Volume 6 Issue 3

College of Paramedics draft response statement on sepsis

DRAFT: Response statement on sepsisThe College of Paramedics is aware of the recent publication by the Parliamentary and Health Ombudsman of Time to Act; Severe sepsis: rapid diagnosis and treatment saves lives.The College of Paramedics fully supports measures that improve patient care and the service offered to patients. It further supports the role which ambulance staff and those providing urgent and emergency care in the NHS, military organisations and private sectors play in the detection and initial treatment of those patients showing signs and symptoms of sepsis.The UK Sepsis Trust has worked with several UK ambulance services in the development of a pre-hospital sepsis screening tool for the early recognition of sepsis patients. These developments have included representation from the College of Paramedics which has seen the profile of the role of ambulance staff gain a much wider focus from those working in the acute setting. Work on the recognition and treatment of sepsis is not confined to England and the College further supports the work of clinicians in Scotland, Wales, and Northern Ireland in providing a national approach to the care of sepsis patients.The Parliamentary and Health Ombudsman report highlights that from the 37 000 people a year that die from sepsis, 12 500 lives can potentially be saved simply by early recognition and timely interventions.Dr Ron Daniels, Chair of the UK Sepsis Trust, recently told the College:‘Pre-hospital personnel are at the heart of this change, in streamlining the interface between community-based and acute sector care by screening for sepsis, initiating therapy and pre-alerting receiving units to ensure that the right team greets the patient on arrival.’The College encourages its members to review this report, support working together with community services and acute sector, and for employers to adopt these recommendations in providing seamless care in the early detection of sepsis which includes using the screening tool, initiating treatment by providing fluid therapy, oxygen (if appropriate) and giving antibiotics where available, and to alert the receiving hospitals of the patients diagnosis and condition. This will provide patients with the earliest opportunity to access the Sepsis Six care bundle approved in the acute setting.‘ We invite members to forward comments and suggestions regarding the draft statement (below) to membership@collegeofparamedics.co.uk before 30 April 2014 ’The College is also supporting the UK Sepsis Trust in its work to see the inclusion of sepsis into the NHS Outcome Framework and support the lobbying for sepsis to be included in Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.The College of Paramedics recognises the ability of its members to make a difference in patients’ lives while undertaking their roles as clinicians. The ability to prevent death or serious illness from the early detection and therapy of sepsis is highly valued by the College and demonstrates the pivotal role that pre-hospital personnel can play in reducing avoidable deaths and debilitation from this condition.The College of Paramedics will continue to contribute to discussions with the UK Sepsis Trust and work with all ambulance services throughout the UK, registered paramedics, military members and private providers to raise the profile of sepsis care and treatment.

Pressures of the job…

There is a growing body of literature examining the physical, psychological and emotional pressures of day-to-day life as a paramedic. This qualitative study was undertaken in Israel using a phenomenological approach as the researchers wanted to explore how paramedics experience and cope with critical incidents (CIs). They wanted to find out what impact these CIs had on the work and personal lives of paramedics and how these individuals managed their feelings and thoughts after the CIs.

Does paramedic rapid sequence intubation always have to be traumatic?

This retrospective review of rapid sequence intubation (RSI) of patients with non-traumatic coma by Mobile Intensive Care Ambulance (MICA) paramedics in Ambulance Victoria, incorporated examination of electronic patient care records for all cases where Suxamethonium was administered between January 2008 and June 2011.

Developing leadership in the UK's ambulance service: a review of the consultant paramedic role

Background:This study seeks to understand part of the emerging clinical leadership framework implemented in the UK's NHS ambulance services in recent years. The aim is to explore the relatively new role of consultant paramedics and understand their leadership activities in relationship to nationally determined requirements, and the challenges they face performing this crucial leadership role.Methods:Semi-structured interviews were conducted with all consultant paramedics in the UK in 2013. Thematic analysis and coding were used to analyse the data and identify emergent themes. Additionally, basic demographic data was collected for comparison against national requirements.Findings:The findings illustrated three key themes: credible clinical leadership, an emerging empowered profession, and role expectations. There is a clear indication that consultant paramedics are a key part of clinical leadership for the paramedic profession. However, they are challenged to remain clinically competent by undertaking regular clinical practice and providing visible leadership on the ground, while strategically taking the profession forward. Operational resistance and power issues were highlighted as some of the problems faced by these clinical leaders.Implications:The findings may prove useful for employers in reviewing their clinical leadership structures, and in workforce planning for future consultant paramedics. The paramedic profession and its professional body may equally find this study useful for informing future strategic planning.

