Trauma Care Conference considers expanding role of paramedics in subspecialty

Ketamine has an essential role in pre-hospital care

The programme started with Dr Minh Le Cong joining the conference from web link to talk about all things pre-hospital ketamine. Le Cong guided the delegates through the various uses and benefits for ketamine in the pre-hospital environment, and informed the audience around both the evidence base and his personal experience of using ketamine in various situations within his retrieval medicine environment. From pain relief to sedation and the treatment of mental illness, Le Kong suggested that ketamine appears to have no bounds, while its safe use was well proven.

Delegates were left questioning whether the use of ketamine should be widespread within the paramedic profession or limited to those paramedics working in specialist fields. However, what was not left in doubt was the role ketamine can and does play in improving patient care in the pre-hospital environment.

The effects of dealing with a mass-casualty situation

Next up was Mr Tony Kemp MBE, who shared his personal experience of the Shoreham air crash. As a BASICS nurse, Kemp was providing support as part of the medical team covering the airshow. He gave an honest and detailed account not only of the events that took place, but the effects that could manifest on those responding to such an incident.

Kemp described the most challenging of environments and the turmoil over patient care and safety, while engaging the audience on multiple levels. Most significant was the experience Kemp had around misreporting by the press and the doubt created by the media over the events that actually took place. Additionally, he gave a moving account of the effects such an event can have on the responders and the difficulties of processing the level of trauma post incident. This was described in such a way that the audience understood the position, while more than likely reflected on some of their own experiences from the past. A talk which is hard to convey in a report but will stick with delegates for a long time to come.

Considering ultrasound as the new stethoscope

Following a break and a chance for delegates to get around the many exhibitor stands while grabbing a brew, Mr Jim Walmsley, a critical care paramedic, discussed the hot topic of pre-hospital ultrasound. Walmsley compared the ultrasound device to the origins of the stethoscope and hinted it could be its replacement in the future. He discussed the need for training and the requirement to understand the ‘knobology’ of the whole process. Some of its uses included examining the heart during cardiac arrest, pleural sliding in the detection of a tension pneumothorax and assisting and guiding difficult IV access. Ultrasound use in paramedic practice is in its infancy, yet very much on the increase.

Proposing multi-professional PHEM practitioners

After this Mr Dan Cody, associate clinical director at MAGPAS, talked about the future potential for level 8 paramedic practice. Cody walked delegates through some of the work he has been involved in with the Faculty of Pre Hospital Care (FPHC). He gave a sneak preview to the FPHC position statement on level 8 multi-professional access, in which the aim is to have multi-professional pre hospital emergency medicine consultants (Thomas et al, 2016). He talked around the issue of paramedic rapid sequence induction (RSI) and demonstrated via a video how paramedics are conducting RSI in a physician-supervised environment. He discussed the plans for a new framework to support this development and how he is leading the development of pilot schemes to develop and test this concept on behalf of the FPHC.

Service evaluation on the use of the iTClamp™

This was followed by Gary Shaw, a trauma paramedic with the North East Ambulance Service NHS Foundation Trust. Shaw discussed his service evaluation into the efficacy of using the iTClamp™ (see Figure 1). Shaw and his team had used the iTClamp™ on 25 occasions during the evaluation period and reported huge benefit and success in patient care, especially for difficult to control haemorrhage. The use of this device may now be beneficial in wider use as the evidence presented showed both patient benefit and positive feedback from the clinicians who used the device with in the service evaluation.

Exploring the evidence around airway management

Mr Tim Edwards, consultant paramedic with London Ambulance Service NHS Trust got things going after lunch by exploring the evidence around paramedic airway management in trauma from his PHD studies. Edwards explored the varied and various evidence from around the globe and gave a balanced account of systems that have failed and systems that have proven paramedic-led advanced airway management can have continued, sustained and high success rates. The take away point of the successful systems are good clinical governance, robust and standard training programmes and a culture of acceptance around paramedic empowerment to perform these procedures.

The context for conducting pre-hospital sedation

Pre-hospital sedation was next on the agenda and this was expertly covered by pre-hospital consultant nurse Andy Thurgood. Thurgood produced a thought-provoking talk around how this procedure can be conducted, but its use must be carefully considered in the wider context of the patient's condition. He even made the point that the agitated patient may be one fighting for survival and sedation may not always be the best solution.

Dissecting the debate around cervical collars

Next up Doug Davies explored the evidence around the use of the cervical collar. A debate which has rumbled on for several years and still appears to have no definitive solution in sight. Davies discussed the evidence and the many pitfalls of cervical collar use and the detrimental effects this can have on patient care from raising intracranial pressure, to restricting the airway and having a negative impact on respiration. He did not think the collar was dead and suggested that use in self extrication may still have benefit. The evidence presented from his systematic review was large but not conclusive in any direction. The collar debate is set to continue; however, the routine use in every situation appears to be a thing of the past with little evidence base.

Expanding the practice of paramedics

Finally, Dr David Spiro joined the conference via video link from the United States to discuss video learning in trauma and the wider health applications. This was an interactive session with real patient cases from his platform called Real DX. The audience were able to see real-time patient assessment via video head cam, followed by various diagnostic information such as X-rays, ECGs and blood results to allow them to make and decide on treatment priorities. This talk highlighted a potential revolution for both paramedic education and beyond, with Real DX already hosting a database of over 600 cases.

This closed the paramedic conference on a high, and emphasised from the presentations throughout the day that the paramedic profession continues to grow, expand and develop into areas of practice and education that may have previously been perceived as out of reach. The Trauma Care Conference once again provided a great environment for paramedics to learn, engage and extend our practice for the future benefits of patients.