Volume 3 Issue 7

Continuing Professional Development: Legal issues in paramedic practice

OverviewThis CPD module will focus on some of the key legal issues in relation to paramedic practice. Any text relating to medico-legal issues would of course not be complete without directing the reader to the vast range of excellent texts relating to medico-legal aspects in medicine and nursing, with a developing literature base in paramedic practice. This module will describe some of the core legal principles, specifically those of accountability and liability, that impact on paramedic practice. In addition, the module will also consider the issue of duty of care in prehospital practice and outline some key legal cases specifically in relation to the ambulance service. Law and ethics are often intertwined and rightly so. The legal cases presented in this module allow us to reflect on prehospital practice and critically review some of the professional and regulatory guidance that currently underpins paramedic practice. The second related module, on ethical issues, will further explore some of the issues in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able:• To identify some legal terminology relevant to paramedic practice• To provide an overview of the key legal principles that underpin current clinical practice in the UK• To explore the legal concepts on relation to prehospital care and paramedic practice• To review some medico-legal cases and explore how they relate to clinical and professional practice

Paramedic opportunities at the University of Worcester

Direct entry student paramedicEntry requirements for this course are currently 120 UCAS tariff points and a minimum of six to twelve months recent adult care experience. National vocational level 3 qualifications are no longer accepted for this course as it is felt that they are not robust enough for the programme of study. Recent adult care experience is considered an essential prerequisite to the course as not only does this provide a good foundation from which to work, it also helps develop key transferable skills such as communication, problem solving, manual handling and interpersonal skills.There is no C1 driving licence requirement to commence the course but candidates are advised to possess a provisional C1 licence. This is to ensure they meet the health requirements laid down by the driver vehicle licensing agency and will be able to undertake the C1 course when necessary. Enhanced criminal records bureau checks and occupational health screening are also carried out before any student enters clinical practice.Approach to teachingThe university has an innovative and student-centred approach to the teaching and success of this two-year course and offers patient contact from as early as the third week. Placements are welcomed by students at this early stage. One student commented ‘Going out on placement was better than I thought it would be. I thoroughly enjoyed this.’ Practice placements are then continuous over the four semesters alternating between one and two shifts per week.Students need to achieve 750 hours of clinical practice in each year. During this time they are supervized by a university trained mentor and are supernumerary. This allows the students to develop at their own pace but still within a realistic timeframe to achieve the learning outcomes.By providing mentorship for the students, it encourages them to critically analyze incidents and receive rapid feedback on their progression. The rapid practical placements also reduces skill decay. Students have commented that they feel rapid patient access helps them to assimilate the knowledge gained at university with the practicalities of patient contact. These experiences and observations are then developed during classroom sessions, making any discussion student-centred and providing motivation for the students to learn more.Placements are carried out in a variety of locations from rural villages to inner-city areas so students are exposed to a wide variety of cases.This variation means that students are required to use different skill sets; perhaps one day providing crucial life saving care to a patient on a 30 minute journey to hospital, then another having only ten minutes in which to take a history and provide the appropriate care before arriving at hospital. Skills practiced while on shift are recorded in a workbook and signed by a mentor. This book then provides evidence of the student's practical experiences and forms part of their portfolio which will be an ongoing process throughout their career.Students are placed with named mentors who monitor their progress and alert the university of any students they have concerns about or are doing exceptionally well. This is very much a three way process between students, mentors and the university. When concerns are raised, students may need specialist advice from the university's student services. If the concern is of a practice related nature, then the lecturer practitioner may become involved and extra support would be provided in order to help the student develop weaker areas.Mentors generally work on an ambulance or responder car and the student works as part of a two or three person team. This team development and close working relationship promotes learning and helps students to feel valued. One student commented that ‘mentors are supportive and motivated me as a student to reach my goal.’Students also undertake observed scenarios that provide an opportunity to demonstrate skills in a simulated environment. This allows lecturers to assess individual student's skills and where necessary provide constructive feedback to the students and mentors.Quality assuranceThe course is validated by the Health Professions Council and conforms to the College of Paramedics curriculum guidance and competency framework document (British Paramedic Association 2008). A range of systems are in place to ensure quality is maintained and improved these include Quality Assurance Agency and Local Strategic Health Authority auditing, and internal quality auditingModulesThe course is run in a modular format and subjects include anatomy and physiology, personal and professional development, care loss death and bereavement, evidence and research, paediatrics, pharmacology and work based learning. Initially, students gain hands on practice in core skills such as manual handling and communication skills. As they progress through the course, more emphasis is placed on them to make clinical decisions relating to the patient's care with the aim that they become autonomous practitioners by the end of the second year of study.Figure 1.The university offers patient contact from as early as the third weekUNIVERSITY OF WORCESTERClinical placements are arranged for students in a variety of care settings including operating theatres, cardiology, accident and emergency and palliative care, as well as ambulance shifts. These opportunities are a valued part of the course, allowing students to gain insight into other areas of health care, and perform practical skills such as cannulation and endotracheal intubation. To quote one student ‘I have loved being on shift and have met some amazing people.’To support the students learning, all lecture presentations, handouts, research and useful links to relevant web sites are posted on an electronic program known as blackboard. Students have access to this information simply by logging on to a computer with internet access. This system allows students to refresh their memory of the sessions that have been taught and provides areas of research that may be followed up. Some sessions are made available to students prior to the sessions and this has been very useful for students who are dyslexic by giving more time to assimilate information before receiving the taught session.Figure 2.Paramedics who are already HPC registered can enhance their continual professional development by enrolling on the diploma in higher education paramedic studiesUNIVERSITY OF WORCESTERAssessment methodsAssessment methods are varied but include the more traditional examination style question paper as well as essay writing, practical OSCE assessments, development of posters promoting such things as care of vulnerable individuals and creating new clinical guidelines using evidence based practice. This variety of assessment styles help students contextualise theory with paramedic practice. Students are actively encouraged to promote their profession by publishing work and completing professional portfolios.Communication is a very important aspect of this course and email accounts are set up so students can communicate with each other and university staff. A personal tutor is allocated to each student at the beginning of the course and these tutors are a dedicated point of contact with the university for students who may be experiencing personal or academic issues. Students are of course at liberty to talk to any tutor if they feel it is appropriate.Students are encouraged to learn for themselves with lecturers facilitating the learning rather than actually providing lists of facts that need to be memorized. Some students find this approach a little disconcerting at first but with study skill sessions embedded throughout the modules, this concern seems to dissipate as the course progresses.

