Volume 7 Issue 3

Spotlight on Research

Air ambulance tasking: which dispatch method is best?Despite their wide use throughout the UK, air ambulances remain a scarce resource but, as yet, there is no consensus on the best method to identify when they should be dispatched, especially in relation to patients with major trauma.This London-based, retrospective review of existing data (January 2008–December 2010) set out to demonstrate which of three dispatch methods was the most effective and accurate when identifying patients with serious injury. The three methods used by London's Air Ambulance include dispatch by a flight paramedic based on mechanism of injury (MOI), paramedic telephone interrogation of the caller (INT), and land ambulance crew request (REQ) once they have arrived on-scene.There are differences in the UK in relation to MOI criteria and what triggers dispatch of air ambulances but, for London's Air Ambulance there are six current criteria: fall over 6 metres, ejection from a vehicle, death of another person in the same vehicle, amputation (above ankle or wrist), entrapment under a vehicle (not motorcycle), person under a train.London's Air Ambulance dispatch paramedic screens the calls coming in to the London Ambulance Service NHS Trust (LAS) call centre and if any of these six criteria are identified, then the air ambulance will be dispatched immediately. Other traumatic calls (such as assault, stabbing, drowning, road traffic incident etc.) are triaged by the flight paramedic in the control room, who may need to gather further information by telephoning the original caller prior to initiating dispatch of the air ambulance. If there is insufficient information or the call is missed, then the LAS land crew can request air ambulance assistance once they have assessed the situation on-scene.ISTOCK/ALEXANDERCHERThe primary outcome for this study was accurate dispatch, which was defined as calls needing escort from the scene by the medical team to a major trauma centre, or where the air ambulance team carried out resuscitation on-scene. Inaccurate dispatch included calls where the air ambulance was stood down en-route or where the patient ultimately was left in the care of the land crew.During the study period, 2 203 helicopter dispatches were initiated: 417 by MOI, 1 375 after paramedic interrogation of the call (INT), and 411 after requests by the land crews (REQ). Results found that MOI dispatch was appropriate in 58.7% (245) of cases, paramedic interrogation in 69.7% (959) of cases, and crew request in 72.2% (297) of cases.No significant difference in accuracy was found between crew requests and paramedic interrogation of the caller (p=0.36). However, crew requests and paramedic interrogation were both significantly more accurate than MOI (p<0.0001).Mean time to dispatch was 4 minutes (range 1–34) for MOI, 8 minutes (range 1–56) for paramedic interrogation, and 21 minutes (range 2–61) for land crew requests.When dispatch criteria were applied away from the scene (MOI and INT), 80.2% of seriously injured patients were correctly identified, although this study identified an overtriage rate of 32.8% and an undertriage rate of 19.7%.The authors clearly identify the limitations of their study including the retrospective nature of the research, the missing data for 147 cases, and the reliance on the tasking paramedic to consistently document criteria for dispatch. Additionally, they highlight that when land crews cancelled the air ambulance team once it was en-route, this was classified as an inappropriate dispatch. However, no information was collected as to the reasons for the cancellations. Therefore, there was ambiguity as to whether the original dispatch was appropriate or not, for example, the initial decision to deploy the air ambulance may have been appropriate but the patient may have died after it had been dispatched.In conclusion, these findings support other studies which found that on its own MOI was found to be the least accurate method of tasking. This evaluation found that using a dedicated helicopter tasking desk staffed by a flight paramedic who interrogates calls was as accurate as land crew referrals, but has the added benefit of enabling faster dispatch of the air ambulance. However, overtriage still remains an issue with all methods and this requires further investigation.Spotlight on Research is edited by Julia Williams, principal lecturer, paramedic science, University of Hertfordshire, Hatfield, Hertfordshire, UK. To find out how you can contribute to future issues, please email her at j.williams@herts.ac.uk‘On its own MOI was found to be the least accurate method of tasking’

Excelerate Technology: responding to the evolving communications needs of the emergency care sector

Customer driven solutions, fit for the futureAs the communications requirements of the emergency care sector evolve, we continue our commitment to our customers by investing heavily in new ways to support paramedics in the field, through the use of resilient data, video and voice solutions.With our continuous customer interactions and investment in R&D, we strive to make our solutions ever more effective and user friendly. Our solutions are carefully tailored to the needs of teams working within high risk, high-pressure ‘hot zone’ environments, enabling them to deploy and use our resilient communications technologies confidently and effectively.We have invested in a range of market leading communications solutions that have been developed with specific emergency responder requirements in mind, including:‘RapidNet LTE’—our new private LTE communications network can provide secure and reliable data video and voice (i.e. VoIP and VoLTE) communications via laptops, smartphones and other mobile devices at an incident when terrestrial 3G/4G networks are unavailable.‘Reflex’—our innovative, lightweight vehicle mounted satellite communications (‘pod’) solution designed with rapid response in mind. Reflex enables the user to manage critical situations more effectively by being able to access and share information in real time when first at the scene.New advancements have been made to our Digital Dashboard Management Interface (DDMI) with emergency responders in mind. DDMI, our easy to use operating interface, now includes the integration of physiological monitoring applications, so that paramedics can monitor the health of their teams as well as having the capability monitor patient vital signs at incidents.‘We are truly proud of the difference our solutions are making in emergency response and continue to push the boundaries of our technology for the benefit of our extraordinary customers'—Nicola Savage, sales and marketing director, Excelerate Technology Ltd.

