Volume 4 Issue 11

Weigh out: A new formula needed?

The most accurate method of determining a paediatric patient's weight is to weigh them, however this is not as practical in the pre-hospital setting as it is in the hospital emergency department (ED). A recent study by Winship et al (2012) found that the most accurate formula for estimating a child's weight is the best guess formula, however, this is not currently used in the pre-hospital setting due to it's complexity. Previous studies into the estimation of a patient's age and weight have shown gross inaccuracies (Williams et al. 2010), and although there are certain paediatric weight estimation formula, in some cases, an estimation of the patient's age is required to do this, hence the introduction of inaccuracy.

Home and away: The 2012 international pre-hopsital care conference

ConclusionOverall the BASICS conference proved to be an excellent continuing professional development opportunity for paramedics and other health professionals, with many interesting and knowledgeable speakers. It is an interdisciplinary conference with speakers from the medical, nursing and paramedic professions all which were relavant to paramedic practice or operations. The conference also has an exhibitor area, which enables paramedics to see the latest products available from suppliers and manufacturers and of course offers an opportunity to network and follow-up on presentations of particular interest. The conference organisers are to be congratulated for arranging an event which retained the interest of delegates through its broad range of topics and high quality presentations.

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 firearms in schools, shopping centres and, most recently, a cinema, have heralded the deployment of special weapons and tactics (SWAT) officers and other police type emergency service units more often than ever before.

Critique of the pre-hospital obstetric emergency training course: ALSG

The advanced life support groupThe advanced life support group (ALSG) became a registered educational charity in 1992 and runs a variety of educational courses throughout the year (Box 1). The ethos of the organisation is to ‘preserve lives by providing training and education’.Box 1.Courses run by ALSGALSG paediatricsAPLS—Advanced paediatric life supportPHPLS—Pre-hospital paediatic life supportPLS—Paediatric life supportAPLS—Recertification courseEMNCH—Emergency maternal, newborn and child health (in collaboration with MCAI)ECHT—Emergency child health and trauma (in collaboration with MCAI)VHW—Village health worker (in collaboration with Maternal and Childhealth Advocacy International (MCAI))ALSG obstetricsMOET—Managing obstetric emergencies and traumaPOET—Pre-hospital obstetric emergency trainingEMNCH—Emergency maternal, newborn and child health (in collaboration with MCAI)EMNH—Emergency maternal and newborn health (in collaboration with MCAI)TBA—Traditional birth attendant (in collaboration with MCAI)ALSG acute medical emergenciesMedicALS—Acute medical emergenciesALSG IMMSMIMMS—Major incident medical management and supportHMIMMS—Major incident medical management and support: hospitalHAZIMMS—Major incident medical management and support: CBRNHMIMMS—Team providerMIMMS—Team providerALSG child protectionCPRR—Child protection recognition and responseCPIP—Child protection in practiceALSG transfersSTaR—Safe transfer and retrievalPaNSTaR—Paediatric and neonatal safe transfer and retrievalSTaR—Trust basedALSG instructor trainingGIC—Generic instructor courseALSG's pre-hospital obstetric emergency training (POET) course has been available since 2008 and aims: ‘…to teach the practical procedures necessary to save the mother and fetus in life threatening circumstances before admission to hospital’.(Advanced Life Support Group, 2012).The course is suitable for all advanced-life support level practitioners and is deemed to be particularly beneficial for paramedics and pre-hospital nurses and doctors. To date, 73 people have completed the course in the UK. The charity also has centres in Holland and Switzerland. The course comprises of approximately 10 hours online learning, covering 32 topics in seven modules. This is ratified by an online multiple choice question paper, where a pass mark of 80 % is expected. Following completion of online learning, candidates are required to complete a two day face-to-face course taught by a mixture of consultant obstetricians, doctors, midwives and paramedics. Over these two days learning is achieved through group discussion, simulations and skill workshops.

Interpersonal skills education for undergraduate nurses and paramedics

Interpersonal skills can be described and defined in numerous ways; however a common premise throughout the literature is that they are linked to human interaction and contribute substantially to establishing a high quality caring relationship with patients. Furthermore they are paramount to nurses’ and paramedics’ abilities to operate within diverse, challenging environments and highly charged emotional situations. The aim of this review was to explore how undergraduate programmes are teaching these skills and with what outcomes.MethodsA literature search was conducted using electronic databases, Medline, EMBASE, PsycINFO and ERIC.Results2838 articles were initially identified with only 6 remaining for analysis after applying the inclusion/exclusion criteria. No relevant data pertaining to paramedic undergraduate interpersonal skills was located for inclusion. Undergraduate nursing programmes used more traditional classroom approaches in conjunction with engaging, highly realistic activities. The use of evaluation tools in combination with student self-reporting appeared to be the most thorough and accurate way of evaluating such humanistic skills which are more difficult to quantify than clinically based skills.ConclusionThis literature review has highlighted the lack of research into the teaching and development of interpersonal skills in undergraduate paramedic programmes and a need for this to occur in the future.

