• 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.
    • Delivering enhanced safety, productivity and experience: early results from a frequent caller management system

      Smith, Daniel P.; McNally, Angela (2014-12)
      Abstract published with permission. Inappropriate frequent use of services can be a challenge for private and public sector organisations throughout the world.Whether related to satisfaction and experience, difficulties accessing alternative and more appropriate services, or unrealistic expectations, organisations must develop innovative ways of ensuring the challenge is effectively managed. If successful, organisations could enjoy increased productivity and user satisfaction. Services provided by the NHS must provide timely health care to those in need, but ignoring the challenge of inappropriate use leads to inefficiencies, poor patient experience and clinically unsafe environments. In response, integrated care systems are being developed across the NHS to develop services that are both appropriate and accessible within local communities. Ambulance services are employing a number of different techniques to tackle the issue of inappropriate or frequent use of 999 to access health care. This article examines the challenges associated with frequent 999 callers, shares the experiences of a pilot project in the North West Ambulance Service, and considers the future strategic development of frequent caller management systems for the NHS.
    • Derivation of a Termination of Resuscitation Clinical Decision Rule in the UK

      Jackson, Mike; House, Matthew; McMeekin, Peter; Dinning, Joanne (2017-08)
    • Developing and diversifying

      Smith, Daniel (2019-07-10)
    • Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

      Noble, Adam J.; Mathieson, Amy; Ridsdale, Leone; Holmes, E.A.; Morgan, Myfanwy; McKinlay, Alison; Dickson, Jon M.; Jackson, Mike; Hughes, Dyfrig A.; Goodacre, Steve; et al. (2019-11-02)
      INTRODUCTION: Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration. METHODS AND ANALYSIS: Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible. ETHICS AND DISSEMINATION: Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings.Abstract, URL 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/ DOI: 10.1136/bmjopen-2019-031696
    • Developing understanding and awareness of children’s distress, distraction techniques and holding

      Preston, Christopher; Bray, Lucy (2015-03)
      Abstract published with permission. Purpose: This project aimed to evaluate the influence of an education session on ambulance clinicians’ understanding and awareness of children’s distress, distraction techniques and holding in the pre-hospital setting. Methods: An inter-professional education session that focused on raising awareness of children’s distress, the use of distraction techniques and clinical holding during pre-hospital care was provided. A mixed methods approach was then used to evaluate both existing and newly acquired knowledge and opinion through the use of questionnaires (n=26) and focus group discussion (n=20). Results: Despite literature suggesting that ambulance clinicians may not use distraction techniques during pre-hospital care, data gained from this project indicates that use of distraction techniques is widespread (92%, n=24) and has been adapted to fit within pre-hospital care. The inter-professional education event was reported as being of value for ambulance clinicians. Conclusions: Ambulance clinicians endeavour to provide a positive experience for children undergoing procedures, despite reported limitations in education, exposure and equipment. By using a collaborative and consultative education event, it is possible to facilitate ambulance clinicians to challenge their practice and improve their reported knowledge of dealing with children during procedures in the pre-hospital setting. Additional work needs to be undertaken to further explore and improve pre-hospital practice in relation to children’s distress and clinical procedures.
    • Development of V-FAST: a vision screening tool for ambulance staff

      Rowe, Fiona J.; Dent, Joseph; Allen, Frank; Hepworth, Laura R.; Bates, Rachel (2020-08)
      About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Abstract published with permission.
    • Diabetes mellitus: balancing blood glucose

      Heardman, Jessica (2013-07)
      Abstract published with permission. This case study seeks to explore the pathophysiology of diabetes mellitus and the effects that this condition has upon the individual. The aetiology of diabetes mellitus will be discussed, in conjunction with an analysis of clinical signs and symptoms presented by the disease reflecting the underlying pathophysiological processes. Clinical treatment options will also be discussed, in relation to their influence on the management of disturbances in the underlying disease process. In line with patient confidentiality guidelines (Department of Health (DH), 1997), patient-identifiable information will be omitted.
    • End-of-life care within the paramedic context

