Volume 7 Issue 7

Does paramedic intubation improve patient outcome?

And now for something completely differentThe second contribution to Spotlight on Research this month includes a summary of a research study which received one of the College of Paramedics' small grants for research: ‘A pilot study into the sensitivity and specificity of pre-hospital sepsis screening in the North East.’Researchers: Graham McClelland (North East Ambulance Service NHS Foundation Trust) and Jacqui Jones (South Tees NHS Hospitals Foundation Trust).Research question: How sensitive and specific is the pre-hospital sepsis screening tool (SST) used by North East Ambulance Service NHS Foundation Trust (NEAS) for detecting severe sepsis?Project aims: This project addressed the following aims:• 1. Estimate the sensitivity of the SST for detecting severe sepsis• 2. Estimate the specificity of the SST for detecting severe sepsis• 3. Explore the effect of paramedic detection and treatment of severe sepsis• 4. Inform the development of a larger, regional trial.We calculated the sensitivity and specificity of NEAS staff using the SST in practice which addressed aims 1 and 2. We changed the focus slightly as we realised that investigating the sensitivity and specificity of the SST was impractical in the sample we were able to collect. We also realised we were using the hospital SST as the gold standard to judge the pre-hospital SST against and as these are based on the same tool this would be meaningless. We documented the impact of NEAS detection of sepsis and NEAS pre-alerting for sepsis which addressed aim 3. Lessons have been learnt through the conduct of the project which can be used to continue this work on a larger scale, which would address aim 4.Results: The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity). An issue was identified with the SST used in that NEAS staff don't have access to lactate or white cell count which are both included in the tool. Many patients were identified as having severe sepsis based on lactate measured at hospital.Conclusions: It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Triggering symptoms for sepsis and severe sepsis are documented but sepsis is not being recognised or documented. Point-of-care lactate may improve identification of severe sepsis.If you would like further information on this study, contact Graham McClelland, research paramedic, North East Ambulance Service NHS Trust on Graham. McClelland@neas.nhs.ukSpotlight 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

Length of professional education of paramedics and nurses at community colleges in the Northeast United States

Aim:To determine if the professional bodies of knowledge of paramedics and nurses are roughly equivalent for each discipline at the point of primary licensure.Methods:A list was compiled of all paramedic education programmes in the Northeast US states of Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey and Pennsylvania. Each programme was then surveyed to identify those institutions that offered college credit for their paramedic education programme and also had an associate's degree nursing programme. Northeast paramedic education programmes that were not accredited by the Commission on Accreditation of Allied Health Education Programs were then identified that offered college credit for their paramedic education programme and also had an associate's degree nursing programme.Results:In total, 23 colleges in the Northeast United States had both paramedic and registered nursing education programmes offered for college credit. Paramedic education required a mean of 41 credits compared to a mean of 37 credits for nursing education.Conclusions:While paramedics are less likely to have a college degree than registered nurses, their specific professional education programmes are equivalent. Further research is required to establish if the paramedic body of knowledge is both deep and complex enough that it is unsafe for non-paramedic registered nurses to be functioning in the pre-hospital environment.

Pain: highlighting the law and ethics of pain relief in end-of-life patients

As the world of palliative medicine is rapidly becoming a fixture in the pre-hospital field of practice, this article looks to explore the ethical and legal issues surrounding pain relief for end-of-life patients by paramedics.Particular attention is focused on the moral and ethical principles of care as proposed by Beauchamp and Childress (2008), as well as the legal aspects of care as set out by the European Court of Human Rights. Through the use of law cases, this article looks to demonstrate precedence for practice, as well as the implications that arise thereof.This article concludes that, although many aspects are still a grey area for paramedics, the depth of law cases, alongside the moral arguments, show that providing paramedics act with the best interests of the patient at heart and work within a multi-disciplinary team, the administration of analgesia to prevent suffering can be legally and ethically proven.

A review of a self-prescribed medication regime in undiagnosed diabetes

The purpose of this review is to critically analyse how a single pathology can influence a patient's susceptibility to either beneficial or adverse effects of a self-imposed medication regime. The benefits and risks of polypharmacy, from self-medicating and substance misuse will also be considered. The review will also focus on the challenges posed by patients suffering with concurrent illness, identifying problems encountered and proposing tailored solutions while evaluating current evidence.

