Volume 3 Issue 5

Continuing Professional Development: Seizures in the prehospital setting

OverviewSeizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’, however, these patients often have deep psychological trauma that needs careful handling and empathy.Learning OutcomesAfter completing this module you will be able to:▪ Have an understanding of the pathophysiology of epilepsy in relation to prehospital care▪ Recognize the importance of completing a full set of observations and taking a full history in a post-ictal or seizing patient▪ Potentially be able to recognise the differences between epileptic and non-epileptic seizures▪ Understand the pharmacology of drugs given in prehospital care

A year in the life of a remote medic

Step one: offshore medic courseWe attended the course in March 2010 and found it to be excellent. The course needs to be well prepared for because as a part of it, you take a UK resuscitation advanced life support course on the Thursday and Friday of the first week and prehospital trauma life support on the Monday and Tuesday of the next. Both of these courses are intense but when run consecutively, they really test your preparation.I enjoyed my placements which I completed at Nottingham A&E and a local GP surgery. The primary health side I found to be really interesting, coming from a prehospital background. The selected GPs surgery was very supportive and proactive in our training.

I.F.E.A.R reflection: an easy to use, adaptable template for paramedics

Paramedics are required by the Health Professions Council, as a condition for maintaining their registration, to maintain high clinical standards and continuously engage in their own professional development. Similarly, student paramedics are required to provide a portfolio of evidence that demonstrates their development and eventual competency. One means of engaging with this process is to apply a formal reflection process to emergency calls attended. Reflection is a hot-topic in paramedic education. However, it is known that for some, reflection can be daunting. Concerns about the academic process, writing and knowing where to begin are often articulated by students attending higher education programmes. This article outlines a suggested reflective framework adapted from Gibbs (1985) reflective cycle. It outlines a series of applicable, sequential questions. Reflection is about using questions to retell a story; it’s about answering these questions critically and, in so doing, often results in a well structured, reflective case-study; as well as improving one’s own clinical understanding and practice. In practice, we have found that both experienced practitioners and student paramedics have been able to use these steps to shape their writing. For those new to writing reflective case studies, the questions help to provide the muse for overcoming the ‘blank-sheet-of-paper’ inertia that can accompany portfolio building.

Analysing Thurstone and Likert attitude scales as data collection methods

The development of the paramedic as a health care professional and the movement of paramedic education into the higher education setting has resulted in the need for paramedics and student paramedics to be aware of and understand research methods. This article does not explore or apply the entire research process, as it focuses on a specific part of the research. The article explores and contrasts two different data collection methods used to measure attitudes, one of which will be familiar to most healthcare professionals: the Likert Scale. Less frequently used is the Thurstone method and reasons for this are discussed. The author offers an example how these methods might be used to measure attitudes about the preparedness of paramedics to address end of life care issues.

Evaluation of the use of portfolios in paramedic practice: part 1

2009 saw the first audit of paramedic portfolios by the Health Professions Council (HPC) and later this year, the second national audit will take place. In the first of a two-part evaluation of the use of portfolios in paramedic practice, the history of professional portfolios is chartered including their current position within the paramedic profession. A number of contemporary issues with portfolios are identified, including format and how they relate to a paramedic's continuing professional development. The impact of the Knowledge and Skills Framework on portfolio use is also discussed.

Falls in the prehospital environment

Falls contribute significantly to the workload of ambulance paramedics. Falls can range dramatically in severity, with no injuries to considerable morbidity and mortality. The objective of this study was to identify the incidence of falls and the outcome from an ambulance perspective. Method: A literature search was conducted using electronic databases: Ovid Medline, EMBASE and Scopus. These databases were searched from their beginning to the end of July 2010. All references from the articles retrieved were also reviewed. Articles were included if they reported on falls attended by ambulance crews, or fall related injuries in the prehospital environment. Results: A total of 405 articles were identified with 21 articles meeting the inclusion criteria. There was one randomized trial, seven retrospective studies, two prospective studies, and one combined prospective retrospective study. Of the remaining studies, one was an epidemiological study, one a literature review, one clinical observation study, one pilot study and one case study. Five articles were excluded due to a lack of prehospital specific data. None of the studies reported a definition of a fall. Conclusion: Despite the relative frequency of falls, there is a substantial gap in the prehospital literature covering the implications for paramedic practice.

Mental health in the care of paramedics: part 1

Mental health disorders are common, presenting frequently in emergency and prehospital settings. Patients suffering from psychotic disorders, mood and anxiety disorders, substance misuse disorders, maternal psychiatric disorders, personality disorders and parasuicidal behaviours commonly present to the emergency services. Although the advanced management of such conditions requires considerable therapeutic sophistication, emergency health care services can contribute greatly to the initial management of patients. In the first of a two-part series, this article will provide an overview of mental health services and provide guidance on the early management of personality disorders, depression, anxiety and psychotic conditions.

