Continuing Professional Development: The pathophysiology of labyrinthitis

OverviewLabyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo and fever. Subsequently, it is an illness commonly diagnosed by health practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly.Learning OutcomesAfter completing this module you will be able:• Describe the pathophysiology of labyrinthitis.• List the clinical symptoms associated with labyrinthitis.• Distinguish between labyrinthitis and other similar conditions.• Manage patients with a simple diagnosis of labyrinthitis.• Know the treatments and care pathways available to them as a healthcare professional, including a basic pharmacology of the most relevant medications.

Prehospital emergency care course: PhEC

The courseThe weekend course currently costs £735 for BASICS members and £800 for non-members, candidates might also want to consider paying for accommodation during the course and this can be booked online via the BASICS website. It may also be worthwhile for potential candidates to consider joining BASICS in order to benefit from this discount and to receive the various other benefits of membership to this leading organization. Currently, BASICS membership costs from £47 for student members (with no journal subscription) to £177 for full members, including a paper subscription to the Emergency Medicine Journal.As mentioned previously, the course material is delivered over three days. There is however a large syllabus to be accommodated within these three days and candidates can expect to begin lectures at 08:00–08:30 each day and not leaving before 18:00. It is also advisable not to expect to be ‘spoon-fed’ information during the course; as although there are excellent lectures and instructional practical sessions, a large amount of prior knowledge and preferably experience is certainly needed.Once you have registered for the PhEC course on the BASICS website, you will be sent further registration documents, recommended reading lists, the Manual of Core Skills produced by the RCSEd and a practice test paper (with answers).It is definitely advisable that all candidates work through the Manual of Core material and other recommended reading thoroughly, prior to the course. It is also important to remember that the course culminates in a national examination and participants are expected to have a broad understanding and knowledge of the subject areas covered, even if certain interventions are beyond their current scope of practice. For example, it would not be unreasonable for a candidate to be able to state that the patient in their moulage may benefit from interventions such as ketamine, escharotomy or surgical cricothyroidotomy. Equally, one should anticipate the exam to require knowledge of drugs or interventions not currently available to paramedics, or not covered by the basic paramedic curriculum.Overall the course encourages all candidates to be aware of the latest developments in evidence based practice, especially in terms of relevant NICE guidance, which may be a change from other prehospital care courses; where either the course material or the word of the instructors is taken as gospel, without necessarily being supported by the current evidence base. Typical course content is outlined in Box 2.Box 2.Typical course contentsScene assessmentMechanism of injuryAssessment of trauma patientsAirway assessment and managementSpinal immobilization and splintingExtrication techniquesHaemorrhage controlVascular accessPaediatric emergenciesMajor incidentPrehospital analgesiaCardiac arrest, dysrhythmias and ALSThrombolytics and ECGDrowningHypothermiaMaternal emergenciesMedical emergencies.

Doing more with less

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What influences people's decision to call 999 in cases of acute stroke?

Onset of acute stroke is a time critical emergency with rapid access to appropriate stroke care reducing mortality or minimizing the level of residual disability after a stroke.This study explores factors that influence people's decisions about when to make the call to the emergency medical service (EMS), and what their experiences are of this interaction.

ECG prediction tools: just a gimmick?

This study examines whether decision support provided by the electrocardiograph (ECG)-based, acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) and the thrombolytic predictive instrument (TPI) can help improve accuracy of diagnosis, triage and ultimately treatment of acute coronary syndrome (ACS) and ST elevation myocardial infarction (STEMI) when used in the prehospital setting.

Book Review

The development of the paramedic profession in Australia has rightly received international recognition in recent years. Yet despite this book's origins it is unlikely to achieve similar acclaim. Described as a ‘practical guide’ with clear clinical guidelines covering 50 common medical emergencie I would have to say that the content fails to adequately address either.

Book Review

One of the key roles and responsibilities of the paramedic is it to manage and control pain; paramedics have a duty of care to ensure that pain is managed effectively. Failure to ensure a duty of care can have serious consequences.