Essex and Herts Air Ambulance: a focused case series for pre-hospital practice

Burns and scalds are relatively common in children and can be distressing for all involved. General principles of early management are to limit the progression of the burn through cooling, and to manage pain in order to perform a thorough assessment and improve the patient's experience. Assessment of burns includes an estimation of body surface area involved, an appreciation of the depth of burn, and the consideration of ‘special areas’ affected. A number of tools and guides exist that help standardise this assessment. However, it is impossible to truly know the size and extent of the burn during the first contact meeting in the pre-hospital environment as a burn matures and develops over the course of 72 hours. Treatment regimes are focused upon improving blood flow to the area of stasis, a fragile circumferential area between the zone of coagulation, in which the tissue is already unsalvageable, and the zone of hyperaemia, where blood flow to the surrounding tissues in increased.We report the case of a 2-year-old boy who sustained a scald to the abdomen after pulling over a freshly made cup of tea. We describe an approach to burns in children, in collaboration with parents. This case highlights the need for early adequate analgesia, thorough assessment, and triage to the correct hospital where the patient's injury can be appropriately managed. We also highlight areas in which an extended care service such as a helicopter emergency medical service (HEMS) team can help, particularly in terms of supplementary analgesia and transfer to specialist units.

Paramedics developing rapport with the elderly: a pilot study

Objective:The objective of this study was to investigate whether paramedic students’ active engagement with elderly patients would enhance their ability to develop rapport with elderly patients and what impact guided self-reflection would have on this.Methods:This pilot study utilised mixed methodology incorporating an interventional study design with focus groups. Paramedic students from Monash University, Melbourne, Australia participated in an engagement activity with independently living elderly residents. The Rapport Questionnaire (RQ) and focus groups were used to evaluate the project.Results:Eleven undergraduate paramedics participated (n=11). Data analysis of the RQ revealed three items to be statistically significant and have a large effect size: Confident (p<0.01, r=0.55), Empathetic (p=0.03, r=0.48) and Overall ability to develop rapport (p<0.01, r=0.58). The guided self-reflection group improved most substantially across three areas: Confident (p=0.09, r=0.37), Empathetic (p=0.18, r=0.29) and Overall (p=0.14, r=0.3), while the control group improved in the Empathetic item only (p=0.75, r=0.07).Conclusion:Student's recorded improved confidence, empathy and overall ability to build rapport with the elderly through this engagement activity. In addition, students who receive guided self-reflection displayed greater improvements in the above three areas than their control counterparts. The results were substantial and warrant further research in this area.

Paramedic attitudes to deliberate self-harming behaviour in Ireland

The National Suicide Research Foundation tells us there were 12 210 presentations of deliberate self harm (DSH) to emergency departments in the Republic of Ireland in 2012 (National Suicide Research Foundation, 2012). They note the highest rate of DSH was among 15–19-year-olds.The purpose of this article is to stimulate discussions and reflections among paramedics around DSH, to identify beliefs around this issue and perhaps, to challenge some of these beliefs.The paramedic may be the first point of contact for increasing numbers of mental health patients. Our focus is on repairing physical injuries with little attention being given to the patient's experience

Continuing Professional Development: Common paediatric illnesses part two—identification, management of infectious illnesses and the associated immunisation schedule

OverviewThis Continuing Professional Development (CPD) module is the second part of a series of two modules that focus on the identification and management of common, preventable paediatric illnesses, their history, epidemiology, key signs and symptoms, transmission, complications and specific treatments. This module will also outline the current childhood immunisation schedule in the UK.Learning OutcomesAfter completing this module you will be able to:• Identify and describe some minor, infectious paediatric illnesses presenting in the pre-hospital setting.• Outline the treatment and management for minor paediatric illnesses.• Identify the key notifiable infectious diseases in the UK• Demonstrate awareness of the current childhood immunisation schedule in the UK.

Book Review

The importance of evidence-based practice cannot be under-stated in a modern health service and within paramedic practice, the recent publication of the ambulance service clinical guidelines is testimony to that. Yet with the relatively recent evolution of higher education in our profession, the concept of conducting and interpreting formal research may still be alien to some.

Self-injury awareness for paramedics

On 1 March, people across the globe took part in the annual Self-Injury Awareness Day. Introduced around 15 years ago, its aim is to encourage people to be more open about their own self-harm, with mental health organisations making special efforts to raise awareness about self-harm and self-injury (LifeSIGNS, 2014a).

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