Volume 7 Issue 12

End-tidal CO2 monitoring in the pre-hospital environment: more than just endotracheal tube placement confirmation

Ambulance clinicians can encounter critically ill and injured patients in many unpredictable and challenging environments. The delivery of care and optimising use of all available equipment is essential. Effective measurement and interpretation of end-tidal CO2 (ETCO2) monitoring in relation to a patient's clinical state may be one of the most valuable and potentially underused tools available to pre-hospital clinicians.This article will highlight the benefit of ETCO2 monitoring in the pre-hospital field beyond endotracheal tube placement confirmation. It will discuss the importance of ETCO2 and how it is used in other healthcare settings. An overview will also be given to the devices used and how they work. It will conclude that ETCO2 is a powerful tool which needs to be used, understood and embraced by pre-hospital clinicians.

Pre-hospital treatment of supraventricular tachycardia: a literature review

Background:Tachycardia is a common finding within the unwell patient and can occur as a normal physiological response or as a result of an underlying arrhythmia. Supraventricular tachycardia (SVT) is a common cardiac arrhythmia which can be treated through a range of differing techniques. The aim of this review was to identify whether the current evidence base supports UK paramedic practice and whether the treatment provided could be enhanced.Methods:A literature review through the databases CINAHL, Pubmed and Medline was carried out, using a Boolean search strategy. Articles were included within the study if they discussed the management of SVT through the use of the Valsalva manoeuvre, carotid sinus massage or adenosine within the hospital or pre-hospital environment.Results:A total of 32 papers were identified for possible inclusion, with 18 papers being included. The Valsalva manoeuvre was shown to be the most effective vagal manoeuvre, with reversion rates of 21.4–27.7% within the pre-hospital environment. The use of adenosine was shown to be effective in reverting SVT, with most total reversion rates being 80.7–100%. The initial 6 mg dose was shown to have lower efficacy than the subsequent 12 mg doses. Correct paramedic identification rates of SVT were greater than 75%.Conclusions:The Valsalva manoeuvre has been shown to be effective and potentially more effective the quicker it is used following onset of the SVT. The safe use of adenosine by paramedics within the US and Australia support the introduction of adenosine into UK paramedic practice.

An introduction to black humour as a coping mechanism for student paramedics

Black or gallows humour has long been recognised as having therapeutic value, particularly when used by individuals dealing with traumatic incidents. With this in mind, it is no surprise that this type of humour is commonly used by emergency services personnel. It is a bona fide coping mechanism which can contribute to the resilience, health and wellbeing of emergency services personnel but one which, to the uninitiated, may appear callous and uncaring. With student paramedics now taking the higher educational route into paramedicine, they will have had less exposure to ambulance service culture before qualifying than would have been the case with the old ‘in service’ pathway. This often results in the type of humour employed by their new colleagues coming as something of a culture shock. This article hopes to go some way to explain why this type of humour is employed, what purposes it serves, and prepare students so that it may appear less shocking when they first encounter it.

Continuing Professional Development: Understanding and identifying upper airway infections

OverviewThis Continuing Professional Development (CPD) module will look at conditions that affect the upper respiratory tract including pharyngitis, laryngitis, tonsillitis, tracheitis, epiglottitis and croup. It will review the anatomy and physiology of the respiratory system, before considering typical medical presentations and possible treatment options for paramedics.Learning OutcomesAfter completing this module you should be able to:Identify the most common conditions affecting the upper respiratory tract.Understand the anatomy and physiology of the respiratory system.Recognise what treatment should be given to patients presenting with upper respiratory tract conditions, and where appropriate, convey to A&E.

Paediatric cardiac arrest: time to ‘stay and play’?

Outcome for paediatric out-of-hospital cardiac arrest (OHCA) is generally poor, with survival reported as less than 10%. Those who do survive are likely to have an unfavourable neurological outcome. This retrospective observational analysis study examined the relationship between on-scene time and improved survival. The study also examined which pre-hospital interventions may lead to improved survival. The researchers had a focus on the length of time on scene, level of care (basic/advanced) and administration of fluids/medication.

