Continuing Professional Development: Managing abdominal pain: a guide for paramedics

OverviewAmbulance personnel encounter patients with abdominal pain on a weekly, if not daily basis. Despite this exposure, many of these patients continue to be managed without appropriate analgesia. Ambulance services remain focussed on trying to promote effective pain management, however this message still does not reach many clinicians. An understanding of pain mechanisms, assessment tools and subjectivity will aid the clinician in evaluating these patients, whilst a knowledge of current and possible future pain management strategies will assist when happening upon these service users.Learning OutcomesAfter completing this module you:• Will have been given a refresher in abdominal pain emergency management, enabling you to improve your current practice• Will be able to better understand the mechanisms involved in pain perception, which in turn will give your treatment a sound underpinning knowledge base.• Will be aware of the current pharmacological agents available to ambulance staff in the management of abdominal pain and that further advancements in this area are on the horizon.• Will understand that what you perceive to be pain, is not necessarily the same as your co-worker or the patient you are attending, giving you a blank, non judgemental canvas to start your assessment.• Will be able to cascade the learning you have undertaken to your fellow colleagues in an attempt to eradicate poor pain management from the ambulance service once and for all.

Paramedic Science degree programmes at the University of Greenwich

Options for studyThe foundation degree (FdSc) and the BSc both follow the curriculum laid down by the College of Paramedics. The foundation degree is a diploma, level 5-type qualification, whereas the BSc is level 6. Both are three year programmes but the second and third years of the foundation degree are part-time. In these years, students spend half their time working for the London Ambulance Service as level 2 and level 3 practitioners respectively.The BSc programme, which is more academically focussed than the foundation degree, is full-time.The foundation degree has been developed in partnership with the London Ambulance Service NHS Trust and meets the Health Professions Council registration standards for paramedics. Throughout the first year, students take up practice placements in local NHS acute and primary care settings, in addition to engaging in academic study.Students undertake an advanced driving course and also study vocational ambulance skills such as resuscitation, adult and paediatric, immobilisation equipment and administration of certain drugs.At the end of the first year of the foundation degree course, students spend five weeks on operational duties with the London Ambulance Service where they are assessed to see if they have reached the required standard to progress to year two.In years two and three, they spend six months working for the London Ambulance Service, three months on placement and three months split between studying at the university and at the organization's Bromley Education Centre, where they learn advanced paramedic skills such as advanced airways management, cannulation, intraosseous infusion, needle chest compression, advanced patient assessment and 12-lead ECG diagnoses.Both degrees include a course on Transition to Paramedic Practice, which is devoted to helping students apply for jobs. The university places great importance on supporting its students to find employment, and to date all of the university's paramedic graduates have been successful in this area. Course content of both courses is outlined in Box 1 and 2.Box 1.Foundation degree course contentYear 1Academic skills for health and social care: 30 creditsFoundations for effective practice: 30 creditsIntroduction to clinical sciences: 15 creditsClinical sciences: 15 creditsSkills for effective practice: 30 creditsPortfolio development 1Year 2Ambulance service work-based learning 1: 30 creditsPsycho-social aspects of paramedic practice: 15 creditsPatient assessment: 15 creditsPortfolio development 2Year 3Ambulance service work-based learning 2: 30 creditsComplex patient assessment: 15 creditsTransition to paramedic practice: 15 creditsPortfolio development 3Box 2.BSc Paramedic Science degree course contentYear 1Academic skills for health and social care: 30 creditsFoundations for effective practice: 30 creditsIntroduction to clinical sciences: 15 creditsClinical sciences: 15 creditsParamedic skills for effective practice: 30 creditsPortfolio development 1Year 2Paramedic practice based learning 1: 30 creditsEthics and law for paramedic practice: 15 creditsPsycho-social aspects of paramedic practice: 15 creditsLeadership in practice 30 creditsRelating clinical sciences to patient assessment 30 creditsPortfolio development 2Final YearParamedic practice based learning 2: 30 creditsComplex clinical sciences: 15 creditsAdvanced patient assessment: 30 creditsProject for healthcare practice: 30 creditsTransition to paramedic practice 15 creditsPortfolio development 3

What worries people about performing CPR?

This study examines whether or not lay people who have undertaken basic life support (BLS) courses are then willing to perform CPR on either an adult or a child, and, if not, why not.

Prehospital trauma management: a fluid opinion

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).

Book Review

The definition of ‘occupational medicine’ offered relates to patients with health and safety problems arising from the workplace and is cited by the authors as representing a large proportion of emergency admissions.

Evaluation of the use of portfolios in paramedic practice: part 2

This second of a two-part evaluation on the use of portfolios in paramedic practice, focuses on what constitutes evidence of a paramedic's competence and ultimate fitness to practice. A variety of evaluation models are identified to help in this process and this is developed further with reference to some educational theories. In the final part of the evaluation, the author proposes a number of recommendations concerning the use of portfolios within the paramedic profession and draws on the issues identified in the first part of the evaluation to summarize the current position of paramedic portfolios.

