Volume 9 Issue 10

Paramedic attitudes towards DNACPR orders

Background:Qualitative research involving paramedics and their involvement in end-of-life (EoL) care has already been published, but there have been no published attitudinal studies specifically relating to do not attempt cardiopulmonary resuscitation (DNACPR) orders and paramedics working in the pre-hospital setting in the UK.Objective:To gain an understanding of paramedic attitudes towards an increasingly common aspect of paramedic practice, focusing specifically on the pre-hospital environment and identifying any corelation between gender, length of service, and level of educational attainment.Design:A paper-based questionnaire was distributed to all paramedic grades, operational out of two ambulance stations of a regional NHS ambulance service in March 2017. The questionnaires were designed using a combination of free-text boxes and Likert scales. A total of 33 questionnaires were issued and 11 completed questionnaires were returned.Results:Respondents indicated the importance of communication in relation to DNACPR orders, as well as the role of allied health professionals and family members in the process. Respecting the patient's wishes was considered paramount, as was educational provision surrounding DNACPRs.Conclusion:The majority of respondents reported that they were comfortable incorporating DNACPR orders in their clinical practice, although more modest responses were returned regarding the level of education received in this area of paramedicine.

Continuing Professional Development: The challenges of pre-hospital paediatric trauma

OverviewThis Continuing Professional Development (CPD) module explores the challenges paediatric trauma presents to pre-hospital and emergency clinicians. There has been a nationally increased focus to improve the quality of trauma care in the UK, leading to the development of regional trauma networks in 2012. This focus includes children. This module will discuss the challenges and issues of dealing with paediatric trauma and how some of the problems encountered might be mitigated.

Amended police powers under the MHA 1983

Paramedics are frequently called to people with acute mental health problems and often assist in caring for and transporting individuals subject to police powers under the Mental Health Act 1983, sections 135 and 136. Those powers will change when Chapter 4 of the Policing and Crime Act comes into force this autumn. In this short article featured for World Mental Health Day, Richard Griffith considers the impact of amendments to police powers on paramedic practice under the Mental Health Act 1983 introduced by the Policing and Crime Act 2017, Part 4, Chapter 4.

Cardiac arrest and the role of transthoracic echocardiography

The role of transthoracic echocardiography (TTE) is one of the top five research priorities in prehospital critical care (Fevang et al, 2011). TTE is a non-invasive diagnostic tool in cardiac arrest, using ultrasound images to visualise the real-time activity of the heart (Hernandez et al, 2008). TTE has the potential to reduce the time between the onset of cardiac arrest and appropriate therapy. There are several reversible causes of cardiac arrest that can be identified by TTE in the pre-hospital environment. The method and value of identifying pulmonary emboli (PE), cardiac tamponade and hypovolaemia will be discussed. Equally, TTE can exclude certain reversible causes, indicating that the cardiac arrest is of an irreversible nature and the resuscitation attempt is futile. The application of TTE in this context will be reviewed in depth, from the current literature to the physical practicalities. As such, the aim of the present study is to clarify the role of TTE in patients suffering out-of-hospital cardiac arrest.

SAR helicopter paramedic practice: EtCO2 measuring to assist with CPR attempts

This article is a review of literature conducted in as systematic manner using the PRISMA statement as a basis for its methodology to answer the following question: How can EtCO2 measuring assist with CPR attempts in SAR Helicopter paramedic practice?’ Results revealed that CO2 coming out of an ET tube indicates that it is in the correct position. An EtCO2 value of <1.33 KPa or an EtCO2 that falls by ≥ 25% of the baseline are the variables most significantly correlated with not achieving ROSC. Diminishing EtCO2 readings may be an indication to increase CC depth, or change a tiring CC provider to optimise CPR attempts. A sudden rise in EtCO2 is a highly specific but non-sensitive marker of ROSC.

The workplace and mental wellbeing

This year, World Mental Health Day celebrates its 25th anniversary on 10th October 2017. Following Lynda Sibson's article last month, it's clear that the mental health of workers in health and social care is in need of attention. This year's theme, ‘Mental Health in the Workplace’, promotes the positive impact of wellbeing on staff and the care they deliver.

Providing support to students following a mass casualty incident

Out on placementEdge Hill University currently runs a 2-year diploma programme for Paramedic Practice evolving into a 3-year BSc (Hons) starting from September 2018. At any one time, the department will have a cohort of students in university studying and another learning through clinical practice placements. These placements are either with NWAS or on a range of multi-professional bespoke placements facilitated across the entirety of the North West region. Throughout their 2 years of study, students are expected to work closely with their paramedic mentors, developing the necessary skills and confidence required to progress into independent (although still supervised) practitioners during their final year.On Monday 22 May, 62 first-year student paramedics had just commenced a week of clinical placements with NWAS. The students, aged 18 years to their mid-50s from a variety of backgrounds and experiences, only joined the university in September 2016. Being in their eighth month of study when the tragedy struck, their experience of paramedic practice was somewhat limited. Working alongside their paramedic mentors, some students were deployed to the incident.As news of the attack began to break across the world, academic staff in the Paramedic Department of Edge Hill University were aware that students may be involved in the immediate response to the arena attack. On the morning of 23 May it was confirmed that eight of the first-year student paramedics had been involved in the immediate response to Manchester Arena. It became clear that a number of other students were also on duty and were indirectly involved in supporting the response by continuing their placements with their mentors and responding to regular calls from the community. It was apparent that all students involved would require support and the following is an account of the actions of Edge Hill University Paramedic Department and the NWAS in the aftermath of the incident in order to support the students.

What's next for England's ambulance services?

Details of the delivery of new ambulance standards were announced in July 2017 at the Health and Care Innovation Expo in Manchester. In this comment, Alistair Quaile examines the implementation, outline and evaluation of the programme, noting potential positive changes for patients, emergency care and ambulance staff.

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