Smallpox and the origins of vaccination

Smallpox is a highly infectious virus with a high mortality rate. Until the 19th century, smallpox epidemics regularly swept the UK. In some areas of the world, smallpox epidemics continued well into the 20th century. Smallpox has now been eradicated by an international effort led by the World Health Organisation (WHO). The eradication of smallpox was achieved by vaccination, and the history of vaccination is closely linked to the treatment of this disease. Despite being eradicated in the natural environment, there are still stocks of smallpox kept by two governments which are the cause of ongoing debate. Today, biological weapons are considered part of the threat posed by terrorist organizations and a deliberate smallpox release is a conceivable scenario. This article will describe smallpox, its connection with vaccination and why knowledge of diseases such as smallpox can be valuable to paramedics.

New cardiac arrest guidelines: implications for paramedic practice

New UK, European and international guidelines for cardiopulmonary resuscitation (CPR) were published in October 2010 (Nolan et al, 2010). These guidelines marked the 50th anniversary of modern CPR (Kouwenhoven et al, 1960). The new guidelines give greater emphasis on early bystander CPR, high quality chest compressions with minimal interruption, early effective defibrillation and good quality post cardiac arrest care for achieving neurological survival in cardiac arrest victims. Guidelines 2010 recommendations also attempt to make it easier for rescuers to achieve this in any setting. The full UK guidelines can be accessed from the Resuscitation Council (UK) website (www.resus.org.uk). In this article, the authors discuss issues relating to the new guidelines that they feel are relevant for paramedic practice.

Benefits of joining the Emergency Planning Society

The Emergency Planning Society was formed in 1993 through the merger of the Emergency Planning Association and the County Emergency Planning Officers Society. The society, its branches and its various groups organize conferences, workshops, working parties, studies and seminars to examine emergency planning practice and experience, and to develop advice on good practice. Here, Jeff McClure, Assistant Emergency Planning Manager with Northern Ireland Ambulance Service, discusses the society in more depth, and examines the role of paramedics in the society's structure.

Can apprenticeships provide an alternative pathway?

In a recent Career Development article published in the JPP (Howson, 2011), Alan Howson opened our eyes to the concept of emergency care apprenticeships and posed the question; can the apprenticeship route provide an alternative pathway to paramedic? This is an interesting question and one that should be considered carefully because the consequences of the paramedic profession making a mistake in terms of the future education of its registrants could prove to be hugely damaging to patients and the profession. Here, Pete Gregory, Consultant Editor, JPP and Senior Lecturer in Paramedic Practice, Coventry University, discusses this in more depth.

Calculating risk

Inevitably, following an incident of unprecedented scale and severity, there are going to be lessons learned. The West Cumbria shootings on 2 June 2010 is no exception, which saw Derrick Bird shoot 12 people dead, and himself.

Book Review

Representing a common medical emergency for paramedics, any text which covers the management of diabetes should be high on their reading list. But this book is very much of a mixed bag and one which ultimately focuses on the diabetic patient after they have been admitted to a treatment centre.

Paramedic ultrasound: a tool of the future?

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).

How does provision of emergency healthcare impact on carers?

This paper represents a component of a larger study evaluating the paramedic practitioner in older people’s support (PPOPS) scheme. This service was designed to provide community-based clinical assessment (and treatment where appropriate) of older people with minor acute conditions in an attempt to reduce unnecessary transfer to the emergency department (ED).

Nausea and vomiting: a prehospital challenge?

Undertaken in California, this six-month prospective, observational, non-randomized trial examines the use of ondansetron for the treatment of nausea and vomiting in the prehospital environment.

Disaster management and emergency planning at Coventry University

The Centre for Disaster Management at Coventry UniversityBased upon two decades of experience, the newly-established Centre for Disaster Management is already a successful initiative, based within the Department for Geography, Environment and Disaster Management at Coventry University.CDM has emerged from a platform of excellence based upon extensive expertise and knowledge of Disaster Management themed studies at Coventry University since 1994. CDM is one of the most popular leading providers of undergraduate and postgraduate education programmes and CPD professional training courses in the UK. CDM’s specialist applied research extends across developed and developing nations, globally. CDM offers courses of particular relevance to paramedics, and regularly has a stand at the annual Emergency Services Show.The courses CDM offer within the disaster management and emergency planning fields cater for a whole host of students, including those straight from A-Levels, mature students, those already in employment and those looking for a change in career. Equipped to meet the needs of students with diverse backgrounds, the Centre’s staff is comprised of a range of highly experienced individuals, from both academic and practical backgrounds.CDM, and indeed Coventry University, prides itself on the quality of support that staff provides to students. Senior Lecturer and Course Leader for the MSc in Emergency Planning and Management, Ron Mountain, worked for 15 years in emergency planning for the London Fire Brigade, and has worked in academia for nearly 10 years. Senior Lecturer, Co-Director of the Centre for Disaster Management and Course Leader for the Diploma in Emergency Planning, David Massey, has 34 years experience as an emergency responder and emergency planner, both in the fire service and a local authority, and has worked at Coventry University since 2008.‘Disaster management courses at Coventry University have been taught for over 15 years and within the department, we are an acknowledged market leader in most of our specialist areas. We have constantly achieved excellent ratings for the quality of our teaching and we are committed to a programme of continual improvement in the content and delivery of our programmes.’ Professor Hazel Barrett, Associate Dean of Applied Research, Former Head of the Department for Geography, Environment and Disaster Management.’

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