Pre-hospital coronary heart disease: Analysing performance indicators

The prevalence of coronary heart disease is massive within the UK and is the leading cause of myocardial infarction. Between a third and two thirds of associated deaths occur in the pre hospital setting, many within the first few minutes of symptom onset. Immediate quality treatment is proven to improve patient survival however recent evidence suggests patients are not receiving all the elements of a quality care bundle. Pain management has been identified as one area which requires national improvement to meet standards directed by the National Service Framework for Coronary Heart Disease. In response, Ambulance services nationally have used clinical performance indicators to address quality issues in order to enhance practice and achieve target. This article reviews the importance of pain relief in the treatment of acute coronary syndrome and analyses the use of clinical performance indicators in the pursuit of best practice within the North West.

Legal substances and their abuse: Legal highs

Non prescription drugs of abuseStimulants such as caffeine, dextromethorphan in cough remedies, cough and cold remedies containing stimulants or antihistamines are misused and abused for improving performance and for their hallucinogenic properties by many young adults (Williams and Kokotailo, 2006; Conca and Worthen, 2012).

The introduction of the intubating laryngeal mask into paramedic practice

Objective:To ascertain key paramedic-reported factors affecting the implementation of the Intubating Laryngeal Mask Airway (ILMA) into paramedic practice with specific focus on educational practices.Methods:A sequenced exploratory descriptive research design incorporating a questionnaire and semi-structured interviews was employed. Quantitative data collected through the questionnaire was analysed using frequency distribution and Chi Square analysis. Qualitative data from both the questionnaire and the interviews was thematically analysed using a coding and cross comparative analysis technique within a conceptual framework based on Roger’s Diffusion of Innovation model.Results:The results show an educational programme, which departed from the traditional in-theatre model of training, can successfully prepare paramedics for using the new ILMA device for advanced airway management (AAM). Paramedics reported the educational program increased their confidence in using the ILMA for tracheal intubation for AAM, and that they achieved tracheal intubation success rates using the ILMA that were similar to those achieved using the laryngoscope. A blended educational approach of manikin and in-service training is required to be effective for improving their confidence and competence in ILMA tracheal intubation.Conclusions:The successful introduction of an innovation such as the ILMA into paramedic practice requires an education program that is blended and supports an effortless and sustainable change to practice. The results show simulation based ILMA tracheal intubation education can increase paramedics’ confidence and competence as a suitable alternative to the laryngoscope for paramedic tracheal intubation.

‘A pain in the back’: Psoas abscess and the importance of red and yellow flags

A case of low back pain is reported. The patient presented with low back pain, and while in the Emergency Department (ED) sepsis was observed. Following investigations including CT lumber spine and pelvis, Ileopsoas abscess (IPA) was found. This case report reflects the difficulties in early diagnosis of the rare presentation of IPA, while highlighting the importance of red and yellow flags in the assessment of low back pain.

First evaluation of CPD advanced paramedic teaching methods in Ireland

Aim:Continuing professional development (CPD) will soon be mandatory for advanced paramedics (APs) registered with Ireland’s pre-hospital regulatory body. Effective and efficient CPD methodologies are needed. We determined what type of training methods might be used to reduce associated costs while maintaining effectiveness and benefit.Methods:In 2010, an ‘up-skill’ programme for APs was introduced in Ireland comprising: a) self-directed learning using a purpose-designed manual; b) workbooks based on the manual and clinical practice guidelines; c) small group practical sessions with discussion-based skill stations; and c) practical scenario-based assessment. Participants were invited to complete a web-based survey assessing a) short-term effectiveness, b) medium-term effectiveness, and c) user friendliness of the educational modalities. The preferred learning styles and respondents’ perceptions of outcome were determined.Results:Overall 49 % of participants responded. Of those eligible, 73 % believed that practical learning encouraged knowledge retention and skills in the immediate and medium-term, 82 % believed practical learning influenced patient care immediately, while 75 % stated that it influenced patient care six months later. All respondents agreed that practical learning was important, with 90 % stating that it was enjoyable. Overall, 80 % found the provided manual accessible, while >40 % believed that the manual alone did not provide all necessary information, 77 % had referenced it since completing the programme.Conclusion:APs enjoyed, and benefited from, the educational programme and the knowledge gained benefited patients in the short and medium-term. This study suggests that educators and training sponsors should consider the benefits of small group-based practical learning for APs.