The role of the patient in patient assessment

Despite the differences in emergency healthcare provision between Sweden and the UK, this qualitative study provides interesting data related to patient assessment which has relevance to an international audience.

Book Review

This is another book with an American favour and as the title suggests, focuses on what are called Hospital Emergency Response Teams. These are teams which are called upon in-hospital when the aid facility is faced with a crisis situation.

Can wikis be used to support case-based learning in paramedic education?

Higher education has seen a rapid increase in the use of Web 2.0 applications, such as wikis, blogs, podcasts and vodcasts. While their use and integration has been investigated by other cognate and non-cognate disciplines, this has yet to be formally undertaken by the paramedic discipline. Therefore, this article describes a pilot study that examines the student use of wikis to support case-based learning (CBL) within a Bachelor of Emergency Health (BEH) degree at Monash University. The aim of this study is to report student attitudes on group work using wikis during weekly CBL activities. Methods: a cross-sectional study using a convenience sample of second year undergraduate students enrolled in the BEH degree were surveyed using a short paper-based self-reporting questionnaire focused on attitudes towards wikis. Included with the questionnaire was a brief set of demographic questions. Results: overall, participants reported positive attitudes and perceptions towards the use of wikis and peer-based learning during the weekly clinical cases. For example, item 1: ‘I found the group wiki useful in completing the team task’ reported a median score of 3 (IQR 2-3), while item 3: ‘using wiki encouraged better participation of each group member in the case’ reported a median score of 2 (IQR 2-3). Despite the positive results, there were areas that require further attention such as social loafing, and development of a more flexible learning management system. Conclusion: although findings from this study are preliminary, it appears that wikis are a useful addition to CBL in paramedic clinical units. Further research is warranted using a larger sample size, and integrated and compared across both clinical and non-clinical units. Closer examination of discrete pedagogical issues such as peer- and self-based learning is also necessary, particularly with the increasing use of educational technology being used throughout higher education.

Trauma: just another statistic?

