Volume 5 Issue 12

Anatomical and physiological mechanisms of heartblock associated with AMI

Heart block (HB) is a recognised complication of acute myocardial infarction (AMI) and is often a marker for increased mortality and morbidity. An appreciation of the anatomical and physiological mechanisms associated with the development of HB in AMI is important for the prediction and management of complications when dealing with such cases. Certain forms of HB are classically linked to infarction of specific anatomical territories in AMI. However, variations in pre-morbid state and anatomy of the coronary vessels provide potential for the development of HB in any patient experiencing AMI, regardless of the territory affected.

The decision-making process in an emergency: a reflection on paramedic practice

This article will use a case study to critically reflect and analyse the decision-making process used in an emergency situation. It will discuss a range of factors that influenced the clinical decision-making process and how this prompted immediate transport to a local hospital. A wide range of supporting evidence will be explored and the decision-making process will be questioned and challenged. Relevant professional, ethical and legal issues will be considered and discussed. The inclusion of other colleagues, patients, relatives and their involvement, within the decision-making process, will also be deliberated.

Publication of the new Paramedic Curriculum Guidance

LeadershipThe College of Paramedics has adopted and integrated the ethos of the NHS Leadership Academy (2011a)Clinical Leadership Competency Framework (CLCF) into the curriculum guidance document and concurs with the supporting guidance introduced by the NHS Leadership Academy (2011b) for integrating the subject matter into the curricula by higher education institutions, particularly those that deliver paramedic science programmes.

Implementation of a mechanical chest compression device

High-quality chest compressions are a key factor in survival from out-of-hospital cardiac arrest (OHCA). Yet, it is widely accepted that the technique used during CPR is frequently inadequate and often provides only 30% of normal perfusion. Several studies have advocated the use of mechanical chest compression devices in the pre-hospital setting; however, there is little definitive information relating to the process and issues associated with implementing such a device into a large urban ambulance system.

Australian paramedics' provision of analgesia for older fallers

This research, undertaken in Australia over a period of nine months, aimed to outline factors influencing paramedics' clinical decisions related to provision of analgesia, and report on both frequency of administration and effectiveness of analgesia in older fallers with suspected fractures.

Ambulance CPAP Saves Lives: why don't we use it?

Continuous positive airway pressure (CPAP) is an established in-hospital therapy for the treatment of multiple aetiologies of breathlessness, primarily for acute cardiogenic pulmonary oedema (ACPE) due to acute exacerbations of congestive heart failure (CHF), but also (amongst others): exacerbations of chronic obstructive pulmonary disease (COPD), asthma and pneumonia (Gray et al, 2009; Wesley et al, 2011).The use of CPAP as an adjunctive treatment for ACPE patients in front-line ambulances has been proven to improve patient outcome, preventing them from reaching the ‘point of no return’ and a downward spiral into total respiratory failure.This article will discuss current UK ambulance practice and examine the issues surrounding the introduction and use of CPAP as an adjunctive therapy in the treatment of ACPE, secondary to acutely exacerbated CHF, whilst also briefly discussing its use in other aetiologies of breathlessness.

The significance of the Keogh Review

Sir Bruce Keogh's report on the first stage of his review into urgent and emergency care (NHS England, 2013), published 13 November 2013, presents a significant step in the progression of the paramedic profession.

Continuing Professional Development: The causes and paramedic management of bradycardia in the out-of-hospital setting

OverviewThis Continuing Professional Development (CPD) module will outline the normal anatomy and physiology of the heart before considering the paramedic approach to causes and management of bradycardia in the out-of-hospital setting. There are a number of self-directed activities to complete as you move through the article together with a list of further resources to expand your research. This article requires the reader to have a basic appreciation of normal cardiovascular anatomy and physiology, and an appreciation of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.Learning OutcomesAfter completing this module you will be able to:• Define the normal anatomical and physiological cardiac processes involved in maintaining heart rate and cardiac output.• Define bradycardia in adults.• Identify the causes of bradycardia in adults.• Outline how bradycardia is managed by paramedics.

Book Review

Some recently-reviewed books have left me scratching my follicly-challenged head as to their relevance to the JPP readership, so hope then for my hair line (receding faster than the outgoing tide) when another in the successful ABC series emerges.

Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature

Sepsis is increasingly common and has a high mortality rate. Sepsis can be difficult to identify and patients with severe sepsis often initially present to the ambulance service. Lactate testing has been utilised successfully in other healthcare settings to assist with the identification of septic patients and stratification of illness severity.A focused literature review has revealed that pre-hospital lactate testing has shown benefits to clinicians pre-hospitally in the identification of septic patients presenting to the ambulance service. Only four pieces of primary research were identified and small sample sizes and variability of lactate testing limit the generalisation of the findings. Further research is required to fully investigate the potential benefits of using pre-hospital lactate testing to identify those patients with sepsis, severe sepsis and septic shock presenting to the ambulance service.

Understanding a new model of leadership

Leadership is an essential feature of the life of a paramedic. During incidents, whilst working with multi-agency colleagues, and within organisations, leadership is an expected quality of paramedics. Across health and social care organisations leadership is said to be of pivotal importance to future success. This has led to a large investment in leadership development programmes that organisations are now seeking to justify. Leadership as a concept is, however, complex and multifaceted. The nature of leadership has been debated over millennia and still disagreement exists as to how to define it. This paper utilises Critical Interpretive Synthesis to consider how approaches to leadership have developed over time. It concludes with a synthesising argument that leadership is a social construct; as such no single definition will ever be appropriate; however, the four elements that comprise the leadership equation should be considered if the paramedic leader is to be effective.

Air Ambulance National Conference 2013 and Awards of Excellence

Awards of ExcellenceThis year also saw the Association of Air Ambulances' inaugural Awards of Excellence. Held in the evening following the conference, the Awards were open to all air ambulance operations within the UK and nominations were made from patients, staff, management and the general public.BBC television presenter Louise Minchin hosted the awards, her bubbly demeanour and genuine admiration for the nominees being well received by all. She was aided by noted GP and comedian Dr Phil Hammond, who added a number of comic interjections and moments of light relief.Of the awards themselves, four were won by members of the London Air Ambulance (LAA), including: Gareth Davies as Air Ambulance Paramedic of the Year, Dr Anne Weaver as Air Ambulance Doctor of the Year, and Captain Neil Jeffers as Air Ambulance Pilot of the Year.The Lifetime Achievement Award went to LAA's Dr Gareth Davies, who was recognised for his role in pioneering the ‘doctor on board’ model for air ambulances, taking life-saving surgery and advanced pain relief from the hospital to the roadside.Other winners were Poppy Young, for the Outstanding Young Person Award; Janice Flower, who was named Charity Staff Member of the Year; and Jenny Ashman, who was named Charity Volunteer of the Year.The Air Ambulance Campaign of the Year went to Devon Air Ambulance for their ‘Devon Ambulance on Tour’, and the Special Incident Award went to Dorset and Somerset Air Ambulance.The AAA Chairman's Award was presented to Clive Dickin, for the great work he has done for the air ambulance community since taking up the position of National Director of AAA.Following the awards ceremony, Dr Hammond performed a stand-up routine consisting of excerpts from his current tour. Recounting numerous mishaps he had as a junior doctor, the health commentator couldn't have had a better audience, as guests were equally shocked and amused at his younger self's clinical judgement, providing an excellent end to the day's events.

Comment from the editor

In the Journal of Paramedic Practice Volume 5 Issue 9, an anonymously written letter on pages 496–7 included an alleged quote that was clearly attributable to the Medical Director of the North West Ambulance Service NHS Trust, Professor Kevin Mackway-Jones. The quote claimed that Professor Mackway-Jones was not interested in research and that he believed it didn't work.

The inaugural UK student paramedic conference

Lecturer's perspectivePostscriptAs a Professor in the Division of Paramedic Science at the University of Hertfordshire, it was particularly exciting to attend a national event that individuals from our own Student Paramedic Society initiated—from conception of the idea through to final delivery. The programme was packed with relevant sessions and activities, and the nature and quality of the presentations were superb. The actual organisation of the event itself and the attention to detail culminated in a delegate experience that, in my opinion, equalled (and in some cases surpassed) other professionally organised conferences that I have attended over the years. Our thanks and congratulations should be offered to everyone involved, both front of house and back stage.The large number of students attending from other universities and ambulance trusts just serves to illustrate the appetite for this type of event, highlighting future possibilities for the paramedic student body around the country. The delegates engaged in critical questioning on topical issues surrounding clinical practice and the future of the paramedic profession. If the commitment apparent at this conference, by delegates, organisers and presenters alike, is any gauge for future developments in out-of-hospital unscheduled and urgent care and the paramedic profession in general, then things look extremely promising.

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