Pain and suffering: how do we treat both?

This study explores the experience of ‘suffering’ from the patient's perspective. Although undertaken in an emergency department (ED), it has clear relevance for other healthcare professions.

Registered paramedics in Gibraltar: the student perspective

Gibraltar is a British Overseas Territory located on the southern end of the Iberian Peninsula at the entrance of the Mediterranean. It has an area of 6.8 square kilometres (2.6 sq miles) and a northern border with Andalusia, Spain. The Rock of Gibraltar is the only landmark of the region. At its foot is the densely populated city area, home to almost 30 000 Gibraltarians. Although Gibraltar has a small geographical area, there is a large annual tourist and migratory workforce influx, a naval base, a busy port and airport combined with a more typical elderly community population.

Can multi-disciplinary simulation-based training improve patient safety?

It has long been recognised that the emergency department (ED) carries a high risk of adverse events due to its extensive usage by patients with varying acuity levels of injury and/or illness, frequent interruptions of staff during the delivery of care, the need to administer treatments often with limited information about patients’ clinical histories, and the involvement of multi-disciplinary teams comprising a variety of healthcare professions.

End of life care co-ordination

The College of Paramedics recognises the importance of pre-hospital clinicians being aware of patient decisions and preferences for their care when approaching the end of their life. Electronic Palliative Care Coordination Systems hold such information, which can be accessed by ambulance services and other health and social care professionals to support the provision of care for palliative patients, according to their wishes.

A clinical audit of the pre-hospital paediatric respiratory assessment in London

Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient's age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the non-compliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.

The transnational delivery of paramedic education: the Gibraltar case study

Higher education is becoming increasingly more international, with both governments and universities seeking to expand beyond traditional markets as globalisation increases. The internationalisation of education is a broad term that describes the ‘process of integrating an international, intercultural or global dimension into the purpose, function or delivery of post-secondary education’ (Knight, 2003). Transnational Education (TNE) is a more defined area of internationalisation, where students are able to study a higher education course away from the host country (British Council, 2013)This article is a case study account with personal reflections of an example of the transnational provision of higher education to develop paramedic services in an overseas region. In November 2013, a small cohort of students successfully graduated from an HCPC validated paramedic programme in Gibraltar.

Is there scope for an observational pain scoring tool in paramedic practice?

In the pre-hospital environment, attending an older person can pose many challenges, including a lack of a detailed history, polypharmacy and co-morbidities, as well as a lack of out-of-hours support to name but a few. These challenges are enhanced further when the patient is cognitively impaired by syndromes such as dementia.There appears to be very little research available into how the pain of older people with dementia is assessed and managed by paramedics.This article highlights a literature review that was carried out to explore the evidence base and possible implementation of the Abbey Pain Scale, with the view of conducting a study in the near future. Particular focus is made on the education and training required to implement the tool, other environments where it has been adopted, as well as benefits and limitations.

Clinical forum: automated chest compression devices

Kevin Barret, course leader for the BSc(Hons) Pramedic Practice course at the University of Brighton, chairs a discussion on automated chest compression devices, considering their efficacy, ease of use and when they should be employed.

Continuing Professional Development: Common paediatric illnesses part one—identification and management

OverviewThis Continuing Professional Development (CPD) module will focus on the identification and management of common paediatric illnesses, their history, epidemiology, key signs and symptoms, transmission, complications and specific treatments. This module will also present the current list of notifiable diseases in the UK.Learning OutcomesAfter completing this module you will be able to:• Identify and describe some common minor paediatric illnesses presenting in the pre-hospital setting.• Outline the treatment and management for minor paediatric illnesses.• Emphasise common and specific complications arising from minor paediatric illnesses.• Identify the key notifiable infectious diseases in the UK.

