• Administering naloxone: is the answer under our noses?

      Bisset, Elspeth (2009-06-01)
      The intranasal (IN) administration of naloxone to treat opioid overdoses offers many benefi ts over the current, often problematic intravenous and intramuscular routes. Such problems include using sharps around potentially aggressive patients; a high risk of transmitting blood-borne infections and diffi culty obtaining intravenous access in injecting drug users. A literature search was undertaken to examine the effectiveness of the IN route of naloxone administration in comparison to these other routes. Research suggests that the IN route is safe to introduce into practice and it is effective: the time taken from ambulance staff arriving at opioid overdose patients to them responding to IN naloxone appears to equal that of the intravenous route. Intranasal naloxone is not yet licensed for use in the UK and this needs to be reviewed. In the future this method of drug administration should result in considerable benefits and improved safety to both ambulance staff and patients, particularly for the treatment of opioid overdoses. Abstract published with permission
    • Adrenal insufficiency: improving paramedic practice

      Baines, Andy (2015-04)
      Abstract published with permission. Acute adrenal insufficiency, which includes Addisonian crisis, can lead to severe morbidity and even death if ineffectively managed. Unfortunately in the pre-hospital setting patients with acute adrenal insufficiency often receive sub-optimal care. The early administration of hydrocortisone in these cases is critical and significantly improves outcomes to the extent it can be life saving. Such therapy is part of current paramedic practice; however, there is evidence that hydrocortisone is rarely used in the pre-hospital setting. Ultimately, patients with acute adrenal insufficiency may currently be sub-optimally managed by paramedics. To combat this, this article will define the current optimal practice in this area and explain how an e-learning package will be used within North West Ambulance Service NHS Trust to educate paramedics in best practice in this area.
    • The art and science of mentorship in action

      Jones, Paul; Comber, Jason; Conboy, Adrian (2012-08)
      Abstract published with permission. The authors have collaborated to produce this article bringing together more than 60years of combined experience of paramedic practice, education and management. All maintain their paramedic registration and have among their goals the advancement and development of knowledge, skills and professionalism to promote an effective contemporary paramedic who continues to meet the care needs of the communities they serve. Practice mentors are pivotal to the success of a modern, fit-for-purpose paramedic curriculum that requires a significant proportion of learning and assessment to take place in the practice setting. This article focuses on the support that is needed for mentors during major professional and organisational change. Change which is aligned to localised multifaceted organisational strategies and change which includes supporting mentors, enabling them to carry out their function professionally, effectively and with confidence. This article discusses experiences of a collaborative, structured approach to mentorship support which is achieved through organisational, educational and professional alliances. It also explores other approaches and suggests a way forward in terms of a national governance framework.
    • Asthma: an overview of prehospital care

      Scholes, Steven (2008-12)
      Asthma exacerbations are characterized by progressive increase in shortness of breath, decrease in expiratory airflow, productive or non-productive cough, wheezing and feeling of chest tightness. Emergency hospital admissions for asthma are costly and it is estimated 75% are avoidable through effective asthma management and routine care. This article addresses asthma management in prehospital care explaining relevant underlying pathophysiology of asthma exacerbations to provide clinicians with a greater understanding of asthma and its pharmacological and ventilatory management. Abstract published with permission.
    • Breaking bad news and managing family during an out-of-hospital cardiac arrest

      Mainds, Matthew D.; Jones, Colin (2018-07)
      Abstract published with permission. The management of family during out-of-hospital cardiac arrests and death notification to the family of the deceased in the out-of-hospital setting are topics that are poorly evidenced. Two focus groups consisting of six participants in each were conducted, discussing the two subjects. The results suggest that paramedics prefer family not to be present in the room for a number of reasons and that they don’t feel sufficiently trained by their paramedic courses in order to manage family during resuscitation or breaking bad news. The study highlighted a need for more research on both subjects.
    • Building up a positive culture

      Smith, Daniel (2019-01-12)
    • Can paramedics avoid A&E departments with patients complaining of non-traumatic chest pain?

      Best, Pete (2017-04)
      Abstract published with permission. The ‘Paramedic Pathfinder’, a triage tool for paramedics, contains a discriminator for patients complaining of non-traumatic chest pain. The pathfinder advises all patients with non-traumatic chest pain to be taken to hospital. Given a background of large numbers of patients complaining of chest pain and the policy direction of UK ambulance services to treat patients closer to home, the inclusion of discriminator in the pathfinder can be challenged. A greater understanding of ACS, university education for paramedics, bedside troponin measurement, ACS risk scoring, current NICE guidelines and rapid access chest pain clinics have been identified as enablers to remove the discriminator safely and assist paramedics in finding suitable alternatives to Accident and Emergency for certain patients. Risk is an important factor in discussing chest pain and establishing the best pathway for patients. The enablers identified need further testing and development in the pre-hospital environment before they can be utilised.
    • Challenges of SARS-CoV-2 and conflicting PPE guidelines

      Master, Shamima; Gerrard, Mark (2020-11-09)
      During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) has become a contentious issue in healthcare settings, no more so than in the prehospital environment. The current severe acute respiratory syndrome 2 virus (SARS-CoV-2) has pathogenic and transmission similarities to previous coronaviruses, severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). There are differences in global and domestic PPE guidelines concerning SARS-CoV-2. Abstract published with permission.
    • Clinical care in the warm zone: a responder’s perspective upon clinical practice in support of UK tactical medical operations

