Clinical Practice

Clinical intuition: how paramedics make decisions, is experience always best? A case presentation

Firstly, it is important to consider why particular decisions are made, whether diagnoses are correct and what assumptions are made about the patient. It is pertinent to reflect on whether there were...

The expanding scope of EMS: decreasing emergency department overcrowding in the United States

Chronic disease is defined as a long-lasting condition that can be controlled, but not cured (Salzman et al, 2012). Interestingly, over half of the US population lives with a least one chronic...

An integrated ABCDE approach to managing medical emergencies using CRM principles

‘An unplanned life-threatening event in which there is a mismatch between the ambient level of resources and those that a patient needs to regain stability.’ .

Delivering enhanced safety, productivity and experience: early results from a frequent caller management system

999 activity increased by 6.9% last year (Anderson, 2013) with incidents resulting in an ambulance service clinician attending scene increasing by 4% (Anderson, 2013) and patients discharged on scene...

Is it time to change? The use of intranasal fentanyl for severe pain in the pre-hospital setting

Cannulation is the main barrier to the administration of opioid analgesia, and this has been shown to be a problem in the young, the elderly, the shocked patient and the cognitively impaired. Studies...

Increasing objectivity in the assessment of interpersonal skills and attitude

To establish a structure to improve the development of essential non-practical skills..

Why evaluation is important to you, me and everybody

Evaluation is a statement which appraises or adds value to something (Simpson et al, 1986). Evaluation is regularly paired with assessment which encompasses benchmarking and ranking; however, there...

Self-extrication in road traffic collisions: do we really need to cut the roof off?

This literature review incorporates two principal searches. Initially the review interrogated the Ovid Medline database, with search terms including ‘extrication’, ‘movement’, ‘pre-hospital’ and...

Essex and Herts Air Ambulance: a focused case series for pre-hospital practice Case 3: a femoral shaft fracture

A 23-year-old woman who, while crossing the road, was hit by a car coming towards her from her right side. Witnesses reported that the car drove over the patient and dragged her a few yards down the...

Palliative emergencies in the pre-hospital setting

The evidence base for the treatment of palliative patients by paramedics is still limited. However, recent publications by Brady (2012a; 2012b; 2012c), Gakhal et al (2011), Pettifer and Bronnert...

Experiences of two paramedics deployed to the Phillipines in response to Typhoon Haiyan

It is heartening to see the world rally together to assist in devastating events such as this. Many countries immediately mobilised resources in various capacities. The United Kingdom, small island...

Pre-hospital paediatric seizures: midazolam versus diazepam

The aim of this article is to review the evidence for the use of diazepam and midazolam, and to determine which anticonvulsant is the most appropriate for termination of paediatric seizures by...