Paramedics and medicines: legal considerations

This article will cover:The relevant legislation relating to medicines and ambulance servicesThe restrictions that apply to different organisations or individuals regarding the possession of medicinesRegulations on the administration and supply of medicinesPatient Group Directions and Patient Specific Directions.The law in relation to the possession of medicines, administration to patients and the supply of medicines is separate.This article also provides guidance to ambulance services and ambulance clinicians on available options to ensure good patient access to medicines in England. The laws described also apply in Scotland and Wales but there are some different national processes. The law both enables and restricts access to medicines. However, it does require interpretation and a pharmacist can help with this. Where interpretation is contentious then organisations may obtain a legal opinion. Legal opinions can also differ, and can only be resolved in court.

Can handheld POC capillary lactate measurement be used with arterial and venous laboratory testing methods in the identification of sepsis?

Background:The aim of this review was to examine whether the measurement of lactate in capillary blood samples using point-of-care handheld analysers corresponds sufficiently closely with arterial and venous whole-blood samples analysed by hospital central laboratory or blood gas analyser to be used interchangeably.Methods:A systematic search, informed by focused inclusion/exclusion criteria, was performed using multiple databases up to October 2015. A total of 65 articles were considered to have potential relevance and were evaluated in full text, of which ultimately five articles met all inclusion/exclusion criteria, and a final four were selected after data extraction and quality appraisal.Results and Conclusion:All four studies found a predominantly upward bias in the measurement of lactate in capillary samples tested using a handheld point-of-care device over arterial or venous samples tested by laboratory methods or blood gas analyser. In terms of correlation, there was consensus between the studies that the strength of association between the two methods of measurement was statistically significant. Three studies directly examined the extent of agreement between point-of-care capillary lactate measurements and those of laboratory or blood gas analyser reference determined to ±2 standard deviations; 95% confidence intervals, and report contextually broad limits of agreement, identifying a potential for both over triage and, to a lesser extent, under triage. The findings of the review do not support interchangeable use of handheld fingertip point-of-care lactate measurement with laboratory or blood gas analyser methods in the identification of sepsis.

The Valsalva manoeuvre: does syringe size really matter?

ECG of 18-year-old man showing supraventricular tachycardia

A world class resource for the ambulance service: the NARU Education Centre

A truly world class facilitySince 2008, the National Ambulance Resilience Unit's (NARU) Education Centre has been dedicated to the improvement of specialist pre-hospital patient care delivered in especially challenging or particularly hazardous environments.It is best known for its role in maintaining and delivering the national core training for Hazardous Area Response Teams (HART), although its remit and range of courses has grown significantly in recent years.The Centre was awarded the prestigious Skills for Health Quality Mark in 2014 and has recently been reassessed, which is provided by the Sector Skills Council for Health and demonstrates that an organisation has met the unique health sector quality framework for learning and training—and the high standards expected by healthcare employers. The Centre is the only ambulance organisation to hold this accreditation.Preparing ambulance personnel for some of the most difficult and dangerous responses they may ever have to make requires a special blend of good facilities, robust yet creative teaching courses, highly realistic training scenarios and above all, extremely dedicated training staff.NARU has worked tirelessly to get all of these key ingredients in place and today, after 8 years of continuous improvement, the NARU Education Centre is increasingly being recognised as a world-class facility and a genuine standard-bearer for the rest of the NHS.It is the only facility of its kind in Europe and regularly welcomes international observers from all over the world—including from some of the highest profile emergency response and counter terror agencies in the world—all of whom are keen to benchmark their own training against the NARU standard.Head of training, David Bull QAM, says:‘Our international profile is growing because we are the only organisation doing this type of training at this level. We are preparing NHS ambulance staff for the worst—not simply the response to terrorism or firearms attacks but also for wider serious potential public health issues such as pandemic flu or Ebola.‘We continually modify our courses using information gleaned from the latest high profile mass-casualty events, from research and from new data we collect on an ongoing basis and this is why we have carved such a high profile reputation among the international community.’

What the ambulance service ought to be

David Davis, founder and chairman of The Larrey Society, outlines Professor Douglas Chamberlain's future vision of the ambulance service, as outlined in the inaugural Larrey Lecture.

The mandate for change or the emperor's new clothing?