Emergency Medicine 2014

Day oneFollowing a welcome from the morning's chair, Prof Fiona Lecky, ScHARR, University of Sheffield and honorary consultant in emergency medicine, Taunton and Somerset NHS Foundation Trust, the conference began with a discussion of the state of emergency medicine services in the UK by Dr Clifford Mann, president, College of Emergency Medicine and consultant in emergency medicine, Taunton and Somerset NHS Foundation Trust. Dr Mann alluded to the media attention surrounding emergency care professionals in 2013, which arose as a result of widespread concern regarding delays in ambulance handovers, breaches of the four hour target and incidents of poor care. In response to the competing challenges of rising patient attendances, the College of Emergency Medicine published 10 priorities for resolving the crisis in Emergency Departments (also referred to as ‘CEM 10’), which clearly sets out the action which needs to be taken to address the current crisis in A&E.Prof Lecky then delivered a talk on the Head Injury Transportation Straight to Neurosurgery (HITS-NS) Trial, for which she is the chief investigator. The study aimed to assess the feasibility of conducting a clustered randomised clinical trial of early neurosurgery in patients with traumatic brain injury.After morning coffee, Prof Christoph Redelsteiner, scientific director, Emergency Health Services Management Program, Danube University, Austria, addressed the question: is there a need to standardise paramedic practice throughout Europe? Considering differences in the delivery of pre-hospital care of European nations and comparing commonalities, Prof Redelsteiner discussed criteria for a future pre-hospital care provider in a larger European context, that might help to deliver a more equal and balanced system.Drew Wemyss, head of strategy implementation, Scottish Ambulance Service, then discussed different alternative systems of care offered by the Scottish Ambulance Service as a result of strategic aims outlined in their framework document: Working together for better patient care. Focusing on the pre-hospital management of older frail people, Mr Wemyss highlighted the role of the ambulance service in providing high-quality clinical care and navigating patients to the right care, either through telephone or face-to-face clinical assessment.Following lunch, Dr Anil Hormis, consultant in anaesthesia, critical care and pre-hospital emergency medicine, Rotherham NHS Foundation Trust, gave a talk on simulation training and non-technical skills in pre-hospital emergency medicine. Outlining the importance of simulation training in the pre-hospital environment, Dr Hormis explained how it can be used to help cement skills such as decision making and task management in an environment where many different teams are required to work together. Dr Gareth Grier, consultant in emergency medicine and pre-hospital care, the Royal London Hospital and London's Air Ambulance, also delivered a talk on simulation, instead outlining the Royal London Hospital approach. Reiterating the difficulties faced by pre-hospital clinicians when placed in challenging environments, Dr Grier highlighted the benefit of high-fidelity scenario simulation. Perhaps the most thought-provoking take home message of the talk came when he said: ‘you get an expert and change them to a non-expert just by changing the environment.’The final talk of this session was delivered by Dr Kudakwashe Dimbi, mental health clinical lead, London Ambulance Service NHS Trust, on mental health difficulties in the pre-hospital environment. Given that patients suffering from mental health disorders make up a notable portion of the London Ambulance Service's workload, Dr Dimbi highlighted some of the considerations to take into account when providing care to patients suffering from a mental health disorder.The remaining talks of the day were intended as interactive treatment case studies; however, due to a somewhat apprehensive room of delegates, seemed to lack the ‘interactive’ element. That being said, this did not detract from the engaging content that was presented. Dr Mark Bloch, consultant anaesthetist, Aberdeen Royal Infirmary and Aberdeen Royal Children's hospital spoke on difficult airway management; Gareth Mallon, paramedic, East Midlands Ambulance Service NHS Trust, spoke on sudden cardiac arrest; and Dr Ron Daniels, chair, UK Sepsis Trust and chief executive, Global Sepsis Alliance closed the day with a talk on the management of sepsis.

Response to ‘Paramedic treatment—wherever that may be?’

Sally Boor, paramedic, East of England Ambulance Service NHS Trust responds to James Price's article on the Hazardous Area Response Team (HART), published in last month's issue of the Journal of Paramedic Practice.

What is happening in urgent care?

With problems concerning bed occupancy and capacity within A&Es becoming widely recognised, Rodney Jones, statistical advisor, Healthcare Analysis and Forecasting, considers the reason for this apparent lack of capacity and the implications for paramedics and the ambulance service.

Student paramedic recruitment drives

Last month it was announced that the East of England Ambulance Service NHS Trust (EEAST) was aiming to recruit 400 student paramedics as part of the service's turnaround plan which was issued in April last year (EEAST, 2013). The plan was brought about following criticism directed at the service as a result of poor response times, where it was felt that people could not be assured they would receive care in a timely and effective manner (Care Quality Commission, 2013).

The College of Paramedics supports the Ambulance Services Benevolent Fund

The College of Paramedics designed and produced two styles of pin badges in 2013, which have been available to purchase at national conferences, exhibitions and CPD events for the past year. We are delighted to support the Ambulance Services Benevolent Fund by donating £0.50 from the sale of each College of Paramedics pin badge to this most worthy charity.

Reviewing the standards of proficiency for paramedics

Following the recent consultation concerning the profession-specific standards of proficiency for paramedics which closed on 31 January 2014, Ian Peate outlines the role of the standards and how they impact a paramedic's ability to practise safely and legally.