Volume 4 Issue 10

Professional indemnity insurance: is it really worth the cost?

Professional indemnity insurance: is it really worth the cost?As a paramedic, you will often work in a high pressure environment making split second decisions and exposing yourself both to personal risk and professional liability. It is important to ensure thatin trying to save the lives of patients, you are also protected as a regulated healthcare professional accountable to the Health and Care Professions Council (HCPC).I hope that I never need the services of a paramedic but it is reassuring to know that I have a safety net in the form of the ambulance service and that, if I am knocked of my bike while cycling to work, someone will be there to help. As a paramedic, I am certain that, having answered an emergency call, you hope you won’t need the services of a solicitor like me to defend you against a complaint to the HCPC. Unfortunately, complaints can arise even when you have operated within standard protocols and that is why professional indemnity insurance is important.Professional indemnity insurance is your safety net and, in the event of a complaint to the HCPC, your insurer may provide you with the legal support that you require. This kind of support may not be provided by your NHS employer, who would normally only cover you in the event of a clinical negligence claim made by an NHS patient. Indeed, it may have been your employer to raise the concern with the HCPC in the first place. Your union is, of course, a possible source of guidance.Complaints to the HCPC are a serious matter and, at their most serious, can result in a practitioner being removed from the register and unable to work as a paramedic in the future. The investigationand hearing of such complaint is a legal process and the correct support is invaluable. My work in this field has made me acutely aware of the significant difference it can make to healthcare professionals to have legal support and assistance available to them.The first step in the process of a complaint to the HCPC is for it to be referred to the investigating committee, whose function is to determine whether or not the complaint should be referred to theconduct and competence committee for a hearing. The threshold for cases to reach the investigating committee is very low and complaints from members of the public are not screened by any other paramedicprior to the investigating committee stage. As a result, it is entirely possible for complaints that have no real merit to reach the investigating committee and to require a response:The investigating committee College of Paramedics must decide two factors:Whether or not there is a realistic prospect of the conduct and competence committee finding the factual allegations proved, and, if so;Whether there is a realistic prospect of finding that the practitioners current fitnessto practice is impaired.This is known as the ‘realistic prospect test’ and if the answer to both these questions is yes then the case will be referred to the conduct and competence committee for a hearing. In some cases (one way or the other) the answer will be obvious, however, in other cases it will not be so clear cut, even when it may seem to a practitioner that it should be. It is therefore very important to get the right advice at the investigating committee stage.If the response to a complaint is handled correctly, then there is often a good chance that the Investigating Committee will decide to close the complaint with no further action, however, if it is handled badly, the situation can be made worse. Indeed, there are some circumstances in which it will be in the practitioner’s best interests not to respond at all to the complaint at the investigating committee stage. There are a number of factors to consider and much will depend on the nature of the complaint and the chances of successfully avoiding a referral to the conduct and competence committee.When responding to a complaint, careful consideration needs to be given to: Should the factual allegations be admitted or denied?What, if any, additional factual evidence should be obtained?What evidence is there of current fitness to practise?What should and should not be included in the response?What evidence should and should not be disclosed?Are there are any legal points worth making?Receiving expert advice on the legal and evidential issues involved and the best strategy to be adopted is invaluable in dealing with a complaint at the investigating committee stage.The value of legal assistance is even more paramount if a case if referred for a hearing. I am afraid that (despite our best efforts) some cases are referred to the Conduct and competence committee and further legal and evidential issues will rear their heads at that stage. In addition, the value ofa skilled advocate at the hearing simply cannot be underestimated. Legal costs can very quickly mountup and can be prohibitive in the absence of professional indemnity insurance.For the vast majority of responsible and competent paramedics, the idea that they will be involvedin this kind of process is alien and, as one of the ‘good guys’, it is easy to think that ‘it won’t be me’.Unfortunately, the present culture is one where complaints against healthcare professionals are onthe rise and, while it is the minority of poor practitioners who make the headlines, beyond the frontpages, there are many good practitioners who, despite their best efforts, find themselves having to account to their regulator for a one of mistake or an entirely unjustified complaint.I hope that you will never have to deal with a complaint to the HCPC, however, the risk is one that is worth guarding against so that, if you are ‘knocked of your bike’, there is an emergency service you can call on.

