Volume 9 Issue 3

The future of community paramedicine

Historically, the function of emergency medical services has been two-fold: To provide medical assistance during acute and life-threatening medical conditions, and to transport patients to hospital emergency departments. As emergency care facilities and personnel are expected to deal with routine and uncommon problems alike, operations and maintenance of paramedic units incur high costs. Various models to integrate these units into community healthcare are now being proposed to optimise the cost-benefit ratio of emergency medical services.

Ultrasound: A potential new approach for cardiac arrest management

Introduction:Out-of-Hospital Cardiac Arrest (OHCA) is a common occurrence within the pre-hospital environment (approximately 10,000 OHCA in London - over one third of England's national total of 28000; BHF 2015). The management can be associated with difficult decision-making. Ultrasound (US) has recently been introduced to critical care practice, yet evidence is poor around this topic in relation to OHCA.Search strategy:All cardiac arrest empirical literature within the last 15 years on US both in-hospital and pre-hospital.Discussion:Sensitivity analyses within OHCA in comparison with current practice show US is more accurate in predicting mortality than it is in predicting survivability to hospital admission or discharge. US is therefore well placed as a tool for cardiac arrest management alongside End Tidal Carbon Dioxide (ETCO2) monitoring and Electrocardiogram (ECG) findings, as none have the benefit of being a linear marker of survival.Conclusion:Recommendations show that US should form part of critical care management in OHCA as a sensitive real time marker of kinetic ventricular activity. This is alongside other markers of cardiac output, all of which carry variable levels of sensitivity (ECG, ETCO2) to best inform the advanced paramedic practitioner.

Continuing Professional Development: Diabetes in pre-hospital care

OverviewThis CPD module aims to outline some of the complications a diabetic patient may present with in a pre-hospital setting. Diabetes Mellitus (DM) is a long term condition of high blood sugar. It is a condition of hormones, a condition of metabolism and a condition of inflammation. These multiple aspects give rise to various long term complications that the paramedic should be aware of. This module highlights the complexities that could present to paramedics when attending to a diabetic patient in pre-hospital settings.

Using consensus group methods to improve simulation using immersive media in paramedicine

Problem:Simulation is a cornerstone of paramedic pedagogy. It facilitates a learning-centred approach which explicitly links the learning and teaching environment to the real world and enables the student to construct new understandings of paramedic practice threshold concepts. Although the benefits of simulation in medical and health education have been well researched, there is a paucity of research into how to deliver simulation using immersive media (IM) due to its recency as a strategy in paramedicine. This study explored student feedback of simulations using IM to improve the efficacy of learning activities designed for the recently commissioned University of the Sunshine Coast (USC) immersive simulation studio.Method:Feedback was taken using a modified Nominal Group Technique (NGT) consensus method post implementation of an IM strategy. Participants were second year students of the Bachelor of Paramedic Science program at USC who had undertaken simulation using immersive media in 2015.Results:The research has revealed the value of listening to the student voice in enhancing simulation design. Two major themes arose regarding the value of IM according to students. Firstly, the students perceived that benefits were derived from the closer approximation of an authentic practice environment through the use of immersive media. Secondly, that students felt that the immersive style allowed them to practice of a broader range of technical and non-technical skills than in a conventional classroom.Conclusion:IM was perceived as a positive experience by students as they reported IM to be more engaging, increasing their confidence, situational awareness and improved their non-technical skills. The USC paramedic program will continue to develop the IM strategy as a signature pedagogy.

Therapeutic hypothermia in cardiac arrest

Therapeutic hypothermia (TH) following cardiac arrest is commonplace in many hospitals. It is thought to improve survival rates and offer neuroprotective benefits. However, its use in the pre-hospital arena is still uncertain. The objective of this literature review is to collect and consider evidence and address these uncertainties with a view to offering recommendations for practice. A systematic search was undertaken, and from the literature reviewed, there was no unanimous evidence that pre-hospital TH improves patient survival or neurological outcomes. It is clear that all of the different modes of initiating TH that were evaluated were effective in reducing patient temperature on arrival at hospital.

Efficacy and safety of methoxyflurane: managing trauma associated pain in UK SAR helicopter paramedic practice

This article reviews the efficacy and safety of Penthrox (methoxyflurane) when administered in analgesic dosages. The review included one randomised, double blinded control trial and the remaining evidence consisted of reviews or observational and data-linkage studies. This paucity in a significant number of high quality pieces of evidence is mitigated to some extent by the collaborative unanimity of all the papers reviewed. All papers concluded that Penthrox was an efficacious analgesic. There was no evidence of Penthrox having long-term deleterious effects under an analgesic dosing regimen. The addition of an activated charcoal filter to the Penthrox inhaler renders the risk of occupational side effects negligible. Penthrox appears to be a safe and efficacious analgesic.

A report on the International Conference in Emergency Medicine and Public Health: Qatar 2016

Pre-conference workshop activitiesThe scientific committee planned the pre-conference workshops to be of relevance to a wide audience consisting of a variety of practitioners in EM, Public Health, and pre-hospital practice. Of specific relevance to paramedic practice were hands-on workshops in the following areas:Advanced Airway Workshop: What to do When You Stop Breathing?Decision Making, Communication, and Resource Management in Emergency Rapid Sequence IntubationPre-hospital Patient Immobilization TechniquesManagement of Catastrophic Haemorrhage in the Pre-hospital SettingEmergency Toxicology: HazChem Workshop (Figure 1)Pre-hospital Clinical Approach and OHCA (Out of Hospital Cardiac Arrest)ECGs Made Easy: Everything you Need to KnowManagement of Mass Gatherings: Health PerspectiveFigure 1.Doffing and donning demonstration by HMC Ambulance Service's Specialised Emergency Management team of a level C hazardous chemical protection suit with breathing apparatus. Picture courtesy of Hamad Medical Corporation, 2016.

Keep up to date with Journal of Paramedic Practice!

Sign up to Journal of Paramedic Practice’s regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month.