Volume 2 Issue 12

Continuing Professional Development: Dealing with the ‘difficult’ patient: strategies for practice

OverviewThis Continuing Professional Development (CPD) module will focus on the identification and management of the ‘difficult’ patient in prehospital care. ‘Difficult’ patients are an aspect of most health care professional's (HCP's) clinical lives. The management of such individuals can be challenging; causing stress to both the practitioner and those around them. The aim of this Module is to outline and identify some of the ‘difficult’ patients, and consider some management strategies and techniques on how these patients can be managed appropriately and safely. The module will also assist in managing your own feelings, by helping you to understand the rationale of some of the personality types.Learning OutcomesAfter completing this module you will be able to:▪ Understand the classification of the ‘difficult’ patient▪ Understand the significance of the contributing factors to the ‘difficult’ patient▪ Describe some of the personality disorders than can contribute to the ‘difficult’ patient scenario▪ Develop you own coping methods▪ Begin to rethink some of your own values and beliefs towards such patients and consultations.

Essential life support: emergency obstetrics

Advanced Life Support in Obstetrics (ALSO) (UK) has been providing training courses relating to obstetric emergencies in the UK since 1996. The course lasts two days with doctors and midwives teaching doctors and midwives and other professionals, some of whom have been paramedics.ALSO instructors have been involved in teaching paramedics at the request of ambulance services. Having a specifically designed one day course geared up to meet the needs of those called out in the community for maternity emergencies was considered to be a way forward for emergency staff having to deal with these situations. This course has been called Essential Life Support in Obstetrics (ELSO).

Devon air ambulance: a case example

The first thing a patient in need of emergency treatment may recognize is the red flight suit of a South Western Ambulance Service NHS paramedic operating from the Devon Air Ambulance. This would be one of the specially trained and highly committed band of 12 full time paramedics who work on the air ambulance.While each of these air crew paramedics will insist that the bright red helicopter is treated just the same as any other ambulance, but one with rotor blades instead of tyres, each appears to have forged a special relationship with the work of the Devon Air Ambulance Trust and each supports it in a variety of ways above and beyond the call of duty

December roundup of the EMS blogging world

It is that time of year again, and while many of our potential patients are enjoying the festive season (sometimes to excess), the ambulance services struggle to cope with the normal –winter pressures— that we see each and every year. So with that in mind, lets give you some reading for those long, lonely periods of standby.

The changing Australian healthcare landscape: implications for paramedics

This article argues that the Australian paramedic sector has reached a critical point in its development as a recognized profession. It identifies and describes a number of the most influential factors that are currently driving change throughout the Australian health care system and that can be demonstrated to have significant impact upon the emergency health care sector. In order to remain and grow as an autonomous and respected part of being part of contemporary service delivery, and consequently becoming recognized as a profession, a number of key questions demand answers: does the sector have the capacity to help with burgeoning health care workforce shortages or offer alternatives in service delivery? If it does, does the role equate to some form of extended practitioner or shared care roles such as physician assistant or paramedic practitioner? Either way, it appears reasonable that the role, responsibilities and function of a paramedic both in urban and rural locales in the near future will undergo some form of change: the question is whether any such change will be professionally developmental or detrimental? While this article focuses on the issues in Australia, many of these issues are also faced by the paramedic profession and health care sector in the UK. Therefore, it should provide the JPP readership with useful material in their ongoing development of alternative service delivery models and quest to improve workforce productivity.

Treating the unexpected: the opiate overdose patient

Ambulance practitioners are regularly faced with those who present with a form of drug overdose. The subject of substance misuse can be controversial, delicate and are not always straightforward to manage. Not only can substance misuse be a sensitive topic to approach, but patients can be adept at hiding the signs and symptoms from friends, family and ambulance practitioners (Caroline 2008). In addition, it may be difficult to establish what exactly has been taken, when, and how much. Gaining consent to treat the patient can also be fraught with difficulties. This reflective account uses a case from practice which highlights several of the difficulties that ambulance practitioners face when dealing with this type of patient.

Use of Dermabond® adhesive for wound closure at the scene

Topical skin adhesives (TSA) are commonly used in hospital accident and emergency (A&E) settings for the closure of simple, minor lacerations. An observational study was conducted in a UK ambulance trust to assess health resource use associated with the management of simple lacerations when using Dermabond® TSA at the accident scene, compared with its use in A&E after transportation of the patient to hospital (standard of care (SOC)). A decision tree model mapped both treatment pathways to establish full costs to the NHS. Call-out times and staff interventions were recorded. Treatment of patients at the scene with Dermabond® TSA reduced the call-out time (mean reduction 32.64%, median reduction 31.91%). Total cost per patient pathway for patients treated at the scene was £200.81 with Dermabond® TSA and £611.43 for patients receiving SOC. Treatment at the scene with Dermabond® TSA resulted in a total saving to the Merseyside Ambulance Service of £345 327 over the 5-month study. The use of Dermabond® TSA by emergency care practitioners at the scene for the closure of simple, minor lacerations is acceptable, cost effective, and provides NHS trusts with the opportunity to work towards government initiatives for reducing the number of patients treated within the acute hospital setting.

The prehospital early warning triage tool

The purpose of this article is to provide background information and guidance in the use of the prehospital early warning triage tool (PHEWT); and completion of the PHEWT documentation. The system is intended to provide an aid to prehospital care clinicians in ensuring all patients (ages 16 years and above) are triaged and conveyed to the department or unit best suited to their needs. In order to bring this triage system to fruition, a forward thinking ambulance service could take this on as a well constructed, multi-centre validation study. The article itself is simply the generation of that idea.

Creating awareness: the Ambulance Services Benevolent Fund

The Ambulance Services Benevolent Fund is a registered charity, established in 1986 to help ambulance service personnel and their dependants from all over the UK, Ireland, Channel Islands and the Isle of Man in times of genuine hardship. The Trustees are all unpaid volunteers and the assistance given to both serving and retired ambulance personnel grows year on year. Here, Simon Fermor, ASBF Secretary, discusses the fund in more detail.

Lessons to be learnt

The events that occurred in London on 7 July 2005 have, as did the twin towers disaster in New York in 2001, changed our lives in the UK and other parts of the world. The event was a tragedy for many people, 56 people lost their lives with a number of others seriously injured and maimed (The Stationery Office, 2006). The bombings on that day in July were an act of indiscriminate terror and have had a significant impact on a wide spectrum of our society and further afield. The first on the scene in response to that emergency were the London paramedics.Too often in the past, tragedies have been witnessed which could have been avoided had the lessons of previous experiences been properly learned. The Secretary of State has statutory powers to set up external inquiries. In 2000, the Department of Health published a report of an expert group on learning from adverse events in the NHS-An Organisation with a Memory. The emphasis of the report was on learning lessons from events that caused harm in the health service. It is the function of a government to protect its public and this includes those who provide emergency services.

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