Leadership and Management

Leadership in training: a Q&A with Ian Corrie

  • February 2019

As well as the use of practical clinical scenarios, the training weekend was also used to provide leadership and development training for senior members of the regiment. In this special Question and Answer feature, the man in charge, Ian Corrie, provides a more in-depth insight into what the training involved

A Guide to the Mental Capacity Act for Paramedics

A Guide to the Mental Capacity Act for Paramedics

The Mental Capacity Act 2005 is one of the key pieces of statutory legislation used in modern paramedic practice. To the unprepared, the Act can seem complex and daunting; but it is a powerful tool which helps paramedics to deal with often complex and challenging situations in a way which is both ethically and legally safe. What follows is a walk-through of the Act itself looking at the parts which are relevant to paramedic practice and discussing issues relating to them which, it is hoped, will enable paramedics and others involved in delivering pre-hospital emergency medical care to apply the Act with confidence in their practice.

Breaking bad news and managing family during an out-of-hospital cardiac arrest

Breaking bad news and managing family during an out-of-hospital cardiac arrest

The management of family during out-of-hospital cardiac arrests and death notification to the family of the deceased in the out-of-hospital setting are topics that are poorly evidenced. Two focus groups consisting of six participants in each were conducted, discussing the two subjects. The results suggest that paramedics prefer family not to be present in the room for a number of reasons and that they don't feel sufficiently trained by their paramedic courses in order to manage family during resuscitation or breaking bad news. The study highlighted a need for more research on both subjects.

Care pathways for low-risk transient ischaemic attack

Care pathways for low-risk transient ischaemic attack

Background:In secondary care, the urgency of review for transient ischaemic attack (TIA) has relied upon the use of the ABCD2 score, but this tool is not validated for use by emergency ambulance crews. There is a need to evaluate alternative care pathways for patients who might be eligible for direct referral to TIA clinics without prior conveyance to the emergency department (ED).Aim:The aim of this national survey was to describe current service provision across the UK for pre-hospital emergency care of patients with TIA.Methods:The authors approached all UK Ambulance trusts (n=13) by email, asking them to provide details of TIA patient referral pathways.Findings:Twelve ambulance services responded to the survey and nine reported that they had no current pathway; one had discontinued a pathway because of service reconfiguration; and three were currently using one. All pathways used the ABCD2 tool to screen patients and classified patients as low-risk if the ABCD2 score was 3 or below. Non-conveyance exclusion criteria varied. Although compliance with referral pathways was audited in an initial pilot in one service, no other evaluations of the effectiveness of pathways were reported.Conclusion:A minority of UK ambulance services report introducing referral pathways for low-risk TIA patients, avoiding initial assessment in the ED. Safety, effectiveness and acceptability of such pathways have not been evaluated to date.

Why do paramedics have a high rate of self-referral?

Why do paramedics have a high rate of self-referral?

Paramedics have been regulated in the UK since 2003. Analysis shows that the profession has had consistently higher rates of self-referral to its regulator compared with other health and care professions. Between 2013 and 2016, the percentage of paramedics who self-referred averaged 50% of all cases, compared with 6% across all other health professions regulated by the Health and Care Professions Council (HCPC) and 10% across social workers in England. This article reports on possible reasons underlying this trend. Using a mixed-methods approach including a literature review, interviews, focus groups and case analysis, the study identified a number of possible contributory factors. These included pressurised work environments, variable guidance and support from employers, and work cultures of fear and conflict. The evolving nature of the profession was also cited. The research found that there was a cohort of cases that appeared inappropriate—where the referral was for a matter that did not require reporting. Actions are being taken to reduce such self-referrals to avoid the emotional distress and resource implications for those involved.

Smaller, lighter, faster? Reducing the carbon footprint of ambulances

Smaller, lighter, faster? Reducing the carbon footprint of ambulances

This paper outlines a feasibility project investigating the potential for smaller, lighter rapid response vehicles (RRVs) in reducing the carbon footprint and response times of ambulances. Five stakeholder consultations were held with two ambulance trusts, an ambulance manufacturer, a paramedic and the Ultra-Light Vehicle Group to generate three novel design concepts for RRVs, which were then reviewed by four UK fleet managers and four clinicians. The results indicated that the integrated clinician service model could create a future market for smaller, lighter vehicles. Reducing carbon emissions in the short term will most likely be achieved using lower emission engines and improving engine and power management for dual-crewed ambulances. In the medium term (5–10 years), there will be a demand for low emission, composite light-weight dual-crewed ambulances.

