Volume 5 Issue 8

Single-dose activated charcoal as a pre-hospital treatment for self-poisoning

This article aims to find and evaluate current available evidence to determine whether the known clinical benefits of orally administered single dose activated charcoal would justify its use in a pre-hospital ambulance setting. A search of medical databases resulted in evaluation of four studies considered to be of sufficient quality to answer the clinical question. The article acknowledges that further research is desirable into the long-term benefits of pre-hospital charcoal and that much current evidence relies on a reasonable extrapolation of benefit from toxin biomarker data in clinical trials. Nevertheless, it recommends that sufficient evidence now exists for ambulance services to consider its use in cases of self-poisoning attended by ambulance paramedics within one hour of toxin ingestion as recommended by NICE (2004) Clinical Practice Guideline Number 16: Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Recent recommendations lowering the threshold of hepatotoxicity requiring hospital admission to 75 mg paracetamol per kg bodyweight (National Poisons Information Service, 2012) will undoubtedly increase the number of overdoses of the drug encountered by crews where charcoal may prove of benefit.

TOPCAT2: an expert response to out-of-hospital cardiac arrest

Improved quality of pre-hospital resuscitation in out-of-hospital cardiac arrest (OHCA) in Edinburgh, Scotland has been accomplished, in part, through the introduction of resuscitation team leadership supported by a programme of audit, feedback and training for ambulance crews (Lyon et al, 2012).

The implementation of the new health and care system

The key function of the Department of Health (DH) is to help people live their lives better and for longer. The DH has the overall role of leading, shaping and providing funding for health and care in England; it is charged with ensuring that people receive the support, care and treatment that they need, along with the compassion, respect and dignity that they deserve. Along with the DH the new and changing health and care organisations are working together to accomplish this common purpose.When national priorities have been set the DH enables and supports health and social care bodies to deliver services according to these priorities, as well as working with other parts of government to achieve this. The DH sets objectives and budgets and they hold the system to account on behalf of the Secretary of State for Health. The Secretary of State for Health has ultimate responsibility for guaranteeing that the whole system works in unison to meet the needs of patients and the public.

The A&E crisis: the burgeoning effect on paramedics

The Government's response to the pressure in emergency and urgent care revolves around improving local system management in the short term and restructuring care for the medium term. Urgent Care Boards (UCBs) have been created to implement emergency care improvement plans in the local area. However, it was felt by the Committee that UCBs would not be able to implement reforms and influence commissioning. Confusion over a number of features of UCBs, including whether they are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups, has led the committee to conclude that although UCBs have the potential to provide local system management, they currently lack clear direction or executive power (HCHH, 2013a).

A pilot international exchange programme for paramedic students

RationaleStudy in other countries is viewed as a strategic goal for many universities, as it promotes understanding of world issues affecting society, cultural competence, and international engagement, which are valued graduate attributes. There are also social benefits for the student as well as opportunities for academics involved in the exchange programme through expanded professional and research opportunities.Monash University actively promotes international study as a strategic goal and a means of enabling global engagement. Graduate attributes include cross-cultural competence and the development of ethical values, and these are supported through exchange programmes with international partner institutions (Monash University, 2011). Although international study is widely promoted to students, exchange opportunities for paramedic students in Australia are currently limited. One reason for this is the relatively few number of undergraduate university level paramedic programmes outside the country. However, there are many similarities between paramedic practice in Australia and the UK, which is reflected in the curricula for bachelor level paramedic programmes in both countries. This provided an opportunity to pilot an exchange programme between two universities in these countries.

Understanding the difference between overweight, obese and bariatric

Emergency care providers cannot help but notice that there has been an increase in obese and bariatric patients. This article discusses the differences between people who are overweight, obese or bariatric, and explores the ways that obesity can affect a person's health. The impact of this on the management of over-sized patients and the service delivery of emergency care professionals is outlined.

Clinical placements in residential care facilities part 2: negative experiences

Objective: This paper analyses clinical placements undertaken by final year undergraduate paramedic students in residential aged care facilities. Barriers to effective teaching and learning are identified in order to tailor such placements to better meet future health system demands.Design: The research employed qualitative methodology using thematic analysis to identify key themes in the data.Setting: A cohort of final year paramedic undergraduate students (n=17) completed a five-day clinical placement in one of two residential aged care facilities in Tasmania, Australia.Method: This component of the research involved the collection and analysis of qualitative data from student and mentor feedback meetings during placement.Results: Barriers to teaching and learning while on clinical placement were identified and categorised into a number of key themes. These include: a lack of clarity of the placement structure, inadequate clinical liaison support, and limited contact with residents and facility staff.Conclusions: Developing placements that consider the barriers to effective learning identified in this research will facilitate further development of quality, evidence-based, best practice models of undergraduate paramedic student learning in residential aged care facilities.

