Volume 2 Issue 1

Spotlight on Research

Undertaken in Melbourne, Australia, this study examines whether a patient's gender influences the provision of analgesia in prehospital settings. A retrospective review of patient care records identified 1766 patients eligible for inclusion in this part of the study. The median age of the sample was 61 years and 52% were female. The results indicate that in 95% of cases paramedics documented a pain assessment, and that a Numeric Rating Scale (NRS) was the most frequently used assessment tool (71% of cases). Of those patients reporting pain, 45% did not receive analgesia but there was no significant difference between the sexes (P=0.93). Overall, fewer males reported severe pain (indicated as 8–10 on the NRS) than females. The findings revealed a significant difference in relation to what type of analgesia was administered, with fewer females receiving morphine (13% 95% CI, 11–15% P=0.01). There are some limitations to the study as it was retrospective which, among other things, restricts opportunities to check the accuracy of documentation; also the research only includes one ambulance service which may limit its generalizability. However, studies such as this contribute to a raised awareness of the diversity of issues which may contribute to effective pain management. Future prospective research must further examine factors influencing paramedics' clinical decision-making during the management of patients' pain.

Role of paramedic mentors in an evolving profession

In an increasingly demanding profession, the role of a paramedic mentor in the development of paramedics is of pivotal importance. This article aims to review the existing position of paramedic mentors and examine the key challenges facing the mentors themselves and the paramedics they support.

Perceptions of doctors in prehospital care: a study

The Tayside Trauma Team has been providing a physician-staffed primary retrieval service in Angus and Tayside for many years. This study aims to explore the experiences and current opinions of paramedics and ambulance technicians in Tayside and Angus regarding the role of physicians in prehospital care as well as their understanding of what physicians bring to the on-scene management of trauma patients.MethodsAn anonymous questionnaire was devised and circulated electronically to all paramedics and ambulance technicians in Tayside and Angus.ResultsMore than three quarters of respondents agreed that the ability of physicians to perform specific advanced practical procedures were advantageous on scene. Most disagreed that doctors carried out unnecessary interventions on scene and that a doctor's presence prolonged scene times, compromised scene safety or meant patient care was ‘taken over’.DiscussionThere appears to be a high level of understanding of the role of physicians in prehospital care among paramedics and ambulance technicians in Tayside and Angus. The majority of ambulance crews recognize that there are a key set of skills that a doctor can provide on scene to trauma patients.

Medical students in prehospital care

Medics' First Responders are medical student volunteers from Cardiff University who respond to life-threatening (category A) 999 calls, providing crucial assistance to patients in partnership with the Welsh Ambulance Service. It was the first UK Community Responder Scheme to consist entirely of medical students (Cardiff Medics' First Responders Website, 2006). The main benefit is to the local community through the management of cardiac arrests. Aims: First responders aim to arrive on the scene within 6 minutes, which should be achievable in 80% of cases. Students are fully trained in the necessary skills required for callouts, including basic life support and the use of automated external defibrillators. Limitations: Currently, there is no sustainable fundraising policy in place and many logistical difficulties face the community, with responders being spread across Wales because of University placement commitments. Progress: A new committee was formed in 2008, which has built on the society's previous successes, training over 100 members in one year. Fundraising and publicity have increased. In the future, the society aims to provide responders at large national events (such as rugby matches), as well as aiming to have two teams responding simultaneously, covering a larger area of Cardiff.

Birth: an evidence-based approach

Paramedics are involved in transferring women during labour and must also be able to manage births occurring outside of the hospital setting. Prehospital obstetric incidents represent a significant proportion of large cost litigation claims in the United Kingdom (Dobbie and Cooke, 2008). Therefore, it is important to have an understanding of the physiology of birth and how best to avoid unnecessary complications. Culturally, birth is perceived as a dangerous event, and birth in an unplanned setting can be a frightening experience for women and for others present. However, birth is a normal physiological process and in the absence of prior interventions, complications are uncommon (Walsh, 2007). This paper will discuss an evidence-based approach to the management of normal birth and provide recommendations for practice which will reduce the risk of complications occurring and potentially improve the experience for women.

JRCALC: advice or requirement?

The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) is the body that develops and reviews clinical guidelines for use by paramedics working in the UK and it has been instrumental in moving ambulance services from locally-derived protocol and guidance to a national, systematically developed set of guidelines based upon current best evidence. The evidence is based upon systematic reviews, meta-analyses and randomized, controlled trials, where available. JRCALC states that its ‘guidance is advisory and has been developed to assist health care professionals, together with patients, to make decisions about the management of the patient's health, including treatments’ (JRCALC, 2006). The guidance is intended to support decisions and sound clinical judgement, not replace it. This begs the common question: what are the consequences for me if I make a clinical decision that deviated from the JRCALC guidance?

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