Harari Y, Riemer R, Jaff E, Wacht O, Bitan Y. Paramedic equipment bags: how their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance. Appl Ergonomics. 2020; 82:102977
The position of bags during an out-of-hospital cardiac arrest (OHCA) may not be seen as a priority for many paramedics. However, Harari et al (2019) argue that paramedics are at a high risk of musculoskeletal (MSK) injuries and that paramedic performance is affected by where bags are placed and moved during an OHCA. Their study examined 12 teams of paramedics (two per team) during a simulated OHCA. Measurements included bag placement, cardiopulmonary resuscitation (CPR) quality, physiological effort and biomechanical loads. Although conducted in Israel, personnel and equipment bags were not dissimilar to UK practice.
Results established that despite a relatively low mean number of bag movements (6.8), the mean biomechanical load force exerted was high (89N), resulting in 72% of paramedic movements associated with a high to very high risk of an MSK injury. The positioning of bags appeared to negatively affect CPR quality, with a mean of 68% of compressions within the recommended rate, and only 27% within the recommended depth. Physiologically, there was no significant difference between paramedics' heart rates or perceived effort.
The findings highlight the significant risk of MSK injury when moving bags and the possibility that a standardised layout may improve CPR quality. However, this is dependent on the patient location/position, number of paramedics attending and a team's ability to recognise tiredness/ineffective CPR.
Whitley GA, Hemingway P, Law GR et al. Predictors of effective management of acute pain in children within a UK ambulance service: a cross-sectional study. Am J Emerg Med. 2019; In Press
This retrospective observational study aimed to identify which children were more likely to achieve effective pain management when suffering acute pain and attended by a UK ambulance service. For the purpose of this study, effective pain management was defined as the abolition or reduction of pain by ≥2 out of 10 using the numeric pain rating scale, Wong-Baker FACES® scale or FLACC (face, legs, activity, crying and consolability) scale.
Data for 2312 children were included in a multivariable logistic regression analysis which adjusted for a number of confounding factors including child age, child sex, type of pain, senior clinician experience, analgesia administration, nonpharmacological treatment administration, paramedic crew, hospital travel time and index of multiple deprivation.
Results showed that children who were younger, attended by a paramedic, administered analgesia or living in an area of medium or low deprivation were significantly more likely to achieve effective pain management. A subgroup analysis showed that analgesia administration did not predict effective pain management for younger children aged 0–5 years; the authors hypothesised that non-pharmacological interventions are more effective in this age group. Qualitative research is in progress to help explain these findings.
Wołoszyn P, Baumberg I, Baker D. The reliability of noninvasive blood pressure measurement through layers of autumn/winter clothing: a prospective study. Wilderness Environ Med. 2019; 30(3):227–235
Noninvasive blood pressure (NIBP) measurement is a key part of the cardiovascular assessment, and traditional teaching has emphasised the need to have direct contact between the cuff and bare skin in order to obtain accurate readings. This is not always feasible in the out-of-hospital environment where patients may be clad in multiple layers of clothing in the colder months. This prospective study investigated the reliability of NIBP measurements performed through two and three layers of autumn/winter clothing in two research groups: healthy volunteers and patients. NIBP measurements were made in a random order: on the exposed arm; on the arm covered by a standardised cotton and polar fabric test sleeve; and with the arm covered by a cotton-polar fabric and down jacket test sleeve. The time taken for measurement was also recorded.
NIBP measurements were taken on 101 volunteers and 50 patients, and no clinically or statistically significant differences were found. Measuring over a sleeved arm extended the time of measurement by an average of 3.5 seconds in comparison with bare arm measurement. Although not conclusive, this study adds to earlier studies that have reported reliable results when NIBP was carried out over a layer of light clothing such as a cotton shirt or light sweater.