• 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.
    • Developing and diversifying

      Smith, Daniel (2019-07-10)
    • 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.
    • 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.
    • 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.
    • GP perspectives of paramedic referrals to urgent and primary care

      Burns, John (2018-07)
      Abstract published with permission. Background: This article stemmed from a search for more understanding about how paramedics relate to urgent and primary care (U&PC). Methods: The current study is qualitative, involving interview with seven general practitioners (GPs) in Wirral, Merseyside. Their verbatim evidence was audiorecorded, transcribed and analysed. Findings: There were three superordinate themes established: variability of referrals; the value of referrals sometimes being overlooked; and the need for skills development to improve referrals. Conclusion: The paramedic skillset is essential for appropriate referrals as long as their limitations are considered by GPs, while future research should focus on how paramedic skill bases can evolve in the U&PC community.
    • Heliox in acute severe asthma in the A&E setting: a review

      Scholes, Steven (2013-09-29)
      Heliox (HeO2) is a mixture of helium and oxygen, often mixed in 80:20 or 70:30 ratios for use in medicine and clinical investigations. Heliox has been available for use in the UK since 2002 and is supplied as Heliox 21 (21% oxygen and 79% helium) by BOC Gases for medical use in asthma, croup, chronic obstructive pulmonary disease and other medical procedures. Heliox use in asthma exacerbations remains largely experimental owing to the limited number of randomized controlled trials. This review aims to critically analyse the efficiency of Heliox use in acute asthma exacerbations in the Accident and Emergency (A&E) setting, evaluate its effectiveness as a medium for nebulization, and assess potential benefits to clinical practice. Prehospital application will also be discussed in moderate-severe asthma exacerbations. It is envisaged that the factors relating to Heliox use in asthma are focused to provide an additional therapy to the current choice of therapies for prehospital clinicians. Abstract published with permission.
    • How accurate is the prehospital diagnosis of hyperventilation syndrome?

      Wilson, Caitlin; Harley, Clare; Steels, Stephanie (2020-11-09)
      Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity. Abstract published with permission.
    • How it's done: search tools and techniques for major bibliographic databases

      Holland, Matt; Dutton, Michelle; Glover, Steve (2021-05)
      This article explains how to write an effective search plan using simple steps. The article takes you through the tools and techniques that are widely used in major bibliographic databases such as MEDLINE and CINAHL to conduct searches. These include Boolean logic, truncation and wildcards, in-field searching, proximity operators, limits and subject thesauri. Each process is illustrated with an example to help you apply them to your own searches. The process of using these tools and techniques to either narrow (find fewer results) or broaden (find more results) is described and summarised in an easy-to-use table. Abstract published with permission.
    • Hyperventilation syndrome: diagnosis and reassurance

      Wilson, Caitlin (2018-09)
      Abstract published with permission. This article provides an overview of hyperventilation syndrome (HVS). Hyperventilation is to breathe in excess of metabolic requirements; in the absence of an underlying organic cause, it is defined as HVS. Alternative terms used in literature are panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing and breathing pattern disorder. This article explores HVS signs and symptoms beyond the familiar clinical signposts of tachypnoea, chest tightness, paraesthesia and anxiety. It will also discuss differential diagnoses and pre-hospital treatment of HVS, focusing on reassuring patients and assisting them in establishing a good respiratory pattern. Patients with HVS use a significant amount of hospital and emergency service resources, ideally placing paramedics to diagnose and treat HVS in the pre-hospital setting to avoid unnecessary and costly hospital admissions. Further research is needed to evaluate the pre-hospital prevalence and diagnostic accuracy of HVS, identify clear diagnostic criteria and design screening tools.
    • Infections of the heart and how they relate to the ambulance service

      Savage, Leon (2015-08)
      Abstract published with permission. Background: In the pre-hospital environment, the treatment of acute coronary syndrome (ACS) is at the forefront of most clinicians’ priorities when symptoms include non-traumatic chest pain. As ACS is a leading cause of preventable deaths, less emphasis is placed on other potentially life-changing conditions that are associated with non-traumatic chest pain. Objectives: This article discusses the three main groups of cardiac infections (pericarditis, myocarditis, and endocarditis). It then discusses how they can be identified in the pre-hospital setting and how the ambulance service can contribute to the subsequent diagnosis of patients presenting with these conditions. Discussion: Pericarditis is a relatively common cause of non-traumatic chest pain. It has symptoms that can be found in the pre-hospital environment such as specific ECG changes and symptoms that can be identified during an initial consultation. Myocarditis has a low incidence rate as well as a wide variety of symptoms that can be associated with other common ailments. It is a very hard condition to determine in the pre-hospital environment. Endocarditis in the intravenous drug user population is a significant condition and has a high mortality rate.
    • Is paramedic practice ready to adopt the NICE Transient Loss of Consciousness Guideline?

      Thoburn, Steve (2013-10)
      Abstract published with permission. In 2010 the National Institute for Health and Care Excellence (NICE) published a guideline to assist clinicians, across various healthcare settings, to diagnose and subsequently manage patients experiencing a transient loss of consciousness (TLoC). The guideline emphasises that patients who are diagnosed as having had an ‘uncomplicated faint’ or ‘situational syncope’, from the initial assessment process, may not require conveyance to the nearest emergency department. JRCALC have included these recommendations within the latest published guidelines. Evidently, this may reduce inappropriate admissions and reduce unnecessary NHS expenditure. In addition it enables clinicians to provide care to patients within their home environment thus improving their experience and outcome as a service user. Furthermore, non-conveyance may reduce ambulance turn-around times enabling clinicians to become available to respond to life-threatening emergencies sooner. However, to utilise the guideline, clinicians are expected to be proficient in aspects of history taking, physical examination and 12-lead ECG interpretation. The current paucity of pre-hospital evidence base provides no support for use of the guideline by paramedics. It is questionable as to whether further education and training are required, before paramedics can utilise the guideline, to diagnose and discharge patients at scene without causing any detriment to patient outcome.
    • Just don't call me sir!

      Smith, Daniel (2019-06-08)