Volume 9 Issue 8

Continuing Professional Development: Highlighting the law and ethics of pain relief in end-of-life patients

OverviewThis Continuing Professional Development (CPD) module explores the ethical and legal issues surrounding pain relief for end-of-life patients by paramedics. Particular attention is focused on the moral and ethical principles of care as proposed by Beauchamp and Childress (2008), as well as the legal aspects of care as set out by the European Convention of Human Rights. Through the use of law cases, this module looks to demonstrate precedence for practice, as well as the implications that arise thereof.

The need for sound professional advice

Acid attacks in London have drawn attention to a vicious, mutilating and life-changing scourge, the existence of which many might never have suspected in the UK. London is being referred to as the ‘corrosive capital’ of the UK, with close to 1500 acid attacks reported over the last 6 years.

Durham and Cleveland police firearms unit tactical team medics: lessons from the first six years

Background.Since 2007 Durham and Cleveland Firearms Police have trained a small number of firearms police officers to an enhanced level of first aid qualification. This article reviews the history of this programme, the patient report forms submitted during the period 2013-2016 and analyses the types of incidents attended.Methods:66 PRFS were interrogated and analysed from a four-year period between Jan 2013 and Dec 2016. There was a marked increase in PRFs submitted during that time. Over half the casualties were male, resulting from assault (15) 21%), road traffic collisions (14)19%) and deliberate self-harm (14)19%). The most frequent medical interventions were wound dressing and direct pressure, airway manoeuvres and Oxygen therapy. On-scene times with patients prior to handover to NHS staff ranged from 0->60 mins. 0-20 minutes (22), 20-40 minutes (15), 40-60 minutes (10) and >60 minutes (1).Discussion:This data shows that the TTMs provide a useful medical response often arriving before other medical provision is on scene. Despite the primary role being to respond to firearms trauma, officers have dealt with a range of medical scenarios and provided a range of interventions.

Should oral steroids be routinely supplied to prevent asthmatic relapse?

In 2014, the National review of Asthma Deaths recognised the significant burden of associated morbidity, amongst avoidable factors and recent contact with healthcareprofessionals that commonly occur prior to a fatal asthma exacerbation. It also recognised delayed and undersupply of preventer medications, particularly oral steroids, that are linked to relapsing into a repeat exacerbation. Oral steroids are not without significant systemic side effects and carry their own risks which must be balanced against the risk of relapse. This literature review seeks to establish if oral steroids should be routinely supplied to prevent asthmatic relapse. Exacerbations induced by viruses, allergies and medications are commonly known to contribute towards deterioration and these high risk patients have been found to gain the most benefit from a 7-10 day course of oral steroids. This is recommended as an effective, cheap and safe option with minimal side effects for higher risk patients. Paramedics should consider supplying, or obtaining a supply of oral steroids for high risk asthmatics following an acute exacerbation of asthma when the patient does not require, or refuses, further assessment or observation in an accident and emergency department.

Ocular management for CS gas exposure: exploring treatment in the pre-hospital setting

Problem: The use of CS gas has increased dramatically in recent years yet how to implement optimal management is still a matter of debate. A lack of a sandardised approach to care has left a vacuum in which various treatments have been proposed, some with no evidence base. Whilst some of these treatments may simply not work, others will increase the pain and time taken to recover. Approach: This paper looks, specifically at the ocular management of exposure to CS gas as the eyes are often the most severely affected of organs and therefore the focus of the first aider's efforts. Suggested ocular treatments proposed by the general public were explored alongside existing professional guidelines and available academic literature. Conclusions: Recommending best practice remains difficult and treatment will often have to be adapted to the local environment. Adherence to commonly agreed principles is essential and includes preventing secondary effects by use of personal protective equipment, removing those affected into a well ventilated area, removing contaminated clothing and offering reassurance.

Development of clinical and inter-personal skills to support people living with dementia

There is a lack of understanding on how paramedic students develop their knowledge, skills and attitudes to support people living with dementia and their families. This original qualitative study applied focus groups to explore paramedic students' perspectives. First and third year paramedic students were recruited from two ambulance service providers in the South of England. Data were collected during January and February 2017 and three themes emerged: 1) challenges of communication 2) students' negative emotional response, and 3) lack of social care and pathways. Paramedic students did not discuss person-centred approaches to support people with dementia; however they all acknowledge the impact of dementia as unique to each person, their family and situation. Undergraduate paramedic education needs to support the development of students' communication and interpersonal skills. Both university lecturers and placement educators need to provide consistent, clear, detailed information to enable students to support and care for people with dementia and their families.

Stroke assessment and management in pre-hospital settings

This article will review the assessment and management of acute stroke in the pre-hospital setting. Stroke affects over 111,000 individuals per year, with almost 1 million individuals living with the after effects of stroke in England today. 85% of all strokes are ischaemic, treatments including with intravenous thrombolytic agents and mechanical thrombectomy, the remaining 15% haemorrhagic strokes are able to managed with decompressive hemicraniectomy. The key risks factors for stroke will also be briefly discussed, since they are commonly presenting conditions in the pre-hospital setting. A range of specific stroke assessment tools will be presented – not all are used, nor appropriate, for the pre-hospital setting – but it is useful to be aware of these. The article will also include differential diagnosis and stroke mimics. The key features of acute stroke are the sudden onset of focal neurological sings and symptoms.

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