Volume 7 Issue 9

Moving sepsis care to the front line: knowledge and views of pre-hospital clinicians

Background:Previous in-hospital studies have highlighted the opportunity pre-hospital clinicians have to recognise sepsis at an early stage. Left untreated, mortality in septic shock increases rapidly. Sepsis screening tools have been developed to assist recognition; however, current knowledge of sepsis, effectiveness of previous training and attitudes towards implementation of a screening tool is unknown.Methods:A survey was emailed to 529 paramedics and 131 advanced technicians in the North of England to determine their current knowledge of sepsis, views around previous training and the use of a screening tool. Case studies were included to investigate current management of patients with history of infection.Results:144 clinicians completed the survey, gaining a 21.8% response rate. 54% (95% CI 46%, 62%) of clinicians felt like they had good knowledge, leaving 46% of clinicians feeling a lack of knowledge. 94% (95% CI 89%, 97%) thought emergency departments should treat sepsis immediately or within the first hour. Case studies highlighted variability in the management pathways chosen and 98% (95% CI 94%, 99%) of clinicians required further training. 97% (95% CI 92%, 99%) agreed a screening tool would assist in the identification of septic patients and 98% (95% CI 95%, 99%) would use the tool.Conclusions:Severity level and importance of quick recognition and management are acknowledged among clinicians. Although response rate is a limitation of this study, knowledge levels differentiate greatly among the cohort and nearly all state they require further education. Clinicians agreed a screening tool would help identify septic patients and would use it alongside clinical acumen.

Essex and Herts Air Ambulance: a focused case series for pre-hospital practice

Due to the relative infrequency of major trauma in the paediatric population, along with the presence of family members during the resuscitation, management of trauma in this age group can be both emotive and highly challenging. Through comprehensive assessment, targeted resuscitation and considered triage to an appropriate paediatric trauma facility, pre-hospital care clinicians can help to improve outcomes in the paediatric trauma patient (Simpson et al, 2012; Nystrup et al, 2015).This article aims to provide a structured, evidence-based approach to the assessment and management of the injured child in the pre-hospital setting. We report the case of a 10-year old female involved in a pedestrian versus van road traffic collision (RTC). The principles of systematic assessment and holistic management of the paediatric trauma patient are discussed. We also discuss where an extended care service such as a Helicopter Emergency Medical Service may be of assistance.

Can paramedics treat sepsis?

Background:Sepsis is the most common time-critical medical emergency attended by UK paramedics but lacks the pre-hospital treatment options available for other common conditions. Sepsis treatment is simple, effective and quick to deliver and frontline paramedics may be able to significantly improve patient outcomes if empowered to recognise and treat sepsis.Methods:The Isle of Wight (IOW) Pre-hospital Piperacillin/Tazobactam (PrePip) project tested the concept that paramedics could accurately recognise and safely treat sepsis in the pre-hospital environment. By selecting two high-risk patient groups and developing new patient group directives and protocols for paramedic antibiotic delivery IOW sepsis treatment was radically altered to focus on early pre-hospital care.Results:The project showed that paramedics were highly effective in recognising sepsis in clearly defined patient groups with their diagnosis of sepsis being corroborated by in-patient consultants in 93% of cases. Paramedic-delivered interventions such as collection of blood cultures and administration of IV fluid and broad-spectrum IV antibiotics were shown to be both safe and timely.Conclusions:This project suggests that a new ‘call-to-needle’ paradigm of sepsis treatment may be possible, with UK paramedics providing key elements of the Sepsis Six before reaching the emergency department. This may have significant implications for restructuring sepsis services.

A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service

Background:Over the past decade there has been a focus on improving pre-hospital recognition and treatment of patients with sepsis. This pilot study investigates pre-hospital sepsis recognition, including the use of a Sepsis Screening Tool (SST), treatment and whether timely identification influenced the time to treatment and outcome at the receiving unit.Methods:A cross-sectional sample of patients with a documented suspicion of sepsis by North East Ambulance Service NHS Foundation Trust (NEAS) was combined and cross referenced with patients coded for sepsis at The James Cook University Hospital (JCUH) to generate a sample of sepsis patients seen within January 2014. NEAS sepsis recognition was compared with SST identification by retrospectively examining patients' medical records. Sensitivity and specificity for NEAS diagnosis were calculated by comparing NEAS identification with JCUH diagnosis using the hospital SST.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).Conclusions:It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Use of the SST would improve the ability of NEAS clinicians to identify patients with sepsis.

