The ethical and legal dilemmas paramedics face when managing a mental health patient

This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike.

Creating a safety net for patients in crisis: paramedic perspectives towards a GP referral scheme

An innovative policy implemented by a UK Ambulance Service allows paramedics to refer patients to a GP Acute Visiting Service scheme. Initial evidence suggests that this alternate route of care can decrease hospital admission rates, decrease A&E waiting time and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that are not captured by the quantitative analysis. The goal of this qualitative-observational study was to gain insight into the GP referral scheme from a paramedic's perspective. All notes were transcribed, coded and analysed using a Grounded Theory approach. Four main themes emerged: 1) barriers to referral including wait time, process, and lack of confidence, experience and training 2) approaching the patient with the GP referral scheme in mind 3) frustrations with GP decision making and 4) awareness/understanding of the scheme's impacts. This study provided valuable insight into the paramedic's perspective of the GP referral scheme. Maximising understanding of the scheme, investigating the GP's perspective in decision making and ensuring knowledge and accountability of paramedics, GPs and the public were identified as solutions to strengthen and increase referral rates and scheme success.

Point-of-care testing for C-reactive protein in acute cough presentations

Acute cough is one of the most common illnesses in the UK with an estimated 48 million cases per annum. The majority of these presentations are thought to be of viral aetiology and self-limiting in nature, yet some studies report antibiotic prescription rates of approximately 65% in the UK. Clincians' decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. Despite warnings about antimicrobial resistance (AMR) from the World Health Organization, clinicians in the UK continue to have high prescription rates for acute cough presentations in comparison to other developed health care systems. This article will consider the feasibility, efficacy, benefits and limitations of using point-of-care testing (POCT) of C-reactive protein (CRP) within primary care in the United Kingdom to help inform management of acute cough.

Frank's Sign as a clinical marker of cardiovascular disease

Clinical examination is a core skill undertaken during the pre-hospital phase of patient care, as imaging modalities and laboratory tests are generally unavailable. While a basic cardiovascular examination is taught on undergraduate paramedic courses, there are a number of other findings that may assist in the formulation of an impression or diagnosis during the pre-hospital phase. We present one such finding and discuss its usefulness and limitations.

Continuing Professional Development: Cardiogenic Shock

OverviewThis Continuing Professional Development (CPD) module will explore the delivery and theory of chest compressions used in the out of hospital setting. There are a number of self-directed activities to complete as you move through the article together with a list of further resources that are used to reference this article and to expand your research. This article requires the reader to have an appreciation of basic anatomy and physiology and an awareness of the general approach to assessing and managing patients in the out of hospital, emergency setting before completion.

Barriers to paramedic education in black and ethnic minority (BME) groups

Purpose:To gain an understanding of how Black and Minority Ethnic (BME) groups respond to information about paramedic courses, their experience of the enrolment processes and their experience of paramedic training.Methodology:Telephone interviews were conducted with qualified paramedics and student paramedics from BME groups.Findings:Interviews revealed issues in relation to the accessibility and understanding of information on paramedic education and a lack of information in preparation for paramedic courses, causing unrealistic expectations. A lack of diversity in the student population, incidences of racial offence (unconscious or conscious), and a lack of visibility of BME staff in the ambulance service as well as in the wider community were identified.Practical implications:The results produced from this evaluation may contribute towards a series of recommendations in order to better inform practice to increase the diversity of students entering into paramedic science and in order to avoid issues such as student attrition

Emergency services are ‘not a game’

The new year issue of the journal is going to press as an exhausting month for paramedics comes to an end. In addition to the usual array of unexpected emergencies, paramedic services across the country are recovering from rescuing many hung-over members of the public during the festive season.

Equipping paramedics to look after their mental health and wellbeing

Advanced Care Paramedic Natalie Harris writes about potential ways for paramedics to care for their mental health.