A tactical analgesic option for Durham and Cleveland police firearms medics: the journey

  • February 2019

Background:With an ever-increasing exposure to clinical situations, predominantly trauma, firearms medics at Durham and Cleveland police forces began to consider whether an increase in their scope of practice was needed; specifically, whether they could add analgesia administration to their clinical protocols.Considerations:The request was directed to the Tactical Medical Advisory Group (TMAG). This faculty comprises a clinical lead, emergency medicine doctors, military and civilian paramedics and tactical team medic (TTM) trainers. Analgesia in general was discussed, then potential analgesic agents were considered. The faculty agreed that the analgesic agent would have: to be available to all tactical team medics at all times, so should be highly portable); a minimal regulatory and training burden; a rapid effect with minimal side effects; and no conflict with prehospital medicine practice.Implementation:A 6-hour training course in methoxyflurane (Penthrox®) with summative assessments was designed and delivered by TMAG to all TTMs over a 4-week period. The chair of the TMAG agreed to be the signatory for the prescription-only medicine document and a standard operating procedure was drawn up. Sufficient stocks of methoxyflurane were then purchased and distributed across both police forces' armed response units, together with updated patient report forms, administration documents and feedback forms completed by TTMs after incidents.

Human factors in student paramedic practice

  • January 2019

Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.

Examining the benefits of paramedic engagement for the novice researcher

  • December 2018

Background:Paramedics new to research need to know how to optimise the quality of proposed research studies. A prehospital mixed-methods study design required guidance, not only from an academic perspective but also from experts within paramedicine. Paramedic engagement was defined as an exercise where paramedic researchers and paramedic clinical academics could be involved as advisory professionals.Aim:The aim of this paramedic engagement was the revision of a proposed research design on how senior clinical advisers determine futility in pulseless electrical activity in out-of-hospital cardiac arrest.Method:Five research paramedics and four clinical academics were interviewed by email using semi-structured questions. A generic qualitative inquiry with inductive content analysis was applied.Results:Paramedic engagement identified five themes: rewording the proposed study title; acknowledging that paramedics withdrew resuscitation; the implications of prolonged futile resuscitation; the need for autonomous paramedic decision-making; and improving research methodology.Conclusions:Professional paramedic engagement meant a number of complexities were identified within prehospital research and and pragmatic solutions were provided to the limitations in the proposed design. Novice researchers within paramedicine would benefit from early paramedic engagement to facilitate the design of research studies, provide guidance on methodology and identify limitations to improve the overall quality of prehospital research proposals.

A qualitative exploration of current paramedic cardiac auscultation practices

  • September 2018

This exploratory study addresses the current paucity of knowledge available in UK paramedic practice in relation to cardiac auscultation. There is a recognised lack of data surrounding the efficacy, safety and relevance of patient assessment skills in the pre-hospital setting in general, and cardiac auscultation specifically. This study provides information about current paramedic practice, and provides a basis for further research in this area. An online survey was distributed using convenience and snowball sampling, receiving 328 responses within a 31-day period. The results show that many paramedics rarely, or indeed never, undertake cardiac auscultation and that many lack confidence in recognising normal and abnormal heart sounds. There is also a divided opinion among respondents who provided free-text answers, with some feeling that the skill of cardiac auscultation is vital in pre-hospital care and others firmly disagreeing. This research lays the groundwork for further developments in training, education and continuing professional development for paramedics.

Building psychological resilience in the paramedic

  • April 2018

Paramedics face the need to be critically introspective, reflective and reflexive every working day. Their work involves not only the functional need to clinically assess, diagnose and manage critically ill and injured members of the public, but also a situated responsiveness to the scenes of severe trauma and death. Few other professions demand such an acute degree of personal and professional resilience; an underpinning education is therefore pivotal to facilitate the development of this resilience to equip and ensure an effective healthcare workforce. For all paramedics, the need to facilitate deconstruction of their experience and meaning-making from constituent aspects of paramedic practice, culture and context is a central element of their capacity for resilience, as well as their psychological ability to recognise and apply coping strategies in their everyday roles. This affective domain learning has been embedded across academic curricula and traditionally taught via methods such as role play, inquiry-based learning, and simulation. The current article presents gamification as another potential methodology for inclusion in undergraduate curricula that can provide the future workforce with transferable skills of reflection and reflexivity in situational responsiveness. LEGO® Serious Play® and narrative storytelling are used to illustrate this discussion; a technique that originates from business and leadership teaching and learning methodologies, but the origins of which lie in the philosophy of social constructionism. An adaptation of Gilbert's Multi-Modal Compassionate Mind Training is used to illustrate how LEGO® Serious Play® might facilitate the construction of affective domain learning for resilience in paramedic practice.

