Spotlight on Research

Real-time feedback in simulation: does it improve CPR performance?As the title alludes to, this study took place across 10 European emergency medical services with the aim of determining if real-time objective feedback, while training on manikins, improves CPR quality among professional pre-hospital EMS healthcare providers. The study also looked at whether competition between participating sites and, indeed, between the individual participants, had an effect on motivation to train, and improve performance (as has been suggested by other studies).Standard protocols (European Resuscitation Council 2010 adult and paediatric guidelines) and standardised bag valve masks (BVM) were used, and identical manikins were provided to simulate both adult and infant scenarios for out-of-hospital cardiac arrests (OHCA). The study was carried out over two stages, 6 months apart.Each of the 10 EMS sites recruited 20 pre-hospital healthcare professionals to participate in the study. Stage 1 provided objective assessment (for later analysis) of the participants' performance in standardised adult and infant cardiac arrest scenarios. Participants worked in two-person crews and no feedback was given during or after the scenarios.The participants were also asked to complete a demographic questionnaire including role identification, length of time since professional education, last CPR assessment and recent OHCA clinical experience. Before participating in Stage 2 (6 months after Stage 1), site training co-ordinators were encouraged to motivate their crews to practise with standardised equipment provided for the study, which enabled real-time feedback.Stage 2 was a repeat of Stage 1 and reassessed CPR performance. It also repeated the questionnaire, but with extra questions about how many times they had practised between the stages and what they thought about the value of objective feedback during training.An independent samples Student's t-test and Chi square Asympt. Sig (2-sided) test were used to analyse the questionnaire data. The mean objective CPR scores and the 95% confidence intervals calculated for both stages were analysed (more detail in main paper).In the adult scenarios there was an increase in the overall CPR score from 81 in Stage 1 to 95.1 in Stage 2: with an increase of 10.8 mm in the mean depth of compression, a reduction in the mean rate of compressions per minute from 116.4 to 111.8, and a reduction in mean overall leaning (-1.0 mm). In infant scenarios there was an increase in the overall CPR score from 55.1 in Stage 1 to 86.5 in Stage 2: with an increase of 7.4 mm in the mean depth of compression, a reduction in the mean rate of compressions per minute from 127.2 to 116.7, and a reduction in mean overall leaning (-1.8 mm). Interestingly, key EMS site information, while not part of the research, highlights the diversity of size of the sites and staff roles.Results showed no statistically significant difference between demographics in both stages at the sites. The study suggests that the real-time feedback while undertaking CPR manikin training appears to significantly improve adult and infant CPR performance (the improvement being greater in infant CPR), especially when frequently practised. The findings also indicate that competition between participants appears to motivate staff to perform the training.The researchers felt that there was a limitation in terms of the sample numbers, with only 20 individuals per site selected as a convenience sample, and they would have preferred a larger sample size.This paper will be of particular interest to those who engage with the education and training of CPR for EMS staff and students, and to all practitioners with regard to the usefulness of real-time feedback in practice sessions, where that equipment is available.

Mass-gathering medical care: a retrospective analysis

Background:Patient care at mass-gathering events presents a unique challenge both in terms of organisation and the delivery of care.Methods:We carried out a retrospective analysis of women and children attending the designated first aid area of a large-scale international annual religious event in Alton, Hampshire in the United Kingdom (UK). Data analysis was done for the years 2011–2013, inclusive.Results:There was a consistent increase in attendees with an associated rise in the total number of patients. The top 10 medical conditions encountered remained similar throughout the years 2011–2013. There was a significant burden of chronic conditions in our cohort.Conclusions:This study adds to the body of knowledge by providing conditions that are commonly seen in a large-scale mass gathering setting. The patient demographic highlighted in the results can be used to plan and prepare for future mass gatherings in many different contexts.

Teaching to encourage deep learning in paramedic science students: a case study

The needs of the modern NHS requires a paramedic who can analyse complex data, make increasingly complex decisions and use evidence to inform treatment plans to ensure quality in patient care. The student paramedic will not simply acquire these qualities, rather higher education should be focused on teaching that encourages deep learning. If successful, the design of teaching and learning will ensure that, upon graduation, a paramedic has the skills of critical thinking, autonomous practice and lifelong learning that will enable them to provide the best care for patients. This article is a case study examining the design of a series of lectures about history taking. The lectures were designed specifically to encourage deep learning in paramedic students. The design of teaching and learning activities is explored alongside current evidence, to assess the extent to which deep learning was achieved among the students. Throughout the article it is evident that a deep approach to learning in higher education is crucial if the profession is to meet the needs of patients and the NHS.