A critical appraisal of the pre-hospital management of cervical spine injury in children and young people

Paediatric cervical spine injury (CSI) has been outlined in current literature as a research priority, where it has been included in the top 10 clinical research priorities by the Pediatric Emergency Care Applied Research Network. This article therefore aims to review the evidence base underpinning UK paramedic practice when managing children and young people at risk of CSI. In this article, particular focus shall be given to clinical practice challenges while exploring the risk over benefit debate of spinal immobilisation. Throughout this article, considerations for future research and of adopted future practice shall also be made.

Developing understanding and awareness of children's distress, distraction techniques and holding

Purpose:This project aimed to evaluate the influence of an education session on ambulance clinicians' understanding and awareness of children's distress, distraction techniques and holding in the pre-hospital setting.Methods:An inter-professional education session that focused on raising awareness of children's distress, the use of distraction techniques and clinical holding during pre-hospital care was provided. A mixed methods approach was then used to evaluate both existing and newly acquired knowledge and opinion through the use of questionnaires (n=26) and focus group discussion (n=20).Results:Despite literature suggesting that ambulance clinicians may not use distraction techniques during pre-hospital care, data gained from this project indicates that use of distraction techniques is widespread (92%, n=24) and has been adapted to fit within pre-hospital care. The inter-professional education event was reported as being of value for ambulance clinicians.Conclusions:Ambulance clinicians endeavour to provide a positive experience for children undergoing procedures, despite reported limitations in education, exposure and equipment. By using a collaborative and consultative education event, it is possible to facilitate ambulance clinicians to challenge their practice and improve their reported knowledge of dealing with children during procedures in the pre-hospital setting. Additional work needs to be undertaken to further explore and improve pre-hospital practice in relation to children's distress and clinical procedures.

Reflective practice for paramedics: a new approach

Reflecting upon practice is an essential process by which we can question, make sense of, clarify, and develop our knowledge and performance as clinicians. Unlike people who work directly with their peers and seniors, the opportunities for paramedics to discuss at length scenarios and cases with appropriate clinicians can be scarce. Johns (2010) identifies reflective practice as a means of professional supervision, which can act as our guiding peer when we need to step back and consider our practice in a structured and organised way. Developing clinical insight using reflective models is a key aspect in the training of the modern paramedic, and a necessary duty for qualified staff to undertake in order to ensure that their practice remains current. To be effective, reflective models must encourage the questioning of what we already know and do, and facilitate the broadening of our knowledge so that we may improve our practice and create new ideas. The author aimed to create a reflective model that fulfilled those requirements in a way that was as accessible to those who are familiar to structured reflection as to those who are new to the process, but was compassionate to the unique role of the paramedic.

A review of a self-diagnosed diabetic case study

This paper reflects on a case of a 26-year-old male taking medication for undiagnosed diabetes. The patient is resident in the United Arab Emirates (UAE) and while Federal Law does not place the same focus on patient confidentiality as UK law, all patient identifiable information has been anonymised in line with the Principles of Caldicott (Department of Health, 1997) and has received ethical approval.The purpose of this review is to critically analyse the effect of self-medicating for a self-diagnosed condition, in this case diabetes. The focus of the case study draws on multiple experiences in which a patient has self-diagnosed and implemented a medication regime without advice from medically trained personnel.

Community first responders: improving access to defibrillation in cardiac arrest

The benefits of early CPR and defibrillation together have shown to potentially increase rates of survival following out-of-hospital cardiac arrest considerably. Alan Weir looks at the implementation of community first responder and public access defibrillation schemes for improving access to care for patients in cardiac arrest.

Raising awareness of self-injury

How often do you come across someone who has hurt themself? Often enough, I might imagine, what with your particular line of work. How about people who have intentionally hurt themselves?

Paracetamol Overdose

OverviewThis Continuing Professional Development (CPD) module considers paracetamol overdose—both accidental and deliberate—in the pre-hospital setting, and presents an update on current practices that paramedics need to be conversant with in responding to what is a dangerous and potentially fatal situation.Learning OutcomesAfter completing this module you will be able to: Understand the pharmacology of paracetamol overdose. Identify the different categories of overdose. Understand the potential pre-hospital treatment options. Recognise the role communication plays in the management of a patient who has overdosed.

Book Review

Early Intervention in PsychiatryAnybody who works within the primary care sector will have doubtless experienced frustrations at what is often perceived as a paucity of mental health services readily accessible for their patients. Not necessarily different from other primary care services and as this book advocates, certainly not in keeping with the principles of early intervention.In many fields of medicine, early intervention will not only find favour with clinicians and patients but is also supported by an ever-increasing evidence base. This book, however, is concerned solely with mental health and certainly provides a comprehensive coverage of this area of health care. It addresses the most common psychiatric disorders across all age ranges and considers best available evidence. The content is delivered in such a way as to be digestible for a wide range of allied health professionals, not solely those with a specific focus on mental health.The principle of early intervention is predictably emphasised throughout and the stoic contribution which the voluntary sector makes in that regard is given due attention. But what really does make for an engaging read is how the contributors have chartered an obvious paradigm shift in the delivery of mental health services from the early 1990s to the present. In particular, the transformation from a generic mental health service model to a more individual approach, identifying and supporting those patients experiencing a first episode of psychosis.‘Digestible for a wide range of allied health professionals’Evidentially sound, but as to whether it is an accurate picture of mental health services in the community, I will leave that to your own reflections. A number of the contributors certainly bear testimony to the positive impact this change in approach has had. Even with my now customary middle-aged sourness, don't let that detract you from what is a compelling read.

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