Volume 9 Issue 12

Student Perspectives

In preparation for our upcoming 2018 JPP Student Column which will launch in the next issue, we take the opportunity to speak to a few 2nd year student paramedics from Edge Hill University about their experiences.

What is the most appropriate out-of-hospital opioid for adults with traumatic pain?

Aims:The aims of the current research were to investigate the most appropriate out-of-hospital opioid for adults with traumatic pain. Providing adequate analgesia has multiple benefits both during and post injury.Methods:The literature search was carried out using multiple databases to identify relevant out-of-hospital research with additional grey literature to support. The main themes encountered were intravenous morphine compared to intravenous fentanyl, and the contrast between them.Discussion:There were no significant differences in effectiveness or adverse effects. Intranasal application was thought to be favoured where intravenous access was unobtainable.Conclusions:Further research is required to establish which is the most appropriate opioid. This could include a greater focus on the onset time, duration and optimal dose. Increased education and organisational focus would need to be addressed alongside a change in drug formulary for the out-of-hospital clinician.

A review of ketorolac as a prehospital analgesic

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as part of a multimodal approach to managing acute pain. Administering NSAIDs by intramuscular (IM) or intravenous (IV) injection allows them to be used in patients who are nil-by-mouth, who cannot swallow, and to allow a more rapid onset compared to the oral route. Current paramedic practice in the UK does not generally allow for the use of an NSAID given by IM or IV injection for acute pain. While paramedics may administer paracetamol and morphine intravenously, the only option for an NSAID is oral ibuprofen, or rarely oral naproxen or rectal diclofenac. Ketorolac is an NSAID, which can be administered by IV or IM injection. It is an effective analgesic agent when used alone, or in conjunction with other agents as part of a multimodal approach to analgesia. This article reviews the evidence from peer-reviewed papers and current clinical guidelines surrounding the safety and efficacy of ketorolac as an analgesic agent for acute pain, and discusses its potential use in UK paramedic practice.

Acute stress and frontline healthcare providers

Background:Repeated exposure to stress increases the risk of acute stress response (ASR) and post-traumatic stress disorder (PTSD).Aims:The authors aimed to investigate ASR/PTSD symptoms among a multidisciplinary population of frontline health professionals who care for injured and critically unwell patients.Methods:A voluntary, anonymous questionnaire included an Impact of Events Scale-revised (IES-R) assessment, addressed stressors, teamwork, and mentorship. An IES-R score of >33 indicated symptoms in keeping with ASR (lasting <1 month) and PTSD (lasting >1 month).Findings:15% (27/181) of returned questionnaires had an IES-R score >33; 19 had symptoms >1 month. Seven participants with IES-R >33 group had sought professional help. Less than half knew of a mentorship programme at their place of work.Conclusion:There is a hidden, untreated burden of stress symptoms among frontline emergency healthcare providers, and a variable environment of mentorship and teamwork. Attention is warranted if patient safety is to be optimised.

JPP SoMe

What are paramedics tweeting about?Rob Moore @wmasrobmooreApparently it's #ThankAParamedic day today! So if you know a paramedic, or one has looked after you recently, say thanks! It'll make their day, I promise! #BlueLightHappyPete Gregory @eddlecanardExcellent editorial board meeting with @Para_Practice, looking forward to a great future for the JPPParamedic Practice @Para_PracticeWe want to know your thoughts on the #Budget2017 - how will these changes effect your practice? Is enough being done to save the NHS? Comment and share our thoughts with us @NeeNawsteveIm hoping my trust will get additional funding for student paramedic places, then being told you've passed the interview and will be given a placement *it* funding can be found.If* not it …. nightshift brainParamedic Practice @Para_Practice‘Don't block my drive’ note left on the windscreen of an ambulance - have you had any negative experiences with members of the public you weren't treating?@romduck: Goodness, who HASN'T?@Paramedic_In_GP: Let's be pragmatic for one second, whilst trying very hard not to provoke a fight… Whilst we are engaged in an emergency-life goes on around us.Your emergency, might not be that of your neighbour. We must accept this.@cwtchynycegin: Hammering on the doors whilst ALS in process. Bystanders aware of circumstances wanting to know how long we'd be so they could move their cars@leeparrott45: My old crew mate (retired now) had a story from the late 80s. Doing CPR on a patient, had left front door open in house. Suddenly a man appears in the front room shouts “Move the ambulance!” And then leaves! Sadly, it's not a new phenomenon. #NHS@flyeruk69: There's a big difference between pragmatism and selfishness, while the neighbour might be impatient to carry on in this life, the ambulance crews are working hard to save a life

The London Bridge attack: managing multiple victims of penetrating trauma

For clinicians arriving first at mass casualty incidents, one of the greatest challenges is not focusing attention on one individual patient, but to assess the needs of the many in order to establish prescribed procedures and the resources required. However, for the victims of potentially lethal stab wounds, there is often little that prehospital clinicians can offer over very rapid transport to in-hospital surgical intervention. In this article, the authors explore the conflict between the established and often protracted major incident approach against the immediate needs of someone who has just been stabbed, in contrast to the different management challenges of victims of blunt trauma. A view of the London Bridge attacks is presented from the perspective of a London Ambulance Service advanced paramedic practitioner in critical care. The advantages of having an experienced advanced clinician able to offer early clinical and on-scene leadership manifested in several ways, and these will be highlighted here.

The NHS must do more to retain staff

The most important resource for the NHS is its staff. When people fall ill, they expect the best and safest treatment, but receiving safe and effective treatment will depend on having an NHS that is well-resourced, with an investment in its staff. The NHS has to do more to develop and retain its most precious resource.

Major traumatic brain injury: how do hypotension and hypoxia affect mortality?

During the prehospital treatment of major traumatic brain injury, hypotension and hypoxia occur frequently. The presence of either is associated with decreased survival, but little is known about the effect on patient outcomes when they occur together. Spaite et al (2016) evaluate how hypotension and hypoxia, occurring in combination or separately, affect survival.

Does precedence trump in the origins of confidentiality?

Good clinical practice has to be entwined with good ethical practice. Therefore, it follows that the clinical acumen of a modern paramedic develops at the same rate as their moral and ethical practice. As a newer profession, paramedics have relied on rules and codes from others to help maintain this balance, but their ancient and basic structure fails to address the nuances of modern practice. The paramedic profession has required a heuristic approach, as well as relying on the precedent of modern laws and codes, to underpin practice while simultaneously recognising the limitations of oath-based principles. This response has been necessary to address the increasingly complex and complicated situations paramedics encounter in their clinical environment.

Continuing Professional Development: Fundamentals of blood pressure measurement

OverviewThis Continuing Professional Development (CPD) looks at how the body regulates blood pressure, what a healthy blood pressure is, how it should be measured and what happens when blood pressure rises or falls. It is important for paramedics to recognise possible causes of blood pressure changes, understand how these fluctuations occur and how to measure blood pressure accurately.

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