Baby on the way: Was an ambulance in the plan?

ObjectivesThe East of England Ambulance Service NHS Trust (the trust) sought the views of patients it attended who were imminently about to give birth at the time of the 999 call to the trust. This was a patient group who had previously never been specifically targeted by the trust as part of its on-going patient feedback activity to inform service development.MethodsAll imminent birth patients during a four consecutive month period from August to November 2008 were sent a questionnaire asking them about their contact and satisfaction with the ambulance service at the time of the birth.ResultsResults of this survey have shown that almost a fifth (19.4 %) of patients who had intended to give birth in hospital had planned to use the ambulance service for their transport. Perceived complications, severe pain, labour not progressing, or the advice of a midwife were the main reasons given for unplanned use of the service. In this sample, a greater percentage of patients who planned to give birth at a hospital or maternity centre actually gave birth at home (25.5 %), than was achieved by patients who had planned a home birth (16.7 %).ConclusionsFurther investigation is needed to inform developments in partnership working between ambulance and maternity services to better serve this patient group.

Acute exacerbation of COPD: Are we still over-oxygenating?

Chronic obstructive pulmonary disease (COPD) affects thousands of people across the UK. It accounts for a large amount of hospital admissions, which are often seen by the ambulance service during acute exacerbations. Discussion has surrounded the amount of oxygen this type of patient should be receiving during acute exacerbations. Research to provide evidence–based practice for the use of oxygen in the hospital and pre-hospital environment has been ongoing for several years. In 2009 the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) changed their guidance following the British Thoracic Society's (BTS) release of new guidelines in oxygen use in adult patients, thus determining that oxygen should be delivered in a more precise manner. However in light of current evidence could further changes be made in the delivery of oxygen, by using air–driven nebulisation during the delivery of drugs to patients presenting in the pre-hospital environment with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This would allow patients to receive an appropriate amount of oxygen during their transfer to hospital, giving improved care and treatment of patients at risk of hypercapnic respiratory failure. This article will discuss the changes to practice which have already been identified and recommended and also discuss the potential implications these changes may have on patient care.

Framework for assessment of the 12 lead ECG in transient loss of consciousness

Following the introduction of pre-hospital thrombolysis, the acquisition and interpretation of the 12 lead ECG has become a routine part of UK paramedic practice. Although there is a growing body of evidence that confirms the diagnostic ability of paramedics in this area, little is known regarding the ability of paramedics to scrutinise the 12 lead ECG for other abnormalities. Recent publication of NICE guidance (NICE, 2010) relating to transient loss of consciousness (T-LOC) requires practitioners responsible for assessment of the 12 lead ECG post T-LOC to be competent in identifying a range of abnormalities. This paper describes a novel assessment framework in the form of a mnemonic designed to assist paramedic students in scrutinising the ECG for abnormalities post T-LOC. The need for further research to validate this assessment framework in educational and clinical settings is emphasised.

Recognising and managing severe sepsis in the pre-hospital environment

Severe sepsis is a complex medical condition in which the immune system overreacts to an infection leading to circulatory shock and organ failure. Patients with severe sepsis are critically ill and have a high mortality rate in the absence of early aggressive treatment, however, recognition and treatment of the condition remains poor. Recent improvements in the care of patients with myocardial infarction, stroke and multiple trauma have demonstrated how pre-hospital recognition and treatment can greatly improve outcomes for patients, and paramedics are well placed to provide similar improvements to the care of patients with severe sepsis. This article will explore the pathophysiology of sepsis, the recommended treatment bundles suggested by the ‘sepsis six campaign’ and the difficulties faced in implementing such treatments. Finally, it will explore the interventions that could be undertaken by Paramedics to improve patient care.

Care and compassion: Have you got what it takes?

As health care professionals, we have incredible jobs that place us in the extremely privileged position of looking after our patients with care and compassion through dedication, motivation and enthusiasm.

‘Home and away’: International pre-hospital care conference

Surf and turfOne of the more curious presentations was delivered by Paul Savage on delivering emergency medicine in hostile or dangerous environments at sea. Titled: Big sick/little sick: good medicine in bad places. The latest RNLI Casualty Care programme, the presentation, along with Adrian Noon's ‘…the ‘sinew and cartilage of the affair’, an element, he said, so commonly underestimated by paramedics on entering the profession…’‘To V or not to V, that is the question’ experiences of festival medicine, explored the significant change in administering pre-hospital care that different environments can demand. The need to use different, unconventional medical vehicles in order to reach patients at festivals, such as quad bikes and bicycles, was noted by Noon, whereas Savage spoke about the change in priority that occurs from ‘care-on-scene’ to ‘transport to hospital’ when administering care the sometimes hostile setting at sea.

Book review

The days of rote learning as the principle means of attaining the lofty rank of ‘paramedic’ are mercifully numbered. However, there will always be an element of ‘memory’ work involved, and, with a greater emphasis now being placed on the actual understanding of paramedic practice, these sorts of texts should fit comfortably on any paramedic's (and student paramedic's) bookshelf.

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