The hanging/hanged patient and relevance to pre-hospital care

Death and injury from hanging is a complex situation which requires careful and appropriate assessment and management in the pre-hospital environment. It is arguably an area of limited understanding and therefore may not be assessed and managed in the most effective manner. Most hanged/hanging patients will be found in their homes, rather than in institutions. It could be argued that due to prevalence as a suicide method, the majority of pre-hospital ambulance service staff will respond to at least one hanged or hanging patient within their careers, thus a greater understanding will benefit both clinician and patient. Patients who attempt or achieve suicide will rarely achieve fracturing the spine and severing the spinal cord, bringing into question the requirement for the traditional cervical collar and spinal immobilisation techniques. Death from asphyxiation and carotid/vagal reflex require consideration and management as does raised intracranial pressure, which is likely to occur.

Ambulance service at creaking point

Recent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

Celebrating an evening with men of destiny

To mark the 250th anniversary of the birth of french surgeon Dominique Larrey, The Larrey Society is hosting its first Larrey Lecture. David Davis, the society's founder and chairman, gives a background to the inaugural speaker, Professor Douglas Chamberlain, who has been integral to the development of the paramedic profession.

Approving educational programmes for paramedics

The publication of the Health and Care Professions Council's (HCPC) Education annual report has highlighted the on-going need for closer engagement between the regulator and education providers. Ian Peate outlines the role of the HCPC and how it approves and monitors educational programmes in the UK.

Trauma Care Conference considers expanding role of paramedics in subspecialty

Andy Thomas reports on the paramedic programme of the 17th International Trauma Care Conference, held this year at the Yarnfield Conference Centre, Stone on 17–21 April 2016.

Clinical care in the warm zone: a responder's perspective upon clinical practice in support of UK tactical medical operations

Active shooter incidents both nationally and internationally have embedded significant cultural reforms within emergency medical services response frameworks. The deployment of specialist responders within specific pre-identified areas or ‘zones’ of an active shooter incident is unprecedented, and reflects the level of public expectation now required of the ambulance service.As seen within the recent 2015 Paris attacks, the delivery of effective clinical practice in tactical medical operations (TMO) facilitates a range of unique challenges for clinical responders. Conflicting priorities between operational tactics and clinical priorities, especially within multiagency working, has historically led to ‘Good medicine becoming bad tactics, and bad tactics leading to further casualties' (Butler, 2001: 625).Although situational dynamics may make it impossible to ever achieve an absolute equilibrium of safety and tactical efficiency within this sphere of practice, this article intends to contribute toward achieving this ideal by reviewing the Tactical Emergency Casualty Care (TECC) guidelines to establish if this framework would be compatible for use within the UK's TMO response framework.

What do ambulance service personnel perceive to be the process of and issues with inter-hospital transfers?

At present, the inter-hospital transfer process has been described as suboptimal and current literature fails to describe or analyse the complete transfer process. In particular, the challenges and barriers from UK NHS ambulance services are yet to be described. To examine this further, a study has been undertaken to explore a NHS ambulance service personnel's experiences, perceptions and issues relating to the inter-hospital transfer process.The findings have shown that ambulance personnel approach inter-hospital transfers from a business perspective, which affects the way they process and perceive transfers. There exists a consensus among staff that the inter-hospital transfer policy or procedure is not fully understood, due to a lack of clarity and mixed messages throughout the process. Staff members view the inter-hospital transfer process as a nuisance and have acknowledged it was inadequately executed. Additionally, undertaking certain inter-hospital transfers is seen as challenging paramedics' professional identities.

What are family member experiences of the resuscitation of a relative?

This study aimed to gain insight into the feelings and perceptions of family members who witness an adult family member resuscitation. Little is known about family members' experiences and their needs and priorities. Resuscitation is a complex and highly emotive situation but guidance for paramedics to support families either in the decision-making process or to remain present is limited. Policy developments around improved and shared decision making are not evident in any guidance for resuscitation for paramedics. Paramedics have always been involved in resuscitation in the family home, but as they remain on scene for longer periods, it is important that the issue of family participation is addressed and specific guidance produced to enable paramedics to offer more focused and enhanced support to them, and involve the family members in the decision-making process which is a requirement from recent policy developments.

Critical care paramedics: who's doing what?

This systematic review conducted in 2013 is an interesting read for anyone involved, or wishing to be involved, in the pre-hospital care of critically injured patients and the emerging role of UK critical care paramedics (CCPs) in the delivery of advanced level skills in this subset of patients.

Book Review

ABC of DiabetesI suspect that for the majority of paramedics, exposure to the world of endocrinology is limited to managing diabetic emergencies, specifically hypo- or hyperglycaemia. In the case of the latter, this is likely to involve either a referral to a GP/diabetic nurse or conveyance to A&E. Paradoxically, this is one of the most common emergencies a paramedic is tasked to, and even if not directly related to the disease itself, a number of disease processes can impact on it. So a welcome text to review but how does this market itself to paramedics?The early detection and prevention of diabetes may historically rest with GPs, but increasingly paramedics are being asked to promote wider health benefits to patients, so there is some useful background information here. More specific complications of the disease, such as during pregnancy, I would suggest is best left to the medical specialists in that field, although a generic introduction is provided and a general awareness of such complications is no bad thing. Similarly, cardiovascular and renal complications are given some attention, as is a brief overview of the psychological issues associated with diabetes.‘Overview’ is the key word here, and for fear of repetition, depth is compromised for the sake of breadth. As an introductory text, however, as are all in the ABC series, this is quite effective.Embracing recent discussions relating to a paramedic's scope of practice and associated levels of education, this is precisely the sort of area of medicine a paramedic could contribute more to than simply the administration of glucagon or glucose. In broadening one's scope of practice one must also widen their reading material. On that score, this text paves the way.A sound introduction. Worth a read.

Continuing Professional Development: Stroke and transient ischaemic attack—risk factors, identification and asessment

OverviewThis Continuing Professional Development (CPD) module will outline key factors in acute stroke assessment in adults, risk factors associated with strokes, and provide an overview of a provisional diagnosis and an outline of current treatment for acute stroke. While specific stroke treatments are outside the remit of paramedic and pre-hospital practice, similarities do exist in the treatment for acute myocardial infarction: time is of the essence. Therefore a brief overview of the current treatment for ischaemic stroke, such as thrombolysis and thrombectomy, will be the focus of this module.Learning OutcomesAfter completing this module you should be able to:Identify and be aware of the key risk factors in acute stroke.Outline the key stroke mimics and differential diagnosis.Understand the importance of a targeted assessment.Provide an overview of treatment for acute stroke.