Leadership and Management

Beyond STEMI: paramedics' views on how to improve their ability to interpret ECGs

Thursday, December 2, 2021

Background: Internationally, the paramedic scope of practice is developing. Bypassing emergency departments in favour of direct access to primary percutaneous coronary intervention laboratories has been limited largely to cases of ST-elevation myocardial infarction and new-onset left bundle branch block, but updates to international guidelines suggest that enhancing paramedics' skills in interpreting electrocardiograms (ECGs) and widening the bypass criteria could be beneficial. Aim: The aim...

Applying organisational behaviour theory to aid emergency staff retention

The purpose of this theoretical concept article is to spark a dialogue on the use of organisational behaviour theory to address emergency responder retention. In the United States, emergency medical services (EMS) appear to be burdened with continuing problems of retaining staff. Poor responder retention affects the ability of EMS to deliver high-quality services; without trained, educated and experienced first responders, the EMS system struggles, and what suffers is the ability to provide...

Virtual reality training in cardiopulmonary resuscitation in schools

The UK average survival rate from out of hospital cardiac arrest (OHCA) is 8.6%, which is significantly lower than in comparable countries where survival rates can exceed 20%. A cardiac arrest victim is two to four times more likely to survive OHCA with bystander cardiopulmonary resuscitation (CPR). Mandatory teaching of CPR in schools is an effective way, endorsed by the World Health Organization, to train the entire population and improve the bystander CPR rate. Despite this, as with other UK...

A decision theory overview and case-based discussion

Paramedics make decisions as part of their everyday role but often, the theory behind clinical decision-making is not discussed in depth. This article explores the theories of decision-making as they apply to a clinical case. With the increasing use of technology in healthcare, the introduction of human reliability analysis is becoming more pertinent.

History and experience of a volunteer ambulance first responder scheme in London

Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER...

Paramedic-led acute home visiting services in primary care

Home visiting is traditionally carried out by GPs but it is becoming increasingly difficult for GPs to do, and many doctors want it removed from their contract. This is opening up a space for the paramedic profession, with paramedics carrying out home visits and designing future primary care services. Paramedics working within primary care can possess the knowledge, leadership and complex skills needed for home visiting, and some are independent prescribers; they can lead acute home visiting...

Winning in winter with marginal gains: enhancing welfare on the frontline

Winter pressures on the NHS challenge every one of us. Patients may experience delays waiting for emergency ambulances and face extended waiting times at hospital emergency departments (ED). During this season, GPs, hospitals, NHS organisations and staff will face increased demand for services; yet are still required to deliver on agreed performance targets with only a finite availability of resources. Add Brexit and the second wave of COVID-19 wave into the mix and it might appear difficult to...

Paramedic prescribing: implementation in practice

Background: In April 2018, legislation was changed to allow paramedics to prescribe independently. There is limited research regarding how paramedics are implementing their prescribing qualification. Policy papers and other literature were largely written before April 2018 and therefore document expectations regarding prescribing paramedics within the healthcare system. Aim: To explore if paramedic prescribing is being practised as expected. This article reports part of a larger study that...

ParaVR: a virtual reality training simulator for paramedic skills maintenance

Background: Virtual reality (VR) technology is emerging as a powerful tool in medical training and has potential benefits for paramedic education. Aim: The aim of this paper is to report the development of ParaVR, which uses VR to maintain paramedics' skills. Methods: Computer scientists at the University of Chester and the Welsh Ambulance Services NHS Trust (WAST) developed ParaVR in four stages: identifying requirements and specifications; alpha version development; beta version...

PTSD in paramedics: history, conceptual issues and psychometric measures

Post-traumatic stress disorder (PTSD) is more common in paramedics than in the general population because of the stressful and distressing nature of their work. Forms of PTSD associated with chronic stress and repeated trauma are scarcely researched among paramedics. This is striking as this workforce is potentially more likely to be affected by these types of PTSD. Diagnostic processes are still largely based on acute rather than chronic psychological trauma. PTSD diagnosis has been influenced...

The zero point survey and egg-timer model combined for crew management

Managing a complex scene and a critically unwell patient at the same time is a challenge for any paramedic, in terms of both personal preparation and crew resource management. While modern paramedicine requires new solutions to situated challenges, a good starting point is to review existing frameworks to seek ways of maximising the safety of the care delivered by paramedics. This paper provides a synthesis of the theoretical egg-timer model of disparity combined with a practical framework...

Could mindfulness activity improve occupational health in UK paramedics?

Emerging research is supporting the implementation of mindfulness-based strategies for NHS staff. It has been shown that, by spending 10 minutes daily on the activity, health professionals can improve their emotional and cognitive functioning, while reducing work-related rumination. Through an exploratory multi-methods approach, this study sets out to quantify the occupational health levels of paramedics, and establish their appreciation of both their employer's health and wellbeing policy and...

The paramedic profession: disruptive innovation and barriers to further progress

The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the...

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