Cycle response unit paramedics

The processTo be a UK ambulance service cyclist, completion of a five day PSC course is mandatory. Prior to attending the course, prospective subscribers can acquaint themselves with the many patrol skills within the pre-course workbook. The 36-page workbook covers the various skills required to be an efficient, safe cyclist representing your organisation while remaining in the public eye. The workbook is informative with good visual aids and useful knowledge checks to prepare the student for the course, irrespective of previous cycling experience. Over the five-day course the student must successfully complete an aerobic fitness test, anaerobic fitness test, written paper, road assessment, skills assessments and bike maintenance test (Box 1).Box 1Key assessments on the public safety cycling courseAerobic fitness test (patrol test)The student must cycle 2.5 kilometres at 80% maximum heart rate in a time frame adjusted for age, but typically within 5-6 minutesAnaerobic fitness test (sprint test)The student must cycle 1 kilometre in a time frame adjusted for age but typically between 105- 135 seconds.Workforce stamina test (cycle road assessment)A continual assessment throughout the course in which the student cycles the speed and distance set by the instructor to demonstrate the level of fitness required for the job. Normally at a speed of 15 mph over a distance of 1 kilometre safely to national standards level 3 for cycling.Written testConstitutes of 25 multiple-choice questions (not negatively marked) based on the pre-course workbook and the Highway Code. To pass, the student must achieve 75 % or higher.Skills assessmentsSlow speed skills such as the offset serpentine, the ten-foot box and the lock to lock.Bike maintenance testThe student must demonstrate a cycle maintenance test such as removing a wheel, changing a tyre or fixing a puncture.(Public safety cycling, 2012)The students are taught various skills that they need to perform at slow speed, including the ten-foot box, offset serpentine and lock-to-lock. All the skills require the rider to complete a circuit with tight corners in a small space involving continual cycling where the rider’s feet are not permitted to touch the floor. Throughout the course there are plenty of opportunities to practice with instructor support until the assessment and the skills have been mastered.Over the duration of the course, obstacle clearing skills and the bike safety checks (ABC Quick Check) are taught and practiced. The student also has a kit familiarisation, so, upon reaching the call, they already have had an introduction to the various pieces of equipment they will be required to use when in the field. The course also involves practising group riding as CRUs are often used at large events and in order to portray a professional image this skill must be practiced—furthermore a night ride forms part of the PSC course which prepares the students for the subtle differences when cycling in the dark hours. Students who successfully complete the PSC course are given five shifts with an experienced CRU rider until they are confident and are then permitted to travel as solo CRU riders. This is not the end of the training however, as annually the CRU riders have to successfully undertake a Cycle Certification Test, involving a fitness test to ensure that they are maintaining the standards required to undertake their CRU duties.

Improvements in clinical handover: what next?

Wanted: reviewers for Spotlight on ResearchWe are always looking to expand the number of reviewers contributing to this section of the Journal of Paramedic Practice.If you would like to be involved, then please contact me. You may have a paper in mind already, and, if this is the case, email me first to make sure that someone else is not already reviewing the same paper as it will prove rather frustrating for you to write a review and then find out, after all the hard work, that your review will not be published as it is already in press having been reviewed by someone else.If you do not have a paper, that is not a problem. Once you and I have made initial contact, I can find out what your professional interests are, and then I can source you an appropriate paper.Spotlight on Research aims to review, in about 600 words, research–based papers that have been published in other journals. Clearly, in this length of review, we cannot produce a depth critical analysis, but neither are our reviews just a simple repetition of the paper’s abstract.The idea is to fag up key issues from published papers, to construct an overview of the central elements of the study including some reference to the study’s selected methodology, and to highlight the relevance of the findings to the paramedic profession.These reviews provide a useful resource for our readers who may not have sufficient time to review all journals every week or every month. Our reviews inform other people about studies that have been undertaken in the UK or in other countries which have relevance to unscheduled urgent care and paramedic practice. People read our reviews and if it is an area of interest to them, they may well be inspired to access the full paper.I will give you as much or as little support as is required to help you construct a publishable review. So do not be put off because you have never published before, just remember that everyone has to start somewhere. If you are new to writing we will work together to develop the review, editing and refining your draft review until we have a product that we both agree is ready to be shared with our readers.Working on a review is a good introduction to the world of writing for publication as well as something that more experienced writers can do to augment their portfolio of publications. This type of activity is useful to the paramedic profession, great for your professional development, and it makes a significant contribution to your own CV.So, get cracking and email me at J.Williams@herts.ac.uk and you could be in press within the next six months.

Which paediatric weight formula is best suited for the out-of-hospital field?

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula. The objective of this study was to identify a paediatric weight estimation formula relevant to the pre-hospital field.Methods: A literature review was undertaken using a variety of electronic medical databases from their commencement date until the end of May 2012. Keywords used in the search included: Weight estimation, drug calculations, pediatric, paediatric, EMS, EMT, paramedic, emergency medical service, emergency medical technician, pre-hospital, out-of-hospital and ambulance. The keywords were used individually and in combination. The inclusion criterion was any study type that described the development or evaluation of a paediatric weight calculation in the pre-hospital or hospital setting.Findings: There were 635 articles located with 25 meeting the inclusion criteria. The commonly used APLS weight estimation formula significantly underestimates a child’s weight. The best guess formula appears to be more accurate at estimating the weight; however more research needs to be conducted to validate this method for the pre-hospital field.Conclusion: As the average weight of children increases, the accuracy of weight estimation formulas decreases, suggesting that these methods will be unable to sufficiently adjust to deal with future rises in average weights of children. Further research is required to determine the most appropriate formula for paramedics to use in the pre-hospital setting.