Cardiac arrest resources that improve patient outcomes

Cardiac arrest resources that improve patient outcomes

Survival rates for out-of-hospital cardiac arrest (OHCA) patients in the UK are low compared with other developed countries. UK ambulance services are in an important position to influence these survival rates by improving their ‘chain of survival’ (Nolan et al, 2006). A paramedic-led resource, with enhanced technical and non-technical skills specialising in OHCAs, has been shown to improve patient outcomes in this population group in the UK. The author proposes that this concept should be considered by all UK ambulance services to improve OHCA patient survival.

Time for Dementia: an innovation in education

Time for Dementia: an innovation in education

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

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

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.

Emotional labour in paramedic practice: student awareness of professional demands

Emotional labour in paramedic practice: student awareness of professional demands

Purpose:The purpose of this study was to explore student paramedics' awareness of the emotional demands of their future role, particularly regarding the delivery of compassionate care.Problem:There is a dominance of nursing literature in the discourse around compassionate care and emotional labour, and a paucity of research in the paramedic literature.Methods:A survey was issued to a small convenience sample of paramedic students. Excel was used to organise data collected, which was then presented graphically as tables and charts.Results:Key findings were drawn out and it was found that there were some correlations between the literature reviewed and results generated.Conclusion:Student paramedics had identified factors affecting their emotions in placement very early on in their studies. There was evidence of students covering up their emotions whilst in placement. The research reinforced the need for further larger scale and longitudinal studies.

Exploratory study into the views of paramedics on paramedic prescribing.

Exploratory study into the views of paramedics on paramedic prescribing.

The purpose of this paper is to establish the views of a group of Paramedics on Paramedic prescribing. Although at the time of writing the proposal to the Commission on Human Medicines they rejected prescribing for Paramedics, work is still ongoing with various bodies to move forward with the application. A focus group of a small number of Paramedics was held, and the researcher performed a review of relevant literature. The development of the role of paramedic from an ambulance driver to a highly skilled and knowledgeable healthcare professional was discussed. It was established that the profession's close links with higher education institutions would be pivotal if paramedics are to be given prescribing rights. The study concluded that paramedics believe they should be able to become independent prescribers, as it would help further their career, giving the profession added credibility. As paramedics already give a rounded healthcare approach to their patients, this would only be enhanced by prescribing rights, as a ‘complete’ health care attitude could be established.

Live tweeting by ambulance services: a growing concern

Live tweeting by ambulance services: a growing concern

Despite advances in technology being a driver of paramedic professional development, particularly over the past decade, the introduction of new forms of technology appears to have presented paramedics with some professional challenges. Paramedics, pre-hospital clinicians, and ambulance service providers in both the United Kingdom and Australia, have begun using social media technology to communicate what they do to the general public. Unfortunately some of the material that has been communicated appears to breach professional standards of practice, and therefore has the potential to cause harm to the patient, the individual paramedic, and the paramedic profession more broadly. This article will present the rationale behind why this behaviour is unprofessional, ethically and legally unsound, and why it must cease. We offer a tool that will assist paramedics, and other healthcare professionals, to practise safe and professional social media use in their workplace.

Future of digital technology in paramedic practice: blue light of discernment in responsive care for patients?

Future of digital technology in paramedic practice: blue light of discernment in responsive care for patients?

This discussion explores the significance of digital technology to responsive patient care in applied paramedic practice. The authors' previous research identified the relative ambiguity of the role of digital technology in facilitating and supporting patients in practice, and the findings revealed the relative transferability of this finding to wider allied healthcare clinical and professional practice. The discussion encompasses two key debates, namely a) How best the quality of the digital technology patients engage with can be discerned with regard to the vast availability of information and b) what the fundamental pedagogical implications to the way paramedic education in the UK is currently delivered might be in relation to equipping the future paramedic workforce to empower patients and their families and carers in emergency situations. The discussion paper concludes with an overview of the tensions that unregulated apps pose in practice and how engaging with the public about the use of digital technology could be a key aspect for review in UK undergraduate curricula and staff development.

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