Leadership and Management

Perceptions and experiences of mental health support for ambulance employees

Background Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. Aims To investigate ambulance staff perceptions and experiences of organisational mental health support. Methods A cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined...

Innovations in preoperative control of exsanguination in major trauma

Exsanguination places a considerable strain on trauma systems worldwide, and is estimated to be involved in 20–40% of trauma deaths. This article evaluates innovations in the preoperative care of the injured patient to minimise the impact of bleeding. These include reform of organisations and structure of trauma networks, adoption of objective prehospital triage tools and changes in ambulance crews' approach to on-scene interventions. Developments of methods to mechanically control these...

Mandatory vaccination for healthcare workers: an ethical dilemma?

Vaccines are advocated as the best defence against COVID-19. While most NHS staff, including ambulance clinicians, have been vaccinated, some remain hesitant. All health and social care staff, with some exemptions, were originally expected to be fully vaccinated by 1 April 2022. However, this is currently on hold due to the recent reconsideration by the Secretary of State.There are ethical arguments against and in favour of mandatory vaccination. Arguments against include potential harm and loss...

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

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...

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