Influence of life experience on undergraduate paramedic students’ placement

Life experience has long been considered a vital aspect of paramedicine and paramedic education (Cooper, 2005). This has become more relevant in the past few years with the advent of widespread higher education institute (HEI) undergraduate paramedic programmes nationally. This qualitative research, using semi-structured interviews and a focus group, aims to explore relationships between the prior life experience and placement engagement of first–year paramedic students. Findings highlighted the multi-faceted nature of engagement in placement and emphasised the need for provision of quality clinical placements and suitably qualified/experienced mentors. This ensures support and understanding can be provided on an individual basis to students.

Using patient experiences of emergency and unscheduled care for quality improvement

Paramedics like, all health care professionals are required to support and justify their actions through evidence based practice. A concept that for many years now has focused on clinical and randomised control trials to produce its sole evidence base. This article explores the growing recognition in recent decades among all healthcare professions not just paramedicine, that the collection and analysis of the experiences of service users, family, friends and carers cannot only justify practitioner actions, but improve the quality of emergency and unscheduled care services.

The role of paramedics with extended practice: exploring the healthcare context

With National Health Service (NHS) providers facing the challenge of measurement through clinical outcomes, measures of effective service provision, this article explores the political influences; background and current approaches which have expanded paramedics’ scope of practice.As there are conflicting demands upon ambulance service NHS trusts provision of healthcare, these features are related to experiences within the London Ambulance Service, and where relevant to national experiences.The educational requirements, practitioner attributes, leadership development and service user perception are explored.In an environment where paramedics are expected to deliver innovative healthcare, partly driven by political influence it is important to understand how an extended scope of practice has involved and can be delivered while ensuring patient safety.In helping to shape the future delivery of out-of-hospital healthcare while integrating in the changing urgent and emergency provision, paramedics must remain aware of these multifaceted drivers upon their practice.

Leadership within the ambulance service: rhetoric or reality?

Just as part 1 of this article (Armitage and Taylor, 2012) introduced the concept of management and leadership, specifically within the context of the ambulance service, part 2 will stimulate further discussion in connection with the development of leadership related knowledge, skills, experience and behaviours among paramedics. Throughout the piece, the need for leadership development at an organisational and professional level will be promoted, and the authors will explore why leadership and leadership development is a key component to paramedic practice, as well as considering how ‘human factors’ and ‘non-technical’ skills are central to a sucessful process of leadership. The NHS Leadership Framework will be reviewed and the authors will consider how it can be used by individuals, organisations and the paramedic profession as a whole to drive leadership development in the future.

Redefning leadership in the ambulance service

When I first set about researching leadership with my colleague, James Taylor, I was taken aback by the plethora of frameworks, models, matrixes and competency sets dedicated to what makes an effective leader. Then there is also the distinct concept of clinical leadership and the fundamental differences between leadership and management.

Tactical medical course

It is an unfortunate state of affairs that now exists in the US where the instances of ‘active shooter’ multi–casualty events, due to a person or persons wielding frearms in schools, shopping centres and, most recently, a cinema, have heralded the deployment of special weapons and tactics (SWAT) offcers and other police type emergencyservice units more often than ever before.

Continuing Professional Development: Considering and applying pharmacokinetics

OverviewManaging medicines in modern healthcare practice is a significant issue for all healthcare professionals. Paramedics have a particular role in managing medication in acute care settings and those environments are often the most challenging. Despite this key role; many healthcare professions are often afforded little opportunity to consider the science behind medicines management behaviours.This article explores, in a reflective manner, the principal actions of the body on the drugs we administer in attempt to assist the paramedic practitioner to make greater sense of the effects of medication in practice. The article explores the theory behind considering the absorption, distribution, metabolism and excretion (ADME) of medicines and highlights how ADME considerations are made in everyday practice. The reader is asked to reflect upon the value of this information and take forward a model of understanding pharmacokinetics in the context of caring for patients.Learning OutcomesAfter completing this module you will:• Define and describe pharmacokinetics to a fellow healthcare professional.• Use the acronym ADME to describe the important aspects of human pharmacokinetics.• Develop an awareness of the application of pharmacokinetics while dealing with patients.• Explain with greater understanding why drugs are administered through particular routes, for example, at meal times, and relate this knowledge to basic pharmacokinetic principles.

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