Volume 9 Issue 11

‘Have you had Viagra within the past 24 hours?’

Rapid drug-induced vasodilation is essential in treating coronary medical emergencies. Through oral or sublingual administration of glyceryl trinitrate (GTN), changes occur in cyclic guanosine monophosphate (cGMP) levels, as well as a reduction in blood pressure. Patients who require GTN treatment may also take vasodilatory medication for other medical conditions, including erectile dysfunction (ED). Current guidance in the UK contraindicates GTN use alongside sildenafil (commercially known as Viagra) and other related drugs, owing to the likelihood of life-threatening hypotension. Therefore, it is essential that paramedics and emergency responders establish whether patients have taken sildenafil within the past 24 hours before administering GTN. This article identifies the action mechanisms of both drugs, and provides an evidence-based explanation for co-administration outcomes; a dramatic drop in blood pressure which can potentially be fatal. This article also reflects on the challenges faced by paramedics when considering administration of GTN to determine whether sildenafil has been taken within the past 24 hours.

Norms of staff responses to falls in residential care

The aim of the current research was to review the first-line response to patient falls in the independent care sector in North East England. The authors used an online questionnaire via ‘Survey Monkey’ software package, and a convenience sample of 24 of 32 independent care sector homes from South Tyneside, representing a 75% response rate. Policies and guidelines for falls were investigated and the findings highlight the disparate responses to incidences in care-home settings. Despite 96% having a policy on falls, only 80% included an assessment of possible injury or harm and 13% included no direct guidance for staff when residents fall. The most common action was to ring emergency services to move patients, even in the absence of physical injury. There was considerable ambiguity around the assessment of injuries and whose responsibility this was, particularly in falls with potentially non-visible injuries. Ambiguity was also present in the management of falls, where there was overlap between accident and falls policies. The current research highlights the need for policy standardisation. There is a potential fiscal impact on emergency ambulance services when they are contacted as the first-line response for falls regardless of the occurrence of injury. This has implications on staff education and the strategic planning of emergency ambulance services. Further consideration on the suitability of falls policies is urgently required.

Time for Dementia: an innovation in education

This paper describes an innovative undergraduate educational initiative called the Time for Dementia programme. It was developed to improve the knowledge, attitudes and skills in dementia among healthcare students. Time for Dementia involves pairs of healthcare students (medical, paramedic, adult and mental health nursing, and allied health professionals) visiting a person with dementia and their carer in their homes over a period of 2 years. The aim of the programme is to enable students to learn with people with dementia and their carers—recognising that people with dementia have unique expertise derived from their experiences. Their personal narratives offer students a unique insight into the subjective experiences of dementia.

In the shadows of other health services

On 25 September, the Health and Care Professions Council (HCPC) launched its consultation on the qualification threshold entry level to the register for paramedics—a consultation period that runs until 15 December. Currently, the threshold is set at ‘equivalent to Certificate of Higher Education’ and is the lowest of any registered health profession in the UK. This is a defining moment for the paramedic profession, which has long existed in the shadows of other health vocations.

Intoxication and violence during ambulance call-outs

Ill-equippedAn interesting and concerning point raised by the research was that staff felt they were not equipped appropriately to deal with intoxicated individuals, with 50% noting that they felt they lacked the relevant training. The final main point summarised that many ambulance staff felt there should be tougher policies on intoxicated individuals. Three-quarters (76%) of staff supported the idea of an NHS policy that would charge people for ambulance call-outs when their own intoxication was the cause for requiring an ambulance.

The difficult choice between resuscitation and letting go

Coming back to lifeWhen I was a toddler, I choked on a boiled sweet. I became silent and turned purple. My quick-thinking mother (a carer for children with learning disabilities) picked me up by my feet, sharply slapped my back, and the sweet came flying out. I was one of the lucky ones and didn't need CPR; 2-year-old Francis Dean choked to death on a hard-boiled lollipop (Bunyan, 2009). In fact, 5051 people died from choking in 2015 (National Safety Council, 2017). When someone is choking, the need for CPR can rapidly develop (St Johns Ambulance, 2015).As a University student, I suffered a grand mal seizure and stopped breathing. My mother came to the rescue again, administering CPR before the ambulance arrived. It happened in Singapore, I received first-class hospital treatment but it did rather interfere with the holiday of a lifetime.During a college firework party, the crowd rushed back to avoid a rocket headed in their direction. I was crushed under a heap of people at the bottom of a garden pond on a cold November evening. Adrenaline, not my mother, resuscitated me that time.

Understanding the statistics in cardiac arrest survival

Cardiac arrests have a 100% mortality rate if no resuscitation efforts have been made within the first 10 minutes. American physician, Sebastian Sepulveda, explores the data surrounding sudden cardiac arrest, including the impact of readmission, regional differences and the effects of early initiated CPR.

Is now the winter of our discontent? Exploring seasonal pressure on the NHS

Winter is near and the media shall soon begin its yearly forewarnings of undue strain that the season brings upon the NHS. In this news feature, Alistair Quaile examines whether these warnings are genuine or mere hyperbole, and considers the causes of winter pressure, as well as what the NHS can do to combat these seasonal demands.

Continuing Professional Development: Using clinical decision making and reflection strategies to support practice

OverviewThis Continuing Professional Development (CPD) module explores clinical decision making and reflection for paramedics. Both skills are essential for any healthcare professional to possess in that they underpin and enhance practice by providing a robust framework for structuring one's thinking and subsequent actions.This article highlights the need for the study of clinical decision making, which forms a vital part of the paramedic's practice. It provides a background to clinical decision making before presenting an example case study.

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