Do non-ambulance placements meet student needs?
Non-ambulance placements are becoming increasingly important in pre-registration paramedic courses but do they meet the needs of the student? This study undertook semi-structured interviews with 33 first-year BSc (Hons) degree paramedic students to explore their experiences of non-ambulance placements. Interviews were recorded, transcribed and then analysed thematically; themes were expectations, patient journey, communication and mentorship.
Participants reported many positive outcomes such as improved communication with patients and other health professionals, a greater understanding of the role of the paramedic as part of the overall patient journey, and recognition of how prehospital interventions can impact ongoing patient care. They also felt better informed about what would happen once the patient had been handed over to hospital staff and would be able to use this knowledge to help prepare patients for what to expect. However, despite evidence of excellent mentorship, some participants also reported feeling unsupported at times with evidence of professional isolation and a lack of support. The study shows that there are very clear benefits to be gained from non-ambulance placements but the authors also concluded that there was work to be done in supporting clinical mentors, tearing down barriers between professional groups and exploring our similarities and strengths.
Revisiting the definition of pain
Although not research, this article is important as it is the first update in the International Association for the Study of Pain (IASP) definition of pain since 1979. The current definition, ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’, has been widely accepted by researchers, clinicians, Governmental and non-Governmental organisations, including the World Health Organization. However, it has not been exempt from criticism, especially in light of recent advances in the understanding of pain. Among its criticisms have been that the definition does not adequately address pain in disempowered and neglected populations, such as neonates and the elderly; that it neglects the ethical dimensions of pain; and emphasises the verbal reporting of pain at the expense of non-verbal reporting.
Over the last 2~years, a 14-member, multinational taskforce group reviewed and revised the definition to ‘An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,’; they also bullet-pointed the accompanying notes. The full impact of this change is difficult to discuss in 200 words but the full article is open access and worth reading.
Prehospital enhanced care teams, scene time and triage compliance penetrating trauma patients
In cases of penetrating trauma, a reduction in prehospital scene time is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship between the presence of prehospital enhanced care teams (ECT) (critical care paramedics or helicopter emergency medical service), on the scene time and triage compliance, of patients presenting with penetrating trauma patients in a UK ambulance service. The primary outcome was on-scene time with a secondary outcome relating to compliance with the trust's Major Trauma Decision Tree (MTDT).
Patients who had sustained central penetrating trauma were included in this retrospective study; 171 patients met the inclusion criteria and 165 had complete data available. The presence of an ECT improved the median on-scene time in central stabbing by 38% (29 m 50 s vs. 19 m 0 s, p = 0.03). The compliance with the Trust's MTDT also improved when an ECT was present (81% vs. 37%, OR 7.59, 95% CI, 3.70–15.37, p < 0.0001).
The authors concluded that ambulance services should consider routine activation of ECTs to such incidents; however, work needs to be done establish why the time differential exists and to support ambulance staff to reduce their on-scene times and decision-making in such incidents.