In England, the Chief Allied Health Professions Officer has been encouraging allied health professionals to engage in sharing their views and having their say with regards to an emerging mandate for change. However, Ian Peate warns that engaging with these participants and failing to take into account current feeling within the NHS will amount to empty rhetoric.

Continuing Professional Development: Prehospital management of severe traumatic brain injury

OverviewThis Continuing Professional Development (CPD) module will explain how to treat a patient with a traumatic brain injury, with reference to elements such as the intracranial compartment, cerebral blood flow, and a practical case study. From this, a paramedic may enhance their practice around stabilising a patient with severe head injuries in a pre-hospital setting.Learning OutcomesAfter completing this module the paramedic will be able to:Demonstrate an understanding of the pathophysiology and clinical manifestations of Traumatic Brain Injuries (TBI) and elevated intracranial pressure (ICP).Perform an assessment of a TBI patient and formulate a prehospital management plan.Formulate a prehospital treatment plan for a patient with a TBI.Demonstrate the ability to make transport decisions for patients with a TBI.

Hazardous Area Response Teams: celebrating 10 years in the making and counting

The Hot Zone Working ProjectThe Hot Zone Working Project had been in operation since 2004 and was slowly but surely gathering its evidence on behalf of the Ambulance Service Association. At the same time, a Multi-Agency Initial Assessment Team (MAIAT) had begun a 12-month trial in London by London Ambulance Service NHS Trust (LAS), London Fire Brigade and the Metropolitan Police. There were two firsts for MAIAT which included a multi-agency base and vehicle set up, but it also saw paramedics trained in breathing apparatus and respirators so they could access patients in hazardous areas.The evidence from the Hot Zone Working Project and MAIAT was submitted to the Department of Health in early 2005 with the expectation of a long deliberation. The tragic events of the 7 July 2005 accelerated discussions as MAIAT was deployed and a decision and funding were allocated shortly afterwards. The next 6 months proved to be busy, challenging and rewarding for all involved, who now had the opportunity to improve the health response to these types of incidents and critically improve the outcomes for patients.

SoMe, SoWhat? #SoEssential: using social media as a key learning and teaching tool

Professional and student guidanceProfessional guidance on the use of social media by paramedics has been issued by the College of Paramedics (CoP, 2016). This guidance covers how to use social media effectively and responsibly, including what to avoid publishing. It encourages users to ‘stop and think’ before posting, and is cautious, tentative and full of warnings. However, it does not mention how social media can be exciting, or how it has the possibility to change and influence practice.The Health and Care Professions Council (HCPC)—the regulator of the paramedic profession—has very similar advice to that of the College when it comes to social media, emphasising how it should be used responsibly. In a key change to their professional standards, appropriate social media use has been incorporated as a key standard in both professional and student guidance (HCPC 2016a; HCPC, 2016c). The HCPC have also recently consulted on further developing a policy for social media (HCPC, 2016b).Teesside University has its own policy on social media, which follows the main threads of the College of Paramedics and HCPC guidance. The guidance offered is of course very welcome, but the pace and development of these and other platforms are phenomenal. It is the lead author's view that the professional and regulatory bodies need a more positive and stronger focus on the benefits of social media for healthcare professionals.‘Social media allows you to create your own identity built upon self-expression and your own “personal brand”

Emergency Care of Minor Trauma in Children

Representing one of the most challenging patient groups for paramedics, this pint-sized offering addresses minor trauma in children. The authors are all consultants in the field of emergency and children's medicine and far from over-complicating the subject, are successful in delivering a text which defies the nomenclature of ‘pocket guide’.

Journal of Paramedic Practice consultant editor, Professor Ian Peate, awarded OBE

Following the announcement that Journal of Paramedic Practice consultant editor, Ian Peate, was awarded an OBE in the Queen's Birthday Honours, colleague Lynda Sibson takes a look back at the work which led to the royal acknowledgement.

Passing the mantle: a parting farewell

This issue of the Journal of Paramedic Practice will be my last as editor. It has been an honour and privilege to edit a publication aimed at one of the most exciting healthcare professions, and I am grateful for being given this fantastic opportunity. I took over the journal in 2013, having previously worked on a nursing title, and in those few short years have witnessed a notable change within the paramedic profession.