Emergency calls increase by 6.1%

In June, annual performance data for ambulance services in England were published by the Health and Social Care Information Centre (Workforce and Facilities Team, Health and Social Care Information Centre, 2015). It revealed that the number of emergency 999 calls presented to ambulance switchboards over the past year was 9 million. This represents an increase of 515 506 (6.1%) over last year's 8.49 million calls. To break this down, this is an average of 24 661 calls per day or 17.1 calls per minute.

Coventry University competes for Pilsen Cup of Paramedics

Day one: navigating night-time scenariosFriday night was the start of the competition. We were given a comprehensive kit bag and a mobile phone to receive our scenarios through. After dinner there was a brief for our team leaders, who we nominated earlier in the day by the diplomatic method of ‘shortest straw’, about the agenda for the evening. After this we were asked to wait in our hotel rooms until the phone rang giving us our first scenario.Our very first task was located a few miles down the road and thankfully, we were given a lift. Upon our arrival we were told that this was a major incident scenario. One person on the team acted as a controller and the other two as the first crew on scene. The scenario was set in the basement of a restaurant, initially in the dark using only head torches for light. We were met with some small obstacles and a child's play mat, portraying a village using dolls and cars to depict a major incident. There were several emergency service vehicles around the town and our task was to run a major trauma scenario acting as the first crew on scene with another team member as a controller some distance away. As a crew we were given a radio for communication and a tablet device with a slideshow showing the casualities involved in the collision and the extent of their injuries and vital signs. The controller also sat in the dark away from the scene, using just a head torch to move resource cards around and a radio to communicate any resources required by the on scene crew.Luckily, we were just finishing our module in clinical decision-making at university, including a day long taught session in major incidents and mass casualty treatment. After 15 minutes of lots of talking, sweating and a little confusion, this scenario finished and we were whisked off to wait for the next scenario. At this point we didn't really know how many scenarios we'd be doing but were told we should be finished by about 3 am. So, with adrenaline still rushing through our bodies, our second scenario came through a short while later.The controller passed details of a 30-year-old male patient, called Mr Novak, complaining of abdominal pain on the second floor of a hotel. Leaving our room, we were guided to the lift. After summoning the lift the doors remained closed but we heard people inside shouting, clearly in distress. After a little confusion and translation we established there was a woman in active labour inside and no way to get in. We briefly discussed the scenario and when told that no other resources were available, we concluded that the task was to give instructions to the people inside to deliver the baby safely. This ran smoothly with a positive result at the end for all in the lift…until we were questioned about Mr Novak upstairs. We all forgot about Mr Novak, something we found out later we were not alone in. This was a glimpse of what was yet to come and thankfully for us, the end of our night.Figure 1.Navigating across a river to rescue a man with suspected arm fracture

Book Review

Prehospital Trauma Life SupportOur American cousins have long since incorporated the management of major trauma into paramedic practice. Indeed, the evolution of trauma networks in this country was based in no small part on the model incorporated on the other side of the great pond. So it is of no surprise that the associated literature has evolved in tandem—witness the 8th edition of this text.While celebrating this wealth of material I am, if nothing else, consistent in my review of it, principally that a lot of the literature on trauma needs to be read in conjunction with that which is more specific to the underlying anatomy and physiology. And so it is with this. Highlighting procedures and techniques is one thing, understandingWhy they are performed is another entirely. It is not unreasonable for a paramedic to have to read widely on a subject as diverse and complicated as trauma, yet the authors have still managed to capture most aspects of major trauma in this volume.Even in accepting that elements of trauma such as mass casualty management and terrorist attacks are developing their own body of knowledge and skills, a credible overview is presented here. Another specialist area, paediatric trauma, is perhaps a little lacking in substance, although the priorities of care are still well identified. This is reinforced further through an excellent chapter on the ‘golden principles’ of pre-hospital trauma care, which is worth a read in itself.Trans-Atlantic differences are not difficult to spot—for example the section on airway management—so the reader should acknowledge that this has been written with an American readership in mind. But this book does demonstrate that it isn't just the Nancy Caroline legacy which prevails in paramedic literature from the US. The fact that this 8th edition has been endorsed by a number of professional colleges and trauma associations in America is testimony in itself. You can add my name to that list. Recommended.

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