Clinical Practice

Prehospital emergency anaesthesia: time taken to care for and respond to a critically injured patient

  • July 2019

The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Trauma: Who Cares? report recommended that people trained to administer anaesthesia and intubate severely injured patients should be available in prehospital environments. Published articles, reference documents and guidance reports were reviewed to compare the management plans and standard operating procedures produced by an ambulance trust in England that provides prehospital emergency anaesthesia (PHEA). Documents...

Decision making for patients categorised as ‘amber’ in a rural setting

Background: Reducing unnecessary conveyances to hospital can help relieve pressure on emergency departments. Making decisions about conveyance in rural areas is particularly challenging because of the travel distances involved. Aims: To explore perceptions of paramedics in a rural setting about how they make decisions regarding conveyance and non-conveyance for patients categorised as ‘amber’ (serious but not life-threatening). Methods: Data were collected through interviews with 17...

Managing common end-of-life cancer presentations according to the evidence

The ambulance service is increasingly being called to patients suffering from cancer who are near the end of their lives. This presents challenges to clinicians who may not be confident in the management of symptoms near the end of life. The approach to, and management of, these types of patients often requires different considerations to more traditional emergency calls. This article reviews the evidence around the management of common cancer presentations at the end of life. In particular, it...

Does digoxin cause more harm than good?

Background: The most recent British National Formulary recommends digoxin therapy for patients with heart failure (HF) and/or supraventricular arrhythmias, particularly atrial fibrillation (AF) and atrial flutter. The positive inotropic and negative chronotropic effects of the drug are undoubtedly desirable when managing these conditions, yet the use of digoxin is decreasing in popularity among prescribers. Aim: The aim of this literature review is to evaluate the use of digoxin for treating...

Point-of-care blood tests in decision-making for people over 65 with acute frailty

Background: National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount. Methods: This was a single-site quality improvement project using point-of-care blood testing...

Methoxyflurane (Penthrox®)—a case series of use in the prehospital setting

Methoxyflurane (Penthrox®)—a case series of use in the prehospital setting

Methoxyflurane (Penthrox®) is a fluorinated hydrocarbon, which when first used in general anaesthesia was noted to have strong analgesic properties in subanaesthetic dosage. More than 5 million doses have been sold for use in Australia since 1978 and have been found to have an excellent safety profile. After rigorous review by the Medicines and Healthcare Regulatory Agency, methoxyflurane was granted a product licence in 2015 in the UK and Europe for the relief of pain in patients with...

Human factors, cognitive bias and the paramedic

Human factors, cognitive bias and the paramedic

The consequences of human factors and cognitive bias can be catastrophic if unrecognised. Errors can lead to loss of life because of the flawed nature of human cognition and the way we interact with our environment. Seemingly small mistakes or miscommunications can lead to negative outcomes for patients and clinicians alike. It is easy to see therefore why the College of Paramedics now recommends the teaching of human factors at higher education institutions. Using a problem-based approach, this...

Splinting of injuries: best practice guidance

Splinting of injuries: best practice guidance

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this instalment, Rory McKelvin discusses the application of splints to fractures and sets out a best practice step-wise approach to assessment, decision-making and application in prehospital settings

Acute traumatic coagulopathy: the lethal triad of trauma

Acute traumatic coagulopathy: the lethal triad of trauma

Trauma is the leading cause of death for people in the UK and North America, especially for those aged 15–24 years. However, if early management regimes of permissive hypotension, high-flow oxygen and administration of tranexamic acid are applied, mortality risk can be reduced significantly. Acute traumatic coagulopathy (ATC) is an internal process that is initiated by significant or massive trauma because of hypoperfusion resulting in hypovolaemic shock, activation of protein C, platelet...

Correct pulse measurement

Correct pulse measurement

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this month's instalment, Andrew Kirk discusses common pulse sites and correct technique for obtaining a patient's pulse

Tourniquets in the treatment of prehospital haemorrhage

Tourniquets in the treatment of prehospital haemorrhage

Background:During recent conflicts in Iraq and Afghanistan, tourniquets were a useful tool in the management of non-compressible prehospital catastrophic haemorrhage. Recommendations for use within the civilian setting were then made. However, civilian research supporting this change in practice is limited.Aims:The aim of the research is to evaluate the utility of prehospital tourniquet application through description of the complications associated with use, as well as identification of...

Hyperventilation syndrome: diagnosis and reassurance

Hyperventilation syndrome: diagnosis and reassurance

This article provides an overview of hyperventilation syndrome (HVS). Hyperventilation is to breathe in excess of metabolic requirements; in the absence of an underlying organic cause, it is defined as HVS. Alternative terms used in literature are panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing and breathing pattern disorder. This article explores HVS signs and symptoms beyond the familiar clinical signposts of tachypnoea, chest tightness, paraesthesia and anxiety. It...

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