Volume 6 Issue 4

Shock horror! How accurate is the PHTLS classification of hypovolaemic shock on scene?

Pre-hospital assessment and management of major trauma is challenging, and this research highlights some of the complexities confronting ambulance staff when encountering these events. The purpose of this retrospective study was to validate the pre-hospital trauma life support (PHTLS) classification of hypovolaemic shock, derived from the advanced trauma life support (ATLS) guidelines.

Is interprofessional teaching enhanced through peer-assisted learning?

The concept of interprofessional teaching and learning is not new to education programmes for healthcare professionals in the UK as can be evidenced by, amongst other things, the creation of the Centre for the Advancement of Interprofessional Education (CAIPE) (www.caipe.org.uk) back in 1987.

Decision making for refusals of treatment—a framework to consider

Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.

What makes clinicians decide to use spinal immobilisation? A review of the literature

Current practice of spinal immobilisation appears to be based heavily on historical practice rather than scientific precedence. Evidence shows that it is common practice to immobilise patients, yet studies demonstrating the benefit of this is limited. The decision made by the clinician to immobilise a patient is based on fear of reprisal, caution and ritualised practice rather than robust clinical assessment or a definitive criteria. A global, standardised criteria and robust immobilisation method is yet to be established.This article will examine and critically analyse existing literature surrounding patient immobilisation following a suspected or confirmed acute neck injury. In particular, literature on the use of a cervical collar and head blocks and the use of clinician decision tools will be critically analysed.

Is there a lawyer on board? In-flight emergencies and other Good Samaritan acts

The legal liability of paramedics and other health professionals who perform Good Samaritan acts, particularly in response to in-flight emergencies on commercial aircraft, is a topic about which there is disproportionate and largely unwarranted concern. It is often a surprise to many people that English law imposes no ‘duty of rescue’ and also makes no special provision for the person who does intervene as a Good Samaritan.The common law principle is that a bystander has no legal obligation to come to the aid of another person but, if they choose to do so, then they must exercise due care and may be liable if they fail to do so and end up causing harm.This article explains the concept of the ‘duty of care’ in relation to paramedics and other health professionals, highlighting circumstances when they may be liable for negligence, and provides guidance for dealing with in-flight emergencies.

Student perceptions in relation to Paramedic Educator (PEd) roles

This article examines student paramedics' perspectives of the Paramedic Educator (PEd) role, focusing on specific mentoring qualities that impact upon their learning. Furthermore, it aims to identify ‘mentoring’ issues specific to the paramedic profession. The study used semi-structured interviews with university paramedic students. The key attributes of a ‘mentor’ as identified in the nursing and healthcare literature were found to be relevant to the paramedic profession. Participants identified current challenges in practice specific to the paramedic profession. Questions are raised regarding the extent to which the culture of mentorship within ambulance services is sufficiently established to support students and PEds; the status quo poses significant challenges for students wishing to join the profession.

That's what the country can afford

Following the government's recent announcement that the NHS Pay Review Body's proposed 1% pay rise would be paid to some but not all NHS staff, Ian Peate argues how it undervalues health care workers and goes a long way from producing a happy and engaged workforce.

The Independent Ambulance Association set to tackle training standards

Anita Human explains how the IAA's Training Framework will reinforce the importance of providing a consistent and standardised approach to the focus and delivery of skills and training, enabling UK-wide recognition of training standards in the independent ambulance sector which is patient focused, educationally sound and valued by commissioners.

Supporting ambulance service development

Following mounting pressures on England's emergency care services, the NHS Confederation's Urgent and Emergency Care Forum has brought together organisations from across the whole health and care system to debate, develop and share ideas for improving urgent and emergency care. The resulting briefing published by the NHS Confederation, which incorporated findings from a survey of 125 senior NHS leaders and an analysis of national data, highlighted a concern that only ‘sticking plaster’ solutions were being offered to overcome pressures placed on A&E departments, rather than solutions which focus on the long-term challenges ahead (NHS Confederation, 2013).

Book Review

Following on from last month's review which had a ‘research’ theme, this book takes it a step further and is concerned with interpreting research using regression methods. For those of you not overly familiar with research paradigms, this is essentially the interpreting of research findings using a variety of statistical methods.

Continuing Professional Development: Basic pathophysiology and the BTS/SIGN guidelines for treatment of asthma in adults

OverviewThis Continuing Professional Development (CPD) Module will focus on the basic underlying mechanisms of disease in asthma: a chronic respiratory disease characterised by recurrent episodes of airway constriction.Learning OutcomesAfter completing this module you will be able to:• Appreciate the respiratory pathology responsible for the clinical presentation of asthma.• Appreciate the current range of treatments widely used to control chronic asthma.• Cover the essentials of transporting a patient to definitive care during a severe asthma attack.

Continuing Professional Development: Capnography

OverviewThis Continuing Professional Development (CPD) Module will discuss the principles of partial pressures of gas, how the partial pressure of expired carbon dioxide is measured and review examples of the waveforms produced by ventilated patients.Learning OutcomesAfter completing this module you will be able to:• Define capnography and demonstrate an understanding of how it is recorded.• Discuss the merits and limitations of the three main ways of presenting capnography.• List the indications for capnography.• Describe the four phases of a normal capnograph waveform.• Develop an awareness of capnograph waveform deviations and misinterpretations.• Have an appreciation of how capnography relates to arterial carbon dioxide levels and the normal values.

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