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.
Front-line ambulance professionals often find themselves having to deal with intoxicated and hostile members of the public. Robert Kaiser urges that current help and support offered to paramedics needs to be reviewed.
Pain management is a complex area of patient care, especially when it involves children. This qualitative study undertaken in Dublin and Cork in Ireland set out to identify any barriers to effective pre-hospital paediatric pain management as perceived by a group of advanced paramedics (AP).
This study examines the clinical competencies of paramedics, critical care paramedics (CCP) and critical care doctors (CCDr) practising within the former Great Western Ambulance Service (GWAS). Between September 2012 and January 2013, researchers reviewed standard operating procedures, professional guidance documents, equipment available to the practitioner and clinical records, as well as conducting direct observations and surveying each professional group to determine their clinical competencies.
Airway management by pre-hospital care providers is often the subject of intense debate. It is recognised that there are wide variations in clinical training and skill fade is high among paramedics due to lack of experience and exposure (Hodkinson, 2010). Recent years have seen the development of a wide variety of video based laryngoscope devices, several of which have potential application to the pre-hospital field. There are a number of advantages and disadvantages to these devices, which are explored in more detail. Prior to any recommendations being made, further research including clinical trials would be required in the pre-hospital field, to assess the suitability of videoscope devices for paramedic airway management.
Increasing levels of obesity in Australia are having a direct impact on those associated with primary care and patient transport.Whether the patient movement is undertaken in the uncontrolled environment of the home or the controlled environment of the hospital, design features generally limit the use of equipment and the application of safe handling procedures.Ambulance and fire services are increasingly developing policies and procedures that address the movement of obese and morbidly obese (bariatric) patients and the purchase and use of equipment. Yet the efficacy of these procedures is hampered by the absence of a standard definition of the term ‘bariatric’. Various definitions of ‘bariatric’ are applied in different sectors and risk-based approaches rather than those based on weight, body dimensions or BMI may be more useful.Substantially more work is required to inform the development of intervention strategies that will lead to significant and sustained risk reduction. Further work is also needed to quantify the frequency of bariatric patient movement within the emergency services across Australia. A clear representation of the journey and the interfaces between the agencies and carers and their respective roles would assist with defining the problem and understanding the solutions.
Paramedics, by the nature of their work, often enter into unknown, critical and sometimes hostile situations. Danger can emanate from the patient, particularly if they are confused, in a state of panic, inebriated or psychotic, from friends and family, work colleagues, or from members of the public. In such situations the best advice is undoubtedly to withdraw and summon support. This paper, however, addresses those situations where that is either not possible or appropriate. A model for understanding aggression as it unfolds is offered together with an examination of the interpersonal defusing and de-escalating skills.
Sudden cardiac arrest is a life-threatening condition but is one that can respond well to timely intervention such as early defibrillation. The use of Automated External Defibrillators has been shown to reverse serious cardiac arrhythmias and improve patient survival. Automated External Defibrillators analyse patients’ cardiac rhythm and advise on whether or not a patient is in a cardiac arrhythmia that requires a shock as part of the resuscitation attempt. This paper will explore the use of these devices, providing information on when and how they are used.
BackgroundAmbulance based paramedics across the UK do not regularly experience large numbers of seriously injured trauma patients. Delivering trauma care to patients with life-threatening injuries within this environment can involve some of the most challenging decisions in a clinician's career. Faced with emotive, dynamic and unpredictable environments, paramedics need to be given appropriate education and opportunity to successfully manage this patient group. Anecdotal evidence, noted through the Helicopter Crew Course conducted by London's Air Ambulance (Varela et al, 2012), proves low-fidelity trauma care education is an achievable and effective way of delivering advanced trauma care education within the doctor and paramedic group. Using this unique approach with the right coordination, imagination, ethos and an operationally experienced teaching faculty, patient outcomes are inevitably improved. This method can also provide an inexpensive and credible way of delivering trauma care education to all ambulance based paramedics.
