Research
Respecting an autonomous decision to refuse life-saving treatment: a case study
Autonomy is a key principle in biomedical ethics, giving patients the right to be involved in their own care. Professional autonomy allows paramedics to make critical decisions around patient care in an emergency, enabling them to provide life-saving treatment. A patient's autonomy can conflict with that of a paramedic, leading to complex ethical challenges, which can affect the way a paramedic performs their duty of care. An autonomous patient has the right to refuse treatment, creating ethical...
Confidence levels of students before and after a minor illness/injury placement
Within the UK, the paramedic scope of practice has noticeably changed over recent years. Many paramedics are now going into roles within general practice surgeries, minor injury units, and urgent care treatment centres. A framework including a skill set was therefore initiated outlining the need for more non-ambulance placements within the undergraduate paramedic curriculum. This article reports the findings of a quantitative study, exploring the confidence levels in managing patients both...
Psychological vulnerability and suicidality within the ambulance service: a review
Paramedics must be physically and mentally robust to seamlessly adapt between emergencies and disasters. Developing evidence suggests that ambulance colleagues may be at higher risk of suicide; yet few studies explore causal factors and effective interventions. Mental distress, illness and associated physical symptoms of emotional injury, have long been the subject of global systematic review; however, an inadequate understanding of the cumulative anguish leading to suicidality remains. Research...
Impact of paramedics carrying just-in-case end-of-life care medication
Background: Early in the COVID-19 pandemic, it was predicted that frail community patients with symptoms of severe COVID-19 infection may need urgent symptom management—and that unless they had already been identified as being in their last weeks of life, they would be unlikely to have just-in-case (JIC) medications at home. The Welsh Ambulance Services NHS Trust therefore placed JIC medications on emergency ambulances to increase symptom management options for paramedics treating patients with...
Disaster preparedness of health professionals at mass gatherings: a scoping review
Mass gathering disasters involving large numbers of casualties can adversely affect the performance of healthcare systems. This scoping review aims to explore the current literature on the preparedness of health professionals for disasters during mass gathering events. Four databases were searched to identify papers examining health professionals' disaster preparedness during mass gatherings between 2011 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping...
Mass casualty triage: using virtual reality in hazardous area response teams training
Background: In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training. Aims: The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI. Methods: The author co-developed a VR marauding terrorist attack...
Prehospital end-tidal carbon dioxide measurement
The prehospital environment presents numerous challenges regarding the diagnosis and subsequent management of critically ill patients—diagnostic aids are limited; point-of-care testing is almost universally unavailable and senior medical advice can be beyond timely reach. Pulse oximetry provides real-time assessment of peripheral tissue oxygen saturation, but not of ventilation adequacy. The past decade has seen the gradual introduction of end-tidal carbon dioxide monitoring or capnography into...
Competence of UK paramedics in performing standard paramedic skills
Paramedics working in a traditional ambulance service role infrequently see patients who are critically ill or injured; in addition, pressures on hospitals have caused long waiting times, further lowering exposure to all patient groups and reducing how often paramedics use their clinical skills, potentially negatively impacting performance in practice. This study sought to establish the competence of paramedics in a set of skills that included frequent and infrequent as well as simple and...
Raised levels of depression and PTSD in ambulance staff: causes and solutions
Background: Ambulance staff are reported to have higher levels of mental health problems, including post-traumatic stress disorder (PTSD), than the general population. Vicarious trauma has been attributed to the increased prevalence of depression and PTSD in ambulance service staff. Aims: This literature review explores the causes of the greater prevalence of PTSD and discusses interventions to lower these high rates. Methods: A literature review was carried out and four relevant studies...