RSS 1.0Publications - Northern Ireland Ambulance Service
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Looking back and aheadIn her first column of 2025, Alice Cochrane reflects back on the year behind her, and ahead at the areas in which she can continue to develop on her NQP journey. Abstract published with permission.
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Prehospital treatment of autonomic dysreflexiaAutonomic dysreflexia is a potentially life-threatening condition that can affect people with established spinal cord injuries above the level of T6. If left untreated, it can lead to uncontrolled hypertension causing stroke, seizures, pulmonary oedema and death. In Ireland and the UK, there are approximately 60 000 people living with spinal cord injuries who are at risk of developing autonomic dysreflexia. Despite this, there are no prehospital guidelines on treating the condition to date. This educational article aims to address this gap in knowledge and offer potential treatment options for paramedics and ambulance clinicians, which can be effectively applied to this cohort of patients in the future. Abstract published with permission.
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Influence of simulation fidelity on student learning in a prehospital settingBackground: Simulation creates a low-risk environment for patients and participants and allows experiential learning. Aims: This literature review aims to determine whether the fidelity of simulation (the extent to which it reflects reality) influences learning. Methods: A search of databases for research within the past 10 years was carried out, and 22 articles were reviewed. Findings: Three themes emerged: models of simulation that address fidelity; the role of the facilitator; and need for sound educational theory to underpin simulation. Conclusion: Although evidence is sparse, simulation offers benefits to paramedic students and paramedics. It is particularly useful regarding rarely occurring events, especially those with significant consequences. While a high-fidelity prehospital scenario can be difficult to achieve, simulation can be educationally effective. Effectiveness depends on: the simulation model; whether fidelity is appropriate to the scenario and recognises participants’ sensory capacity; having a dedicated facilitator; and being based on a sound educational strategy. This combination allows learning outcomes to be met and the gap between theory and practice to be bridged. Abstract published with permission.
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Time for reflectionIn April, I began my career with Northern Ireland Ambulance Service (NIAS) alongside five other newly qualified paramedics (NQPs), who each are at varying stages of their NQP programme—I am right at the start of mine. The NQP framework is relatively new to Northern Ireland, mainly driven by the recent establishment of an undergraduate paramedic degree at Ulster University. It is fair to say that I felt like a guinea pig and I was worried about how this ‘trial and error’ would affect my progression as an NQP. Abstract published with permission.
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Both sides of the pictureIn the June issue, I shared with you the first few weeks of being a Newly Qualified Paramedic (NQP); discussing the induction process and my first shifts ‘out on the road’. Up to now, I have been working with paramedics of varying experience, and have had a few shifts with emergency medical technicians (EMTs). I have settled well into my station and am fortunate to be able to attend a variety of ‘jobs’; I could be in the city centre of Belfast or down towards Portaferry – the joys of working in a small country! Abstract published with permission.
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Thrown in at the deep endIn the April issue, I shared my experience of the Newly Qualified Paramedic (NQP) recruitment process, and provided some tips on preparation. Since then, I have completed a 3-week induction and a handful of observational shifts, and have settled into my new rota as part of a double crew ambulance (DCA). Abstract published with permission.
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Prepping for practiceIn her second column, Alice Cochrane is preparing to put on her paramedic epaulettes. Abstract published with permission.
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The space in betweenIn her first column, Alice Cochrane navigates the space in between university and practice Abstract published with permission.
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Prehospital anaesthesia by a helicopter emergency medicine service: a reviewBackground: The Northern Ireland (NI) Ambulance Service launched its helicopter emergency medical service (HEMS) in 2017. Aims: This paper reviews the first 200 cases of prehospital emergency anaesthesia (PHEA). Methods: A retrospective review of the NI HEMS intubation database between 29 July 2017 and 28 February 2021 was conducted. Findings: PHEA was delivered as rapid sequence intubation (RSI). There was a 100% RSI success rate. The mean 999 call to RSI time was 65.9 minutes (median=61 minutes), with 14.6% of procedures carried out within the National Institute for Health and Care Excellence target of 45 minutes or less. The first pass oral intubation rate was 89.3%. There was a significant difference in the number of male compared to female patients (men=145; women=55; P≤0.0001). Conclusion: PHEA delivery by the HEMS since it was set up has been successful provided in a safe, robust manner. Reducing the 999 call to RSI time in line with the National Institute for Health and Care Excellence target was identified as an area for development. Abstract published with permission
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Emergency services and technological governanceTo read and gain value from this book, I first had to research some basic concepts. Ethnography Firstly, what is ethnography? Ethnography is a qualitative research method in which a researcher—an ethnographer—studies a particular social/cultural group intending to better understand it. Ethnography is both a process (e.g. one does ethnography) and a product (e.g. one writes an ethnography). In doing ethnography, an ethnographer actively participates in the group to gain an insider’s perspective and to have experiences similar to those of the group members. In writing ethnography, an ethnographer creates an account of the group based on this participation, interviews with group members, and an analysis of group documents and artefacts (Kramer and Adams, 2017). Sociology. Abstract published with permission
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Where I am goingFollowing on from a tumultuous 12 months adjusting to a new ambulance service, my second year as a newly qualified paramedic (NQP), and an assault that forced me to step back from the role that I love for 4 months, I have often wondered ’where do I go from here?’ While I wish to never be faced with such a sinister situation again, the time away allowed me to gain an invaluable prospective on my journey thus far—where I was, where I am now and, most importantly, where I am going. Abstract published with permission.
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One patient at a timeWhen I was a student paramedic, my mentor had a steady string of little pearls of wisdom like this, always hidden behind a wall of dark humour and cynicism, but that were equally endearing towards my untainted, and unhinged enthusiasm for all things paramedic. And while I did not fully know what he meant at the time, after 3 years as a student, and now 2 as an NQP, I am finally starting to understand it. Abstract published with permission.
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A mass distribution letter as an early intervention for potential frequent callersIntensive engagement with frequent callers (FCs) has been shown to be effective at reducing call volumes and producing positive outcomes for service users. Aims: This study aimed to examine the impact of sending a mass distribution letter to potential frequent callers (PFCs) on emergency call volumes. Methods: A standardised letter containing advice and information for newly identified PFCs was introduced in an attempt to signpost service users to more appropriate care providers before they met the FC criteria. In total, 96 letters were distributed to PFCs and their impact on emergency call volumes was assessed. Findings: Emergency calls decreased from 439 to 187 in the 10 weeks following letter distribution, equating to an average reduction of 57.5%. Conclusion: An association was found between letter distribution and a reduction in emergency calls. Future opportunities for development include an emphasis on feedback from recipients and determination of specific causality. Abstract published with permission.
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Use of specialist paramedic dispatch in emergency ambulance controlOptimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes (NHS, 2015). Aim: This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of specialist resources, to establish if the evidence supports the use of one model to manage these resources, and to ascertain best practice. Method: A structured literature review was undertaken and thematic analysis was used to explore the findings of the literature, leading to the establishment of recommendations for best practice in this area. Results: The literature discourages dispatching specialist teams based solely on computeraided dispatch software codes, and recognises that specialist paramedic dispatchers have a better understanding of the clinical and ethical challenges of appropriately dispatching specialist, finite resources. Conclusion: The literature supports the use of clinicians in dispatching specialist resources to best meet the needs of those patients who are critically ill or injured. Abstract published with permission.
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The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitionersPrimary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs' experiences are of these developments. Abstract published with permission.