Mentorship: a reflective journey of self discovery

DescriptionThroughout my entire working life I have had a passion for training and education and greatly enjoy mentoring and developing the skills of others. As I did not have any specific training, teaching or mentorship qualifications, however, this has always been in an “informal” capacity. Due to my professional experience and the knowledge I have acquired and developed I consider myself to be “profcient” (Benner, 2001) as a specialist clinician working within my area practice, but a “Novice” (Benner, 2001) in the area of mentorship. I always strived to be a “good mentor”, but realistically, had a limited understanding of what this actually meant and had no understanding about learning styles, learning theories, or learning domains. I had also never written a teaching plan or undertaken any formal assessment of learners.I began my journey on the mentorship module with high expectations that it would provide the underpinning knowledge and theory to bridge this chasm in my understanding and allow me to progress from “novice” through to “advanced beginner” and then on to become “competent” as a mentor (Benner, 2001).

Pre-hospital lactate measurement: is it feasible?

It is well documented that sepsis is one of the leading causes of death in the UK, associated with high mortality rates and costing the NHS in excess of 2.5 billion pounds every year. Several studies have investigated the effect of recognition tools in the identification of sepsis and septic shock; however, to date, few have explored the contribution of point of care (POC) lactate testing on the early detection of sepsis.

“Trojan Ambulances”: an emerging threat

A trusted vehicle such as an ambulance could be used as part of a terrorist plot to help deliver a vehicle borne improvised explosive device to its intended target. Such a vehicle being used in this manner is called a ‘Trojan’ vehicle. Examples of such use exist from other countries worldwide and it is not unreasonable to think that this type of terrorism attack could be used in this country. Drastic mitigation measures have been used abroad to prevent this form of terrorist attack from occurring; however, these can cause delay to patient care and hospital access. In this country more simple security measures (such as those used to prevent theft of property) can be utilised to mitigate against this type of attack, and paramedics, along with the wider ambulance sector, have a role to play in implementing such security measures and preventing such an attack.

A good death: key conceptual elements to end of life care

Humanity is aware that death is an unavoidable inevitability of life; however, for most it is not a subject that overwhelms our everyday lives. For patients with life limiting, palliative, and end of life conditions, however, this is different, and with what little control they do retain over their health, experiencing a “good death” remains a priority. Paramedics in their capacity as community workers are frequently called to assist end of life care patients and their families, and whilst they may be au fait with practical and clinical elements of practice, such as pain relief, the conceptual and philosophical elements are perhaps less well known.This article introduces the concept of a “good death” before expanding on epistemology, existentialism, death anxiety, spiritual pain, grief, as well as the role of person and family-centred care, and empowerment. In addition, this article draws upon the author's personal experience of end of life care, in the hope that paramedics might have a better holistic understanding of the concepts related to those dying patients and families with whom we come into contact, ensuring a high quality, family centred, peaceful death for all.

Continuing Professional Development: Head injury

OverviewThis Continuing Professional Development (CPD) module will outline the epidemiology and pathophysiology of head injury, before defining categories of head injury and important details concerning their pre-hospital management.Learning OutcomesAfter completing this module you will be able to:• Demonstrate an appreciation of the epidemiology of head injury.• Understand the pathophysiology of head injury.• Define the categories of head injury.• Describe the important factors of pre-hospital management of head injury.

Personal Reflective Learning Log

This pull-out section of Journal of Paramedic Practice (JPP) has been designed to enable paramedics to use it as a tool for recording, reading, learning and reflecting. We invite you to use some, or all, of the questions on these pages to reflect on your practice and professional development. The page may be easily removed from the journal to use in your personal CPD portfolio.

Book Review

I felt a sense of impending despondency when I first looked inside the front cover and discovered this book is ‘….useful to doctors and nurses based on the intensive care unit.’ Yet I read on. Ok, so this was only the preface so perhaps I should have demonstrated more literary ‘nouse’ and at least got to the contents page! Here, at least, some key themes of paramedic practice appear in the form of assessment and stabilisation and the ever-present airway, breathing and circulatory assessment.

Younger is harder: Pre-hospital IV access success rates in children

This retrospective medical record review investigated peripheral intravenous (IV) access success rates by paramedics in patients aged ≤18 years in Minnesota and Western Wisconsin from 1 January 2003 until 31 May 2011. From 2003 onwards, paramedics recorded IV attempts via an electronic medical record system, and this was used to export data for analysis. Prior to this, written records were used to verify success rates.

Post-traumatic stress disorder among ambulance personnel: a review of the literature

It is becoming increasingly apparent that ambulance personnel are vulnerable to developing post-traumatic stress disorder (PTSD) and associated symptoms.The aim of this literature review is to identify PTSD within the scope of emergency ambulance work and think of potential ways to reduce it.