Dr Colville Laird emphasises importance of collaboration at AAA National Conference

Working together in pre-hospital careFollowing a brief welcome from AAA national director, Clive Dickin, Hannah Sebright, AAA vice chair, outlined the challenges facing the air ambulance sector. The keynote presentation was then given by Dr Colville Laird, chair of the Faculty of Pre-Hospital Care, who explained how he was tasked by the organisers of the conference to deliver a ‘controversial’ talk. Coming under the enigmatic title of ‘Air Ambulances, Budgerigars and Formula One’, Laird highlighted the importance of working together in pre-hospital care, as the result is better than the sum of its parts. He emphasised that air ambulances are only part of a very big system in pre-hospital care and that the Faculty of Pre-Hospital Care is encouraging interaction between all levels of care provider.Dr Nick Crombie, clinical lead for Midlands Air Ambulance, then discussed some of the possibilities of pre-hospital research. Crombie explained how the current evidence base in the pre-hospital environment is weak and that we need organisational systems to enable research. He noted that because a high proportion of current research is hospital driven, it is often extrapolated into the pre-hospital setting, or based on anecdote.After a short break for coffee, Dr Dindi Gill, consultant in emergency medicine, spoke on Wales Air Ambulance and the setting up of the Emergency Medical Retrieval and Transfer Service (EMRTS). Launched in April 2015, the service aims to stabilise and transfer the most critically-ill and injured patients to hospital by road and air, ensuring they receive the best life-saving care.Erica Ley and Ryan Jones of Essex and Herts Air Ambulance Trust then gave a talk on the use of positive end-expiratory pressure (PEEP) in patients with traumatic head injury, considering whether it improves survival. Presenting the results of a number of studies, they explained how intracranial pressure tends not to increase with PEEP and that there is contradictory evidence regarding appropriate levels of PEEP. A decrease in mean arterial pressure is a uniform finding and PaCO2 levels can increase if alveoli are hyper-inflated instead of recruited. However, they mentioned that they could not find any data on the use of PEEP for traumatic brain injury in the pre-hospital environment, and so pointed out that further studies are needed.The final talk before lunch was given by Fraser MacKay of FEC Heliports, outlining the good, the bad and the ugly of helipads. According to MacKay, elevated helipads represent the good of helipads, as they offer the greatest choice of obstacle-free helicopter airways. The bad refers to helipads that are built at ground level. These are less expensive than elevated helipads, but take up more space. The ugly was explained as non-conventional operating sites with little or no marking, limited visual clues and no lighting.

Third annual UK Student Paramedic Conference welcomes largest cohort yet

‘Set yourself up to succeed, not to fail and remove fear’Andy Thomas, former paramedic research fellow in the RAF, and current clinical specialist, kicked the day off with his presentation on the successes of battlefield surgical airways and the possible implications for civilian practice. He shared his unique insights on the potential causes for a disparity in adjunct placement success rates between British and US Forces, suggesting that the standardised British approach may be responsible for reductions in bandwidth depletion and consequent error. He rounded his talk off by highlighting the importance of training for success, invigorating attendees with what he called his final ‘golden nugget’: ‘Set yourself up to succeed, not to fail and remove fear.’

Aiding staff to recover from injury and return to work

Since The Ambulance Services Charity (TASC) was formed earlier this year, we have been continuing to raise awareness of the vital advice and support services the charity is making available to both serving and retired ambulance personnel, and their families and dependents in times of difficulty, bereavement and urgent need.

Professionalism in the face of terror

It is with great sadness that November will be remembered for the worst attack on France since World War II and the deadliest in the European Union since the Madrid train bombings in 2004. On Friday 13 November, multi-site terrorist shootings in Paris left 130 people killed and over 300 in intensive care. A state of emergency was declared by President François Hollande, and temporary border checks introduced. While the outcome of the attacks left the country devastated, it is worth highlighting the proficiency at which Paris organised an effective medical response to the attacks, which ensured that many lives could be saved.

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