      Hooper, Craig (2016-06)
      Abstract published with permission. Active shooter incidents both nationally and internationally have embedded significant cultural reforms within emergency medical services response frameworks. The deployment of specialist responders within specific preidentified areas or ‘zones’ of an active shooter incident is unprecedented, and reflects the level of public expectation now required of the ambulance service. As seen within the recent 2015 Paris attacks, the delivery of effective clinical practice in tactical medical operations (TMO) facilitates a range of unique challenges for clinical responders. Conflicting priorities between operational tactics and clinical priorities, especially within multiagency working, has historically led to ‘Good medicine becoming bad tactics, and bad tactics leading to further casualties’ (Butler, 2001: 625). Although situational dynamics may make it impossible to ever achieve an absolute equilibrium of safety and tactical efficiency within this sphere of practice, this article intends to contribute toward achieving this ideal by reviewing the Tactical Emergency Casualty Care (TECC) guidelines to establish if this framework would be compatible for use within the UK’s TMO response framework.
    • A clinical review of the indications for, and subsequent implementation of, a pilot pre-hospital sepsis pathway within NWAS

      Butterworth, Daniel (2015-10)
      Abstract published with permission. Aim: Review the clinical evidence for, and introduce a modified ‘Red Flag’ sepsis screening tool, treatment pathway and associated education package into a pilot site within the North West Ambulance Service NHS Trust (NWAS) and evaluate its impact. Methods: Retrospective application of a modified ‘Red Flag’ sepsis screening tool to 259 hospital confirmed cases of sepsis to evaluate the current identification and treatment of sepsis within NWAS.A subsequent prospective pilot launch of the tool within central Manchester in collaboration with Salford Royal Foundation Trust and Central Manchester Foundation Trust hospital emergency departments,collecting and analysing 100 cases of suspected sepsis in which the screening tool has been utilised. Results: The modified ‘Red Flag’ sepsis tool was found to be highly sensitive when applied retrospectively. Only 46% of confirmed severe sepsis cases were found to show hypotension (systolic BP <90 mmHg) pre-hospital. In the pilot,complete analysis of Systemic Inflammatory Response Syndrome (SIRS) criteria and a suspicion and documentation of sepsis increased from 15% to 94%. Compliance with a bundle of care in suspected severe sepsis cases increased from 10% to 90%. Conclusions: The introduction of a modified ‘Red Flag’ screening tool significantly improved pre-hospital sepsis identification and treatment within the pilot site. Paramedics were able to give fluid boluses to normotensive patients in suspected severe sepsis safely without adverse incident.
    • COPD: an overview of prehospital care

      Scholes, Steven; Hedges, Nicola (2009-12-18)
      Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. It is a debilitating airways disease which presents to the ambulance service with varying severity and is characterized by airflow obstruction which is usually progressive, not fully reversible and does not change markedly over several months. It may coexist with other comorbidities such as cardiovascular disease, making diagnosis of exacerbations difficult. COPD management in the prehospital environment is focused on effective recognition and the early application of pharmacological intervention to alleviate symptoms using current Joint Royal Colleges Ambulance Liaison Committee Guidelines. Abstract published with permission.
    • Could mindfulness activity improve occupational health in UK paramedics?

      Forster, Christopher (2020-05-05)
      Emerging research is supporting the implementation of mindfulness-based strategies for NHS staff. It has been shown that, by spending 10 minutes daily on the activity, health professionals can improve their emotional and cognitive functioning, while reducing work-related rumination. Through an exploratory multi-methods approach, this study sets out to quantify the occupational health levels of paramedics, and establish their appreciation of both their employer's health and wellbeing policy and mindfulness as a concept, for the overall purpose of gaining a qualitative insight into whether mindfulness activity could improve occupational health. Paramedics reported high levels of occupational stress, coupled with minimal levels of knowledge or experience of mindfulness as a health-promoting concept. Structured application of mindfulness strategies within prehospital care may promote a range of health benefits for paramedics, lead to improved organisational efficiency for trusts and support positive outcomes for patients. Abstract published with permission.
    • Creating a safety net for patients in crisis: paramedic perspectives towards a GP referral scheme

      Blodgett, Joanna M; Robertson, Duncan; Ratcliffe, David; Rockwood, Kenneth (2017-01)
      Abstract published with permission. An innovative policy implemented by a UK Ambulance Service allows paramedics to refer patients to a GP Acute Visiting Service scheme. Initial evidence suggests that this alternate route of care can decrease hospital admission rates, decrease A&E waiting time and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that are not captured by the quantitative analysis. The goal of this qualitative-observational study was to gain insight into the GP referral scheme from a paramedic's perspective. All notes were transcribed, coded and analysed using a Grounded Theory approach. Four main themes emerged: 1) barriers to referral including wait time, process, and lack of confidence, experience and training 2) approaching the patient with the GP referral scheme in mind 3) frustrations with GP decision making and 4) awareness/understanding of the scheme's impacts. This study provided valuable insight into the paramedic's perspective of the GP referral scheme. Maximising understanding of the scheme, investigating the GP's perspective in decision making and ensuring knowledge and accountability of paramedics, GPs and the public were identified as solutions to strengthen and increase referral rates and scheme success.
    • Decision making for refusals of treatment—a framework to consider

      Jones, Steven; Williams, Barry; Monteith, Paul (2014-04)
      Abstract published with permission. Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.