Is full pre-hospital spinal immobilisation best for the patient? A review of current controversies

Spinal immobilisation has long been an accepted part of pre-hospital care. There is, however, a lack of evidence that spinal immobilisation is effective in reducing spinal cord injury (SCI). The aim of this article is to review a broad range of literature in relation to spinal immobilisation and consider some of the current controversies.Despite a lack of high-quality research, following a comprehensive literature search, 13 pieces of primary research and 4 pieces of secondary research were identified. The literature identified a number of potential controversies relating to the principal effectiveness of immobilisation, side effects of immobilisation and patient outcome in comparison to non-immobilised patients. Given these areas of controversy, many of which are of fundamental importance, it seems logical that further high-quality research is required to establish whether spinal immobilisation is effective or otherwise.

Health Care Professionalism at a Glance

It seems to be en vogue in the publishing world at present to offer up publications which, by design, are intended to provide the reader with the briefest of overviews of a given area of health care. The problem comes when publishers and authors alike attempt to compress ‘health care’ as a whole into the slenderest of volumes and somehow advocate it as delivering a credible overview of something so incredibly diverse and complex. Unfortunately, so it is with this text.

Pre-Hospital Advanced Cadaveric Trauma Skills (PHACTS) Course review

Who is it for?The course is specific to trauma skills training in the pre-hospital setting and focuses on providing delegates with exposure to those skills that are rarely performed. As well as hands on skills, the course looks in detail at the human factors involved when caring for a major trauma patient and allows all delegates the opportunity to become the team leader.Delegates were from varied professional backgrounds, including medical, nursing and paramedics with differing levels of seniority and experiences. The course is aimed at higher level pre-hospital practitioners (Level G and H) (Faculty of Pre-hospital Care, 2015); however, other participants may be considered at the discretion of the directing staff. Although not essential, some pre-reading on the anatomical structures involved in traumatic injuries and airway management would be advantageous.

Paramedics' health and wellbeing: how important is diet?

Research into paramedic health and wellbeing is beginning to gain some traction. This pilot study has shed light on the health behaviours of paramedics: its focus being examination of the eating habits of a small group of paramedics. The aim was to compare energy intake and expenditure of paramedics on work and rest days to understand what impact it could be having on the health of these participants.

A review of the Great North Air Ambulance Pre-Hospital Emergency Medicine Crew Course

BackgroundPrior to joining GNAAS in April 2015, I had worked as an NHS paramedic for 9 years. This included several years on the road as both a rapid response paramedic and on the hazardous area response team (HART). In addition, I gained experience as a paramedic for the British Superbike and MotoGP medical teams at a number of race tracks around the country. After successfully applying to join GNAAS, I was enrolled on the PHEMCC as part of my induction training.Before arriving on the PHEMCC, I had very little knowledge of what the crew course entailed. My preconceived ideas of the course content differed quite significantly from the actual programme. I expected that the main focus would be on providing critical care interventions and studying the evidence base behind them. Although practical training was indeed a key part of the course (particularly performing pre-hospital anaesthesia, thoracostomies, thoracotomies etc.), it was the emphasis on the non-technical aspects like crew resource management (CRM), communication skills, working in close partnership with a senior doctor and developing the interface with other emergency services that surprised me most.A doctor/paramedic team working together in pre-hospital emergency medicine (PHEM) brings a unique skill mix to a critically-injured patient at the scene. There is increasing evidence to suggest that advanced interventions including pre-hospital anaesthesia, blood component therapy and advanced procedural skills, such as thoracotomy, bring an increased survival benefit to the sickest of patients at the roadside (The Association of Anaesthetists of Great Britain and Ireland (AAGBI), 2009; Chesters et al, 2013).‘Before arriving on the PHEMCC, I had very little knowledge of what the crew course entailed. My preconceived ideas of the course content differed quite significantly from the actual programme’Great North Air Ambulance Fleet

The diagnosis and management of acute cluster headache in the out-of-hospital environment

Cluster headaches are the most painful form of primary headache and the most common of a group of headaches known as trigeminal autonomic cephalalgias (TACs) (Imai, 2013). It is estimated that 25 million days are lost from work or school because of migraine each year (National Institute for Health and Care Excellence, 2013), and a potential cost of £956 million to health services due to service use, and £4.8 billion due to lost employment each year (McCrone et al, 2011).Given the burden upon health services and the wider economy, a number of strategic drivers for enhancing general management of headaches have been produced with explicit aims of reducing inappropriate referrals and admissions.This article reviews the current literature and discusses the appropriateness of non-specialist clinicians working in out-of-hospital, and in primary, urgent and emergency care, such as paramedics, safely diagnosing and managing cluster headaches in the community, while also considering the balance of possible risks and fiscal benefits in doing so.It concludes that community practitioners could safely manage recurrent episodes of cluster headaches within the community, with good referral and consultation pathways being put in place. However, caution should be paid to discharging those patients presenting with first bout of cluster headache without specialist clinical assessment. Furthermore, while there is some evidence to suggest that this community management may be cost effective, this conclusion cannot be definitely drawn without the authors undertaking a full cost–benefit analysis, which was not within the scope of this paper.

Continuing Professional Development: Exploring endocrinology

OverviewThis Continuing Professional Development (CPD) module will look at how the body organises change through hormone control, exploring the subject of endocrinology. It will support the paramedic to think about the normal functions of common hormones from the level of origin through to target end organs. It will also help us to think about endocrinology-related diseases, in terms of when those hormones are over-produced or under-utilised and the clinical implementation of what that means to paramedic practice.Learning OutcomesAfter completing this module you should be able to:To recognise the relevance of endocrinology to paramedic practice.To explore endocrinology related anatomy and physiology.To be able to risk stratify acute endocrinology considerations.

Opportunities for paramedic practice-based education

The current shortage of paramedics presents particular challenges for paramedic educators in the field of practice learning. However, Kath Jennings and Alison Rae argue this may present new opportunities for student paramedics to develop their knowledge, skills and attributes within other healthcare settings alongside the traditional ambulance service placement.

Revalidation and the paramedic

There will be changes to the ways in which paramedics are audited and how they provide evidence that they are adhering to the Health and Care Professions Council (HCPC) standard. The standard requires all paramedics to continue to develop their knowledge and skills while they are registered with the HCPC (HCPC, 2012).