Volume 5 Issue 5

Implementing the JRCALC Guidelines

Last month saw the publication of the long overdue and eagerly anticipated updated version of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Guidelines for use by UK Ambulance Services (JRCALC, 2013), the first major re-write since 2006. Seven years is a long time in terms of clinical care, so it is not surprising that the new guidelines reflect some significant changes and it may take a while for all of these changes to be assimilated and introduced into clinical practice. The main changes have been collated and presented on the Association of Ambulance Chief Executives (AACE) website (AACE, 2013) and are accessible for all to read. The publication of the guidelines is just the first part of what could be a protracted implementation programme where employers decide whether or not they are going to make available all of the drugs that now appear in the guidelines, and whether or not they will embrace all of the recommended changes to practice or adopt them with some local variation such as different timing, dose, sequence or removal of elements of the guideline.

Pre-hospital ROSC in cardiac arrest: how important is it?

Paramedics make difficult decisions every day, but few carry more consequences for the patient than the decision whether to transport people who are in cardiac arrest, or to stay on scene continuing the resuscitation attempt. The colloquial phrases ‘stay and play’ and/or ‘load and go’ are often heard in ambulance station crew rooms referring to these decisions.

Looking at the information resources available for paramedic practice

What is evidence-based practice?The NHS invests in library and information services and electronic resources to support clinical practitioners in developing and delivering evidence-based services. This definition of evidence-based medicine summarises the intention of using the best and most current research to inform clinical practice:Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.(Sackett et al. 1996)Evidence is contained in leading medical and allied health research journals, summaries and analysis of current published research around a specific topic, e.g. systematic reviews, and in reports, guidelines and reports of best practice.

International student paramedic exchange: the student perspective

An annual student exchange between Liverpool John Moores University (LJMU) and Centennial College of Ontario, Canada, has taken place within the paramedic programmes of each educational institute since 2009. The exchange allows students to take part in observation shifts on ambulances and gain an overview of healthcare systems within a different national setting. It also allows students to gain lifetime friendships and links to students and colleagues within the paramedic field on an international basis. This article gives the perspectives of five students who have taken part in this exchange, from both Centennial College and Liverpool John Moores University, looking at what each of them has gained from the experience, and how it will benefit their future careers.

Investigating gout: taking a new approach to an old disease

Gout is a very painful and common form of acute arthritis, which is becoming increasingly prevalent in many Western societies. Gout was first identified by the Egyptians and is caused by a disorder of the body’s purine metabolism, resulting in raised serum uric acid level, known as hyperuricaemia.Gout tends to affect the older population, particularly obese patients and others with rather negative lifestyle habits, such as a high alcohol intake. However, in the majority of patients suffering from idiopathic gout (75–90%) the evidence suggests that these patients may actually have a genetic disposition to the reduced renal excretion of urate acid.Gout has a rapid onset and the most commonly affected joint is the first metatarsophalangeal, although other joints can also be affected such as the mid-foot, ankle, knee, wrist, finger and elbow.Recommended gout treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids. Preventative treatments include allopurinol, which aims to lower uric acid levels. The definitive diagnostic test for gout is the aspiration of the joint or tophus and the confirmed identification of monosodium urate crystals. The presence of urate crystals confirms a diagnosis of gout and the absence of evidence of infection will rule out the key differential diagnosis of septic arthritis.

Understanding the process and treatment of meningitis and meningococcal disease

Meningococcal septicaemia is a potentially life-threatening disease process which requires early recognition and rapid management in both pre-hospital and hospital phases of patient care. It is estimated that there are around 3 500 confirmed cases annually in the United Kingdom and, as such, widespread campaigns and national guidelines have been developed and adopted throughout NHS trusts. Standard treatment protocols have been developed and adopted to manage patients appropriately; however, other emerging treatment options are becoming more widely acknowledged, but require further investigation before recommendations can be made. It is vitally important that clinicians in patient-facing roles who are likely to come into contact with meningococcal-related diseases adopt a high index of suspicion, basing diagnosis on history, physical examination and clinical investigations. Rapid intervention should be undertaken for any patient where the disease process is suspected.

Assessing the accuracy of Internet-based patient information for whiplash

Objective: The aim of this study was to evaluate the quality and reliability of websites which provide information to patients on whiplash injury using an Internet search tool.Methods: On the application of inclusion criteria, 16 relevant websites were found that met the criteria. These were evaluated using the DISCERN tool, which assesses and scores the reliability and quality of consumer information for health problems. The maximum possible score awarded for an excellent website is 80.Results: Of the 16 websites scored by DISCERN, the majority fell below the maximum. The highest score achieved was 63 and the lowest score 30.Conclusions: The results confirm that clinicians should ensure that they direct patients only to high-value validated websites so that they access appropriate and accurate information.

Social media: the good, the bad and the ugly

With everyone writing about social media—particularly in healthcare—one can’t help wondering if like every other area of IT, health and social care professionals are again on the back end of the early adopters curve.

The prevalence of non-urgent 999 calls: service users’ perspectives

Factors that motivate people to initiate 999 emergency ambulance services for non-urgent healthcare needs remain an area that is poorly understood. With increasing demands on emergency ambulances, it can be argued that the pressure to utilise healthcare resources effectively has never been higher.

