Volume 3 Issue 1

The role of ambulance clinicians in management and leadership

Ambulance clinicians are ‘professional problem solvers’. As such, they share much in common with managers within organizations, and have much to offer in terms of the contribution that they can make to the management and leadership of the organisations within which they work. This article highlights the importance of management and leadership development opportunities being made available for ambulance clinicians. A practical approach is advocated, whereby ‘hybrid roles’ are developed to enable individuals to gain practical experience of management and leadership within a structured and supportive environment, while retaining an element of clinical practice. A case study is used to illustrate the article, based upon the author's own career within the NHS to date which has combined both management and clinical practice with structured management and leadership development. Practical advice is offered for those ambulance clinicians who may be interested in undertaking such development in future, or who wish to explore further their role as clinical leaders.

A case of heat-related illness

Although heat-related illnesses are relatively uncommon in the UK, nonetheless, this can pose serious dangers to military personnel posted to the Middle East as well as tourists who are not acclimatised to the hot weather of a tropical country. This article illustrates some common presentations of heat-related illnesses by highlighting the case of a man who suffered from heat exhaustion after he lost consciousness in his car. This case happened in the authors' home country, Malaysia.

Polytrauma: a case report

In the prehospital setting, the ‘foot of the bed inspection’ becomes an ‘over the ambulance dashboard inspection’. A mangled wreck at the foot of a tree is usually a good indication that someone has been injured and that timely clinical intervention may be required. By considering the mechanisms involved and performing a thorough primary survey, time critical patients can be triaged and treated with efficiency. As paramedics’ assessment skills continue to improve and doctors gain prehospital experience, it is anticipated that a well balanced team will emerge. A team that is aware of their limitations and limit their interventions to the time permitted to intervene. This case study is based on the young male driver of a vehicle that has been involved in a high speed collision with a tree. It aims to identify the probable pathologies, explain the pathophysiology of clinical signs and discuss, with evidence, the treatment options and appropriate destination for the patient.

The paediatric assessment triangle: a powerful tool for the prehospital provider

The paediatric assessment triangle (PAT) is an internationally accepted tool in paediatric life support for the initial emergency assessment of infants and children. It is a rapid, global assessment using only visual and auditory clues, and takes only seconds to perform. The PAT has three components: appearance, work of breathing and circulation to skin. It is the first step in answering three critical questions: (1) How severe is the child's illness or injury? (2) What is the most likely physiologic abnormality? and (3) What is the urgency for treatment? The combination of abnormalities observed by the three components defines one of six categories of clinical status: stable, respiratory distress, respiratory failure, shock, central nervous system (CNS)/metabolic disorder, or cardiopulmonary failure. The category of illness and its severity drives management priorities and determines the initial treatment. In addition, the PAT provides a common vernacular for emergency clinicians and may be applied repeatedly to track clinical status. This article will furnish the prehospital provider with an approach to the recognition and treatment of the acutely ill or injured child.

Emergency prehospital care of burn injuries: thermal, electrical and chemical burns

The prehospital approach to severly burnt patients still remains challenging for prehospital carers. The adequate approach for thermal, electrical and chemical burns, with special focus on paediatric burnt patients, still needs to be further clarified and some controversies remain. This article addresses the preclinical algorithm for burn treatment and discusses contoversial aspects. After the burning process is stopped, the prehospital carer has to deal with cooling the surface, maintaining a balanced body temperature to avoid hypothermia, identify life-threatening injuries, assess the burn size and severity, and provide adequate dressings. Furthermore, airway management in case of inhalation injury, fluid replacement and analgesia/ sedation must be approached before transportation to a specialized centre. In this article, available formulas for fluid replacement and a guide for paramedics, as well as certain criteria for direct delivery to a burn centre, are discussed. Special aspects of the pathophysiology and primary care of electrical and chemical burns, which particularly require measures of self protection, are evaluated. Basic recommendations of paediatric burn treatment are also addressed. All aspects are integrated into the algorithmic approach in order to make the prehospital carer feel sufficiently prepared.

