• Packing an academic punch

      Romano, Vincent (2018-06)
    • Paramedic administration of glycoprotein inhibitors for ST elevation myocardial infarction

      Dykes, Simon (2012-08-16)
      Abstract published with permission. Until recently, paramedics were routinely delivering out-of-hospital thrombolysis for ST segment elevation myocardial infarction (STEMI). Now that primary percutaneous coronary intervention (PPCI) is the favoured reperfusion strategy, STEMI patients are by-passing the local emergency department and taken directly to the catheterisation laboratory via ambulance. STEMI patients within a rural setting are facing the prospect of extended transfer times for reperfusion of an already ischaemic myocardium, a potentially perilous strategy. Empirical research conducted outside the UK has identified that the pre-hospital administration of a glycoprotein inhibitor improves clinical outcome for STEMI patients. Glycoprotein naturally helps to build the fibrin mesh essential within the clotting process. Inhibition of this process by glycoprotein inhibitors IIb/IIIa (GPI IIb/IIIa) prevents aggregation at receptor sites on platelets. Original research supports the notion that GPI IIb/IIIa involvement improves patient clinical outcome for STEMI in the out-of-hospital phase. Paramedics are typically the first contact for the STEMI patient and it is tangible that paramedics have the appropriate skill and knowledge to diagnose the out-of-hospital STEMI. With this in mind, it is the purpose of this article to discuss the use of pre-hospital GPI IIb/IIIa administration and to argue that this intervention should be administered by paramedic personnel.
    • Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

      Brooke, Mike; Walton, Julie; Scutt, Diane (2010-07-28)
      Objectives Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence available to inform this debate is almost entirely obtained from outside the UK, where emergency medical services (EMS) routinely use doctors as part of their model of service delivery. Using a structured review of the literature available, this paper examines the evidence to determine ‘Is there a place for paramedic ultrasound in the management of patients in the prehospital setting?’ Method A structured review of the literature to identify clinical trials which examined the use of ultrasound by non-physicians in the prehospital setting. Results Four resources were identified with sufficient methodological rigour to accurately inform the research question. Conclusion The theoretical concept that paramedic-initiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes. https://emj.bmj.com/content/27/9/702. 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 http://dx.doi.org/10.1136/emj.2010.094219
    • Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature

      Brooke, Mike; Walton, Julie; Scutt, Diane (2010-07-28)
      ABSTRACT Objectives Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence available to inform this debate is almost entirely obtained from outside the UK, where emergency medical services (EMS) routinely use doctors as part of their model of service delivery. Using a structured review of the literature available, this paper examines the evidence to determine ‘Is there a place for paramedic ultrasound in the management of patients in the prehospital setting?’ Method A structured review of the literature to identify clinical trials which examined the use of ultrasound by non-physicians in the prehospital setting. Results Four resources were identified with sufficient methodological rigour to accurately inform the research question. Conclusion The theoretical concept that paramedicinitiated prehospital ultrasound may be of benefit in the management of critically ill patients is not without logical conceptual reason. Studies to date have demonstrated that with the right education and mentorship, some paramedic groups are able to obtain ultrasound images of sufficient quality to positively identify catastrophic pathologies found in critically ill patients. More research is required to demonstrate that these findings are transferable to the infrastructure of the UK EMS, and in what capacity they may be used to help facilitate optimal patient outcomes. https://emj.bmj.com/content/27/9/702.long 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/bmj.h535
    • Paramedic attitudes towards DNACPR orders