BASICS and the Faculty of Pre-Hospital Care International Conference 2013

Day oneTraditional BASICSFollowing a welcome from BASICS chairman Richard Steyn, lifetime member Kenneth Hines delivered the opening talk on the historical roots of immediate care. Outlining the formation of BASICS in 1977—when it was then known as the British Association of Immediate Care Schemes—through to its development as an organisation that provides immediate medical care nationally, Hines captured the ethos of BASICS perfectly in his closing comment: ‘We've gone from a bunch of enthusiastic doctors to a highly skilled professional body.’ALISTAIR QUAILEJonathan Bracken, special counsel, Bircham Dyson Bell, spoke on the concept of duty of care and the fear of liability for negligence. Providing the example of being on board an aeroplane and looking at where a doctor's duty of care lies should a passenger fall ill, Bracken highlighted the importance of recognising your limitations and not to make matters worse.James Pallett, senior clinical research fellow, emergency medicine, King's College Hospital, spoke on the epidemiology of trauma. Presenting a number of shocking figures, including the fact that trauma forms 7% of the NHS budget, he stressed the need for more reliable data surveillance systems.Practical developmentsMatthew Cooke, professor of clinical systems design, WMS and associate medical director, Heart of England NHS Foundation Trust, outlined the latest research in pre-hospital care. This was followed by Sir Keith Porter, professor of clinical traumatology, Queen Elizabeth Hospital Birmingham, who provided a much-anticipated talk on the consensus statements from the FPhC, on topics including patient handling, spinal injury and pelvic injury.Tim Harris, professor of emergency medicine and pre-hospital care, Barts Health NHS Trust and Queen Mary University London, ended the talks before lunch by exploring pre-hospital ultrasound. Outlining its many uses in the pre-hospital setting, Harris' talk was both informative and engaging.Breakout sessionsAfter lunch, a number of breakout sessions took place, including a talk by Andrew Lee, fire officer, Derbyshire Fire and Rescue Service, and paramedic, on changes in entrapment management. With the help of a stripped down Volvo, Lee was able to highlight areas of concern to bear in mind when carrying out extrication services.ALISTAIR QUAILEThroughout the day, students of all disciplines were invited to make presentations and compete for a prize generously donated by the FPhC. The inaugural event showcased a number of impressive proposed pre-hospital care programmes in the form of posters. The students were on hand to explain their ideas and the prize was awarded to Dr Matt Ellington of Addenbrookes Hospital, Cambridge. His poster, entitled “Medical Students: The Future of Pre-Hospital Care?” provided illuminating figures of average UK ambulance service response times with those being achieved by medical school students. As the winner, Matt received a cheque for £100. Students also gave oral presentations on pre-hospital care programmes and the developments of undergraduate programmes in the field.Myles Gibson Eponymous LectureFollowing the breakout sessions, the Myles Gibson Eponymous Lecture was delivered by Stephen Hearns, consultant in emergency medicine, Royal Alexandra Hospital, Paisley. Hearns’ lecture gave an overview of the Emergency Medical Retrieval Service (EMRS). He explained that having finished his training with the London Helicopter Emergency Medical Service, where he developed experience in pre-hospital trauma care and aeromedical evacuation, he attempted to utilise this experience in Scotland, where he has helped to develop the EMRS. The service he has managed to produce in Scotland is truly admirable, and delegates enjoyed being given an insight into the work he has done.Annual dinner and awardsThe annual dinner and awards were an occasion for old colleagues to catch up and celebrate the great work being undertaken in pre-hospital care by a number of individuals.The joint FPhC and BASICS Lifetime Achievement Award went to Dr Dick Herbert. Dick retired in February this year after a long career in pre-hospital care. He, along with Dr John Hall and Dr Barry Davis, founded the first West Midlands based Immediate Care Scheme in Kidderminster in 1981. Since then, he has played an instrumental role in the West Midlands Care Team.The annual Laerdal Award was presented to Dr David Zideman, a much-respected anaesthetist, past chairman of BASICS and the European Resuscitation Council, and honorary physician to the Queen. His award also served to recognise the invaluable role he played as Clinical Lead for Emergency Medical Care for the 2012 London Olympic and Paralympic Games.‘Hines captured the ethos of BASICS perfectly in his closing comment: “We’ve gone from a bunch of enthusiastic doctors to a highly skilled professional body.”’Further BASICS awards were presented to Andrew Butler, Simon Brown, Henry Frydenson, Colin French, David Hickson and Caroline Williams.

A journey with mechanical chest compression

This article explains how and why two UK paramedics chose to review, and lead, the UK arm of one of the worlds largest resuscitation research studies. The article begins with an outline of their original work presented in 2002, and their desire to improve upon that study by gaining a greater insight into chest compression practice.This article is the first of 3 papers by the authors into the theories of resuscitation linked to mechanical resuscitation and best practice.

Health care technologies and working with rural communities

Delivering care to rural communities often poses a challenge, especially in the management of long-term conditions. Ian Peate explains how telemedical tools can provide important clinical care at a distance.

Mental health and older people

World Mental Health Day was initiated by World Federation for Mental Health (WFMH) in 1992 to highlight the importance of mental health. This year, the WFMH Board of Directors decided on the theme of “Mental Health and Older Adults”. Running on 10 October, the day focused on highlighting the mental health issues experienced by older people in their communities, and encouraged people to consider their needs for support and services. There is no denying that people are gradually living longer, as improved healthcare and standards of living have made this possible. In fact, the current number of people aged 60 years and over is more than 800 million, and projections indicate that this figure will increase to over two billion by 2050 (World Federation for Mental Health, 2013). It is thought that people aged 60 years can now expect to survive an additional 18.5 to 21.6 years (United Nations Population Fund, 2012). According to this statistic, soon the world will have a higher number of older adults than children.