Volume 15 Issue 9
Prolonged field care (austere emergency care) principles in UK paramedic practice
Ambulance clinicians are increasingly met with significant delays in offloading patients once they reach hospital. Such delays lead to patients being cared for in backs of the ambulances for far longer than usual; this also pushes paramedics to the edge of their comfort zone in terms of providing prolonged patient care. For prehospital clinicians, this shift to providing prolonged casualty care can be daunting, and it can be easy to overlook essential parts of care when being asked to manage patients for hours rather than minutes. Through an understanding of the 12 core capabilities of prolonged care, and by using the HITMAN and SHEEP VOMIT mnemonics, prehospital clinicians can provide safe and effective prolonged casualty care in situations where onward transfer of care is delayed.
Comparison of prehospital stroke care at private homes and residential care settings
Background: Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population. Aims: The aim of this study was to describe the care of suspected stroke patients according to their residential status. Methods: Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022. Findings: Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001). Conclusion: Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.
Assessment and initial management of the collapsed endurance athlete
Participation in endurance events such as marathons is increasingly popular. Those taking part in these events may collapse and require medical attention for a range of reasons, some of which are well known and recognised by prehospital providers. However, there are conditions that are specific to endurance exercise which may be less well known so potentially less likely to be recognised and managed appropriately. The most common cause of collapse in the endurance athlete is exercise-associated collapse. However, practitioners should be vigilant regarding life-threatening differentials such as exertional heatstroke and exercise-associated hyponatraemia, which are not uncommon. Identifying the cause of collapse in the endurance athlete is difficult as clinical presentations are often similar. The causes, symptoms and management of these conditions are discussed and a management algorithm proposed.
Preparing pregistration students for lifelong learning and practice
In 2020, five Scottish Universities were contracted to deliver BSc Paramedic Science in partnership with regional NHS health boards and the Scottish Ambulance Service. Each university developed their practice-based learning curriculum in their distinct geographical region. Due to the differing needs of each region, the five programmes had similar aims and constraints in delivery but little alignment. A short-life working group was formed of members from each university to develop a national practice assessment document (PAD). The aim was to develop a document that could be used by all five universities and allow for alignment in this core area of preregistration education. This article will describe this process and how this work has gone on to shape work by the College of Paramedics in developing a UK-wide portfolio of practice-based learning (PPBL).
How to occupy oneself when not in lectures
Being among the first to study within a new programme comes with both benefits and challenges—but having drive and a history at the university, as Dan Wyatt does, also comes with the opportunity to build something new for future cohorts…