Volume 8 Issue 7

End-of-life care for nursing home residents: considering the challenges for paramedics

There is a growth of interest in paramedic involvement in end-of-life care issues in general, but one sub-group of the population which clearly requires further investigation relates to people residing in nursing homes. It is known that frequently people in nursing homes, who are nearing the end of their lives, are inappropriately transferred to hospital with potentially negative consequences.

Which factors most influence demand for ambulances in South West England?

Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn.The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand.Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.

Continuing Professional Development: Considering tissue viability in the pre-hospital setting

OverviewThis Continuing Professional Development (CPD) module will look at the subject of tissue viability and will give the paramedic an appreciation of the different elements of wound considerations and the healing process. From this, paramedic practice around assessing wound care may be enhanced.Learning OutcomesAfter completing this module you should be able to:Understand the different functions of the skin.Recognise the different wound types that paramedics may be presented with.Understand the degree of intent.Assess possible wound care options for patients.

Exploring a possible incidence of neurogenic pulmonary oedema

The article highlights a possible occurrence of neurogenic pulmonary oedema (NPO), describing the current theories of its aetiology within the context of widespread central nervous system (CNS) disorders, with a particular focus on those most commonly associated with NPO and sudden unexpected deaths. Due to its often rapid onset, paramedics may be the first medical professionals exposed to the condition when assessing a patient, yet the prevalence of under-recognition and/or anticipation of NPO, the lack of understanding of its aetiology, and the ambiguities in relation to differential diagnoses may delay or prohibit treatment. It is recommended, therefore, that consideration of NPO is incorporated into standard clinical CNS assessment and subsequent airway management decisions. Potential paramedic pharmacological interventions are discussed, although currently not indicated for use in NPO.

Industrial paramedic: an emerging speciality?

The role of paramedic, from its humble beginnings as an entirely ambulance-based profession (and under the solely-NHS employment umbrella), has produced numerous speciality grades in recent years. Within the UK, some of these are represented by the College of Paramedics; however, others are unfortunately not, as yet.For example: the roles of CCP, ECP/PP (critical care paramedic, emergency care practitioner/paramedic practitioner), military paramedic, HEMS (helicopter emergency medical service) and coastguard paramedics, HART (hazardous area response team) paramedics and offshore paramedics are well recognised and established specialised disciplines, often with their own separate, university-based courses to ‘top up’ on the existing paramedic Bachelor of Science.Some specialities, such as remote area and emergency department paramedics, are less well understood and represented.The purpose of this article is to describe the role of the industrial paramedic. It will outline why the skill-set of this role is unique in comparison with those mentioned above, and will debate the case for stand-alone recognition and specific training for this speciality.

Flippin’ education: a new pedagogy for paramedic students?

This article presents a case study in which the author piloted the flipped classroom on a cohort of paramedic science students at a UK higher education institution. The flipped classroom will be explained alongside the rationale for considering it as a good pedagogical addition for paramedic students. As a new pedagogy, the flipped classroom will be considered against what is currently known about learning theories and teaching styles. There are potential drawbacks to this method of teaching and learning and these will be discussed, as will suggestions to mitigate these drawbacks. Finally, the impact upon the students will be considered and the author will comment on the pilot and what this means for paramedic education in the future.

Show me the evidence! Engaging with science in the pre-hospital environment

Scientific insightAs a natural consequence of increased demand for clinical excellence and improved outcomes for patients, there is a related increase in demand for sound academic foundations for pre-hospital treatment. While current guidelines are based on best available evidence, there is a desire to fill gaps in knowledge through further investigation including during clinical trials.Paramedics should be encouraged to engage with the concept of evidence-based practice, and challenge the available evidence base in terms of its quality, source and level. Rather than continuing to blindly use protocols based on limited evidence, the entire pre-hospital community ought to design ways to put these protocols under increased scrutiny and determine the gaps requiring further investigation.Recent trials in the pre-hospital environment such as PARAMEDIC (Perkins et al, 2015), PARAMEDIC2 (Warwick Clinical Trials Unit, 2015), Airways-2 (Clinical Trials and Evaluation Unit Bristol, 2014) and Golden Hour (National Institute for Health Research Surgical Reconstruction and Microbiological Research Centre, 2014) have done precisely that: they have aimed to establish a better evidence-base where one was lacking. The new generation of paramedics ought to say: ‘Show me the evidence!’ when following common procedures based on expert opinion rather than science.

Primum non nocere: first, do no harm

Doing no harm is the prime concern of every paramedic, yet each year millions of people worldwide are harmed by care provided. Ian Peate discusses methods of reducing harm, including implementing ways of mitigating against threats to safety, education on the relationship between error and harm, and learning from mistakes.

Working together to improve efficiencies

It was recently announced that the North East Ambulance Service NHS Foundation Trust, North West Ambulance Service NHS Trust and Yorkshire Ambulance Service NHS Trust will be coming together to form an alliance across the North of England (Association of Ambulance Chief Executives (AACE), 2016). The services have said the launch of the Northern Ambulance Alliance will help to improve the efficiency of ambulance services in the areas covered by all three Trusts.

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