This article explores the clinical assessment, diagnosis and current management of tension pneumothoraces in the prehospital arena by UK ambulance service paramedics. Using a case study from clinical practice, the signs and symptoms, aetiology and clinical manifestations of tension pneumothoraces are examined, with the specific aim of achieving an accurate diagnosis and effective pleural decompression. This article explores the effectiveness of needle thoracocentesis: the sole method of pleural decompression currently available to UK paramedics. It aims to compare the effectiveness of this procedure with other, and considered more reliable, methods of pleural decompression. Inherent risks and associated complications are examined and conclusions are drawn, including the proposal that critical care helicopter emergency medical services (HEMS) paramedics who have completed additional educational programmes, operating under strict clinical governance systems, and who are frequently exposed to seriously injured patients, be afforded the autonomy to practice incision thoracostomies in traumatic cardiac arrest patients in the absence of their medical colleagues.

The paramedic kairotope theory: findings

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. The findings comprise a theory of how expert paramedics accomplish the very difficult task of managing emergency scenes, which is a crucial pre- and co-requisite for the provision of patient care. This theory introduces a new term, the ‘paramedic kairotope’ as a conceptualization of this expertise, comprised of knowing when and where to act in a field/clinical situation. The theory further describes this competency as being informed by two social processes: substantial use of interpersonal communication and innovative problem solving.

Book Review

The updated second edition provides readers with a wealth of knowledge concerning the legal aspects of medicine. This edition addresses the considerable changes that have occurred in the world of medicines; it not only captures the changes within the medicines field, it also builds on the changes in the health and social care arena.

The revision of the primary survey: a 2011 review

This article outlines changes that have been made to the patient assessment primary survey for ambulance staff that was adopted by South Western Ambulance Service NHS Foundation Trust (SWAST). It provides a brief history of the airway, breathing and circulation approach (ABC), and the transition to (C) ABCDE undertaken in 2007, following the publication of the paper by Hodgetts et al (2006). The article intends to describe and build on the lessons learned from the last 4 years of using a standardized approach to patient assessment. The article is designed to create further debate among our peers regarding hybrids of patient assessment.

Management of the ruptured abdominal aortic aneurysm: challenges facing paramedics

An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest before arriving at the emergency department and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner's knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia with specific reference to the issues associated with aggressive fluid resuscitation, and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner's with an insight into how prehospital interventions affect the patients’ ultimate outcome and postoperative quality of life.

A guide to renewing your registration with the Health Professions Council

How do I renew my registration with the HPC?In early June 2011, we will send a registration renewal form to all paramedics on the register. All sections of this form needs to be filled in, signed and returned to the HPC with the renewal payment.Every registrant must do two things to make sure their name stays on the HPC register:Pay the registration renewal fee (various payment methods)Send us their signed renewal declaration.We also stress that registrants must be sure to pay and sign. Even if the direct debit payment comes out of your account, you still need to complete and sign the renewal form.All registrants are required to pay their renewal fee and return their signed and completed renewal form to the HPC as soon as possible but no later than the 31 August 2011 to make sure their name stays on the register.‘The HPC launched a new online system last year which enables registrants to renew their registration and pay their registration fee securely’

Why are firefighters not part of the team?

There is sufficient international evidence to demonstrate that first responders, including professional firefighters, improve patient outcomes, especially from out-of-hospital cardiac arrest (Ho et al, 1997; Hollenberg et al, 2009; Hoyer and Christensen 2009). With demonstrated improvement in cardiac arrest outcomes by using first responders, this has led to a move in recent years to have automatic external defibrillators (AEDs) placed in prominent locations where large numbers of people congregate so that the response time to defibrillation is as short as possible (public access defibrillation (PAD)). This policy has proved to be successful in decreasing the response time to the person and subsequent defibrillation, albeit with small numbers in the studies compared to other ‘first responder’ programmes (Colquhoun et al, 2008; Fleischhackl et al, 2008).

Increasing community public access to defibrillation

The national charity, The Community HeartBeat Trust, is working with ambulance services across the country to increase the penetration of defibrillators into the community. Here, Martin Fagan, National Secretary, Community Heartbeat Trust, discusses the charity in more detail and its relevance for paramedics. Email for correspondence: secretary@communityheartbeat.org.uk

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