Safe transfer of simulation-based intubation skills to patients in cardiac arrest

  • March 2018

Background:Studies investigating the transfer of endotracheal intubation skills from simulation training to out-of-hospital patient scenarios are limited.Aims:The aim was to evaluate the outcome of endotracheal intubation simulation training among paramedics and the safe transfer of skills to out-of-hospital cardiac arrest (OHCA) patients.Methods:Paramedics participated in a 1-day simulation training course including five Airtraq endotracheal intubation attempts using three different types of mannequins (n=15 attempts). Performance and outcome of transfer of intubation skills to patients were monitored for the next 35 months. European Resuscitation Council international advanced cardiopulmonary resuscitation guidelines (Nolan et al, 2005) were followed to ensure patient safety.Findings:Endotracheal intubation was attempted in a total of 417 patients with OHCA by 51 (96%) of the 53 participating paramedics. In 366 (88%) patients, intubation was successfully performed in the first or second attempt. Aspiration, airway secretion, a high modified Cormack Lehane score and insecure verification of tube placement were the most common reasons for failed intubation.Conclusion:Endotracheal intubation with Airtraq in adult patients with OHCA can be performed safely by paramedics after receiving a 1-day simulation-based training course.

Integrating aged care in the curriculum: the importance of design and evaluation

  • February 2018

Background:The current study describes the design and implementation of a residential aged care facility placement, and reports student experiences using an attitudinal survey across two cohorts.Method:Placements in January 2014 and 2015 were surveyed to identify barriers and enablers to student learning. Descriptive analysis was used to report the frequency of responses for categorical variables. Chi-square tests were used to analyse change in item rank by year. Content analysis was used to analyse text responses.Results:Initial 2014 results show that 75.4% of respondents agreed that they were able to achieve the required learning outcomes during this placement, with 72.8% agreeing that the placement improved their knowledge of community-based care for the elderly. Students tended to agree that the placement improved their confidence as practitioners, and that the experience helped to improve communication skills.Conclusion:This initiative showed that it is possible to enable learning outcomes that are directly related to core paramedic competencies. The placement was associated with improved understanding of age-related health problems. In addition, the placement provided opportunities to observe the role of health professionals in the maintenance of an older individual's health, social and spiritual needs.

An innovation in mental health specialty placements

  • January 2018

The current article describes how an innovative approach to mental health training for student paramedics can prepare the future workforce with the skills and knowledge needed to provide high-quality care. Action research methodology is used to describe the delivery and evaluation of the placement, identifying its key and sustainable learning impacts for all involved. Key to its success was the co-production of the placement from beginning to end, including service users and qualified paramedics. The outcome of the placement enabled students to develop the confidence and ability to provide compassionate person-centred care as well as the skills to cultivate self-care and resilience.

Time for Dementia: an innovation in education

  • November 2017

This paper describes an innovative undergraduate educational initiative called the Time for Dementia programme. It was developed to improve the knowledge, attitudes and skills in dementia among healthcare students. Time for Dementia involves pairs of healthcare students (medical, paramedic, adult and mental health nursing, and allied health professionals) visiting a person with dementia and their carer in their homes over a period of 2 years. The aim of the programme is to enable students to learn with people with dementia and their carers—recognising that people with dementia have unique expertise derived from their experiences. Their personal narratives offer students a unique insight into the subjective experiences of dementia.

A day in the life of a paramedic advanced clinical practitioner in primary care

  • September 2017

This ‘day-in-the-life’ article is the author's first-person account of his experiences as a paramedic working in an inner-city GP practice, while training to be an advanced clinical practitioner. The author aims to illustrate the range and complexity of the role of paramedics based in primary care, and how this role is developing beyond the traditional scope of paramedic practice. The article presents actual patient encounters, which reflect a typical working day in primary care. Through this approach, the author hopes to demonstrate how paramedics can complement and extend the skills of an established primary care team. Furthermore, studying advanced clinical practice at postgraduate level provides new and extended clinical skills and knowledge, allowing paramedics to work with greater autonomy.

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