The duty of candour applies to you and your employer

The need for a culture of openness and transparency within healthcare services following the Stafford Hospital scandal has emphasised the importance of a duty of candour. Ian Peate considers the complex issue of candour from an employer and employee perspective.

Book Review

Medical Statistics from Scratch: An Introduction for Health ProfessionalsContinuing the ‘research’ theme in this month's review and an aspect of research which is perhaps most familiar: statistics. From the outset it should be clear that the book has not been written specifically for paramedics but is aimed at the medical profession in general. This is certainly not a criticism, as it reflects the growing emphasis on research and clinical evidence in health care, as well as the growing number of clinicians becoming involved in medical research—paramedics included.Consistent with the title, this book is predominantly aimed at those undertaking research for the first time and in particular, those having to develop a good understanding of medical statistics. For those of you who work in an ambulance service within the NHS, statistics should be nothing new! In reality, there is a great deal more to them than simply numbers on a spreadsheet.Statistics can be a complicated area even for the most seasoned researcher, so don't expect this book to be the panacea for all that is confounding. What it does do is successfully identify the principal areas of statistics and provide a brief commentary on their application. Furthermore, as the application of statistics is specifically tailored to medical research, a bit of perspective is provided for clinicians and students looking to dabble in ‘stats’ for the first time. Such is the nature of research that one text could never be all-embracing but that was never the author's intention, and the content is certainly appropriate to the target readership.‘If you are a relative novice to research…then this is worth a readNow in its 3rd edition, this text has been in publication for over a decade. This is testimony in itself to the quality and relevance of the content. If you are a relative novice to research or are looking to fend off a cold sweat at the very mention of statistics, then this is worth a read.

The rapid rise of The Larrey Society

The Larrey Society is the first cross-sector ‘think tank’ established to help shape the future policy of emergency medical services. David Davis, the society's founder outlines some of the campaigns initiated in the six months since the society's inception, as well as future plans in the pipeline.

Paramedics have a clear role to play in the management of patients with sepsis

Over the past decade, sepsis has risen to political, public and health professional attention as a major cause of avoidable death and morbidity. In September 2014, NHS England issued a Stage 2 Safety Alert on sepsis (NHS England, 2014), reinforced by an announcement of intent from the Secretary of State for Health in January 2015 (Department of Health, 2015).

Reducing the alcohol burden

According to a new survey, almost half of paramedics in the North East of England have been subjected to alcohol-fuelled physical assaults while on duty (North East Ambulance Service NHS Foundation Trust (NEAS) and Balance, 2015). The survey of more than 350 paramedics details the impact of alcohol misuse on the region's paramedics, and also revealed more than two in five NEAS paramedics have at some point been sexually assaulted/harassed while on duty. Additionally, nine out of ten paramedics agreed that dealing with alcohol-related callouts places an unnecessary burden on their time and resources; and three in five paramedics believed they shouldn't have to deal with the consequences of excessive consumption of alcohol. A quarter of paramedics stated that at least 50 % of their workload on weekday night times is alcohol related, while two thirds of paramedics stated that alcohol-related incidences account for at least 50% of their workload during weekend shifts.

Continuing Professional Development: Evaluating classifications of heart failure

OverviewThis Continuing Professional Development (CPD) article will explore the subject of heart failure looking at different types of classifications, diagnosis criteria and considerations of patient assessment and management for the paramedic. It will look at scoring systems and objective evidence to help you decide what sort of heart failure your patient may be presenting with.Learning OutcomesAfter completing this module you should be able to:Describe heart failure as a clinical syndrome.Evaluate classifications of heart failure.Explore background pathologies linked to heart failure.Contextualise pathophysiology of the heart failure patient.

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