January roundup of the EMS blogging world

Just me, Just my BlogFirst off is a post from Leanne, who authors the blog ‘Just me, Just my Blog’. In this piece of writing, Leanne looks ahead and acknowledges the difficulties she may face in achieving her goals in her EMS career. She is new to the profession, on the very first rung, but she has an obvious passion for EMS. In ‘looking back – forging ahead’ (Just me, Just my Blog, 2011), we get to walk alongside a provider who wants to make a difference both in her patients experience as well as EMS in general. Some may say lofty goals, but I think she will get there.

Book Review

At first glance, this title is rather appealing to paramedics. But as the literary doctrine says, never judge a book by its cover.

Do patients seen by ECPs need an early warning?

As ambulance services continue to move from a predominantly transport orientated service into a resource which offers provision of mobile healthcare, outcomes of patients seen by prehospital practitioners will face increased scrutiny. This research examines the correlation between decisions taken by emergency care practitioners (ECPs) as to whether or not to transfer patients with a respiratory condition to hospital, and the pandemic medical early warning score (PMEWS). The PMEWS total is calculated from a combination of physiological measures, age, chronic disease presence, functional ability, and social factors.

Paramedic rapid sequence intubation in severe head injury: is the debate over?

Spotlight on Research is edited by Julia Williams, Principal Lecturer, Paramedic Science, University of Hertfordshire, Hatfield, Hertfordshire UK. To find out how you can contribute to future issues, please email her at j.williams@herts.ac.uk (to avoid disappointment or duplication we recommend an initial email before beginning any writing).

Continuing Professional Development: Becoming a reflective practictioner: a framework for paramedics

OverviewReflective practice has gained the momentum of a runaway freight train among ambulance practitioners. The benefits of engaging in such an activity are now widely known and are recognized for playing a key role in professional development among prehospital professionals. Writing a reflective practice account for the first time can appear daunting and off-putting but with a little help and plenty of practice practitioners will be able to reap the benefits of reflective practice in no time at all. A variety of frameworks are available to guide the ambulance practitioner through this process and choosing the correct model of reflection could be argued as being the single most important first step when engaging in reflective practice. This module provides an opportunity to identify the origins of reflective practice and to explore the popular paradigm as it exists today. The ‘reflection’ activities will allow the user to gain experience undertaking a reflective account following one of the three profession specific frameworks.Learning OutcomesAfter completing this module you will be able to:▪ Appreciate the historical origins of contemporary reflective practice▪ Discuss the benefits of undertaking reflective practice▪ Complete a reflective practice account using Model 1 by Willis (2010)▪ Recognize the importance of ethical health care practice.

Evolutions in stroke care: the significance

Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. In 2001, the Department of Health recognized the importance of developing better stroke services by including specific milestones, targets and actions in the National Service Framework (NSF) for Older People. In 2007, the Government launched the National Stroke Strategy to modernize service provision and deliver the newest treatments for stroke. Here, Andrew Volans, Consultant in Emergency Medicine, looks at some of the strategy intentions and describes some of the developments in the acute care sector. Email for correspondence: andrew.volans@acute.sney.nhs.uk

Provision for the training of offshore medics

Who can become an offshore medic?Old regulations stated that only registered nurses or ex-military medics could fill the role of an offshore medic, and some training providers still adhere to out dated guidance. However, the new regulations of 2001 have opened the door to other health care professionals who may wish to follow this career path. It is the responsibility of the training centre to determine if individuals are qualified and suitable for the role of offshore medic. NUH acccepts the following who wish to undertake the offshore medic course: registered nurses, paramedics and registered operating department practitioners, along with ex military combat medics and naval medical assistants. On application, applicants are asked for a Curriculum Vitae and proof of registration if applicable. The offshore medic must by law undergo training at a HSE approved training centre.

What to do in 2011?

So, here we are, at the end of the first month of 2011. I hope you have recovered from the season's festivities and the demands of working for an emergency ambulance service over the usually busy time of Christmas/New Year.

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