Volume 9 Issue 5

Refusals and delays: ambulance service under pressure

Winter of 2016–17 saw a record number of ambulances being turned away by Accident and Emergency (A&E) departments due to overcrowding. Unsurprisingly, this had a knock-on effect on the emergency service response times. Attending to patients turned away by A&E for longer periods of time meant that other patients in need of emergency care were left waiting for an ambulance. Around 12% of the serious Category A emergency calls did not meet the response time target of 19 minutes this winter.

ABC of Domestic and Sexual Violence

In the UK each week, two women are killed by their partners. The crime survey for England and Wales reports the prevalence of lifetime partner abuse to be experienced by approximately a third of all women and a fifth of all men.

The Ambulance Service: what it ought to be

The title of this brief comment was the final part of my inaugural Larrey Lecture given in London on 13 July 2016. It represents only an opinion; hence, some disagreement is naturally expected, and indeed, welcomed. Honest debate can stimulate progress.

Taking healthcare to the community: the evolving role of paramedics

Within paramedic unscheduled care, there has become a fixation on delivering urgent care provision to the patient. Whilst this has its roots in one very familiar Bradley Report (Department of Health 2006), the well quoted Keogh Report also sets out that ambulance services should develop into ‘mobile urgent treatment services capable of dealing with more people at scene, and avoiding unnecessary journeys to hospital’ (NHS England 2013: 8). In essence, delivering care to the patient. The accessible literature shows that across the World, community paramedic programmes follow similar notions. Canada (Reust et al 2012), Australia (Blacker et al, 2009) and certain states within the USA (Jensen et al, 2016) offer community schemes where paramedics work in collaboration with other community services to meet community-defined needs. Although differing in their individual approaches, the general principle is the same: paramedics are reaching out into the community to provide care which often reduces emergency department attendances and results in cost savings, both to the patient and the health provider (Nolan et al, 2012; Jensen et al, 2016). Some patients will always require care to be delivered to them due to various mobility, co-morbidity and access issues. Equally, many patients do not have these issues and are able to travel. What many current healthcare models do seem to miss, is the responsibility this report offers. Keogh explicitly states that the ‘report sets out some principles. How they are developed locally will, and must, vary to suit local circumstances and wishes. We will need different approaches in metropolitan, rural or remote areas. The majority of people needing urgent care do not have life threatening problems so we must focus our attention on bringing the best care to people as close to home as possible, wherever they live’ (NHS England 2013: 9).

Community paramedics: need of legal education specific to the pre-hospital non-emergency environment (discussion based on Texas)

Emergency medical services (EMS) have responded to the Affordable Care Act's target to reduce healthcare spending and focus on preventative health by developing community paramedicine programmes in the USA. Currently in their infancy, these community paramedicine programmes aim to utilise existing skills and knowledge to combat patient readmission to the emergency department, and empower the public to take control of their healthcare path. Paramedics are taken out of the pre-hospital emergency environment and placed into a new undefined prehospital non-emergency preventative health care territory. As EMS morphs into a preventative healthcare realm in Texas, questions of community paramedicine healthcare designation and legal ramifications arise. Community paramedic knowledge of these healthcare designations and legal ramifications is indispensible to the success of such a programme.

Continuing Professional Development: Vertigo and pre-hospital care

OverviewIn this CPD module, we will look at the symptoms of vertigo. Vertigo dizziness is a presentation that paramedics may face, and is often associated with other presentations, such as head injury, stroke and benign pathology. This module will explore some of the different causes of vertigo and how the paramedic can approach this in a safe way, considering the different pathophysiology of each type of vertigo.

Appropriateness of action learning in the physical and virtual spaces: a discussion

Paramedics are autonomous health professionals who must graduate into the workforce with complex problem-solving skills, an ability to exercise critical thinking, and clinical reasoning skills to challenging situations, if they are to practise safely. Face-to-face action learning (AL) has long been acknowledged for contributing to the development of such skills, by providing a platform for structured thinking, group working, and a tool for developing participant's ability to ask insightful questions (Pedler et al, 2005) and more recently, action learning in the virtual space is becoming increasingly popular. Virtual action learning has emerged for reasons including globalisation, where the emergence of multi-national and dispersed students has become commonplace (Dickenson et al, 2010) and advances in technology that have allowed more collaborative communication.This discussion paper provides an introduction and background to action learning (AL), virtual action learning (VAL) and explores the appropriateness of these paradigms as a tool for embedding reflective practice and problem-solving skills among undergraduate student paramedics.

Asthma, infection and the World Anti-Doping Agency: a case study

Paramedics are now encountering ever more complex medical situations, and are expected to formulate holistic management plans. This case provides an interesting scenario whereby management was considered not only in conjunction with current evidence and guidelines but also with patient preference. This article will explore the assessment and management of a patient presenting with asthma and a chest infection whilst considering legal, ethical and professional factors.

Patient confidentiality and safety: a classic conundrum

Paramedics frequently have to balance patient confidentiality and patient safety. Patient information is subject to legal, ethical and professional obligations of confidentiality and should not be disclosed to a third party for reasons other than healthcare, without consent. Whilst there is an imperative to preserve the professional/patient relationship, there are occasions where this is not possible. This article considers circumstances when confidential patient information may be disclosed without the consent of the patient and discusses the legal, ethical and professional aspects of decision making in this context. A clinical example from practice is presented where an ambulance crew was called to a 50-year-old man with type I diabetes, which is normally well controlled with insulin. He is employed as a van driver, but has experienced two sudden hypoglycaemic episodes in 3 weeks rendering him unconscious. Once treated, he declines transport to hospital, any onward referral or to inform the Driver and Vehicle Licensing Agency (DVLA) through fear of having his driving licence suspended.

What can dyslexic paramedic students teach us about mentoring? A case study

The context or background for the study:This paper was written following a critical analysis and structured reflection on mentoring and teaching a dyslexic paramedic student including approaching from personal experience as well as identifying a gap in research. The purpose of this study was to discover what paramedic mentors can do to improve their interactions with dyslexic stu-dents.Basic procedures:Following the experience of teaching one student, to work on this definition of dyslexia: “difficulties in processing, particularly literacy and the acquisition of reading, writing and spelling’.”; Using an analytical method – qualitative and reflective.Main findings:Inclusive learning helps to fight stigma while improving education for all whether they dis-close dyslexia or not. There are many steps that can be taken by mentors to support stu-dents, including allowing time to think/to practise and support with organising.Conclusions:Inclusive learning benefits all students, not just students with dyslexia. Students do not legally have to disclose a dyslexia diagnosis, so, introducing inclusive learning for all students using accessible and practical learning could benefit more students.

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