Volume 2 Issue 9

Emergency planning: major incidents and command training

Major, complex, multi-casualty incidents occur with surprising regularity and previously, the command of these from a health perspective was often delegated to those with the most experience. Time served in the ambulance service was often the measure of one's ability to take command of such an event. The police and fire and rescue services have long established training programmes for their commanders. This training is in addition to their normal day job and is specific to incident command. Police and fire officers can only perform in that role if they have successfully completed the training required. The same cannot be said of health incident commanders.

Spotlight on Research

This paper examines advanced airway management techniques provided by tactical emergency medical services (TEMS). Twelve medical flight-crew personnel and 19 emergency medicine residents participated. Wearing a ballistic vest and helmet, they crawled towards a manikin lying behind a barrier (eight feet long and 12 inches high) before performing each technique. The primary outcome measure was time to successful ventilation; secondary outcomes included the number of attempts before successful ventilation, and the maximum height that the practitioner was visible above the barricade.

September roundup of the EMS blogging world

This month it is back over the Atlantic for ‘The Happy Medic's (Happy Medic, 2010) turn to be our featured blogger. Happy Medic, aka Justin Schorr, is a San Francisco fire fighter paramedic, who I had the opportunity to go and work with for 10 days in November 2009 for our little project that ended up becoming ‘The Chronicles of EMS’ (The Chronicles of EMS, 2010).

Book Review

The acid test for any book which passes through my hands is its relevance to paramedic practice—especially at the prehospital stage. But I have to say I'm struggling with this one.

Can paramedics clear the cervical spine?

Clinical decision rules to allow clinical ‘clearing’ of the cervical spine are widely used in emergency departments. This topic review considers the literature relating to whether paramedics can clinically clear the cervical spine in the prehospital environment. A comprehensive literature review was undertaken which found eight relevant articles for review. Overall, prehospital professionals, when applying the two commonly used in-hospital clinical decision rules, have a similar sensitivity to their in-hospital colleagues.

Health care policy with ambulance clinicians in mind

Governments decide health policy and control the NHS through the Department of Health (DH) (Williamson et al, 2010). For this reason, some of the most pertinent policies and documents published by the DH have been chosen for discussion within this article. The wealth of documents, policies, strategies and recommendations governing ambulance clinicians' working lives, can sometimes be overwhelming and cover an extensive range of topics. It can be a lengthy and onerous task to read through even the summaries of each document and deciding if the content pertains to the role. The DH is the principal government department with responsibility for health matters and publication of health policy for England. However, there may be some overarching principles that are similar for Scotland, Northern Ireland and Wales. Details and structures created are slightly different throughout the UK (Williamson et al, 2010). The focus of this article is on England and the application to the NHS, however some principles may be applicable to the whole of the UK. It is the intention of this article to summarize some DH documents, which will enable the ambulance clinician to reflect on the impact health care policy has on their care provision, role and responsibilities. Ambulance clinicians may benefit from the use of this article as a starting point to further enquiry into other agencies. For example, the Care Quality Commission and publications from local ambulance trusts, which often reflect the national government focus at a local level.

Bacterial tonsillitis: prevalence, prediction and treatment by the ECP

Sore throat or tonsillitis is not necessarily considered a life-threatening emergency but such calls are received and attended to by the ambulance service. It is believed that this is because a face-to-face assessment is often required as the symptoms of a high temperature, headache, lethargy, vomiting and a stiff neck are far too similar to those of meningitis. With complex telephone triage now being performed by nurses and emergency care practitioners (ECP) on clinical support desks within most emergency operation centres, it is hoped that this complaint could be narrowed down and a more appropriate ECP response despatched. When presented with tonsillitis in the community, it is difficult for the practitioner to establish whether the infection is of a bacterial or viral origin. Learned behaviour would suggest that white exudates on the tonsils deem a bacterial origin and requires antibiotic treatment, but this can sometimes be a self limiting illness and antibiotic treatment is not indicated and will only assist with resistance. This article looks as the incidence of bacterial tonsillitis, tools to predict bacterial tonsilitis, and the correct antibiotic and length of course once established. It also briefly touches on the Department of Health's current consultation on paramedic prescribing rights and how a delayed prescription treatment plan cannot be achieved working under a patient group directive (PGD) when treating bacterial tonsillitis.

Changing standards of proficiency

The Health Professions Council (HPC) is charged with establishing standards of proficiency that are prerequisites for entry to each part of the register. As well as ensuring safe and effective practice, these standards are the minimum standards expected of registrants. Changes are being proposed to the generic standards to ensure that they are applicable to all professions they regulate. A consultation process is now underway that will impact on the wording and the structure of the standards-currently there are 26 overarching generic standards and 53 detailed generic standards with a different number of profession specific standards. The proposal also aims to reduce the current generic standards to 15, with the express intention of ensuring that they are overarching and applicable to all professions.

Human factors within paramedic practice:the forgotten paradigm

It would seem hard to imagine how you could draw a comparison between a commercial airline pilot struggling to land a stricken plane in a storm and a paramedic fighting to save the life of a patient in cardiac arrest. Although very different circumstances, they both have one thing in common: that is, they are both vulnerable to a condition known as ‘the human factor’. Examples of where Human Factors (HFs) exist within the prehospital profession can be various, common examples are environmental distractions e.g. noise from bystanders, mobile phones, machines, or more simply caused by lack of sleep and inadequate nourishment. This article discusses human factors within the prehospital environment and will highlight the benefits of being able to recognize and act upon them, with a specific focus upon the impact they can have on the ambulance practitioner operating in the field. It discusses human factors training and recognizes the role of crew resource management (CRM) and its importance within the prehospital profession.

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