation, energy and education. Although AI is in its infancy in healthcare, it is still being used in many ways, including medical imaging, chatbots, diagnosis, treatment, and telephone triage in an ambulance setting.