Determining the paediatric educational needs of prehospital providers: part 2

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. These challenges exist worldwide. Specific recommendations for paediatric educational content and learning strategies are lacking. The purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon and to examine these findings in the context of international emergency medical services (EMS) training. This was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the state of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. A review of the literature was conducted to compare the paediatric training of prehospital providers in the US and the UK. Participants identified a need for more paediatric training and they described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Barriers included distance and cost, especially for rural providers, as well as time for training and lack of availability of courses designed specifically for the prehospital provider. Participants recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Our findings support previous studies that show prehospital providers feel less comfortable providing care to children and face barriers such as time, cost, distance, and availability of relevant paediatric education. Although identified challenges are likely related to the demographics of Oregon, providers offered suggestions that may be applicable to prehospital providers more broadly, and include: 1) spending more time with children in a variety of setting and increasing the emphasis on assessing medically complicated children; 2) assuring local, affordable and relevant paediatric training opportunities; and 3) using online training modules and simulation to bring flexible ‘hands-on training to providers. Both the challenges and recommendations from this study have potential applicability to prehospital paediatric training in the US and UK.

Listening and communication styles of undergraduate paramedic students

There is a need to identify if current undergraduate paramedic students have the appropriate attributes to ensure they are effective listeners and communicators and whether additional or specific elements need to be added to the paramedic curriculum. The objective of this study was to identify the listening and communication style preferences of undergraduate paramedic students at a major Australian university. Methods: a cross-sectional study using paper-based versions of the listening styles profile (LSP) and the communication styles measure (CSM) were administered to a cohort of students enrolled in the Bachelor of emergency health (paramedic). Ethics approval was granted. Results: students reported a preference for the people listening style and to a lesser extent, the content listening style. Consistent with this, they also reported a preference for the friendly and attentive communication styles and exhibited little preference for the dominant and contentious communication styles. Conclusion: the students’ self-reported preferences are well suited for the role of paramedic and it is likely that a disposition towards these styles of listening and communication also lead these people to enrol in a paramedic course given their preferences are associated with an interest and concern for the welfare of others.

Community resilience: what significance does it have for an ambulance service?

The Scottish Ambulance Service (SAS) has developed a strategy for community resilience. This article explains what community resilience is from an ambulance service perspective, and why this approach is considered critical for the service to meet its objective of delivering quality patient care, and to address some of the major challenges currently experienced. Important benefits for communities and partners from other sectors are identified, and an outcome-focused approach indicates how these will be achieved. The five key strategic components are outlined, with examples related to practice. Challenges and opportunities for taking the agenda forward are discussed.

Prehospital assessment of stroke: time is brain

Prehospital identification is a vital initial step in the emergency medical management of stroke. There are several symptom-based screening tests which facilitate the identification of patients following a systematic clinical assessment. Screening also identifies conditions that mimic stroke and may require their own specific treatment. Between stroke recognition and arrival at hospital, there are important observations and treatment responses which will improve the outcome for patients. Rapid symptom identification and transportation to an appropriate unit will increase the probability that patients with ischaemic stroke can receive thrombolysis. The importance of prehospital stroke assessment is likely to increase with the development of future technologies.

The UK forum for stroke training and the stroke-specific education framework

This short article comments on the stroke-specific education framework being implemented through the UK Forum for Stroke Training. Caroline Watkins, Professor of Stroke and Older People's Care, Clinical Practice Research Unit, University of Central Lancashire; Tracey Barron, Research and Studies Officer, Priority Dispatch Corp, Bristol; David Davis, Clinical Pathways Coordinator/Stroke Lead, South East Coast Ambulance Service NHS Trust; Steve Hatton, Emergency Care Practitioner, Yorkshire Ambulance Service NHS Trust; Damian Jenkinson, National Clinical Lead, NHS Improvement-Stroke Improvement Programme; Stephanie Jones, Senior Lecturer, Clinical Practice Research Unit, University of Central Lancashire; Christopher Price, Consultant Physician in Stroke, Clinical Senior Lecturer in Medicine, Newcastle University; Adrian South, Deputy Medical Director, Trust Headquarters, Devon; Tom Quinn, Professor of Clinical Practice, Faculty of Health and Medical Sciences, University of Surrey; Michael Leathley, Principal Lecturer, Clinical Practice Research Unit, University of Central Lancashire. Email for correspondence: clwatkins@uclan.ac.uk

