Spotlight on Research

Simpson et al (2010) undertook a systematic review of randomized controlled trials (RCTs) to explore delayed vs immediate defibrillation when managing out-of-hospital cardiac arrest due to ventricular fibrillation.

Book Review

Far from being simply another text in the myriad of the clinical genre, this book takes on the format of a series of case studies. While this takes a bit of getting used to, it is ultimately successful in addressing a wide range of medical complaints.

October roundup of the EMS blogging world

Mark Glencorse, NHS Operational Paramedic Team Leader, Author of 999medic.com, and Co-Host and European Programme Director of ‘The Chronicles of EMS’, updates JPP on the main issues that emergency medical services (EMS) blogs are focusing on and the topics that are creating the best discussions this month. Email for correspondence: mglencorse@yahoo.co.uk

Paramedic education: the significance of graduate attributes

The Australian health care system and delivery of health services is under increasing pressure. Therefore, preparing health care graduates for these expected changes requires careful alignment of graduate attributes to core components of academic curricula. The Australian paramedic discipline has seen a remarkable change in a number of areas over the past three decades including education, training, health care identity, and scope of clinical practice. However, the Australian paramedic discipline is currently in a tenuous position for a number of reasons: it is not registered or regulated nationally and university paramedic education programmes are not formally accredited. This has led to non-standardized curriculum standards and uncertainty whether graduates are meeting industry and health service needs. This article will discuss why graduate attributes are important in registration, regulation and curricula development, and how and why graduate attributes are integral in providing graduates with the employability skills expected by employers. While this paper focuses on the issues in Australia, many of these issues are also faced by the paramedic profession and higher education sector in the UK. Therefore, it should provide the readership with germane material in their quest for curriculum and graduate attribute renewal.

The three faces of atelectasis

Atelectasis, often known as collapsed lung, is a commonly encountered medical emergency. This case study identifies three different types of atelectasis and how they apply to the law of LaPlace. Different mechanisms include collapse from forces outside the lung parenchyma, a reduction in alveolar size from exudative reactions, and an increase in alveolar surface tension. All three mechanisms result in the condition of atelectasis. All three mechanisms can be illustrated as variables in LaPlace's equation. Physiological causes and treatment considerations are discussed for each type.

Paediatric disaster preparedness: essential concepts for paramedics

Children are the world's most valuable resource and its best hope for the future (John F Kennedy, 1963). Recent natural disasters and terrorist attacks have shown how imperative it is that communities and nations address the needs of children to ensure that they thrive in the face of adversity. As first responders and front line workers during disasters involving children, paramedics have a unique and important role in planning paediatric disaster preparedness as well as facilitating personal disaster preparedness. Paediatric disaster preparedness on all levels, from individual to institutional, will lead to improved outcomes in disasters involving children. Although different medical, legal, and administrative structures exist between the UK and the US, some of the lessons learned in the US can enhance paediatric disaster preparedness in all countries. This article aims discuss how paramedics and other first responders can close the gap between available and needed paediatric providers. Specifically, we review how paramedic primary and continuing education can target deficiencies identified by various supervising organizations, and how training can be performed using several successful high fidelity models produced through these resource centres

Improving survival from out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) is a leading cause of prehospital mortality and serious neurological morbidity. Survival from OHCA almost entirely depends on prehospital intervention by ambulance personnel. Recent evidence has shown the importance of good quality cardio-pulmonary resuscitation (CPR) in improving outcome from OHCA. Recent studies have suggested that intubation, intravenous cannulation and drug administration may distract from basic CPR and be associated with poor outcomes following OHCA. This article reviews the latest evidence on prehospital OHCA management and presents the case for a ‘back to basics’ approach.

Update on 'Paramedic management of shock in trauma: unlocking the potential'

In August 2010, JPP published an article by Andy Hitt, titled ‘Paramedic management of shock in trauma: unlocking the potential’. This article critically appraised the treatment options currently available to UK paramedics and maintained realistic improvements based on underlying pathophysiology. JPP has received a letter regarding this, which is printed below, along with a response from the author.

Fighting the fire: a response to fire chiefs' proposal to run England's ambulance service

The fire and rescue service in England has proposed taking over and running the ambulance service. This has obviously sparked a great debate among both the ambulance and fire service industry. According to the Chief Fire Officers Association (CFOA), the ambulance service is struggling to meet its response targets of dealing with 75% of life-threatening calls within eight minutes, and believes the fire service could respond to life-threatening calls within eight minutes 90% of the time. This proposal is detailed below, followed by a commentary by Professor Malcolm Woollard, Honorary Consultant Paramedic and Director of the Pre-hospital, Emergency and Cardiovascular Care Applied Research Group at Coventry University, who argues why this idea is not workable.

No smoke without fire

On Thursday 30th September 2010 on BBC Radio 4's ‘You and Yours’ show, Peter Holland, President of the Chief Fire Officers Association, put forward a proposal for the fire service to take over and run the emergency side of the ambulance service (BBC Radio 4, 2010). His suggestion was that it would save money, provide a better service and improve response times-but at a time when the coalition is set to announce significant cuts in funding of some government departments, is the proposal more about saving fire service jobs than improving performance?

Wilderness medicine: a fellowship programme

The Fellowship of the Academy of Wilderness Medicine qualification (FAWM) was set up in 2005 by the Wilderness Medical Society based in America and currently has 640 candidates, and 176 Fellows. It provides a great opportunity to gain and demonstrate knowledge of expedition and wilderness medicine and to gain recognition for practical experience you have gained in this area. The Wilderness Medical Society also offers a number of other benefits to its members and continues to develop new services and qualifications year after year.

Continuing Professional Development: Introduction to pharmacology

OverviewParamedics have often been considered, particularly by other urgent health professionals, at an advantage for having the ability to administer a wide range of therapeutic interventions. This ranges from the relatively innocuous aspirin to intravenous opiate analgesia, in the form of morphine. However pharmacology, or the study of drugs, is an area of the traditional paramedic training curriculum that has been lacking in recent years. This Continuing Professional Development (CPD) module aims to provide an introduction to some aspects of clinical pharmacology. Pharmacology touches on a number of other areas, such as mathematics, basic physics and chemistry and an awareness of the anatomy and physiology of some key organs, such as the kidney and liver. These particular subject areas may not necessarily appeal or be the most interesting to study and as such pharmacology can detract some individuals from further exploration of this fascinating aspect of clinical care. Pharmacology is really about a journey—the journey of a therapeutic intervention, or drug, from its humble inception in a laboratory test tube, through years of extensive and thorough research and development, to the marketing of a clinically effective drug that has the ability to literally save lives and stem the spread of illness and disease. This module will describe and outline the journey of the drug, from administration, describing the effect it has on the body, interactions, contraindications and how this impacts on clinical practice.Learning OutcomesAfter completing this module you will be able to:▪ Have an overview and understanding of the basic principles of pharmacology.▪ Have an awareness of the concepts of pharmacokinetics and pharmacodynamics.▪ Revised your anatomy and physiology of the kidney.▪ Begin to develop your awareness of some of the professional issues related to paramedic administration of drugs in prehospital care.