Volume 3 Issue 3

Is regulation a necessary evil?

It may appear to many practitioners that regulation is a necessary evil, which does very little for the profession or the individual practitioner. However, one should not lose sight of the importance of regulation, especially that associated with health and social care. I suspect many would agree, retrospectively, that tighter and more stringent regulation of financial services would have been welcomed in the mid–1990s to avoid such repercussions we currently face in the financial market. Yet, one often hears somewhat negative opinions when we talk of the Health Professions Council (HPC) and its role in the regulatory function of paramedics.

MedicAlert: speaking for patients when they can't

Recognize, react and recommendMedicAlert's service relies on the knowledge and quick-thinking of all emergency services professionals. MedicAlert only provide emblems which are worn on pulse points, namely the wrist and neck. This ensures that the emblem is most likely to be spotted by emergency personnel.The emblem is easily recognized as having the international symbol of medicine on the front. It can then be flipped to reveal the vital information engraved on the disc such as medical conditions, allergies and advance decision or organ donation wishes. The emblem also holds the 24 hour emergency line phone number and the member's unique membership number. ‘MedicAlert's service relies on the knowledge and quick-thinking of all emergency services professionals'MedicAlert can also be used worldwide and offers a translation in over 100 languages.The information recorded on a MedicAlert emblem and in a member's personal record will help you if:You are called to an emergency and the person is unconscious or unable to communicateThe individual does not know what medication they are takingThe individual has allergies that need clarifyingThe patient has an advance decisionYou are unsure whether to admit the patient to hospital and would like to know their medical historyThe patient wishes to donate their organsYou want to locate a patient's next of kinYou want to contact the individual's doctor.

Developing your journal

New CPD in every issueFrom May 2011, every month, JPP will contain a detachable personal reflective learning log. This will take the form of a template allowing you to record how the articles relate to your own daily practice, and any further reading, action and evaluation you may be planning as a result of reading the issue. In this way, you will be able to use your monthly copy to show recorded learning outcomes.

Continuing Professional Development: Understanding the assessment and management of hyperkalaemic patients

OverviewThis module will explore the identification and treatment of hyperkalaemia in both the hospital and prehospital settings. Hyperkalaemia is potentially life-threatening and, by improving clinician's awareness of the condition, paramedics should be able to positively impact upon patient outcome. Like many other life-threatening emergencies, prompt recognition and treatment is vital to reduce mortality and morbidity. By using reflective questions and establishing learning outcomes, the paramedic will achieve a foundation in the assessment and management of hyperkalaemic patients.Learning OutcomesAfter completing this module you will be able to:▪ Recognize the signs and symptoms of hyperkalaemia▪ Identify specific ECG changes associated with the condition▪ Understand the risk factors, causes and contributing factors of hyperkalaemia▪ Realize the hospital and prehospital treatments of the condition.

Emergency care apprenticeship: a new pathway

Apprenticeships, nothing new?Apprenticeships are not new but have changed their shape and content several times over the years. The need to train school leavers and re-train adults is ever present—it is the funding of this which has been the main challenge.The author can just about recall apprenticeship programmes running in the 1970s, or rather running out of steam as the UK's traditional industries such as manufacturing went into decline. Then, those wishing to learn a trade followed programmes of training approved by industrial training boards (forerunners of the current sector, skills councils), on a pittance for three years, until they qualified—so-called ‘time served’. In return, employers running apprenticeships were exempt from paying a levy to their training board.‘This is the first new non-higher education qualification for emergency mbulance staff since the driving qualification was formalized in 1995’In the 1980s, with the exception of a few industries, apprenticeships gave way to government funded training schemes, such as youth and adult training schemes.These schemes, however, were time limited (12 months) and lacked a tangible outcome such as a qualification. Some critics viewed the schemes as nothing more than a crude form of wage subsidy with the added bonus of suppressing unemployment figures.Over the years, there have been many government schemes to support and reward training, most recently train to gain (rewarding the achievement of national vocational qualifications, NVQs) and apprenticeships.The most significant development in recent years however, has been the Leitch Review of 2006, which undertook a fundamental review of vocational training in the UK (Leich Review of Skills, 2006).

Can YouTube help save lives?

In recent years, the internet as a platform for delivery of healthcare information has attracted research interest. This study examined YouTube, an internet video-site, to evaluate the source of information, actual content and quality of videos about cardiopulmonary resuscitation (CPR).

Management of elderly people who fall

This paper presents findings from the qualitative component of a mixed-method study which included development and implementation of a ‘clinical assessment tool’ (CAT) designed to assist ambulance staff in their assessment and management (including conveyance decisions) of elderly people who have fallen.

March roundup of the EMS blogging world

Rescuing ProvidenceMichael Morse from Rescuing Providence wrote the post ‘Broken windows’ (2011) to reflect on the frustration he felt when ‘caring’ for a patient who has been produced from the neck pain and claim culture, while in the very next bed a ‘real patient’ is fighting for her life after horrific injuries. I can certainly identify with the feelings he had, how about you?

Are current feedback methods optimal for student understanding and learning?

