Accuracy of prehospital diagnosis of pneumothorax
Failure to identify pneumothoraces in prehospital care carries the potential for significant consequences due to the potential for worsening of the pneumothorax during transfer. Clinical assessment alone is of limited value in the diagnosis of pneumothoraces, so many may go undetected. The use of ultrasound to increase the sensitivity of pneumothorax detection has become established within the hospital environment and may have utility in the prehospital environment. This study sought to establish the feasibility of non-physicians to undertake prehospital ultrasound pneumothorax diagnosis in a live clinical environment, and assess the accuracy of the diagnosis.
Bilateral lung ultrasound images were randomly selected from 87 patients and assessed using point-of-care ultrasound (POCUS) by three advanced retrieval practitioners (ARPs). Two expert reviewers evaluated these images to determine the quality of the diagnostic images and accuracy of diagnosis.
In total, 22 of the 24 images were considered adequate by the ARPs, but only 19 were considered adequate on expert review. Of those 19 images, both the ARPs and reviewers identified two pneumothoraces which were subsequently confirmed on chest x-ray. In this study, ARPs were able to obtain adequate images and correctly diagnose pneumothorax in the prehospital environment with 66.6% sensitivity (95%CI 66.6–100%) and 100% specificity (95% CI 81.0–100%) compared to expert review.
Peripheral vascular access in prehospital care
The insertion of peripheral vascular access (PVA) devices is a common medical procedure in emergency medical services (EMS); yet there are no specific guidelines about when and when not to use them. The focus in the UK has been to encourage paramedics to insert devices only when they will be used by the attending paramedic; however, it remains unclear whether this is the case.
This Swiss retrospective study included 33 055 cases attended between 1 January and 31 December 2017. Of these, 8603 (26.0%) had a PVA device inserted, which is a significantly lower proportion than in earlier studies. Of those devices, 46% were unused with the majority (66%) found to have been used in patients with low severity conditions. The authors also established that some PVA devices were inserted for the administration of medications that could potentially have been administered via an alternative and less invasive route.
The rationale for inserting a PVA in prehospital care is multifaceted but is more complicated in the prehospital setting, especially regarding the asepsis procedure. While this is a Swiss study, it is worth reviewing when and why PVA devices are inserted in UK practice to minimise risks and time delays.
Sleep hygiene: paramedic knowledge and practice
Shift work, particularly over a prolonged time period, can increase the risk of developing a range of cancers, gastrointestinal disorders, metabolic issues, psychological conditions and hormonal imbalances. It is also associated with increased rates of workplace accidents and lower job satisfaction among employees. A range of interventions has been developed to help shift-workers to optimise their sleep including practising sleep hygiene. This study describes a range of behaviours, lifestyle alterations, and environmental factors that positively contribute to sleep.
The purpose of this Australian study was to assess the knowledge and understanding of sleep hygiene among paramedics, as well as its perceived impact on sleep, and to investigate paramedics' engagement with sleep hygiene practices. The researchers used an online cross-sectional survey that included questions from the Standard Shiftwork Index and Sleep Hygiene Index. Of the 184 participants who completed the study, most reported little or no understanding or knowledge of ‘sleep hygiene’ as a concept. This may be because the terminology that wasn't widely understood as many demonstrated appropriate use of certain sleep hygiene practices such as limiting day-time napping, alcohol and nicotine consumption, and engaging in regular exercise. Consuming a healthy diet, limiting caffeine consumption, engaging in relaxing bedtime activities, and controlling bedroom environment were engaged in less frequently. It would be interesting to see if UK paramedics fare differently.