Exploring the developmental need for a paramedic pathway to mental health

The following article discusses an organisational development need of a national ‘Mental Health Pathway’ to enable paramedics to provide the appropriate care for people who present mental health issues. The Department of Health acknowledges the huge modernisation of the ambulance service in England and faster access to people with immediate life-threatening conditions; however, the service is also responding to an increasing number of patients who have an urgent primary care need, which includes mental distress, as opposed to clinical emergency.The Department of Health (2009) policy calls for a ‘new vision’, where the ambulance service could increase efficiency and effectiveness towards patients who are experiencing non life-threatening emergencies. The key aims are to form a programme of advancement to address both improving mental health and accessibility of services for people with poor mental health. The vision of the policy is that by 2020 mental and physical health will have equal priority. The development of a mental health pathway within the ambulance service may help to reduce admissions or re-attendance, while improving care for patients.An evidence-based approach is used to provide a balanced, logical and supported argument within a reflection of practice. This is evaluated against a hypothetical patient’s case study, which reflects common issues faced by paramedics and ambulance technicians. The analytical process considers patient, professional, organisational and multi-disciplinary team perspectives.

Continuing Professional Development: Clinical leadership for paramedic practice

OverviewThe aim of this CPD module is to outline and describe the concept of clinical leadership for paramedic practice and the ambulance service. Clinical leadership has been defined as ‘the ability to both create and sustain an organisational culture of excellence through continual development and improvement’ (Pintar et al, 2007: 115). Clinical Leadership sets out to focus and motivate individuals within an organisation to facilitate their achievement of clinical and professional aims.Learning OutcomesAfter completing this module you will be able to:• Provide an overview of the concept of clinical leadership for paramedic practice• Outline relevant leadership theories• Describe some clinical leadership concepts and how these apply to paramedic practice• Explore some practical examples of clinical leadership in the pre-hospital setting

Continuing Professional Development: Basic pathophysiology of shock

OverviewThis continuing professional development (CPD) module will focus on the basic underlying physiology of shock; an acute syndrome of inadequate tissue perfusion. Shock is a medical emergency requiring urgent attention and transport to hospital. Given its vast aetiological range, it is an important topic for paramedics and ambulance staff to understand.Learning OutcomesAfter completing this module you will:• Appreciate the physiology of the cardiovascular system in health.• Understand the categorisation of shock.• Be able to describe the aetiology and presentation of haemorrhagic, septic and anaphylactic shock, and formulate a basic management plan.

Continuing Professional Development: Decision making for paramedic practice

OverviewMaking decisions is something we all do several times a day. For the majority of the time, such decisions are made unconsciously or certainly with little regard or much thought or insight into the decision making process itself. However, some of life's bigger decisions tend to be taken more seriously and we often consult with others, such as family, friends and colleagues, undertake some research, or look at various websites before making these choices.In your clinical and professional paramedic life, many of the decisions that you make on a daily basis can vary enormously; from saving someone's life, to deciding which health care professional to refer a patient to. All are undertaken with perhaps little thought to the decision making framework or theories that underpin your practice.As many of your decisions are fundamental to patient care, it is important to have a greater understanding as to how we reach the decision that we do, why we make them and how we could improve on them. This Continuing Professional Development (CPD) module will explore some of these supporting processes and how they specifically relate to paramedic practice.Learning OutcomesAfter completing this module you will:• To provide an overview of the historical and philosophical background to decision making• To identify the key concepts for decision making• To outlines some of the decision making models and frameworks• To explore the application of these models and frameworks for paramedic practice

Book Review

So here they are at last, the much anticipated (and overdue) Clinical Practice Guidelines 2013. Last published in 2006 under the auspices of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), these latest guidelines have again been developed with JRCALC, Warwick University and National Ambulance Service Medical Directors group input, but now under the umbrella of the Association of Ambulance Chief Executives.

Introducing the UK’s first student paramedic society and conference

The beginningThe Student Paramedic Society at the University of Hertfordshire was founded by two students in January 2012, with the aim of providing convenient opportunities for students to attend guest lectures, workshops and practical activities that would support their professional development. Our first event was held in March 2012, and was a small workshop looking at the Mental Health Act (2007) and the Mental Capacity Act (2005). The workshop was led by Sue Putman, clinical lead for learning disability and mental health with South Central Ambulance Service, and was attended by 30 students. The feedback was extremely positive, and students left feeling much more confident about appropriate use of the two acts in their practice. The feedback encouraged myself and co-founder Adam Kenningham-Brown to go on and arrange future talks.April 2012 saw over 70 students fill a lecture theatre for our second event. The topic was acute coronary syndromes (ACS) and the ECG, led by consultant paramedic Mark Whitbread. Over two hours Mark delivered an excellent session that gave students from all stages of the programme the knowledge to accurately diagnose common ECG presentations, and manage the ACS patient appropriately. Mark also highlighted the ongoing work of the London Ambulance Service (LAS) to establish care bundles for this specific patient group, and students received an aide memoire to remind them of best practice.Just a week later we held our final event for the 2011/2012 academic year, covering ‘End of Life Care and Recognition of Life Extinct’. Over three hours, just fewer than 50 students were given an update on the work currently underway to establish a National End of Life Care programme for the ambulance service. The event was delivered by David Whitmore (senior clinical advisor, LAS) and Georgina Jones (End of Life Care project coordinator, LAS). Common ‘End of Life Care’ emergencies were covered, as well as paramedic use of rescue medication and how to determine validity of a DNA-CPR document. Such an interesting topic generated questions and discussion throughout, and we ran over by an hour (this would have been longer if we had let David continue).

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