• The current leadership development opportunities provided for student paramedics by Higher Education Institutions: a literature review

      Rae, Alison; Robinson, Simon (2020-09-01)
      Introduction: The development of safe, competent and capable paramedics is one of the key concerns of education providers or Higher Education Institutions (HEIs). To achieve this, paramedic programmes need to focus on teaching leadership to students. The aim of this literature review was to identify the current leadership development opportunities for paramedic students during their undergraduate training across the United Kingdom, in order to identify current gaps and make suggestions on how HEIs could increase leadership opportunities for student paramedics. Methods: During August 2018, the Scopus, Medline, CINAHL and Academic Search Premier databases were searched (the last three accessed via EBSCOhost). Grey literature was also manually reviewed. Both authors screened the title and abstract and agreed on final papers eligible for full-text review. CASP and COREQ checklists were used to assist in critically appraising the quality of the research and to help decide on the papers chosen for inclusion. Results: The search yielded 511 results (455 after duplicates were removed). The grey literature search also yielded one additional document that incorporated a framework based on primary research integrated within the paper itself. After title and abstract review, seven papers were included for full text critical review. Two papers were then excluded, resulting in a total of five papers being included in the review. Conclusion: Current evidence, although limited, demonstrates the benefit of educational programmes in developing educational and non-educational leadership opportunities for paramedic students. Moreover, there is value to individuals being provided or seeking extra-curricular activities, and students should be encouraged to engage in societies, the College of Paramedics, events and conferences, and to work or volunteer in healthcare or emergency service-related sectors to further enhance their leadership potential and skills. Abstract published with permission.
    • Is prehospital lactate testing useful in improving clinical assessment?

      Robinson, Simon (2019-06-08)
      Introduction: Lactate devices offer the potential for paramedics to improve patient triage and escalation of care for specific presentations. There is also scope to improve existing prehospital tools by including lactate measurement. Method: A literature search was conducted using the Medline, CINAHL, Academic Search Premier, Sciencedirect and Scopus databases. Findings: Acquiring prehospital lactate measurement in trauma settings improved triage and recognition of the need for critical care. Within a medical setting, studies offered mixed results in relating prehospital lactate measurement to diagnosis, escalating treatments and mortality. The accuracy of prehospital lactate measurements acquired varies, which could impact decision making. Conclusion: Prehospital lactate thresholds could aid decision making, although the literature is limited and evidence varies. Lactate values of ≥4 mmol/litre in medical and ≥2.5 mmol/litre in trauma patients could signify that care should be escalated to an appropriate facility, and that resuscitative measures should be initiated, particularly with sepsis, as reflected by standardised lactate values that guide treatment in hospitals. Similarly, a lactate value of <2 mmol/litre could mean de-escalating care into the community, although further research is warranted on this. Abstract published with permission.
    • Tools to predict acute traumatic coagulopathy in the pre-hospital setting: a review of the literature

      Robinson, Simon; Kirton, Jordan (2020-12-01)
      Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation. Abstract published with permission.