The Diploma in Immediate Medical Care (Dip IMC) awarded by the Royal College of Surgeons of Edinburgh (RCSEd) was initiated in 1988 with the aim of providing a structured assessment of those practicing in pre-hospital care.
Endotracheal (ET) tube dislodgement after correct placement is a potentially fatal complication of the intubation procedure if not recognised early.
This article explores the journey of the author, a paramedic educator, who is undertaking a professional doctorate programme (DProf). He compares it with the more traditional PhD route, and looks at the differences in approach and the complexities involved in doctoral study. Professional practice is at the heart of a DProf programme, as its aim is to develop researching professionals rather than professional researchers. The author argues that paramedicine is a practice-based discipline, and doctoral research is aimed at creating practice improvement and continued service development. The author chose to study a DProf as the focus was on research and practice development shaped by personal experiences (reflexivity). Reflexivity can be personal or epistemological, with the latter stance encouraging students to reflect upon assumptions they have made during their research. The author hopes to inspire other paramedics to undertake DProf study while remaining grounded within their own practice.
The North East Ambulance Service NHS Trust (NEAS) is committed to the implementation of a number of nationally proposed initiatives following the introduction of the research strategy Best Research for Best Health (Department of Health, 2006). The ambitious strategy introduces several measures to improve the research environment and ensure that studies commence more efficiently. This article provides an overview of the national initiatives, i.e. the Research Passport Scheme and the National Institute for Health Research Coordinated System for gaining NHS Permissions. These initiatives aim to strengthen and streamline research management and governance across England, which NEAS are actively embracing.
Current asthma protocols advocate the measurement of peak flow expiratory rate (PEFR) by staff in pre-hospital care in their assessment and management of acute asthma. Yet in practice many, if not most, omit to do this. The limited amount of recent research available – which has been conducted by doctors and accident and emergency staff and concerns patients admitted to accident and emergency departments – shows that PEFR is one of the best, if not the best, predictive assessment tool available to ambulance staff. Pulse oximetry and PEFR do not measure the same things and cannot replace each other. Not taking a pre- and post-treatment PEFR is potentially detrimental to patient care and does not comply with Joint Royal Colleges Service Liaison Committee and British Thoracic Society standards. Paramedic-led research on assessment and management of acute asthma in pre-hospital settings is lacking.
Reperfusion options for patients suffering ST-elevation myocardial infarction (STEMI) have developed significantly over recent years and now include both thrombolytic therapy and primary percutaneous coronary intervention (PPCI). This system of care means that patients presenting with STEMI can be transferred directly to a heart-attack centre to receive immediate PPCI. National guidelines state that pre-hospital thrombolysis (PHT) is a crucial part of STEMI reperfusion where PPCI cannot be delivered within 90 minutes of diagnosis. There is evidence describing rates of in-hospital thrombolysis in both MI with ST elevation and MI with LBBB. There is a knowledge gap however describing treatment of MI with LBBB based upon a pre-hospital 12-lead ECG. This paper describes the challenges around PHT in the context of LBBB and offers potential solutions that may provide assistance in making the decision to undertake PHT or not.
Last month, the National Audit Office (NAO) published Major trauma care in England. Published with little fanfare, it evaluated trauma care services in England; the cost-effectiveness of planning and delivery of these services; and the quality of care, including patient outcomes. Every year in England alone, 193 hospitals manage the estimated 20 000 cases of major trauma, which although only account for 0.2% of total activity, result in over 5000 deaths. However, this fraction of clinical care costs over £3 billion in hospital treatment, as well as further care and rehabilitation.