Is preregistration paramedic seizure education fit for purpose?
Data indicate that adult patients suffering from suspected seizures are often conveyed to the emergency department (ED) with no clinical need. In England, ambulance services respond to around 211 000 calls for suspected seizures, so the size of the problem is significant. Clearly, some patients suffering a seizure should be conveyed to ED, but UK guidelines suggest that the majority of patients will not need conveyance. Earlier qualitative studies suggest that paramedics feel that their initial training inadequately prepared them for managing seizures and only a minority reported confidence in making conveyance decisions.
This anonymous cross-sectional online ‘open’ survey conducted between November 2022 and January 2023 was open to students enrolled in a UK educational programme that would qualify them to apply for paramedic registration, and who were in year two or beyond. The survey presented three case presentations in a randomised order: seizure, breathing difficulty, and headache. Participants were asked to rate their confidence in making conveyance decisions and their perceived knowledge of, ability to care for and confidence to care for each of the presentations. These were measured against five-point scales. Participants were then asked whether they should/should have received more training in the area and given a yes/no option.
638 of 685 survey submissions were valid. For seizures, 45.3% (95% CI 41.4–49.2) said they were ‘Very…’ or ’Extremely confident’ to make conveyance decisions, which was similar to responses for breathing problems at 50.3% (95% CI 46.4–54.3), but higher than those given for headache (25.9%, 95% CI 22.6–29.5). The perceived knowledge of, ability to care for, and confidence to care scores reflected similar patterns with lower scores for seizures and even lower for headaches.
Interestingly, only 38% participants believed there was a need for more education around seizures. Furthermore, students on university-based programmes reported higher confidence for conveyance decisions than those completing degree-level apprenticeships.
Too tired to push—effects of increasing compression depth on levels of fatigue
Performing cardiopulmonary resuscitation (CPR) can be physically exhausting and can limit the effectiveness of ongoing CPR with a reduction in the likelihood of a positive outcome. In terms of compressions, quality is defined as provision of compressions at a rate of 100–120 per minute, at a depth of five but not more than six centimetres, with minimal interruptions, and cycle lengths of approximately 2 minutes. Previous studies have demonstrated that maintaining consistent, effective compressions can be challenging—particularly during transport in the out-of-hospital environment. Consequently, more emergency medical services (EMS) agencies use CPR biofeedback technologies to ensure effective compressions throughout the resuscitation.
The aims of this study were two-fold:
A total of 40 paramedic students participated in this randomised, balanced-order, and cross-over design trial. Participants performed 2 minutes of compressions on the manikin, interspersed with 2-minute rest periods for a total of 20 minutes. Participants were asked to provide single-person external cardiac compressions from the side of the manikin at a rate of 100 compressions per minute and a depth of at least 50 mm. The interventional arm of the study involved using Q-CPR while performing CPR; the control arm of the study was self-paced manual CPR without biofeedback. The mean depth of compressions increased from 40.55 mm in the control arm to 44.35 mm in the interventional arm of the study. However, fatigue levels measured markedly higher in the intervention arm with a mean score of 4.68 compared with 2.90 in the manual CPR test. Surprisingly, even with the use of biofeedback, compression depth failed to consistently meet current guidelines.