The trials and tribulations of pre-hospital research

This UK-based study investigates Paramedics' perceptions of research in pre-hospital settings with a particular emphasis on clinical trials.

Seamless communication for HART paramedics saves lives

Safe, effective communication is integral for the Hazardous Area Response Team paramedic. James Price explains the communications solutions the teams employ.

Understanding public protection: a moral maze

Anna van der Gaag comments on the findings from the Health and Care Professions Council commissioned study by the Picker Institute that explored the concept of public protection and fitness to practise.

A study into pre-alerts to North East hospitals for sepsis

A study of sepsis patients pre-alerted into hospitals was conducted in the North East of England from October 2011 to March 2013. This study was conducted to assess the effectiveness of the introduction of a sepsis education programme, which included a sepsis screening tool, and to try and establish the number of sepsis cases encountered by paramedics in the region. The results of this study show that the number of cases pre-alerted into the hospitals increased with the introduction of the screening tool, and gave some indications as to the number of sepsis patients encountered in pre-hospital care. We interpret the increase in pre-alerts as an increased awareness of sepsis, but see little impact on the treatment delivered by paramedics. We draw some conclusions on the number of suspected cases of sepsis seen in the pre-hospital environment but without linking to hospital data are unable to give definitive figures.

Exploring emergency airway management techniques for paramedics

Any patient's condition can deteriorate rapidly and for many different reasons. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management and the key to the management of an airway is through a thorough assessment to firstly ensure whether the airway is patent or not. This paper will discuss airway management in the emergency and intensive care setting.

National Allied Health Professionals Informatics Strategic Taskforce

As we know, the past six months has seen a great deal of change within the Health Service. This change has, as with everywhere else, been evident within the informatics department of the NHS, with the new Health and Social Care Informatics Centre (HSCIC) coming into operation at the beginning of April. This new department is vitally important to all future developments within the Health Service and was emphasised when Mark Davis visited the National Allied Health Professionals Informatics Strategic Taskforce (NAHPIST). Mark is the director of clinical and public assurance, and it was in this meeting that the power of the information we all create was highlighted. In future, all developments within patient care will have to be supported by evidence, and information technology (IT) will support these rather than vice versa, as has been the case in some NHS change programmes. Not only this, but the information we produce will have to be made available to this new body when they request it; therefore, the way information is collated will have to be robust, accessible and in a format that can be easily transferred.

Paramedic RSI can mend hearts as well as minds

In this retrospective cohort study, Kwok et al investigated survival to discharge status in cases of non-traumatic cardiac arrest where endotracheal intubation (ETI) was attempted by paramedics in a metropolitan emergency medical services (EMS) system in the USA.

End of life care in the community: the role of ambulance clinicians

Ambulance clinicians are frequently called to patients who are approaching the end of their life. This article presents an overview of some of the issues that impact on the delivery of care to patients at the end of life, including symptom and urgent care needs in the last few days of life, preferences for care/place of care and coordination of care. Each of these areas pose different challenges for ambulance clinicians. As a way of addressing some of the issues, this article outlines an online education package in end of life care, which has been specifically designed for ambulance clinicians in response to an analysis of their training needs. The learning outcomes and educational approach is described. The education aims to help equip ambulance clinicians with the knowledge and confidence that they need to deliver high-quality urgent end of life care.

The need for paramedics to be able to identify cauda equina syndrome

Cauda equina syndrome (CES) is a rare but serious neurological emergency, which may require urgent neurosurgical intervention. If left untreated it can lead to devastating consequences of paraplegia with bladder or bowel sphincter deficits. It is the experience of the authors that this is a condition that pre-hospital clinicians may encounter but does not currently feature in all paramedic education curricula.This article looks at what the cauda equina is and how CES can occur. It describes the common signs and symptoms as well as identifying those which should be considered as red flags in practice.After also considering the medico-legal aspects associated with the incorrect or delayed diagnosis of cauda equina syndrome, the authors will recommend that this condition should feature on the future curriculum of all paramedic education and should be a differential diagnosis, considered whenever a clinician assesses a patient with back pain, especially of a non-traumatic nature.

The role of the Health and Care Professions Council

John Donaghy responds to Mike Brady's question on the Health and Care Professions Council (HCPC) and paramedic regulation in the May issue of the Journal of Paramedic Practice 2013.

Diabetes mellitus: balancing blood glucose

This case study seeks to explore the pathophysiology of diabetes mellitus and the effects that this condition has upon the individual. The aetiology of diabetes mellitus will be discussed, in conjunction with an analysis of clinical signs and symptoms presented by the disease reflecting the underlying pathophysiological processes. Clinical treatment options will also be discussed, in relation to their influence on the management of disturbances in the underlying disease process. In line with patient confidentiality guidelines (Department of Health (DH), 1997), patient-identifiable information will be omitted.

Clinical placements in residential care facilities part 1: positive experiences

Objective: This paper analyses aged care clinical placements undertaken by undergraduate paramedic students participating in the Wicking Dementia Research and Education Centre's ‘Teaching Aged Care Facilities Program’. Student views on positive learning experiences during placement are identified in order to support further development of high-quality evidence-based clinical placements.Setting: A cohort of final year undergraduate students (n=17) completed a 5-day clinical placement in two participating residential aged care facilities in Tasmania, Australia.Method: The research involved the collection of qualitative data during weekly student feedback meetings whilst on placement that were recorded and transcribed. Quantitative data from pre- and post-placement questionnaires were collected and analysed using IBM SPSS Statistics 20.0.Results: Positive learning experiences identified by students include: an increased understanding of dementia and dementia palliation; development of ‘soft skills’ such as empathy and communication skills; and improved understanding of the operations of residential aged care facilities.Conclusions: Paramedic practice is an emerging discipline that needs to consider the positive learning experiences identified in this analysis. This will facilitate further development of quality, evidence-based models of undergraduate paramedic student learning in residential aged care.

The importance of awarding excellence

Last month marked the announcement of the recipients of the Queen's Birthday Honours, which recognise individuals who have made achievements in public life and committed themselves to serving and helping Britain.

Continuing Professional Development: Critical thinking for paramedic practice

OverviewThis CPD Module will focus on the concept of critical thinking for paramedic practice and the various models that you can use in order to develop your critical thinking skills. The more astute amongst you will notice that the models presented and discussed might be familiar to you as those used in assisting you with reflecting on your practice. However, by developing these models further, it is possible to understand that these models are not simply a tool by which to describe and highlight various issues from a clinical incident, but about beginning to develop a life-long approach to challenging and learning from these incidents.Learning OutcomesAfter completing this module you will be able to:• Understand the key concepts of critical thinking• Provide an overview of reflective and reflexive practice• Explore the theories of reflection-in-action and refection-on-action• Describe and explain the four critical thinking models for reflective learning

Book Review

It appears that I have become somewhat of a magnet for reviewing pocket drug guides, as yet another one has made its way onto my reading list. It is, however, unlikely to make its way onto my book shelf.