RSS 1.0Publications - Scottish Ambulance Service
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Leadership characteristics to reduce staff attrition and absence related to burnoutBurnout among the paramedic profession is an increasing problem and not enough is being done to improve the current climate. It is for this reason that paramedics should individually contribute to the reduction of this issue by developing their own leadership characteristics, such as emotional intelligence, social intelligence, and stress and conflict management. Evidence suggests that these qualities and behaviours reduce the possibility of being subject to burnout symptomology. Implementing positive stress and conflict-management strategies will create a healthcare environment, which will be more enjoyable to work in. Emotional and social intelligence increase the resilience of prehospital clinicians who are subject to occupational challenges on a daily basis. Wider influences such as ambulance trusts, health services and governing bodies have implemented strategies to tackle this issue but clinicians can lead the change from the front line. Abstract published with permission.
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Intranasal ketamine analgesia for non-physician prehospital cliniciansPrehospital analgesia is often under-administered within the UK for various reasons – especially within the paediatric population. Several analgesic options are available in the ambulance service with ketamine being a versatile medication often used by prehospital clinicians who have undergone additional training and governance with the use of a patient group direction. The options for non-invasive analgesia are limited within the ambulance service, even more so for the paediatric population or for non-compliant patients. Intranasal administration is becoming more popular as a route of medication administration for both in-hospital and prehospital clinicians. Intranasal analgesia has been well researched within the in-hospital environment and has shown that IN ketamine is a viable and effective option for providing safe rapid analgesia. Abstract published with permission.
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Reflecting on every caseAs I mark my first year anniversary as a paramedic for the Scottish Ambulance Service provides a good opportunity to reflect on the past year. Murdoch (2019) wrote about decision-making in paramedic practice, referring to Brenner’s Novice to Expert continuum—particularly on how this is applied to newly qualified paramedics. Abstract published with permission
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Prehospital serratus anterior plane block for rib fracturesFractured ribs are a leading consequence of blunt chest trauma, afflicting approximately 12% of trauma patients (Kring et al, 2022; Singh et al, 2022). Beyond the physical injury, significant pain is associated with rib fractures, posing challenges in relation to adequate ventilation and carrying a significant risk of secondary morbidity. The resultant shallow tidal breathing due to painful rib fractures and the absence of deep inspiration contribute to hypoxemia, atelectasis, and V/Q mismatching, heightening the susceptibility to pneumonia and respiratory failure. When clinicians strive to provide effective pain control for these injuries, they must navigate the delicate balance of minimising pharmacological complications (especially respiratory depression and hypotension from opioids), while optimising respiratory function and pain relief. Abstract published with permission.
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Support from advanced practitioners in critical care for ankle fracture dislocationBackground: Analgesic imitations, under-recognition of injury severity and delayed restoration of neutral alignment are common problems around ankle fracture dislocation (AFD). Optimal prehospital management improves long-term outcomes. Aims: This study aimed to explore ambulance clinicians’ experiences of AFD incidents when supported by advanced practitioners in critical care (APCCs). Methods: Semi-structured online interviews were conducted. Data sets were coded and grouped to identify themes via thematic content analysis. Findings: Six clinicians agreed to take part (response rate 42%). AFDs were encountered infrequently (once per year). Four themes were identified: clinicians’ confidence in managing AFD; value-added role of APCCs; prehospital challenges; and reflections on the incident. Conclusions: Benefits of the APCC role include enhanced technical skills, including in ankle reduction and analgesia, and in non-technical skills, such as leadership and decision-making. Improvements in clinician recognition and management of AFD and better awareness of the APCC role are recommended, as is research on optimal prehospital AFD management. Abstract published with permission.
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Can the clinical frailty scale predict futility in out-of-hospital cardiac arrest?Background: Cardiopulmonary resuscitation (CPR) is considered an essential intervention in unanticipated cardiac arrest, but in the out-of hospital setting it is often the default treatment for many patients dying of chronic and incurable disease who experience this. The Clinical Frailty Scale (CFS) can predict an individual’s vulnerability to adverse health outcomes and might be a useful tool in prognostication in the prehospital setting. Aims: The primary aim was to assess if the CFS can be used for prognostication in cardiac arrest and whether UK paramedics would be able to use the CFS in the context of an out-of-hospital cardiac arrest. Methods: A rapid review of the literature was undertaken to identify research relating to frailty’s influence on cardiac arrest outcomes. Five primary research articles were identified and were included. Findings: All the primary research focused on in-hospital cardiac arrest and demonstrated that an higher clinical frailty score was associated with increased mortality following cardiac arrest, with a significant reduction in survival at CFS ≥6. Conclusion: Research could assess whether these findings would be replicated in the out-of-hospital cardiac arrest context and whether paramedics could use the CFS to aid in prognostication in this situation. Abstract published with permission.
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Four pillars to stand onDerek Ford reflects on the importance of the four pillars of advanced practice. Abstract published with permission.
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On reflective practiceDerek Ford shares his experiences of reflective practice and why he now advocates for it. Abstract published with permission
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The Effect of ambient outside temperatures on scoop stretchersBackground: Scoop stretchers are commonly used in the prehospital care of trauma patients. Patients' clothing is often removed early in the care pathway. There may be unidentified risks if scoop stretchers are particularly cold. Aims: The primary aim of this research was to establish if there is a positive correlation between scoop temperatures and outside temperatures when this equipment is stored without access to vehicle heating. Methods: The authors recruited volunteers at ambulance locations across Scotland to measure scoop temperatures using infrared thermometers. These were compared to outside temperatures at that time. Data were subject to bivariate quantitative analysis to assess correlation strength. Findings: Results demonstrated that there was a moderate-to-strong correlation between scoop temperatures and outside temperatures (mean +3.0°C; P<0.001). There was no significant difference for other variables measured. Conclusion: Without active heating, scoop stretchers will be only marginally warmer than the outside temperature, sometimes colder than the outside temperature and sometimes below freezing point. Abstract published with permission