Acute stroke management: an online course

This article will explore the development and evaluation of an online course tailored specifically for emergency health professionals. Methods: a literature search was undertaken to inform the development of the course. Included studies related to stroke and positioning, oxygen therapy, blood pressure, body temperature and blood glucose. Following development and roll out of the course, all participants were invited to complete an online evaluation of the course, which consisted of eight closed and four open questions. Results: between February 2006 and July 2009, 1446 emergency health professionals completed the RESPONSE course. Of these, 570 (39%) completed the online evaluation. 555 (97.2%) participants reported that they were either very satisfied or satisfied with the course and 546 (95.6%) reported an increased knowledge in the management of acute stroke. Conclusion: the positive aspects of this web-based course have been identified as its usability, interactive nature, and flexibility. This online acute stroke course has also been shown to increase knowledge among emergency health professionals and provides a flexible approach to learning.

The paramedic kairotope theory: methodology and rationale

Scene management is an important, yet under–researched aspect of paramedic practice. Using a grounded theory methodology, this qualitative inquiry acquired data from in-depth interviews with paramedics working in rural, suburban, and urban settings in Ontario, Canada to generate a theory of expertise in scene management. The methodology and rationale comprise an effective approach for exploring this area of paramedic practice.

Air ambulance tasking: why and how?

Air ambulances are a scarce and expensive resource and their use carries significant risk for crew and patients (Hennesy; 2005; Holland et al. 2005; Hinkelbein et al, 2008; Lutman et al, 2008). To benefit appropriate patients while minimizing risk and cost, tasking of air ambulance assets should ideally be sensitive and specific. Within the UK and across Europe, there are no standardized criteria to dispatch these resources (Littlewood et al, 2010; Wigman et al, 2010). Even where dispatch criteria are agreed, compliance is variable (Tiamfook-Morgan et al, 2008). The purpose of this review is to look at the evidence and rationale for tasking of air ambulance assets.

Resuscitation from out-of-hospital cardiac arrest in an under-resourced environment

Published data on the epidemiology of out-of-hospital cardiac arrest (OHCA) come mostly from developed countries. Few studies have described the nature of OHCA in developing countries, where resources guaranteeing rapid access to cardiac arrest cases may not be available. A retrospective case series on OHCA in Johannesburg, the first study of this type in an African population, showed that response times were comparatively long, less than half of patients were resuscitated and rates of shockable rhythms and return of spontaneous circulation were lower than those reported in most other published studies. These results are most likely caused by lack of resources, in the form of emergency vehicles, in a region with a very busy emergency medical service, providing prehospital care to a large population. Other factors caused by poor emergency service management tend to complicate this picture and exacerbate the response time problem. Although paramedic learning programmes in South Africa are of a high standard and prepare qualifying practitioners to treat OHCA cases adequately, a lack of effective emergency medical service management and organization means that these human resources cannot be put to good use in improving OHCA outcomes. To improve OHCA outcomes, under-resourced emergency medical services should focus on fundamental aspects of the system to guarantee rapid access to patients, rather than more advanced scopes of practice for paramedics.

A review of the pre-ROSC intranasal cooling effectiveness study

With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.

Paramedic intubation: defining a future for the skill

In November 2010, JPP published a letter from Suzannah Sherlock, titled ‘The future of paramedic intubation: is it past?’ (Sherlock, 2010). This was in response to an article from Mark Hodkinson, titled ‘The future of paramedic intubation: who should be responsible?’ (Hodkinson, 2010). Mark responds to this below and reflects on a recent patient case that he encountered.

The future of ambulance commissioning

Collaborative commissioning modelsHealth Minister Simon Burns has said:‘Ambulance services will be commissioned through GP consortia at local level. What I think will develop is that, just as ambulance services are currently commissioned for geographical areas in England through one PCT, the consortia will appoint lead consortia to commission services for that area.’(Burns, 2011)This echoes recent recommendations from the ASN (2010), which has said that there is a need for a single point of access so that patients are consistently assessed and prioritised and receive appropriate service response. They also suggest that real-time information and data about emergency and urgent care services and patients’ health records should be shared seamlessly between different parts of the health and social care system.

STEPUK: step into the team

The Society for Trauma, Emergency Medicine/Nursing and Pre-Hospital Care (STEPUK) aims to promote student education in the fields of emergency medicine, nursing and prehospital care, as well as establish active student groups at all medical, nursing and paramedic schools across the UK. Here, Tim Williamson, Founding Co-Chair of STEPUK, introduces the society and considers how paramedics can become involved.

Up for the challenge?

In an age of such overwhelming change across the entire NHS, it seems there is rarely time to pause, take stock of the road we travel along, and appreciate the significance of the journey ahead. In December 2010, the Department of Health published ‘The Operating Framework for the NHS in England 2011/12’, which became operable on the 1 April 2011. Although many ambulance trusts are still wrestling to interpret the finer details of what is now required of us, there is little doubt that these new measures of performance are one of the most significant developments in the way ambulance services are measured since the inception of ORCON in the mid 1970s.

Mental health in the care of paramedics: part 2

Mental disorders are common and frequently present in emergency and prehospital settings. Conditions presenting to emergency care services include new onset psychiatric disorder, relapse or exacerbation of a pre-existing psychiatric condition, acute reactions to social adversities or problems associated with substance misuse. Although the advanced management of such conditions requires considerable therapeutic sophistication, paramedical services can contribute greatly to the initial management of such patients. In the second of a two article series on mental disorders, this article will provide guidance on the early assessment and management of bipolar disorder, psychiatric conditions in women, parasuicidal behaviours, acutely disturbed patients and substance misuse disorders. Some relevant legal issues in mental health are also discussed.