Volume 9 Issue 4

Compassionate yet detached

The UK capital was recently struck by a heinous terror attack. As the nation watched the events unfold on TV, authorities and citizens were most impressed with the speed and efficiency of police and the paramedics. The Ambulance Service declared the attack as a ‘major incident’. Social media was flooded with comments regarding what this meant, as it was already obvious for the whole nation that the attack was a ‘major incident’.

The satellite security blind spot: what it means for paramedics on the frontline

Over the course of the next 3 years, the UK's emergency services will be switching over to state-of-the-art handset and vehicle-mounted communication devices, operating on a private 4G network. Part of the Emergency Services Mobile Communications Programme (ESMCP), this new equipment can provide increased resilience and security across all communication channels and navigation devices used by frontline emergency services in the UK. In addition, new services and applications will be launched, which improve the function, efficiency and safety of the emergency services. However, the nature of the security landscape for these technologies and services is evolving rapidly. Their reliance on Global Navigation Satellite Systems (GNSS) to deliver location data to users of the ESMCP leaves them open to outside interference. Unless properly addressed and mitigated, these threats could pose a critical risk.

Continuing Professional Development: Pre-hospital management of end-of-life care

OverviewThis CPD module will outline some of the challenges for patients at their planned end of life. End-of-life care is a specialism which paramedics, as the ‘go to’ provider of out-of-hours healthcare, are often faced with. It will cover a number of conditions which can no longer be cured, but instead, treatment is designed to be palliative. We will focus on some of the emergencies such as secretions, bleeding and pain in the end stages of life.

Non traumatic chest pain – pericarditis

Pericarditis is an inflammation of the two layers of the thin, sac-like membrane that surrounds the heart. This membrane is called the pericardium, so the term pericarditis means inflammation of the pericardium. The causes of pericarditis are thought to be viral, fungal or bacterial in nature. Pericarditis may also present as a result of a myocardial infarction (MI). The presenting signs and symptoms of pericarditis are described as a chest pain which may radiate to the arm and jaw, a pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over one another) on auscultation of heart sounds. The diagnosis of straight forward pericarditis may be within the scope of practice of the Emergency Care Practitioner (ECP). It would be possible for the ECP to reach a working diagnosis and even to initiate a treatment regime, which would predominantly consist of providing analgesia to make the patient more comfortable.

Pre-hospital lactate testing in the recognition and management of sepsis and septic shock

Sepsis a common condition, with a high mortality rate. Patients with this condition are routinely encountered by ambulance clinicians, but recognition of septic shock can be challenging. The pre-hospital phase of sepsis care provides the earliest opportunity for identification and treatment. Lactate measurement is a tool commonly used to stratify patient illness severity in sepsis, and is recommended as part of initial management in the acute hospital setting. A lack of evidence to inform the pre-hospital phase of care for patients with suspected sepsis prompted this pragmatic evaluation of point of care lactate measurement in an ambulance service. It is important to highlight that this study was carried out prior to the 2016 Sepsis-3 definitions and quickSOFA clinical criteria for recognising sepsis.

Pre-hospital care of the transgender patient

Thanks to improved recognition, management, and overall societal acceptance of atypical gender identity presentations, number of transgender patients is increasing. Written by a transgender female, this paper draws from both personal experience and academic literature and discusses what it means to be transgender and the latest biomedical research into the aetiology of transsexualism. Clarification of common terminology is addressed to ensure an appropriate rapport to be built by the prehospital clinician without alienating the patient during the clinical examination and assessment. Specific considerations that may present to a clinician outside of hospital, with information about history taking, drug therapy and mental health challenges surrounding the condition are then discussed. The paper concludes by stating that paramedics and ambulance clinicians must recognise the health care needs of transgender patients and advocate for them to help eliminate discrimination.

Can paramedics avoid A&E departments with patients complaining of non-traumatic chest pain?

The ‘Paramedic Pathfinder’, a triage tool for paramedics, contains a discriminator for patients complaining of non-traumatic chest pain. The pathfinder advises all patients with non-traumatic chest pain to be taken to hospital. Given a background of large numbers of patients complaining of chest pain and the policy direction of UK ambulance services to treat patients closer to home, the inclusion of discriminator in the pathfinder can be challenged.A greater understanding of ACS, university education for paramedics, bedside troponin measurement, ACS risk scoring, current NICE guidelines and rapid access chest pain clinics have been identified as enablers to remove the discriminator safely and assist paramedics in finding suitable alternatives to Accident and Emergency for certain patients.Risk is an important factor in discussing chest pain and establishing the best pathway for patients. The enablers identified need further testing and development in the pre-hospital environment before they can be utilised.

Principlism: when values conflict

To ensure morally justified decisions, clinicians are encouraged to apply ethical theories and frameworks. Beauchamp and Childress’ ‘Four Principles’ approach to medical ethics, or ‘Principlism’ for short, is highly regarded as a simple methodology for considering ethical dilemmas, and is common to many undergraduate clinical programmes. On occasion, ethical dilemmas are complex and one or more of the four principles come into conflict with each other. Critics of the approach have suggested that there is a lack of guidance on how to resolve this conflict.This paper will argue that principlism facilitates an organised and thorough method of reflecting upon an ethical problem and is well suited to the pre-hospital setting. The problem of how to resolve conflicts between the principles will be explored, demonstrating the merit of the approach through its application to a real-life moral problem from the pre-hospital setting.

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