Recognizing the profession: Queen's Ambulance Service Medal for Distinguised Service

The criteriaThere is a number of criteria that have to be met in order to be eligible for consideration and to progress nominations for the QAM. A specific nomination form is available and must be completed in accordance with the guidance provided.It is important when considering an individual for an award that the choice of award and level of award is the correct one. There are a number of awards available through the honours system that recognize an individual's work and contributions. Some of these awards are not ambulance specific and should always be considered.In the royal warrant outlining the nature of the award, eligibility states that the medal will be awarded to all ranks in the NHS ambulance service (or state equivalents) in the UK, Isle of Man and the Channel Islands. Those working in the private/ independent and voluntary ambulance services will not be eligible.Those entitled to be considered will have to demonstrate devotion to duty, distinguished, meritorious and exemplary service, devotion to duty, including service marked over a prolonged period in the ambulance service. Commendable personal performance in the following aspects of the ambulance service will be particularly important when ambulance personnel are being considered for recommendations for award of the medal:Very high levels of sustained performance while temporarily filling posts that would normally attract a higher rank/gradeProlonged service, but only when accompanied by exceptional achievement and meritCompletion of a significant piece of work or project that results in substantial improvements for patients and/or for staffTaking on additional roles or responsibilities (in addition to their core role) that results in significant improvements for patients or staff l Taking a leading role in developing IT systems to improve performance and efficiency of the ambulance serviceTaking a significant and prolonged leading role in training and development to promote staff knowledge and skillsSuccess in organizing ambulance services under special difficulties; for example, managing major, serious or dangerous operational incidents, which make exceptional demands on personnelSpecial services to royalty or heads of state.Eligibility is extended to full and part-time staff. There is no provision to provide a retrospective award to retired staff; those staff in service on or after the date of the medal's introduction and have since retired will be eligible.Usually, staff will have had to have completed 10 years good conduct and exemplary service prior to being recommended for the award of the medal. There may be exceptional circumstances where this may be negated.Time spent on maternity leave, up to a maximum period for statutory maternity pay in respect of each pregnancy, will be treated as counting towards length of service, if that service is deemed exemplary. Any period of part-time work will be regarded as qualifying service so long as the weekly conditioned hours are a minimum of 20 hours.

Sirens and stereotypes

Channel four's six-part series, Sirens, first aired in June of this year and has just come to an end. It is understood that another series is being planned. Billed as a comedy drama, the three key characters star as a team of world weary paramedics repeatedly required to deal with humankind at its stupidest. The programme was created by Brian Fillis and inspired by EMT and rapid responder Tom Reynolds’ book, Blood, Sweat and Tea (Reynolds, 2006). Brian Kellett wrote the book under the pseudonym about life in the London Ambulance Service. The book covers Reynolds’ career from 2003–2006. In his writing, Reynolds is often highly critical of a number of NHS policies and management. Blood, Sweat and Tea (with its associated blog) is now cited in the NHS's own guidelines on staff blogging.

Improving the assessment and referral of mental health patients

This article discusses a report which sought to examine how patients with mental health (MH) problems were treated by South West Ambulance Service Trust (SWAST); particularly in cases of threatened suicide and/or deliberate self harm, the strongest predictor of suicide (Hawton et al, 2003), and compared the findings with the national picture. SWAST had similar organizational difficulties in that MH service providers’ boundaries do not match theirs, so a pan-trust policy is hard to achieve. There are some local arrangements in existence, although this report sought to pursue uniformity in approach rather than reinforcing the notion of the ‘postcode lottery’ of healthcare delivery.