      Armitage, Ewan; Jones, Colin (2017-10)
      Abstract published with permission. Background: Qualitative research involving paramedics and their involvement in end-of-life (EoL) care has already been published, but there have been no published attitudinal studies specifically relating to do not attempt cardiopulmonary resuscitation (DNACPR) orders and paramedics working in the pre-hospital setting in the UK. Objective: To gain an understanding of paramedic attitudes towards an increasingly common aspect of paramedic practice, focusing specifically on the pre-hospital environment and identifying any corelation between gender, length of service, and level of educational attainment. Design: A paper-based questionnaire was distributed to all paramedic grades, operational out of two ambulance stations of a regional NHS ambulance service in March 2017. The questionnaires were designed using a combination of free-text boxes and Likert scales. A total of 33 questionnaires were issued and 11 completed questionnaires were returned. Results: Respondents indicated the importance of communication in relation to DNACPR orders, as well as the role of allied health professionals and family members in the process. Respecting the patient’s wishes was considered paramount, as was educational provision surrounding DNACPRs. Conclusion: The majority of respondents reported that they were comfortable incorporating DNACPR orders in their clinical practice, although more modest responses were returned regarding the level of education received in this area of paramedicine.
    • Paramedic clinical leadership

      Martin, John; Swinburn, Andy (2012-03)
      Developing the paramedic profession is at the heart of the mission for the College of Paramedics. As any profession develops it evolves to take leadership and responsibility for a growing body of knowledge that informs practice. Back in 2008 the College published the second edition of the curriculum framework for paramedics clearly outlining the need for the development of roles at a variety of clinical levels. Having these levels populated creates a clinical framework that will deliver patient benefit and develop future paramedic practice. At its recent Council meeting the College outlined the need to develop education standards, clinical guidelines, and voluntary regulation for these emerging elements on the career framework, and is set to do this over the coming year. In this article Andy Swinburn the College Council representative for NW region outlines how the North West Ambulance Service NHS Trust has put into place a structured career development spanning the professional roles from first registration to consultant practice. https://www.magonlinelibrary.com/doi/full/10.12968/jpar.2012.4.3.181 ] 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.12968/jpar.2012.4.3.181
    • Paramedic perspectives towards gp referral schemes in north west England: a qualitative-observational study

      Blodgett, Joanna; Robertson, Duncan; Ratcliffe, David; Rockwood, Kenneth (2017-10)
      Background An innovative policy developed and implemented by a UK Ambulance Service allows paramedics to refer patients to the GP Acute Visiting Service scheme. Initial evidence suggests that using this alternate route of care can decrease hospital admission rates, increase bed availability, decrease wait time in A and Es and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that have not been 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. Methods We observed eight paramedics throughout full shifts of 8–12 hours. Data was collected using participant demographics, researcher observations and informal semi-structured interviews. All notes were transcribed, coded and analysed using a Grounded Theory approach to identify emerging themes. Results Paramedics expressed a wide range of frustrations with the scheme, identifying the waiting time, the process and a lack of confidence, experience and training as the three major barriers to referrals. They described how they approached patients with the GP referral scheme in mind, identified common characteristics of referrals, described how the triage tool shaped their decision making and shared how they involved the patient in the decision making. They shared too their frustrations with some GP decision making, which they admitted then influenced their future decision making. Finally, they described what motivated them to refer and discussed the lack of awareness and understanding of the scheme’s impact and aims. Conclusions 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. https://emj.bmj.com/content/34/10/696.2 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-2017-207114.4
    • Paramedic research literature 2011–2019. A bibliographic analysis of the contents of Amber, the ambulance research repository

      Holland, Matt; Dutton, Michelle (2020-10)
      The data held by amber presents an opportunity to understand the structure of the published paramedic literature, specifically the output of NHS staff working in English ambulance services 2011–2019. This period is of interest because it represents part of the development phase of paramedic research in England. The authors apply a series of bibliometric measures to generate a profile of the published literature. https://emj.bmj.com/content/emermed/37/10/e9.3.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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.19
    • Paramedics' views on their seizure management learning needs: a qualitative study in England

