Volume 8 Issue 5

Developing the concept of a multi-professional pre-hospital emergency medicine (PHEM) practitioner training programme

What is pre-hospital emergency medicine (PHEM)?The term ‘pre-hospital emergency medicine’ (PHEM) covers a wide range of medical conditions from minor illness and injury to life-threatening emergencies. Pre-hospital interventions therefore also range from simple first aid to advanced emergency care. Clinical providers may be first responders, technicians, paramedics, nurses and doctors. All of this activity may take place in urban, rural or remote settings (Intercollegiate Board for Training in Pre-Hospital Emergency Medicine, 2015).PHEM practice relates to the emergency response, primary scene transfer and secondary emergency transfer functions within pre-hospital care at the level of the consultant (level 8) practitioner (Skills for Health, 2015), with focus on the area of clinical care required for the seriously ill or injured patient. The key drivers include ensuring consistency in the provision of PHEM services, ensuring equality of access, service delivery, quality and clinical governance.

Should we consider the use of alternative sites for needle thoracostomy?

In the absence of advanced practitioners on scene, needle thoracostomy (NT) is the only treatment modality currently widely available to paramedics in order to relieve tension pneumothorax. Both ATLS and JRCALC guidelines (Association of Ambulance Chief Executives, 2013) recommend that for NT, a cannula be placed at the second intercostal space at the mid-clavicular line (ICS2-MCL). This paper, however, cites a number of difficulties associated with NT at this site, namely, variable chest wall thickness (CWT) and inability of practitioners to identify the correct anatomical location. Commonly used alternative sites consist of the 4th/5th intercostal space, mid axillary line (ICS4/5-MAL) and 4th/5th intercostal space, anterior axillary line (ICS 4/5-AAL).

Cardiac care in SAR helicopter paramedic practice: from mountainside to rehabilitation

Despite its decline in recent years, coronary heart disease remains the UKs single biggest killer. When someone suffers a heart attack on a mountainside in the UK, they often need a search and rescue (SAR) helicopter to provide them with timely emergency care and to transport them to a suitable hospital. The early diagnosis of an ST-elevation myocardial infarction (STEMI) from a 12-lead electrocardiogram facilitates timely initiation of reperfusion therapy, but obtaining one in the mountain rescue environment is challenging and sometimes impossible.Although primary percutaneous coronary intervention for STEMI patients is the treatment of choice, facilitating it renders the SAR aircraft unavailable for greater periods of time and requires the relevant, supporting infrastructure to be in place. The SAR paramedic must assess the suitability, validity and usability of clinical guidelines and pathways on a case-by-case basis, then integrate them into the demands of each particular SAR mission. Although cardiac rehabilitation has not traditionally been within the remit of the pre-hospital clinician, responding to the psychological needs of the heart-attack victim in the aircraft may be a significant determinant to their participation in rehabilitation programmes.

A critical review of NICE Guideline 39—major trauma: assessment and initial management

Major trauma is a leading cause of death in the under 40 years age group, and has a significant impact on morbidity, causing a financial burden to the National Health Service (National Audit Office, 2010). A recent guideline published by the National Institute for Health and Care Excellence (NICE, 2016a) seeks to address the recommendations made by a National Confidential Enquiry into Patient Outcome and Death (2007) and the National Audit Office (2010), therefore improving the standards of trauma care delivery across England.This article critically appraises the recommendations made by NICE (2016a), while considering the available evidence and the implications on pre-hospital major trauma care.

Using ambulance service PCRs to understand 999 call-outs to older people with dementia

Objectives:To use local ambulance service patient care records (PCRs) at an aggregate level to study the use of emergency medical services (EMS) by older people with dementia in two English counties. To understand how and where in the PCR dementia is recorded. To measure the proportion of patients aged 75 and over who had an emergency (999) ambulance response who have dementia recorded in the PCR. To carry out a descriptive analysis of any associations with age, gender, reason for the call, time of call, residential status or call outcome.Methods:Four days of PCRs from two counties (UK) for patients aged 75 and over were reviewed and non-patient-identifiable data extracted. Data for the total number of call-outs for those days were obtained from the computer-aided dispatch (CAD) system.Results:In 4 days' records for Cambridgeshire and Hertfordshire (2 304 records), over one third of call-outs (830) were to patients aged 75 and over. Data were obtained from 358 paper records. Dementia was recorded on 14.5% of records and another 7.0% recorded details suggesting dementia or cognitive impairment. Around 15% of call-outs to ≥75-year-olds were to care homes. Ambulance crews attended higher proportions of ‘older old’ people than the local population percentages of 85 to 89-year-olds and ≥90-year-olds. The most common reason (27.5%) for a call-out was a fall.Conclusions:This is the first paper to look in detail at the numbers of older people with dementia seen by emergency ambulance crews as documented in PCRs. It gives a benchmark for others looking at ambulance service data and highlights possibilities and pitfalls of using ambulance service PCR data.

Continuing Professional Development: Understanding paramedic treatment and management of pulmonary embolism

OverviewPulmonary embolism (PE) is one of the most common preventable deaths in the UK. Causing occlusion of the pulmonary arteries, a PE is most often the result of the formation of a deep vein thrombosis (DVT) which ‘breaks free’ and travels to the lungs where it alters the normal ventilation/perfusion (V/Q) relationship, resulting in hypoxia, increased dead space and intrapulmonary shunting.This Continuing Professional Development (CPD) module will explore the pathophysiology, assessment and management of PE by paramedics, and explore the condition's main causes and treatment from the paramedic's perspective.Learning OutcomesAfter completing this module you should be able to:Provide a definition of pulmonary embolism (PE).Identify the common causes of PE.Identify the key steps in performing a respiratory assessment.Outline how the paramedic can treat and management a patient with a PE.

The impact of working shifts: exploring the views of UK paramedics

There is limited research within the UK investigating the effects of shift work on paramedics. Paramedics have relatively high rates of sickness levels and there are links between shift work and health. This study explores UK paramedics’ perceptions of the impact of working shifts.Methods:Exploratory qualitative research was utilised to investigate the perceptions of UK paramedics on the impacts of working shifts. Two focus groups were completed involving 11 paramedics. The transcriptions were analysed using thematic analysis.Results:Paramedics described factors associated with working shifts that mirror research already completed within different occupations: effects on physical health, fatigue, family life, safety and performance; but paramedics additionally described factors that are more limited to working in the paramedic profession such as a broader range of psychological stressors and organisational factors. The theme of psychological health was a wider theme that went beyond shift work and encompassed the overall paramedic role and the unique and stressful nature of the work.Conclusions:This research has allowed an insight into the perceived effects of shift work on UK paramedics and exposes the challenges paramedics face in their working environment. There is a suggested link between the relatively high rates of sickness and the effects of shift work and paramedics’ overall working environment. Further exploration and recognition of the effects of shift work on UK paramedics is recommended.

Delivering a promise over pay

The junior doctor dispute over pay has taken up a lot of space in the news in recent months, yet they are not the only health professionals who are displeased with Government plans.

UK Ambulance Services Clinical Practice Guidelines 2016 Pocket Book

I often spend my time reflecting on what publishers consider pocket-sized. Now this may seem a touch on the trivial side given the contemporary issues currently facing our profession. But consider, if you will, the potential cost savings in uniform issue from burst trouser seams due to bulging pockets (not waist bands).

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