      Wilson, Caitlin (2020-11-09)
      Edited by Tania Blackmore (2020), Palliative end of life care for paramedics provides a comprehensive overview of palliative and end-of-life care within the context of paramedic practice. This recently published book is in its first edition and is available in paperback (£29.99) or eBook (£24.99) format. It sits alongside similar publications from the College of Paramedics such as Law and ethics for paramedics and Independent prescribing for paramedics. Some of you may have noticed that these book topics reflect a selection of the paramedic e-Learning modules, which are freely available for College of Paramedic members through the e-Learning for Healthcare Hub website or via My ESR for NHS employees. The subjects covered in the ‘Paramedic – End of Life and Palliative Care’ e-Learning module loosely reflect those covered in this book; however, the book covers everything in much more detail, and includes many references to current supporting evidence, providing the reader with a greater background understanding of palliative care. The team of authors is a well-balanced mixture of academic and clinical health professionals, with three from a paramedic background and three end-of-life care specialists. The front cover of the book indicates that this book is supported by the College of Paramedics, which hints at its incredible relevance for paramedics and emergency ambulance technicians practising in the UK. Sometimes when being taught by specialists outside of the ambulance service, they impart an immense amount of specialist knowledge, yet prehospital clinicians have to decide for themselves how much is actually within their scope of practice and therefore applicable to their clinical role. Although, the editor includes a (very valid and important) disclaimer at the beginning of the book that ‘healthcare professionals should always follow local procedures and be aware of their own scope of practice’, this process of critical appraisal and judgement on applicability is made much easier by the book's close alignment with UK paramedic practice and the frequent references to the JRCALC Clinical Guidelines 2019 (Association of Ambulance Chief Executives (AACE), 2019). In fact, in that way, it is similar to the Emergency birth in the community book that I reviewed in a past issue of the Journal of Paramedic Practice (Wilson, 2019), which was supported by the AACE and JRCALC. The book takes the reader on a logical journey beginning with the broader historical, social and cultural debates about death and dying in chapter 1, followed by the various definitions of palliative care in chapter 2. Chapters 3 and 4 provide an overview of palliative care emergencies and how to recognise them, followed by guidance on symptom management. Subsequently, chapter 5 focuses on softer skills such as communication, while chapter 6 provides an overview of caring for the dying patient, delirium, medication management and discussions surrounding what may constitute a ‘good death’. Chapters 7 and 8 address the topics of ethics and professional resilience, before chapter 9 ties everything together under the title ‘the paramedic as an end of life care specialist’. A clear favourite within this book was chapter 4, which covers symptom management and seemed so applicable that it may join my ever-growing collection of ‘keep-in-helmet-bag’ books. I also really liked the many visuals, such as the image displaying the relative strength of opioids and others illustrating pain pathways and causes of vomiting and nausea. The authors have also included many educational tables, which in chapter 3 provided useful information on manifestations, relevant considerations and treatment for various palliative care emergencies such as neutropenic sepsis, superior vena cava syndrome and terminal haemorrhage. Although it will be impossible for me to remember all of these details, it will be easy to refer to these tables when thinking through differential diagnoses or reflecting on patient encounters. A great learning tool within this book are the case studies included at the end of most chapters. These cases add a practical element to the book and allow the reader to reflect upon what has been discussed in the chapter. However, many of the case studies and associated questions are complex in nature and although they are likely to have more than one right answer, there will definitely be wrong answers. I wonder if, in subsequent editions, the authors could include potential answers or discussions at the end of the book to ensure that readers are following along the right lines. I found the book to be a bit of a slow starter, as the authors use chapters 1 and 2 to introduce the reader to a wide variety of palliative care policies and frameworks in the UK. Although presented in a structured way, it is at times difficult to see how they fit together and which ones apply to paramedics. For those readers finding themselves similarly confused, I would suggest first turning to chapters 3 or 4 and then revisiting the earlier chapters to learn about the broader picture of palliative care. I think working through this book would make a useful exercise for continued professional development (CPD) as part of a paramedic portfolio or even the associate ambulance practitioner programme. In fact, the title, Palliative and end of life care for paramedics may be slightly misleading: this book is by no means solely suitable for qualified paramedics; emergency ambulance staff in other roles such as emergency medical technicians or clinical advisors within the emergency operations centre would definitely benefit from reading this book, although would have to adapt some of the advice to their own scope of practice. Overall, this book is written in simple and easy-to-understand language, provides excellent tips for further reading and cites relevant and up-to-date references throughout—what's not to love? Well, very little to be honest. I have already recommended this book to several colleagues and feel my own care of patients approaching the end of their life has improved since reading this book. I certainly feel more confident and will likely turn back to this book to answer any prehospital palliative care questions I may face in the future. The best way to summarise this book is by expressing my full agreement with the statement on the back cover: ‘it is essential reading for [prehospital clinicians] hoping to better understand the complexities of caring for patients approaching the end of life’. Abstract published with permission.
    • Enhancing mental health resilience and anticipating treatment provisions of mental health conditions for frontline Healthcare workers involved in caring for patients during the COVID-19 Pandemic - A call for action

      Kullu, Cecil; Coley, Andrew; Cooper, Cary; Aitken, John; Cummings, Jane; Gerada, Clare; Grant, Chris; Rafferty, Joe; Kumar, Raj; Gizzi, Denis; et al. (2020)
    • Experiences of two paramedics deployed to the Phillipines in response to Typhoon Haiyan

      Watts, Peta; Byrom, Tim (2014-10)
      Abstract published with permission. This article describes the experiences of two paramedics from the UK International Emergency Trauma Register (UKIETR) who deployed as part of the UK-Med response to Typhoon Haiyan in 2013. Each had a key role in the deployed teams, both targeting distinct but differing health needs following the Typhoon. Tim Byrom was a member of the first team activated on 13 November 2013. He formed part of a surgical, anaesthetic and rehabilitation team that assisted the Australian Medical Assistance Team (AUSMAT) at their field hospital in Tacloban. Peta Watts was in the second team, deployed two weeks after the Typhoon following invitation to continue assessments and health provision on outlying islands. Her experience involved being part of a unique and effective collaboration between the Department for International Development (DfID), UK-Med, and the British Military in the delivery of an integrated humanitarian aid package.
    • Exploratory study into the views of paramedics on paramedic prescribing