Appropriate morphine administration by paramedics: a review of the literature

Objective: This paper focuses on three main areas: pain management practices for paramedics; in service continuing education programs and, possible pain-management differences between two levels of paramedics.Methods: A literature search was performed using four databases to identify literature reviews and journal articles from 1997 to 2013. The search was focused around three core areas: 1) Pre-hospital pain management 2) barriers to pain management; and 3) pain management education. There was a five stage process to identify the relevant literature based on specific terminology in the abstracts.Results: The literature search located 1 240 articles, incorporating five stages with each stage having specific terms relevant to the research. Thirty two articles met the inclusion criteria. The breakdown of the articles included stage one – 6 articles, stage 2 – 10 results, stage 3 – 11 results, stage four – 5 articles and stage 5 – 0 articles.Conclusions: There remains little high-quality published evidence of systemic theoretical approach with which to validate many aspects of pain management in paramedic practice. Future research must identify if concepts taught in the classroom are being transferred to the clinical setting. Potential findings of such a study could be used to improve organisational awareness of factors that contribute to the behaviour and development of paramedics.

Women's preferences on ECG electrode placement

An interesting phenomenon has been identified in hospital settings with evidence that a greater number of males presenting with acute coronary syndrome receive more cardiac investigations and more treatment than females. There is some evidence that this is also occurring in pre-hospital settings (Daudelin et al, 2010).

Rhabdomyolysis: an overview for pre-hospital clinicians

Rhabdomyolysis is a potentially life-threatening condition that occurs when muscle tissue breaks down, leading to the release of the cellular contents into the circulation. There are broad ranges of causes for this, both physical and non-physical.This article aims to introduce pre-hospital clinicians to what rhabdomyolysis is, the causes of the condition, and also discusses the implications for pre-hospital practice before outlining management.The authors highlight how many of the causes for the condition are frequently encountered in pre-hospital practice and how even those cases which may appear initially simple, such as the elderly fall, can be complicated by rhabdomyolysis in as little as an hour.Finally, recommendations are made for more work to be undertaken to understand the frequency with which patients encountered by ambulance services go on to develop this condition, as well as encouraging those responsible for producing national guidelines to include this condition in their future publications.

Continuing Professional Development: Thermoregulation and heat illness

OverviewThis Continuing Professional Development (CPD) Module will first outline the scientific principles behind heat transfer, before moving on to discuss the body's physiological response to changes in temperature. Finally, we will discuss the pathophysiology and treatment of heat illness before concluding with a series of multiple choice questions.Learning OutcomesAfter completing this module you will be able to:• Describe mechanisms of heat transfer, and utilise this knowledge when devising treatment plans for patients exposed to extremes of temperature.• Understand the importance of physiological mechanisms employed by the body in order to maintain constant internal temperatures, both at rest and when exercising.• Describe the range of conditions within the umbrella term ‘heat illness;’ their aetiology and groups most at risk, the potential progression of the illness, and common treatment strategies.

Personal Reflective Learning Log

Original Articles Some of the key original content in this edition of JPP includes:Rhabdomyolsis: an overview for pre-hospital cliniciansSingle-dose activated charcoal as a pre-hospital treatment for self-poisoningAppropriate morphine administration by paramedics: a review of the literatureThe following space is provided for you to reflect on how any of these articles might relate to, affect, influence of impact upon your practice. Have any of these articles struck you as particularly interesting? Do any of the articles raise questions for you? Have any of them made you want to read further around a particular area? Do you find any of them challenging?

Yorkshire Ambulance Service CEO, David Whiting, joins College of Paramedics

What were your reasons for joining the College of Paramedics?I wanted to help to raise the profile of this important membership organisation that is focused on developing the paramedic profession. As a registered paramedic, I believe the College is best placed to lead on the development of the paramedic profession, particularly relating to raising the profile of paramedics, developing the curriculum and in delivering continuing professional development through a range of activities. I am also keen on a personal level to access the CPD opportunities to help in maintaining my registration.

Book Review

I won't be breaching any literary boundaries by suggesting that the nature of paramedic practice has evolved beyond recognition in the past four decades. But one literary work which may just do that is the ever-present Emergency Care in the Streets. First published back in 1974, this was seen as the text to accompany the very first national curriculum for paramedic training in America—the content of which can also be attributed to the book's author.

Obesity: the human and financial burden

A quarter of the adult population of the UK are now obese and nearly 2% are morbidly obese. The co-morbidities associated with obesity include type two diabetes, sleep apnoea, cancer, depressions and arthritis (NHS Information Centre 2010). The impairment to quality of life and the disability caused by these conditions carries an enormous human, social and financial cost; in 2007 these costs to the wider health economy were estimated to be in the region of £3.2 billion. Obese patients are proven to have a higher prevalence of limiting, longstanding illnesses, and obesity is also known to decrease life expectancy by seven years in a 40-year-old, increasing up to the age of 75 years.

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