Women's historic under-representation in paramedic roles in the London Ambulance Service (LAS) has recently improved, and women and men are equally represented in paramedic roles. However, the gender balance of advanced paramedic practitioners in critical care in the LAS remains unequal, with women constituting only 15.1% of this group.
This study aimed to gather the views of female paramedics to gain some insight into potential reasons for this under-representation.
A feminist pragmatic approach was taken. Qualitative, open-ended surveys were distributed via internal social media and bulletins. These surveys underwent primary thematic analysis to generate lines of enquiry that informed semi-structured interview questions. The questions were then posed to a maximum variation, purposeful sample of six women from the LAS. Interviews were audio-recorded, transcribed and thematically analysed.
Ninety-four women responded to the survey; six were sampled for interviews. The women varied by experience, clinical grade, age, work location and societal factors, including whether they were mothers and the number of children they had. A main overarching theme was ‘social construction of women and career progression within the ambulance service’. This was informed by three interrelated subthemes of ‘caregiving lifestyle’, ‘perceptions of self’ and ‘gender stereotypes’.
Women in the ambulance service have unique challenges that mirror those in wider society. Social constructs may impose unconscious bias and pressures that prevent women from advancing. Organisational structures and the cultural norms of the LAS may require adapting to improve the gender balance of the workforce and therefore the service it delivers.
Biphasic manual defibrillation (MD) is advocated as the preferred strategy for paramedics ahead of semi-automatic external defibrillation (SAED) for out-of-hospital cardiac arrest (OHCA).
A systematic review involved searching CINAHL, MEDLINE and Embase academic databases. Comparative studies where both strategies were tested for time to first defibrillation (TTFD) and related Utstein-based model outcomes were examined to discern which strategy was superior.
Two studies met the criteria. One study found that in 4552 SAED episodes of defibrillation (30.8% of the 14 776 total defibrillation episodes), a decrease of >10% in mean TTFD (<em>P</em><0.001) of an intial shockable rhythm was recorded. The same study reported an overall decrease in TTFD within 2 minutes (95% CI/<em>P</em><0.001), with a 68% improved odds of receiving a shock within two minutes. SAED was associated with a 26% reduction in the risk-adjusted odds of survival (95% CI/<em>P</em><0.009), attributed to cardiopulmonary resuscitation (CPR) delays. The other examined 160 defibrillations in OHCA. The MD median TTFD was 7 seconds faster (95% CI/<em>P</em><0.0001) and responsible for 20% more inappropriate shocks.
Modern SAED is superior in reducing TTFD and inappropriate shocks. The modern SAED and MD strategies can be enhanced by interruption-reducing technology. New SAED algorithms can detect shockable rhythms in 3 seconds. More randomised studies need to be conducted using up-to-date devices. A multifaceted approach incorporating technological advancements, ongoing research and training is necessary to ensure that the most effective defibrillation strategy is employed.
The safety and utility of endotracheal intubation by paramedics in the UK is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess and compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice.
As Derek Ford approaches his first full year as an NQP, he reflects on his growth in practice.