• Understanding right ventricular myocardial infarction in prehospital care

      Master, Shamima (2021-02)
      Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality. Abstract published with permission.
    • The unique advantages of advanced paramedic practitioners

      Brown, Lucy; Hedgecock, Liz; Simm, Catherine; Swift, Juliette; Swinburn, Andy (2011-03-22)
    • The use of the Paediatric Assessment Triangle in the management of the sick child

      Ogden, Kimberley (2016-09)
      Background The Paediatric Assessment Triangle (PAT) has been proven to be effective in the general impression of the health status of the child and can interlink the potential underlying pathophysiology so to alert the clinician into how critically ill/ injured the child might be. It is a rapid ‘hands off’ approach when you first encounter the child. The aim is to highlight the use of this assessment tool to allow the clinician a step wise approach to paediatric care so to enhance our treatment in the prehospital environment. Method A mixed method approach was used to gather quantifiable data from auditing patient report forms over a 3 month period during the implementation of the PAT which was followed by a questionnaire to gather qualitative information from the staff regarding their feelings towards using it. Results Data gathered from patient report forms over the 3 month period after the introduction of the PAT showed an initial baseline of 12% of it being used. Once the tool had been implemented an increase to 63.3% showing a significant uptake from the staff who were trained in its use. The questionnaire indicated that staff were welcoming of the use of the assessment tool and felt more confident when assessing a child. Conclusion The PAT showed a marked increase in being used throughout this project and the majority of staff appeared to be able to utilise it appropriately. An attempt to perform this on a larger scale would be beneficial to gauge whether it would be welcomed on a broader spectrum amongst staff and managers. Recommendations would include receiving more training for paediatrics and for consideration to be made to create a clinical performance indicator for child patients to ensure that patient report forms are being completed appropriately and quality care is being delivered to this category of patients. https://emj.bmj.com/content/emermed/33/9/e4.4.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-2016-206139.16
    • Using social media for good

      Smith, Daniel (2019-09-11)
    • The utilisation of a structured debriefing framework within the pre-hospital environment: a service evaluation

      Tierney, Shaun (2018-06)
      Abstract published with permission. Background: Debriefing improves care and reduces error. To be effective, debriefs should be facilitated by trained individuals utilising structured and validated tools. Currently, in UK ambulance services there is no published evidence that structured processes utilising validated tools are being consistently delivered by trained facilitators, potentially impacting clinical practice. Methods: A pre-intervention survey related to debriefing was sent to 1000 clinicians within a specific geographical area of the trust via e-mail. In addition, 12 senior or advanced paramedics were recruited from the same area to participate in a training day and 12-week trial, utilising the Debrief Diamond as part of post-event debriefing. Following the trial period, all facilitators and participants of any recorded debriefs were invited to complete a post-intervention survey. Results: A total of 130 staff responded to the pre-intervention survey, with 22% reporting that previous debriefs had not identified areas for learning, and 13% reporting that previous debriefs had not identified good practice, learning opportunities or near misses. Post-intervention, 89% believed the process of debriefing was improved utilising a structured framework, 85% stated trained individuals improved the process, 93% reported the identification of good practice, 70% identified team level learning and 100% of facilitators reported improvements in identifying and supporting learning. Conclusion: Improvements in identifying good practice and learning opportunities were reported by both clinicians and facilitators in this evaluation, reflecting current evidence that structured and facilitated debriefs support safer care through the identification and subsequent reduction of human error. Consequently, the evaluation of appropriate debrief frameworks to provide consistency and validity to clinical debriefs in the pre-hospital environment should be considered to support safer clinical care.
    • What happened on Restart a Heart Day 2017 in England?

      Brown, Terry P.; Perkins, Gavin D.; Lockey, Andrew S.; Soar, Jasmeet; Askew, Sara; Mersom, Frank; Fothergill, Rachael; Cox, Emma; Black, Sarah; Lumley-Holmes, Jenny (2018-09)
    • What is your ‘normal’?

      Smith, Daniel (2019-02-04)
    • What makes clinicians decide to use spinal immobilisation? A review of the literature

      Cornah, Julia (2014-04)
      Abstract published with permission. Current practice of spinal immobilisation appears to be based heavily on historical practice rather than scientific precedence. Evidence shows that it is common practice to immobilise patients, yet studies demonstrating the benefit of this is limited. The decision made by the clinician to immobilise a patient is based on fear of reprisal, caution and ritualised practice rather than robust clinical assessment or a definitive criteria. A global, standardised criteria and robust immobilisation method is yet to be established. This article will examine and critically analyse existing literature surrounding patient immobilisation following a suspected or confirmed acute neck injury. In particular, literature on the use of a cervical collar and head blocks and the use of clinician decision tools will be critically analysed.
    • Where to now? Searching beyond Medline

      Holland, Matt; Dutton, Michelle; Glover, Steve (2021-02-10)
      This article looks at the tools available to you to extend your search beyond the major bibliographic sources. The article identifies the type of literature you can find and which tools are suitable to use to find them. It aims to help you to broaden the scope of your search to find more relevant material. There is a warning about predatory journals and the need to take a critical approach to material that has not been peer-reviewed. Abstract published with permission.
    • Why evaluation is important to you, me and everybody

      Simpson, Karen (2014-11)
      Abstract published with permission. The Health and Care Professionals Council (HCPC) suggest that the use of operational evaluation and monitoring contributes to the creation of correct and current assessment standards (HCPC, 2009). This short article is aimed at anyone who attends training courses including mandatory, induction, CPD, management and clinical skills, and explores the theory of evaluation and its benefit in adding depth and value to all training purposes.
    • Why take a peak flow in asthma – a review

      van Wamel, Annelies; Procter, Shaun (2010-02)
      Current asthma protocols advocate the measurement of peak flow expiratory rate (PEFR) by staff in pre-hospital care in their assessment and management of acute asthma. Yet in practice many, if not most, omit to do this. The limited amount of recent research available – which has been conducted by doctors and accident and emergency staff and concerns patients admitted to accident and emergency departments – shows that PEFR is one of the best, if not the best, predictive assessment tool available to ambulance staff. Pulse oximetry and PEFR do not measure the same things and cannot replace each other. Not taking a pre- and post-treatment PEFR is potentially detrimental to patient care and does not comply with Joint Royal Colleges Service Liaison Committee and British Thoracic Society standards. Paramedic-led research on assessment and management of acute asthma in pre-hospital settings is lacking. Abstract published with permission.
    • Write, reflect and be human

      Smith, Daniel (2019-03-13)