Volume 8 Issue 10

National Early Warning Score Lactate (NEWS–L): is it good news for pre-hospital care?

It is recognised that elevated blood lactate levels increase the risk of mortality, even in those patients who appear physiologically stable (Vincent et al, 2016). The National Early Warning Score (NEWS) was introduced in the United Kingdom (UK) as a risk management tool in the Emergency Department (ED). Based on easy to establish physiological data, ED staff are better able to appropriately triage patients. Blood lactate has become a vital measure of the body's physiological response to an insult or injury. The authors of this study were assessing whether adding a serum lactate reading (NEWS–L) to the NEWS assessment could improve the triage of patients in the ED.

Hyperacute stroke unit training for paramedics

BackgroundThe best outcomes for acute stroke treatment occur through rapid recognition and transfer of patients to hospitals with a hyperacute stroke unit (HASU). Pre-hospital ambulance paramedics are crucial to this process as first responders, but they have limited feedback on subsequent patient care and progress to improve their learning.MethodsA dedicated stroke training course for paramedics was developed on a HASU that involved a standardised introductory educational briefing and subsequent participation in clinical activities with multidisciplinary HASU staff. On completion of the course, attendees completed a standardised semi-structured questionnaire about their learning and experience. All text was thematically analysed and themes were developed by iteratively recoding and regrouping the data.Results30 paramedics attended the training course over a three-month period. All candidates reported that the course was useful to their learning and training with ‘real-world’ transferability; 93% stated that they benefited from observing clinicians performing assessments on patients and 73% commented that they gained a better understanding of care pathways and treatment. These two themes encompassed 48% of 160 free-text responses with the other responses being grouped into four further themes (improved patient/family communication, increased awareness of subtle signs of stroke, localisation of intracranial pathology, and improved ‘handover’).DiscussionThis single centre experience of HASU training for paramedics demonstrated a number of key educational themes embedded within the stroke care pathway. This process may be a useful additional educational resource to develop further paramedic training in the hyperacute arena.

Continuing Professional Development: The paramedic and gynaecology

OverviewThis module will introduce the subject of common gynaecology-related presentations and link their relevance to paramedic practice. It will explore irregular periods, heavy periods, painful periods, painful sex, pelvic inflammatory disease, menstrual-related tensions, sterilisation and termination of pregnancy.Learning OutcomesAfter completing this module the paramedic will be able to:Recognise the gynaecological issues that may present as pre-hospital emergenciesKnow the underlying causes of these gynaecological conditionsBe aware of polypharmacy and its disadvantages when treating period painsIdentify and treat symptoms that present after termination of pregnancy

Fit to practise: does more need to be done to improve the health and wellbeing of paramedics?

Paramedics are exposed to both physiological and psychological stressors that the general population does not typically face. Although there is evidence to show that paramedics can be resilient to these, cardiovascular disease, mental health problems and musculoskeletal injuries are still prevalent among paramedics. Exercise has been shown to reduce the physical demands of lifting for paramedics, but data on the effects in other areas of paramedic life are limited. In the general population, exercise is becoming a popular treatment option for mental health problems. However, the methodologies used are inconsistent and it is difficult to draw definitive conclusions from the data available. A more thorough examination of how regular exercise could positively impact the health and well-being of paramedics, who are key, front-line personnel in the medical services, is an area that requires crucial further research.

An overview of the Human Immunodeficiency Virus (HIV)

The World Health Organization recognises HIV as a global health problem. Within the UK there are over 100,000 people living with HIV; 6,000 new cases are diagnosed each year and there is an unrelenting rate of transmission between men who have sex with men (MSM). Paramedics are increasingly likely to encounter patients living with HIV, and it is necessary for them to be familiar with HIV, HIV treatment and the tailored high-impact prevention strategies used to reduce the rate of HIV transmission. Paramedics can also attempt to reduce the spread of HIV by encouraging HIV testing, post-exposure prophylaxis treatment, and routine use of condoms during sexual intercourse. This article aims to provide an overview of HIV within the UK population.

Involving adults who lack capacity in research: ethical and legal challenges for the pre-hospital and emergency medicine context

There is an increasing number of research projects conducted that requires the recruitment of participants in the pre-hospital or emergency setting. A complicating factor in pre-hospital and emergency research (PHER) is that potential participants may lack or lose the capacity to give a valid consent. The lack or loss of capacity is ethically and legally complex for researchers and Research Ethics Committees (REC) whose approval must be gained prior to commencing a study. This paper explores those challenges by drawing upon a number of case studies of pre-hospital research in which adult participants are likely to lack the capacity to consent. The paper begins by outlining the development of the legal provisions for conducting research with participants unable to consent for themselves within the jurisdictions of England and Wales. The paper goes on to explore how researchers can meet the legal requirement for research, how to frame the issues for the purposes of ethical review, as well as offering ethical guidance for practices within the research field.

The Brexit threat to emergency services

“Why the Journal of Paramedic Practice?” I was asked when I applied for the job of Editor. Easy: to me it is the most vital and exciting field of healthcare. Paramedics are the first point of professional contact in an emergency, where the time available to respond efficiently and make an informed decision in the best interest of the patient leaves little margin for error.

Keep up to date with Journal of Paramedic Practice!

Sign up to Journal of Paramedic Practice’s regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month.