      Duffy, Iain; Jones, Colin (2017-07)
      Abstract published with permission. The purpose of this paper is to establish the views of a group of Paramedics on Paramedic prescribing. Although at the time of writing the proposal to the Commission on Human Medicines they rejected prescribing for Paramedics, work is still ongoing with various bodies to move forward with the application. A focus group of a small number of Paramedics was held, and the researcher performed a review of relevant literature. The development of the role of paramedic from an ambulance driver to a highly skilled and knowledgeable healthcare professional was discussed. It was established that the profession's close links with higher education institutions would be pivotal if paramedics are to be given prescribing rights. The study concluded that paramedics believe they should be able to become independent prescribers, as it would help further their career, giving the profession added credibility. As paramedics already give a rounded healthcare approach to their patients, this would only be enhanced by prescribing rights, as a ‘complete’ health care attitude could be established.
    • Fifty per cent reduction in admission by sharing data from ambulance service

      Dermott, S.; Byrne, J.; McCroy, S.; Rajbhandari, S. (2018-03)
    • Frailty as lived, frailty as applied: exploring lived experiences in older patients who have fallen and called 999

      Robertson, Duncan; Cooke, Mary (2016-09)
      Rationale The aim of this pilot study was to explore the personal meanings of frailty within a purposive sample of older patients who had fallen, needed an Emergency Ambulance Service response and were subsequently referred to a falls service. A systematic literature review indicated that no qualitative studies had been carried out within such a sample previously. Methods The qualitative methodology used Interpretative Phenomenological Analysis; which explored the essential nature of frailty as a phenomenon though a series of subjective narrative accounts generated by focused interviews. Employing a reflexive approach to the analysis allowed completion of a participant-centred and ethically sound study. Results Analysis of six focused interviews with older adults provided a thick description which highlighted five themes: Adaptations to frailty, Focus on confidence as psychological frailty, A changing lifeworld-towards social frailty, Reconciling a frail future and Frailty as stigma. These themes were discussed in relation to sociological literature including theories concerning transitions from the third to fourth age, liminality and social death, frailty as stigma and frailty as lived and frailty as applied. Implications This sample of patients represented a group in transition. They occupied a liminal zone situated between the third and fourth age and while acknowledging oldness, they actively challenged biomedical assumptions of frailty through an emphasis on control and individual agency. This study enables paramedics to modulate their communications when encountering elders who reject the notion of frailty as a term applied. For service design, the results allow the voice of the patient group to be heard, so that solutions can be designed in an inclusive, rather than hierarchical fashion. Significantly, this thesis forms part of an emerging body of evidence that questions the usefulness of the term frailty as experienced by this sample of participants. https://emj.bmj.com/content/emermed/33/9/e11.1.full.pdf 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/ http://dx.doi.org/10.1136/emermed-2016-206139.35
    • From trade to profession-the professionalisation of the paramedic workforce

      First, Sue; Tomlins, Lucy; Swinburn, Andy (2012-07)
      Abstract published with permission. How do we achieve professionalisation of the paramedic? The Trait theory identifies professions as having 1. An exclusive body of knowledge 2. Self regulation and 3. Registration. Becoming a profession leads to improved remuneration and greater respect and knowledge, but this does not lead to a change in personal conduct. Professionalism however, is connected to behaviour, attitudes, accountability and responsibility. The behavioural changes and attitudes required of a ‘professional’ are brought about through the combination of higher education and clinical leadership. Academic input integrates clinical leadership with the career structure and all staff at all levels. Clinical leaders are at the coal face, accessible during and after the event, for training and clinical supervision and are therefore transforming practice at every level. However, clinical leadership is ineffective with an uneducated workforce and an uneducated workforce is ineffective without clinical leadership, the two go hand in hand So... What is the way forward for the ambulance service? What are paramedics doing to develop and maintain the profession and professional behaviours?
    • The future of air ambulance services in trauma care

      Davies, Douglas (2009-12-18)
      This article explores the development of air ambulances from being vehicles for inter-hospital transfers to being the modern frontline resources for prehospital care. The service models currently utilised by the various air ambulance charities are explored, as is the influence each of these may have on the delivery of patient care. The organizational structure of air ambulance charities is addressed, as it also impacts upon service delivery and the governance of clinical practice. This area gives rise to an exploration of the potential for air ambulances to offer a unique platform for the development of the paramedic profession and an expanded scope of clinical practice. The article also explores the effect of wider changes within health care and how this impacts upon the services provided by air ambulances. Analysis of potential future developments based upon a number of factors is made and conclusions drawn with regard to both current and future practice development. Abstract published with permission.