Emergency medical services (EMS) and waste: a review of the literature on sustainable EMS waste management

Waste management contributes significantly to the financial costs and carbon footprints of healthcare organisations, thus contributing to climate change and subsequent harm to health. Increasing efficiencies and the introduction of sustainable waste management practice within healthcare organisations, including emergency medical services (EMS), could reduce associated CO2 and other greenhouse gas emissions while reducing costs, enabling funding to be reinvested in patient care.This article aims to contribute to the discussion of sustainable healthcare waste management, particularly within EMS, and provides a review of the literature on this topic. The literature suggests there is a growing interest among EMS in the efficient use of resources and there has been some gradual change in practice, including the introduction of sustainable waste management practices. The literature also reveals that empirical research discussing greenhouse gas emissions associated with EMS is limited, particularly in regard to waste management. The evidence indicates that there is scope for further research investigating the environmental impacts of EMS. Such research could specifically investigate the CO2 emissions associated with EMS waste management and interventions that might reduce these emissions, with the potential sequelae of cost savings or income generation.

Training versus education: the terminology

Learning for pre-hospital clinicians is often defined by the terms ‘education’ and ‘training’. However, there are constrasting views on what constitutes each. Craig Mortimer looks at the difference between these two terms, and considers whether the way they are used impacts upon the individual learner and their development.

Book Review

ABC of HypertensionThis month's review sees a return to a familiar text and an equally familiar subject: hypertension. Clinicians will need little introduction to such a common medical condition but before this text is resigned to the darkest corner of your now well-stocked personal library, consider just how much you actually know about this most ubiquitous of conditions.There is no need for me to wax lyrical about the ABC format again nor the credibility of the authors, which is par for the course for this series. The content covers the more familiar areas of hypertension, such as causes, related health problems and actually obtaining a blood pressure (do you really know how to perform this properly?). Management of hypertension by both the patient and clinician is given rightful prominence, although a cheeky reference to increasing your five-a-day to seven-a-day did not go unnoticed. I have some development issues there.Given this book is now in its 6th edition (first published in 1981), the authors have emphasised recent evidence-based developments in regard to combating hypertension and actually preventing it in the first place. Food for thought for all of us (no pun intended). The pathophysiology of hypertension is succinctly presented in itself, but the impact it has on associated comorbidities and the complications it can generate necessitate further reading, and inevitably, reference to more specific texts. As always, the ABC approach only goes so far.Consistency, however, is the hallmark of the ABC genre and further reading is suggested in the guise of journal articles, web resources, clinical guidelines, professional organisations and other reading material identified for further study in this area.I suspect this text won't appeal to everybody, especially those engaged in a medical specialty. But for students, more generalist clinicians and of course us paramedics, a good understanding of hypertension necessitates that volumes such as this, however thin, should make for compulsory reading.

RCEM conference places health and wellbeing of clinicians at heart of sessions

Alex Sanders-Page, hazardous area response team paramedic, South Western Ambulance Service Foundation Trust, summarises the key messages for paramedics at the Royal College of Emergency Medicine Scientific Symposium 2015.

World Stroke Day highlights continuing need for rapid assessment and transport of stroke patients by paramedics

This year's World Stroke Day, held on 29 October, illustrated the increased risk of stroke for women compared to men. Graham McClelland provides a background to the condition and the role paramedics play in the stroke patient's journey, emphasising the importance of pre-hospital stroke research in improving outcomes.

2015 Resuscitation Council (UK) Guidelines feature expanded section on pre-hospital resuscitation

On 15 October 2015, the Resuscitation Council (UK) published the 5-yearly update on resuscitation guidelines. Not only does this include updates to basic life support (BLS), advanced life support (ALS), and neonatal and paediatric resuscitation, but also includes a detailed and expanded section covering pre-hospital resuscitation, aimed at all those involved in pre-hospital care, but particularly ambulance paramedics.

Reducing winter pressures on the NHS

As the days get shorter and colder weather sinks in, the media has been awash with its usual smear of headlines questioning how the NHS will cope this upcoming winter. The NHS experiences winter pressures every year, as the rise in the number of people admitted to hospital leaves services at breaking point. However, despite planning for this spike in attendance, it remains ever difficult to manage the challenges that are faced and meet the growing patient demand.