I write this editorial as the nation completes a minute's silence, mourning the lives lost in the Manchester attack. Yet another frightening incident, and one that is not unheard of in the recent past. Our emergency services have been lauded by many for their ever-reliable response in times of distress.
Deaths: indicator of demandOn this occasion, deaths (all-cause mortality) are used as an indicator of end-of-life related demand. Each additional death seems to be associated with around 10 additional medical admissions (Beeknoo and Jones, 2016); hence, higher ambulance journeys, plus unexpected demand on social services lead to bed-blocking.Figure 1 shows an apparently confusing situation where most local government areas were high in 2016/17; however, whatever happened was characterised by a huge range. Hence a -2.9% shift for Inner London down to -9.2% in Newham, through to +11.6% for Gloucestershire and even +16.8% in Stroud.
ExperienceWithout doubt, NQPs lack experience. However, this does not preclude the fact that an NQP is still a registered paramedic, and must act in accordance with the paramedic standards of proficiency (Health Care Professions Council, 2014). As experience and expertise develop, clinical decision-making improves (Donn, 2017). Smith et al (2013), established that paramedics of all experience levels were aware of critical time pressures, but that more experienced paramedics were better at resource management and developing rapid treatment strategies.Moreover, Thompson (2015) found that NQPs lack confidence due to experience and exposure during pre-registration mentorship. Although a small qualitative sample, this demonstrates that transitioning to a lead clinician might require continued development post registration. However, in essence, this declares that university programmes are insufficient in providing adequate training to autonomous practice. Kennedy et al (2015) support this claim, finding in a small literature review that feelings of being out-of-depth were a common theme. This is similarly reflected in other healthcare professions such as nursing, where such feelings are allayed with improved confidence, competence and knowledge during transitional programmes (Rush et al, 2013; Edwards et al, 2015).A counter argument is that current student paramedics are exposed to many more multi-professional learning opportunities (Jennings and Rae, 2016), at a time where pre-registration paramedic programmes are at their longest, resulting at bachelors of Science level graduates (Williams et al, 2016). Additionally, Alexander et al (2009) found a negative correlation between American paramedics' commitment to an organisation and level of study, citing that increased factors of autonomy, responsibility, and intellectual challenge may play a role in the poor organisational retention of paramedics at bachelors level. Research should further investigate these factors within the UK.
Hyperkalaemia is a potentially life-threatening metabolic emergency and is the most common electrolyte disorder associated with death. The author attended an incident where a patient suffered asystolic cardiac arrest from hyperkalaemia and was subsequently resuscitated successfully to hospital discharge with good neurological outcome. This piece intends to review all relevant available literature with the aim of developing recommendations to aid paramedics in managing cardiac arrest secondary to Hyperkalaemia. Despite the lack of current good-quality evidence for pharmacological interventions, systematic reviews available have led to the development of clear guidelines. The use of calcium chloride and sodium bicarbonate is recommended, and these are both carried by Critical Care Paramedics (CCPs). Salbutamol therapy has the strongest evidence base of any intervention available out of hospital. It should be considered after the use of the aforementioned medications if the patient achieves ROSC. Consideration must also be taken as to whether the patient would benefit from being moved to hospital to reach vital interventions such as insulin/dextrose therapy and dialysis.
Methamphetamine use in Australia has been the topic of considerable attention by the media, political parties and the general public in recent years. This occurrence, along with the need for ambulance services and personnel to be adequately prepared, warrant further research in this area. This scoping review aims to determine who is currently using methamphetamines, whether prevalence has changed over time, and the impact is this having on emergency ambulance services in Australia.Key Findings:users of methamphetamine in Australia are mostly male, aged late twenties to early thirties and born in Australia. They generally have low levels of education and high levels of unemployment, homelessness, and rates of dependence. Overall rates of methamphetamine usage has not changed, however the proportion of users taking stronger forms of the substance has increased dramatically leading to adverse health consequences and emergency service intervention.Implications:Methamphetamine use is a societal issue which has far reaching consequences impacting on individuals, families, communities and healthcare personnel.Conclusion:the related health issues and aggression associated with methamphetamine affected patients, coupled with the increasing hospital and ambulance utilisation by this population warrants more research being undertaken on this issue.
OverviewIt has been widely acknowledged that evidence supporting the use of cervical collar has been lacking, and that its use was therefore based upon hypothetical benefit. However, modern evidence challenges the very principle of immobilisations on which the collar's use was justified, and argues that the cervical collar is an ineffective immobilisation tool regardless. Cervical collars have always been thought to be a relatively harmless measure. Evidence suggests that the application of cervical collars can be harmful to patients. An assessment of today's evidence justifies an immediate change of practice, and EMS providers across the world are adapting accordingly. Practice change in the UK is well overdue.
The role of front line ambulance staff in the UK has developed so rapidly that it is almost unrecognisable from days gone by, when scoop and run tactics were commonplace. With additional responsibilities, pressurised decision making and a range of sometimes complex interventions, unique pressures have also developed. The purpose of this article is to review pertinent information relating to how these additional pressures can metamorphose into specific conditions such as post traumatic stress disorder (PTSD). The prevalence of this and other debilitating conditions such as depression and anxiety specific to the ambulance service is reflected upon, whilst existing support from the ambulance service is examined. By broadening both knowledge and confidence relating to this increasingly significant problem, formulation of our own local improvements can take place in the near future.
This discussion explores the significance of digital technology to responsive patient care in applied paramedic practice. The authors' previous research identified the relative ambiguity of the role of digital technology in facilitating and supporting patients in practice, and the findings revealed the relative transferability of this finding to wider allied healthcare clinical and professional practice. The discussion encompasses two key debates, namely a) How best the quality of the digital technology patients engage with can be discerned with regard to the vast availability of information and b) what the fundamental pedagogical implications to the way paramedic education in the UK is currently delivered might be in relation to equipping the future paramedic workforce to empower patients and their families and carers in emergency situations. The discussion paper concludes with an overview of the tensions that unregulated apps pose in practice and how engaging with the public about the use of digital technology could be a key aspect for review in UK undergraduate curricula and staff development.