Continuing Professional Development: Tension pneumothorax

OverviewTension pneumothorax is a life threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provide guidelines on the pre-hospital diagnosis and treatment of this condition. This Continuing Professional Development (CPD) module firstly looks at the pathophysiology of the developing tension pneumothorax, discusses the signs and symptoms likely and less likely to be found, looks at the difficulties in recognising these signs and analyses the accepted methods of first line treatment. The module goes on to study alternative pre-hospital management methods and discusses the safety and effectiveness of each.Learning OutcomesAfter completing this module you will:• Appreciate the need for vigilance in making a diagnosis of tension pneumothorax.• Understand the potential for error and patient harm in treating tension pneumothorax, regardless of clinical skill level.• Have an understanding of the wider breadth of research and evidence surrounding tension pneumothorax which complement UK pre-hospital guidelines.• Have reviewed the techniques advocated for relieving a tension pneumothorax in the pre-hospital field.

Paramedics and professionalism: Looking back and looking forwards

Paramedic practice, like many areas of health care, has moved forward dramatically since the early 1970s when the first training scheme for paramedics was established in Brighton. The 1980’s saw a national training scheme adopted and in 2000, paramedics became registered with the Council for Professions Supplementary to Medicine (CPSM), soon followed by the transfer to statutory regulation with the Health Professions Council.

London Trauma Conference 2012

The London trauma conference took place between the 4 and 7 December 2012 at the Royal Geographical Society in Kensington, West London.

Paramedic education: Important developments in 2012–13

The curriculum guidanceSince 2004, the college has made a key contribution to paramedic education through its curriculum guidance and competencies framework, which is currently undergoing its third revision and reflects the rapid evolution of the paramedic role. It will provide higher education institutions (HEIs) and other stakeholders with a comprehensive curriculum to prepare paramedics in the UK as they move through education, training and the early stages of professional practice.A great deal of paramedic expertise from across the UK has been put into the development of the third edition which will be published in March 2013. This includes stakeholder consultation events attended by representatives from higher education institutions and ambulance service employers. The Governing Council of the College firmly believe that this document provides the best available advice for those delivering paramedic education and training and that adherence to it by education providers and employers of new registrants will enhance the quality of paramedical services; throughout the UK. In addition, and perhaps most importantly, this guidance can give service users wherever they are in the country, the information they need to ensure that paramedics have been prepared for practice through an effective collaboration that has involved education providers, employers, and the paramedics’ professional body.The curriculum guidance and competencies framework has developed rapidly from the first (2004) and second (2008) editions that have reflected the transition to and development of the profession. This third edition brings with it some important changes. Firstly the curriculum guidance will be published separately to the competencies framework since the latter requires more frequent review and updating than the former. Second, it acknowledges the expansion in the breadth of care delivered, with particular reference to specialist paramedic management of undifferentiated care needs, and the knowledge and skills of paramedic practitioners who provide this function. It also carries out a similar role in respect of critical care paramedics. These two new specialist roles are likely to be joined by further role development in the future.Education providers will recognise that the curriculum guidance has been significantly revised and reflects the expanding scope of practice of paramedics, whether at registration level or in specialist practice. It also contains guidance in relation to the leadership and support necessary to the development of effective registrants. The guidance aims to assist employers by ensuring student paramedics and newly qualified registrants have the opportunities to better adapt to their new professional role in a supportive environment that increases their confidence and promotes autonomous practice, while minimising the risk of unsafe practice. Most importantly, the curriculum guidance complements statutory requirements by providing guidance from the paramedic professions’ perspective. In this sense the College of Paramedics acts as the guardian of the uniqueness and distinctiveness of the profession. It also enables the experience and expertise of paramedics to be directly assimilated into document form.The Council of the College of Paramedics appreciates the many contributions made to the development of the third edition. Senior members of the college and their colleagues in national and regional groups have worked voluntarily and tirelessly to produce this guidance. Equally important to the process has been the guidance from key stakeholders from education providers and employers.In summary, this third edition expands on previous work, not only by providing a significant updating of the core curriculum but through the inclusion of new sections which reflect the expanding role of paramedics throughout the UK.