It is a sad indictment on society that there is scope for a book to be written on the dangers facing those who work in the ‘helping professions’, yet that is the position we are in. Whilst lamenting this state of affairs, some solace can be taken in the form of this book which is aimed at those professionals whose sole raison d'etre is to help others.
BackgroundThe course was devised and designed by Gavin Wright. Gavin, an emergency medical technician, holds a moving and handling instructors diploma issued by the combined awarding body of Oxford, Cambridge and the Royal Society of Arts (OCR). Responding to a gap in the market for instructor level training he, along with three other members of his family who were also from clinical backgrounds (child care, general nursing and mental health—two of whom were also clinical educators), formed a company specifically designed to tackle this shortfall. This company, latterly known as TLC Worldwide (TLC), in 1997 became the first to offer a five day moving and handling instructor's course through the Royal College of Nursing's Continuing Education Programme.Having had other and similar courses accredited through the Institute of Health Care Development (IHCD), Edexel, OCR and the CPD Certification Service, his work was recognised by St. James’ House in 2008, with the publication of the 60 Years of the National Health Service tome. This publication described the first 60 years of the UK’s National Health Service (NHS), outlining its chronology and development through that period. The various chapters gave a viewpoint of one aspect, such as medical and surgical equipment, which have been used and followed up with best practice awards.Chapter seven dealt with education, training and incentives. Best practice awards were given to 21 different organisations, such as King's College London, for continuing to find great medical pioneers, e.g. Nobel Prize winners Sir James Black and Maurice Wilkins. Another award winner was Blackwell UK for its continuing prolific publication of medical textbooks used in medical education the world over. TLC Worldwide received recognition for safe patient moving and handling training, and taking the concept to a worldwide audience.In 2009 Gavin took on the role of national moving and handling coordinator for the South African Moving and Handling Project (SAMHP). This project is aimed at developing moving and handling interventions in South Africa in their equivalent of the UK’s NHS, the National Health Insurance (Department of Health Pretoria, 2012). This is currently an advisory role, though big things are anticipated in the near future.Another development was the very popular Moving and Handling Instructors Newsletter of which Gavin is the author/web editor. This free online journal is accessed by individuals who are interested in moving and handling in 25 countries.Gavin has spoken at national conferences such as Naidex and the National Back Exchange (NBE). Naidex is aimed at both the public and care workers, while the NBE conference is aimed squarely at members of the healthcare professions who are interested in tackling musculo-skeletal injuries in the workforce and safer moving and handling of people.As Gavin has always been at the forefront of moving and handling development he joined the progressive team at Nordic Care Services Ltd in 2011. Nordic has a reputation of bringing innovative and practice changing products to the UK market. They also have a long history of exhibiting at major conferences and exhibitions. The formulation of a training wing was inevitable and so Nordic Care Training & Education Ltd (NCTE) was formed in 2012 as a not-for-profit company to expand the concept of safer patient handling.To keep his hand in at clinical practice Gavin works on ambulances during his frequent visits to South Africa and also conducts patient assessments with Nordic Care Services products whenever requested to do so by clinical staff around the UK.
A number of readers wrote to the editor responding to an article that was run last month on the increasing demands being faced by A&E departments and its effect on paramedics. Here are two of those responses.
While patient safety and treatment are the foremost concerns for practising paramedics, personal safety is often overlooked. Due to the nature of work undertaken by paramedics, the likelihood that they will encounter hostile and dangerous situations is high. The prevalence of binge drinking, which has become an increasing part of UK culture, has meant that many paramedics working night shifts are faced with inebriated and potentially aggressive patients. This combined with psychotic, confused or panicked patients, emphasises that this is very much a real problem that needs to be taken into consideration.
Original Articles Some of the key original content in this edition of JPP includes:▪ Videoscopes: an additional tool for managing the pre-hospital airway▪ Violence in the workplace: implementing the Instant Aggression Model▪ Impact of increasing obesity on primary health carers: an Australian perspectiveThe 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?