Volume 8 Issue 12

Taking care of the practising paramedic

As the year comes to an end, I am taking stock of the articles and news related to paramedicine in recent months. Interestingly, the nature of a paramedic's job and the hazards it entails have started to get a higher profile on national media. It is therefore hoped that the public will better understand the job of an emergency care professional, but also that authorities will recognise the need to look after these frontline staff.

Concentrate: Medical Law

Within our ever-developing profession, it stands to reason that ‘medical law and ethics’ is now found within many undergraduate and postgraduate programmes.

Evidence based practice from the ashes of clinical freedom

Clinical freedomPrior to the 1980s, clinical judgement played a large part in decision-making (Hampton, 2011; Hampton, 1983), by in large leaving research the role of informing education, rather than practice. The perception at the time was that evidence based practice would simply result in a plethora of protocol driven instructions which would remove clinicians' ability to develop a treatment based on individual patient needs (Schwalm and Yusuf, 2011).This fear may not have been entirely borne out in medicine; however, in paramedic practice it could be argued that being subject to strict protocols such as those found in the national clinical guidelines give some credibility to the argument of 30 years ago. Clinical freedom may often be elusive for paramedics, but true evidence based practice does allow for freedom based on evidence.Evidence based practice is a means to improve clinical practice, where scientific literature (evidence) forms the basis for clinical decisions. It is not the intention that research results will be able to overtake professional skills or negate patient/client choice; quite the reverse, only by using clinical knowledge and listening to patients or clients can Paramedics use research results appropriately.

Paradoxical visits to the emergency department: are we meeting patients' needs?

The subject of increasing emergency department (ED) visits is well recognised by western healthcare systems. In particular, whether it was necessary or appropriate for many of these patients to visit ED remains a vexed question. As such, understanding sub populations that visit the emergency department may offer insight and data into how best to deliver the right services in the right settings, while informing operational planning for ambulance services.

Paramedic-reported barriers towards use of CPR feedback devices in Perth, Western Australia

Feedback devices for cardiopulmonary resuscitation (CPR) have been introduced across a number of emergency medical services (EMS) worldwide with the intention of increasing the provision of high quality CPR. In July 2014, St. John Ambulance Western Australia (SJA-WA) introduced the Q-CPRTM device into mandatory clinical practice; however usage rates were lower than expected.Methods:A voluntary, anonymous survey was issued to a convenience sample of SJA-WA paramedics from September to December 2015 to determine the paramedic-reported barriers towards the use of Q-CPResults:Of the 264 paramedics who participated in the survey, 41% reported having used Q-CPR during their last attempted resuscitation. Among those who had not used it, the reason most commonly cited (37%) was that a mechanical chest compression device arrived on scene prior to the Q-CPR being deployed. Secondly, other interventions were prioritized above the use of Q-CPR (20%). Thirdly, pain associated with use of the Q-CPR prevented its utilization in 17% of cases. Other reasons were less frequently reported.Conclusion:Lower usage rates appeared to be primarily linked to the utilisation of other equipment and interventions in preference to the Q-CPR and to a lesser extent due to pain associated with the use of such devices.

Stay on the ambulance long enough and you'll go full circle: an evaluation of the clinical safety and effectiveness of non-emergency and multi-occupancy ambulance conveyance in non-emergency percutaneous coronary intervention patients

Mechanisms to facilitate rapid ambulance transport of diagnosed STEMI patients from the community and emergency departments (ED) settings directly to primary percutaneous coronary intervention (PPCI) facilities are well established within NHS Ambulance Services. Direct challenge of inter-hospital transfer requests for non-emergency percutaneous coronary intervention (PCI) patients by a regional NHS Ambulance Service identified disagreement between peripheral feeder hospitals and the NHS Ambulance Service on what level of ambulance transport is most appropriate.To reduce unnecessary peripheral feeder hospital requests for paramedic emergency service transfer and resource utilisation in non-emergency PCI patients and to assess the clinical safety of both non-emergency transport and multi-occupancy conveyance for this patient group.A process was established with a regional cardiothoracic centre to support pre-screening of non-emergency PCI patients for conveyance via non-emergency ambulance resources and multi-occupancy. This included centralisation of all non-emergency PCI ambulance transport booking practices and dissemination of learning materials on the process to all stakeholders. During the three-year period 3172 patients were identified as suitable for conveyance by both non-emergency ambulance transports. Of this, 36% (n=1767) were conveyed as part of a multi-occupancy journey and 56% (n=782) were conveyed by non-emergency resources. Overall, 69% (n=782) of all multi-occupancy conveyances were undertaken by non-emergency resources. Two clinical incidents were noted during this period, both of which were managed via clinical telephone advice.Non-emergency ambulances can be safely used to transport non-emergency PCI patients via multi-occupancy, following appropriate pre-screening by the receiving PCI unit. Further work is needed to understand the feasibility of this across other patient groups in the inter-hospital transfer scenario and its transferability to other NHS Ambulance Services.

Continuing Professional Development: Assessment and management of stab injuries in a pre-hospital setting

OverviewThis CPD module will focus on the pre-hospital assessment and management of patients with penetrating traumatic injuries. Whilst the predominant focus is on wounds sustained in knife attacks, the same principles are readily transferrable to the management of all penetrating injuries, intentional or otherwise. For instance, the management of a stab victim with the knife left in situ will bear many similarities to the management of a patient impaled in an industrial accident or road traffic collision. For this reason alone, it is an important area for paramedics and pre-hospital care providers to understand.Learning OutcomesAfter completing this module the paramedic will be:aware of the incidence of knife crime and the chances of encountering it in their professional practiceable to understand the different mechanisms by which sharp implements can cause injury, including incision and puncture wounds to the chest and abdomenable to describe the steps involved in the safe pre-hospital assessment and initial management of such injuries

Autoethnographic analysis of the self through an occupational story of a paramedic

This article discusses the role that storytelling plays in understanding both the personal and professional self from the perspective of a paramedic. The practice of paramedicine provides individuals with a strong platform upon which storytelling can be built, with narration of work-related stories presenting opportunities for reflection on the interplay between organisational culture and self-identity. Using elements of narrative inquiry, autoethnography and critical reflection, a paramedic story is deconstructed and examined from a number of perspectives. From this narrative exploration, three distinct themes emerged and are subsequently discussed: assumptions and preconceptions, fears and insecurities, and distancing and control. The findings illustrate the benefits of exploring paramedic stories in order to recognise, transform or eliminate unhelpful assumptions relating to paramedic practice, and discover unexplored aspects of the self through analysis of story.

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