Student feedback provided to paramedic students is often a contentious issue, with tutors and student paramedics not always agreeing upon the best techniques to employ. It is identified that feedback provided to students should be a learning tool, therefore it should be meaningful. It is also identified that meaning can be lost in the written form, and that face-to-face verbal and visual feedback is the best methods of giving feedback. A research project was undertaken take to elicit the views and opinions on feedback methods, from a group of student paramedics who were new to higher education. the research was undertaken with a view to changing current practice, and improve the experience of student paramedics. Most of the student paramedics opted for tutorial feedback, although one student requested feedback via email. All students were provided with their choice of feedback method and the standard feedback method usually employed. It became obvious during the tutorial time allocated, that time management was going to be largest issue, as the tutorials took a considerable amount of time. The students were then asked how useful each method was to them. Most students stated that the tutorial feedback was where they learnt the most and therefore was the most beneficial. A number of issues were raised during the research, for example: how best to use tutorial time, and how much time should be allocated per student.

Prehospital continuous positive airway pressure ventilation in ACPO: Part 1

Acute cardiogenic pulmonary oedema (ACPO) is a common medical emergency facing UK paramedics. While swift management can delay progression of ACPO, many patients spiral into deteriorating respiratory and cardiac function, leading to respiratory failure requiring endotracheal intubation (ETI). Continuous pulmonary airway pressure (CPAP) is increasingly being adopted for ACPO in the hospital setting, leading to moves to introduce it into prehospital care. This article is the first in a two part review of the literature surrounding CPAP. It presents a critique of the in–hospital studies in order to highlight implications for paramedics wishing to introduce CPAP into their practice. Methods: A comprehensive literature search of MEDLINE and CINAHL from 2000 to November 2010 was conducted using ‘CPAP’ as a subject heading combined with the sub headings: ‘Pulmonary Oedema’, ‘Pulmonary Edema’ ‘ACPO’, ‘Heart Failure’ ‘pre hospital’ and ‘Paramedic’ as key words. A second search was conducted using ‘Non invasive Ventilation’ as a subject heading along with all the subheadings above. Results: 253 papers were retrieved. These were manually scanned for relevance and eligibility, leaving 53 papers for review. In hospital studies were finally limited to 10. Application of CPAP resulted in significant improvements in physiological variables, need to ETI and relief of breathlessness. However, these benefits were not transferred into improved mortality. Maximizing medical therapy to include the use of intravenous nitrates significant improved mortality, and subsequently confounded the results of many CPAP trials. Conclusion: while application of CPAP is yet to be robustly attributed to improved survival in hospital, it may offer opportunities unique to the prehospital environment. Application of CPAP earlier in the acute phase of ACPO has the potential to improve mortality; it would offer a non–invasive means of supporting ventilation prior to ETI, and palliation of breathlessness. Prior to any such moves, consideration should be given to adherence and maximisation of current medical therapy within JRCALC, and future potential for use of intravenous nitrates.

Rapid sequence airway not rapid sequence intubation

There has been a focus when managing traumatic brain injury patients on achieving the gold standard of airway management in the field. This has been often quoted as being rapid sequence intubation. This article looks at the evidence to support this notion and attempts to justify consideration to maintaining an adequate airway with the use of a drug assisted (paralysis) supraglottic airway device insertion (intubating laryngeal mask (ILMA). The focus being on adequate ventilation rather than intubation at all costs. Avoidance of hypoxaemia and hypotension, causing secondary brain injury, should be paramount. The article is of relevance to paramedic services considering the introduction of paralysis assisted intubations. In Australia, the remoteness of locations had originally led to upskilling of retrieval paramedics in some regions which has now been transferred to non–rural paramedics. The introduction of paralysis assisted intubation in paramedics has raised the issue of competencies and continuing maintenance of skills programmes. There are, in addition, many training issues and cost implications to maintain paramedic competency in a skill seldom performed. Australia, like many nations, is suffering from an under supply of medical graduates.

Neutropenic sepsis: preventing an avoidable tragedy

Neutropenic sepsis is a life-threatening side-effect of chemotherapy—patients are still dying from this complication of treatment, and these deaths are largely preventable. The purpose of this article is to raise awareness of the condition, its severity and the importance of timely responses to it. The main issue for prehospital clinicians is that symptoms of neutropenic sepsis, especially in the early stages, are so vague that they are easily misinterpreted or dismissed as opposed to being indicative of a time-critical patient. The patient's history is of paramount importance in identifying patients in the community that are vulnerable to the condition—those recovering from chemotherapy. These patients are highly prone to infection and are temporarily immune compromized due to the medications that they have been prescribed. They are incapable of mounting a response to infection and infective agents can overwhelm them rapidly. It is imperative in this patient group to have a high degree of suspicion about ‘simple’ assessment findings and non-specific symptoms as these can progress very quickly to haemodynamic collapse and death. Timely hospital-directed antibiotic therapy and support can prevent this possible tragedy.

Update on: ‘Treating the unexpected: the opiate overdose patient’

Dear Editor, I would just like to bring to your attention an error in one of the articles published in the December issue of the Journal of Paramedic Practice (Willis, 2010). In the paragraph title, ‘Antagonists: Narcan and Flumezanil’, the author briefly discusses that the ‘patient may have benefited from treatment with Flumezanil even though he responded well to Narcan’.

Update on: ‘Treating the unexpected: the opiate overdose patient’

In December 2010, JPP published an article from Sam Willis, titled ‘Treating the unexpected: the opiate overdose patient’. This reflective account used a case from practice. JPP has received two letters regarding this, which are printed below, along with a response from the author.

Book Review

This is not a manual on how to run a major incident but a rather quirky guide on how to approach any incident involving mass casualties.

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