RSS 1.0North West Ambulance Service [NWAS]
Publications from the North West Ambulance Service. To find out more about NWAS visit their website at https://www.nwas.nhs.uk
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Practice-based education: a scoping reviewBackground: Apprenticeships are key to ensuring that private and public employers can recruit and develop workforces. The degree apprenticeship in paramedic practice allows learners to continue academic study while participating in on-the-job training. Objectives: The aim of this UK-based scoping review is to identify the barriers and challenges in practice-based education, and link the findings to paramedic degree apprenticeships. Methods: A scoping review was undertaken to examine the literature on degree apprenticeships and the barriers and challenges within practice-based education. Findings: Six studies were reviewed. None were specific to paramedicine, so analysis and evaluation were drawn from other professions. Three main themes were identified: role of the mentor/practice-based educator; stakeholder collaboration; and apprentice support. conclusion: Employers are key to the collaborative design of apprenticeship, yet multiple issues in terms of their working with higher education institutions exist. The interpretation of apprenticeship-specific terminology used to assess competence, and the subjective definition of expected standards were key concerns of practice educators. Employers need to provide education to practice educators to support the facilitation of learning and assessment. Responsibility for the success of apprentices lies with both employer and learner. More research is needed on barriers for each stakeholder. Employers require clearer guidance regarding funding and expectations. Abstract published with permission.
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ECGs on the go: a clinical comfort blanketWhile not a book, another valuable resource for paramedics from Class Professional Publishing will be the subject of this quarter’s Book Review. Within this pack, you will find 21 colour-coordinated cards. The colours separate the cards into five different categories related to electrocardiogram (ECG) interpretation: l ST-Segment change Bundle Branch Blocks AV Blocks SVT rhythms Ventricular rhythms. All the topics covered are ones you would expect to find on a paramedic degree course and that have relevance in the prehospital setting. Abstract published with permission.
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Diagnostic accuracy of early warning system scores in the prehospital settingThe use of prehospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and prehospital care settings, a systematic review was carried out by Guan et al (2022) to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or prehospital setting. This commentary aims to critically appraise the methods used within the review by Guan et al (2022) and expand upon the findings in the context of clinical practice. Abstract published with permission.
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Navigating the breadth and depth of primary careThis book states that it is aimed at both paramedics who are new to the world of primary care and those who are already working within a primary care environment. The authors clearly have a wealth of experience in primary care and the prehospital setting, which are equally important when writing about paramedic care in the primary care setting. Alongside the three authors, there are no less than 19 contributors, again representing some crucial clinical areas such as midwifery, end-of-life care, education, and safeguarding. Abstract published with permission
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Could diabetes prevention programmes result in the widening of sociodemographic inequalities in type 2 diabetes? Comparison of survey and administrative data for EnglandBackground The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing type 2 diabetes mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity or deprivation is not known. Methods We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (1) prevalence of NDH (using survey data from UK Household Longitudinal Study (n=794) and Health Survey for England (n=1383)); (2) identification in primary care and offer of programme (using administrative data from the National Diabetes Audit (n=1 267 350)) and (3) programme participation (using programme provider records (n=98 024)). Results Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) (4% of the population with NDH (95% CI 2.4% to 6.5%)) and older adults (aged 80 and above) (12% (95% CI 9.5% to 14.2%)) were slightly under-represented among programme participants (2% (95% CI 1.8% to 2.2%) and 8% (95% CI 7.8% to 8.2%) of programme participants, respectively). People living in deprived areas were under-represented in eight sessions (14% (95% CI 13.7% to 14.4%) vs 20% (95% CI 16.4% to 23.6%) in the general population). Ethnic minorities were over-represented among offers (35% (95% CI 35.1% to 35.6%) vs 13% (95% CI 9.1% to 16.4%) in general population), though the proportion dropped at the programme completion stage (19% (95% CI 18.5% to 19.5%)). Conclusion The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age and limiting illness or disability-related inequalities in T2DM. While ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target under-represented groups to ensure equitable access and narrow inequalities in T2DM. https://jech.bmj.com/content/77/9/565 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Mass casualty triage : using virtual reality in hazardous area response teams trainingBackground: 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 (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.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 (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions. Results: All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage. Conclusion: VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.
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Carrying out research, critical appraisal, ethics and stakeholder involvementResearch skills are a requirement under the Health and Care Professions Council (HCPC) standards for paramedic registration. Paramedics must ‘recognise the value of research to the critical evaluation of practice’. Research in the medical field is important in order to improve the knowledge of clinicians and inform evidence-based practice. The purpose of this article is to demonstrate the key components of the research process, use of a PICO [population, intervention, comparison, outcome] tool to search relevant databases and explain the critical appraisal of research in order to establish if research is valid before implementing results into paramedic practice. Abstract published with permission.