      Sherratt, Frances C.; Snape, Darlene; Goodacre, Steve; Jackson, Mike; Pearson, Mike; Marson, Anthony G.; Noble, Adam J. (2017-01)
      Introduction: The UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at scene or by using alternative care pathways. Most though are transported to ED. One factor that helps explain this is paramedics can have low confidence in managing seizures. Objectives: With a view to ultimately developing additional seizure management training for practicing paramedics, we explored their learning needs, delivery preferences and potential drivers and barriers to uptake and effectiveness. Design and setting: Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed. Participants: A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics. Results: Participants said seizure management was neglected within basic and postregistration paramedic training. Most welcomed additional learning opportunities and identified gaps in knowledge. This included how to differentiate between seizure types and patients that do and do not need ED. Practical, interactive e-learning was deemed the most preferable delivery format. To allow paramedics to fully implement any increase in skill resulting from training, organisational and structural changes were said to be needed. This includes not penalising paramedics for likely spending longer on scene. Conclusions: This study provides the first evidence on the learning needs and preferences of paramedics regarding seizures. It can be used to inform the development of a bespoke training programme for paramedics. Future research should develop and then assess the benefit such training has on paramedic confidence and on the quality of care they offer to seizure patients. https://bmjopen.bmj.com/content/bmjopen/7/1/e014024.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/bmjopen-2016-014024
    • Patient frailty screening: is it needed?

      Ratcliffe, David; Goldstein, Judah; Rockwood, Kenneth (2017-02)
    • Post-traumatic stress disorder among ambulance personnel: a review of the literature

      Simpson, Karen (2013-11)
      Abstract published with permission. It is becoming increasingly apparent that ambulance personnel are vulnerable to developing post-traumatic stress disorder (PTSD) and associated symptoms. The aim of this literature review is to identify PTSD within the scope of emergency ambulance work and think of potential ways to reduce it.
    • Potential applications of capnography in the prehospital setting

      Percival, David (2012-01)
      Abstract published with permission. End-tidal carbon dioxide (ETCO2) monitoring is well established in hospital theatre and critical care settings (Lah and Grmec, 2010), employed for observation and monitoring in anaesthesia. Its application has now extended to the prehospital environment, primarily for the verification of endotracheal tube (ETT) placement, endeavouring to reduce the occurrence of oesophageal intubations (Grmec and Malley, 2004). In recent times, technological advances, coupled with an increased appreciation of the importance of prehospital interventions, has resulted in the production of additional equipment capable of monitoring ETCO2 in non-intubated, self-ventilating patients via a non-invasive nasal cannula. Despite having an extensive range of potential uses, the apparatus is widely underused (Langhan and Chen, 2008). In this article, potential applications in the prehospital setting will be discussed via a review of contemporary literature.
    • Potential use of amiodarone to treat new-onset AF in the pre-hospital setting

      Brown, Philip (2014-08)
      Abstract published with permission. Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA (Naccarelli et al, 2009; Davis et al, 2012; Dagres et al, 2013) and is associated with significant morbidity, high risk of stroke and mortality (Cottrell, 2012). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access. This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.
    • Practice education in paramedic science: theories and application

      Romano, Vincent (2021-01-02)
      This book is immediately recognisable as another Class Professional Publishing release. For me, this sets the expectation high given the number of previous good quality releases. They are often written by experts in their field and are very paramedic-focused. I was curious if this trend would be followed given it is addressing education—a topic that often draws much of its evidence from the nursing profession, especially around mentorship. However, both authors are registered paramedics with a background in education and have gained their own relevant qualifications. This gives the reader further confidence that this book will be aimed at the learning environment specifically within the prehospital setting. Abstract published with permission.
    • Pre-hospital coronary heart disease: analysing performance indicators

      Fletcher, David (2013-01)
      Abstract published with permission. The prevalence of coronary heart disease is massive within the UK and is the leading cause of myocardial infarction. Between a third and two thirds of associated deaths occur in the pre hospital setting, many within the first few minutes of symptom onset. Immediate quality treatment is proven to improve patient survival however recent evidence suggests patients are not receiving all the elements of a quality care bundle. Pain management has been identified as one area which requires national improvement to meet standards directed by the National Service Framework for Coronary Heart Disease. In response, Ambulance services nationally have used clinical performance indicators to address quality issues in order to enhance practice and achieve target. This article reviews the importance of pain relief in the treatment of acute coronary syndrome and analyses the use of clinical performance indicators in the pursuit of best practice within the North West.
    • Pre-hospital detection of post-stroke visual impairment

      Rowe, F.J.; Hepworth, L.R.; Dent, J. (2017-11)