Posterior circulation stroke (PCS) represents up to 25% of ischaemic strokes and affects more than 20 000 people annually within the UK. Prehospital clinical practice guidelines recommend the use of a validated stroke screening tool, such as the ‘Face, Arms, Speech, Time’ [FAST] tool for the assessment of all patients presenting with stroke symptoms. However, with PCS, patients may present with vestibular symptoms, which cannot be detected with ‘FAST’. Furthermore, over one-third of patients with PCS are delayed or misdiagnosed due to a lack of apparent ‘typical’ acute stroke symptoms. The ‘FAST’ tool is deemed to have high sensitivity and moderate specificity in the recognition of ischaemic stroke; yet there is evidence within the literature determining that the ‘FAST’ tool is not adequate for prehospital screening of PCS, leading to misdiagnosis, treatment delay, and severe life-limiting deficits or death. The aim of this literature search is to evaluate how the use of additional neurological assessment, alongside the validated ‘FAST’ tool, could be used within the prehospital setting for the improved paramedic detection of PCS.
The Northern Ireland (NI) Ambulance Service launched its helicopter emergency medical service (HEMS) in 2017.
This paper reviews the first 200 cases of prehospital emergency anaesthesia (PHEA).
A retrospective review of the NI HEMS intubation database between 29 July 2017 and 28 February 2021 was conducted.
PHEA was delivered as rapid sequence intubation (RSI). There was a 100% RSI success rate. The mean 999 call to RSI time was 65.9 minutes (median=61 minutes), with 14.6% of procedures carried out within the National Institute for Health and Care Excellence target of 45 minutes or less. The first pass oral intubation rate was 89.3%. There was a significant difference in the number of male compared to female patients (men=145; women=55; <em>P</em>≤0.0001).
PHEA delivery by the HEMS since it was set up has been successful provided in a safe, robust manner. Reducing the 999 call to RSI time in line with the National Institute for Health and Care Excellence target was identified as an area for development.
There are various staff wellbeing programmes used across the emergency services. The British Military recognised single-session models were not effective and developed Trauma Risk Management (TRiM). A number of organisations now use TRiM as a peer-led traumatic stress support system, including the North West Ambulance Service.
This evaluation aimed to identify engagement with TRiM across the North West Ambulance Service.
A combination of quantitative and qualitative data was analysed from those who engaged with TRiM.
There was a perception that road traffic collision (RTC) and cardiac arrests would cause acute stress symptoms and require a TRiM assessment; this was validated by the uptake of assessments and referral to professional counselling following such incidents.
TRiM can provide effective peer-delivered support across a large geographical workforce. Implementation and coordination are key to ensuring success.
Reflecting on the development of simulation in paramedic education and his own simulation experiences at Keele University, Dan Wyatt weighs in on the value of this learning tool