The future of paramedic intubation: who should be responsible?

Prehospital airway management in trauma patients has been the subject of debate among many professionals for a number of years. At present, the gold standard for airway management and optimal ventilation is endotracheal intubation. Paramedics, as the frontline prehospital care providers, are currently able to practice endotracheal intubation in order to secure an airway, but only when the patient is comatose with no gag reflex. Training in endotracheal intubation has been under close scrutiny by regulatory bodies such as the Joint Royal Colleges Ambulance Service Liaison Committee, with emphasis on using other techniques to secure the airway, including supra-glottic airway devices. Rapid sequence induction and drug assisted airway management is only carried out by doctors working in the prehospital arena. However, a number of studies document that paramedics are more than capable of carrying out successful rapid sequence induction in trauma patients. This article considers the training received by paramedics in airway management, techniques that are employed and the influence of current literature on the debate over paramedic endotracheal intubation.

Paramedic management of shock in trauma: unlocking the potential

Globally, traumatic injury is a leading cause of death for patients under 45 years old. A consequence of serious or poorly managed trauma is shock—a clinical syndrome that is both preventable and treatable if spotted in time. Heightened pathophysiological awareness and a review of diagnostic methods may promote early circulatory support rather than aggressive resuscitation. This could reduce the risk of iatrogenic complications and avoid unnecessary delay. The aim of this article is to critically appraise the treatment options currently available to UK paramedics and postulate realistic improvements based on underlying pathophysiology.

New regulations for the quality and safety of ambulances

Linda Hutchinson, Care Quality Commission Director, talks about the new system of registration for providers of independent and voluntary ambulance services, and the implications for paramedics.

Bridging the gap in evidence base

The JPP aims to support and encourage the continuing professional development of paramedic practice. Part of this development focuses on the evidence and research underpinning clinical practice in the prehospital and urgent care setting, which has been relatively limited compared to other clinical areas. As the paramedic profession develops, so the evidence base is also beginning to grow.

Book review

In November 1994, a small group of senior emergency physicians met to consider the triage process in Manchester. As they have become known, the Manchester Triage Group ultimately devised the now muchdocumented Manchester Triage System (MTS) which was first published in 1996. This book documents the newly revised version of that original model.

August roundup of the EMS blogging world

This month, it is the turn of one of our own UK bloggers to share his story. You met him briefly last month, but this time he takes centre stage. I would like to introduce you all to the ‘Insomniac Medic’, an anonymous blogger who goes by the alias of Ben Yatzbatz.

Starting young: the challenge of developing graduates' road readiness

Australian universities, the majority of paramedic undergraduates tend to come straight from school and many programs are unable to offer early or lengthy on-road placements. This was cited as a cause of the immaturity and poor interpersonal skills raised repeatedly in focus group discussions in a year-long study of paramedic education in Australian universities. Focus groups struggled to label the missing factor in university educated paramedics. A deficit of soft skills was widely suggested, but the phrase was not adequate for the range of problems described. Soft skills is used interchangeably with employability, key skills, generic skills and graduate attributes (HEFCE, 2003; Cranmer, 2006; Treleaven and Voola, 2008), but for paramedics it boils down to road readiness. The suggestion that a new generation of paramedics has fewer relational skills than the last generation could be regarded as hollow, except for the fact that it was graduates who raised the problem in focus groups. Using sociological tools to analyse the cultural context of work, it is possible to suggest that deficits interpersonally may be influenced by an increasingly isolated and de personalised youth culture. This culture particularly affects young people who are moving into a uniquely interpersonal workplace, such as paramedic practice (Metz, 1982; Wright Mills, 2000 [1959]). Some social commentators describe the problem of youth culture as the ‘shrinking home habitat’ (Cunningham and Morpurgo, 2006), whereby changes in family structure, social isolation and parental protection, create a smaller social world for Western youth. At the same time, dependence on communication technologies has created ‘disembodied’ communities (Willson, 1997), lacking in real time contact with strangers. While young people may be ‘digital natives' (Bennett et al, 2008; Prensky, 2001) in their use of technologies and social networking, these skills do not translate into road readiness. Graduates also enter a workplace experiencing previously unknown levels of complexity, escalating diversity including ethnic and aging populations, the needs of marginalized people living in the post-institutional, post-welfare era, and high social sensitivity to issues of inclusion and risk. While social change has been incremental for existing professionals, graduates are immersed into the complexity of a social milieu they may not recognize, from the moment of recruitment.

Mentorship for paramedic practice: is it the end of the road?

This final article in the series of mentorship for paramedic practice concludes with the identification and management of the struggling or failing student. Although fortunately a relatively uncommon occurrence in practice, mentors will occasionally be required to manage their own students and also other mentors' students who are experiencing difficulties in practice. This article addresses some of these issues, such as identifying and managing problematic behaviour and also the use of various strategies by which to manage to students, including the use of action plans. The article concludes with the issue of inconsistent mentorship and the effect that this can have on the students.

Continuing Professional Development: Taking a patient history

OverviewThe aim of this module is to provide the reader with a detailed insight to taking a patient history, identifying some key issues and outlining the importance of documenting a patient history. Many paramedic and prehospital practitioners will already be documenting a patient history on a regular basis as an aspect of their everyday clinical practice. A patient report form (PRF), or similar documentation will guide the practitioner. Emergency care practitioners (ECPs) or paramedic practitioners (PPs) may also use a medical model to guide their comprehensive patient history, as outlined in this CPD module. However, for most paramedics and other prehospital or urgent care professionals, the practice of taking a comprehensive patient history is perhaps less familiar. This module will provide the reader with a background to the importance of tacking a patient's medical history and also to consider developing and refining these skills. This module will also help to explain any patient history notes that you may have read as part of caring for a patient. This module is aimed largely at adult patients, although specific issues in relation to children are identified where appropriate.Learning OutcomesAfter completing this module you will be able to:• Demonstrate an understanding of taking and documenting a comprehensive patient history.• Have an understanding of some of the common patient history taking terminology.• Recognize the importance of history taking as a key component in patient assessment.• Begin to develop and apply some patient history taking skills.A note: This history taking outlined in this module is a general approach to taking a patient's history and does not address the specific history taking in relation to an individual illness or disease and therefore is aimed at being generic approach to taking a history from an undifferentiated patient presenting with a health care issue.

The foundations of paramedic science and beyond

This article explores the inception and design considerations of the foundation degree in paramedic science (FDSc), within the School of Health at The University of Northampton (TUoN). It is written as a collaboration between a student, practice educator and lecturer. It discusses preparation for practice, academic progression and quality assurance considerations. The construction of the programme is outlined with reference to feedback and reflection on its predecessor, a diploma in higher education in paramedic science (DipHE) delivered by TUoN. The FDSc is intended to prepare students for the challenges of contemporary paramedic practice and life-long learning, the latter having become a requisite for UK healthcare professionals (Gopee, 2010; Health Professions Council (HPC), 2010).

Spotlight on Research

Mulholland et al (2008) prospectively evaluated the ability of helicopter paramedics (HP) to use anatomical criteria to predict patients' need for direct transfer to a major trauma centre (MTC) in Victoria, Australia. During 2004-2005, 207 patients (age >15 years) were enrolled in the study.