The reality shock

The successful completion of an approved programme of paramedic education is a commendable achievement but it represents the end of the beginning rather than being the end in itself. For the newly qualified paramedic, the true acquisition of the role is both broad and complex and involves myriad high-level and complex skills that cannot possibly be fully assimilated within the confines of a two- to three-year training programme.

What influences paramedic participation in research studies?

This qualitative study set out ‘to examine paramedics’ perceptions of involvement in out-of-hospital research’ (p642). This work was linked to stroke research that was undertaken both in the US (Field Administration of Stroke Therapy-Magnesium–FAST-MAG–a phase 3 trial), and in the UK in the North East Ambulance Service (Developing and Assessing Services for Hyper-acute Stroke).

Welcome to 2013

If you are reading this, then it is likely we have survived the apocalypse predicted by the ancient Mayans for 21 December (or thereabouts), Christmas has come and gone for 2012, and our attention is firmly on the New Year ahead.

Changes in vital signs of trauma victims from the pre-hospital to the hospital settings and their associations with injury severity and a need for an emergency operation

OverviewThe objective of this article is to characterize changes in vital signs of trauma victims from pre-hospital to hospital settings, their associations with injury severity, and the need for an emergency operation. Methods: a prospective cohort included 601 patients admitted to a level one trauma centre from 1 July to 30 September 2007. All pre-hospital and hospital admission values of Glasgow coma score (GCS), systolic blood pressure (SBP), heart rate (HR), respiratory rate (Resp) and oxygen saturation (SpO2) were recorded. All urgent major surgical procedures were graded in real-time as: emergency, urgent, or not urgent. Injury severity score (ISS) was calculated following completion of all the diagnostic work-up. Patients were classified as major trauma victims if their calculated ISS was 16 or greater, and those who needed an urgent intervention or intensive care. Vital signs trends were analyzed using the students' T–test. Associations with injury severity and the need for an emergency operation were analyzed using chi-squared test. The statistical significance level was set at 5% (P £ 0.05). Results: 243(40%) patients were classified as major trauma. 39(6.5%) patients required an emergency operative intervention—29 for active bleeding and 10 for imminent cerebral herniation. The time from injury to hospital arrival was 44.8 ± 17.63 minutes (mean±standard deviation), the time did not differ for those needing an emergency operation. Pre-hospital GCS £12 and SBP £90 were associated with a severe injury (a relative risk(RR) of 4.95, 95 % confidence interval(CI) 3.25–7.58 for low GCS and 4.60, 2.67–7.94 for low SBP) and emergency surgical procedures (RR, 95 % CI 4.43, 2.28–8.58 for low GCS and 11.69, 5.85–23.36 for low SBP). These values changed significantly from the field to the hospital with the mean GCS increasing 1.65 points and the mean SBP decreasing 7.23 mmHg (P<0.001). One patient out of 473 with a GCS ³14 in the field and no one out of 483 patients with a GCS ³14 on admission needed a neurosurgical procedure. 15/533(2.8%) patients with a pre-hospital SBP >90, and only 2/542(0.4%) patients with a SBP >90 on admission required emergency bleeding control (P<0.005). HR ³120 and changes in HR of 20 beats per minute (bpm) or more were not associated with injury severity. The respiratory rate and the SpO2 did not change significantly, and were not associated with injury severity. Conclusion: pre-hospital vital signs values are expected to change significantly over time. Pre-hospital GCS £12 and SBP £90 predict major trauma, while the HR is not a good indicator of haemodynamic status. When these parameters normalize on admission, an