• Bacterial tonsillitis: prevalence, prediction and treatment by the ECP

      Winch, Spencer (2010-09)
      Sore throat or tonsillitis is not necessarily considered a life-threatening emergency but such calls are received and attended to by the ambulance service. It is believed that this is because a face-to-face assessment is often required as the symptoms of a high temperature, headache, lethargy, vomiting and a stiff neck are far too similar to those of meningitis. With complex telephone triage now being performed by nurses and emergency care practitioners (ECP) on clinical support desks within most emergency operation centres, it is hoped that this complaint could be narrowed down and a more appropriate ECP response despatched. When presented with tonsillitis in the community, it is difficult for the practitioner to establish whether the infection is of a bacterial or viral origin. Learned behaviour would suggest that white exudates on the tonsils deem a bacterial origin and requires antibiotic treatment, but this can sometimes be a self limiting illness and antibiotic treatment is not indicated and will only assist with resistance. This article looks as the incidence of bacterial tonsillitis, tools to predict bacterial tonsilitis, and the correct antibiotic and length of course once established. It also briefly touches on the Department of Health's current consultation on paramedic prescribing rights and how a delayed prescription treatment plan cannot be achieved working under a patient group directive (PGD) when treating bacterial tonsillitis. Abstract published with permission.
    • Changing paramedic students' perception of people who self-harm

      Ramluggun, Pras; Freeman-May, Andrew; Barody, Gabby; Groom, Nicholas; Townsend, Chloe (2020-10-07)
      Aim: This study aimed to identify whether paramedic students' perceptions of patients who self-harm changed following an educational intervention. Background: Self-harm is a major public health concern with an increasing number of incidents being reported in England. Paramedics are often the first contact for those who self-harm and antipathy to these patients among caregivers, including paramedics, has been reported. Negative attitudes to patients who self-harm from health professionals is a considerable barrier to their care. Education on self-harm for paramedics has been historically inadequate, even though it can potentially improve attitudes and how these practitioners engage with those who self-harm. Method: A pre- and post-survey analysis was undertaken to examine whether any identified unsympathetic perceptions of paramedic students (n=30) towards patients who self-harm would decrease following an educational intervention, using a validated questionnaire measuring attitudes to self-harm. Results: Perceptions of people who self-harm were generally moderately negative prior to the educational intervention, with a significant drop in negative attitudes after it was completed. A survey showed that this drop was also mostly sustained 10 months later. Conclusion: Educational interventions may help to reduce negative perceptions of patients who self-harm in paramedic students. Abstract published with permission.
    • Diagnosing and imaging renal calculi: what can be done in the pre-hospital environment?

      McPherson, Melinda (Dolly) (2016-02)
      Abstract published with permission. Renal colic is a common pre-hospital presentation that is often conveyed to hospital due to diagnostic uncertainty. The use of the STONE score and a greater understanding of computerised tomography (CT) requirement in the diagnostic process can aid the pre-hospital clinician in making an informed decision about the management of these patients. Case: A 48-year-old female presenting with symptoms of renal colic who was assessed, managed and treated at home. Methods: A literature search was carried out on Medline, Cinahl, BNI and Embase. In addition, searches of the NHS evidence database (www.evidence.nhs.uk) and the Cochrane Database of Systematic Reviews (www.cochrane.org) were completed. Results: The search yielded 536 results, each of which were browsed for relevance, duplicates removed and their references reviewed. 16 articles were relevant to the use of CT to diagnose renal calculi and four addressed the derivation and validation of the STONE score. These were critically reviewed and conclusions drawn about their applicability to the pre-hospital environment. Conclusions: The STONE score, when combined with clinical judgement and if applied to the right patient group, is an appropriate clinical decision tool to identify uncomplicated renal calculi. CT imaging of this low-risk patient group is not required to confirm diagnosis; however, delayed CT scanning is required to form a management plan.
    • Documentation: are we writing it right?

      Eaton, Georgette (2014-09)
      Abstract published with permission. While the need to keep accurate patient records is acknowledged by the bodies that govern healthcare practice, there is currently little evidence to support a specific standard of record keeping, with advice on following one of several recognised models. For many ambulance Trusts, documentation guidelines are based on expert opinion of what should constitute good medical records and documentation, but this can vary from region to region. However, whichever model is used, there are several core principles that should be used when writing medical documentation. This article aims to provide ambulance staff with general information on documentation in an attempt to enable readers to understand why records are kept, the standard to which records should be kept, and the legal and regulatory issues relating to record-keeping for paramedics.
    • Human factors in student paramedic practice

      Matheson, Rose (2019-01-12)
      Abstract published with permission. Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.
    • Increasing objectivity in the assessment of interpersonal skills and attitude

      Tanner, Kieron (2014-11)
      Abstract published with permission. The concept of failure to fail has become more widely discussed in paramedic practice over recent years; however, it has been observed that on occasion mentors and managers experience challenges around the non-practical components of paramedic practice. Consideration has been given to identifying those elements of practice which can be more challenging to encapsulate, with the aim of providing objective feedback and where necessary set pass/fail standards. A non-practical skills matrix has been developed for consideration by those responsible for the development of ambulance staff and students. The proposal encourages qualities of the burgeoning concept of distributive leadership, incorporates elements of the document Towards a New Model of Leadership for the NHS (Department of Health (DH), 2013a), and having been mindful of the NHS response to the failings of Mid-Staffordshire and the findings of both Lord Francis’ and the Health Ombudsman (Parliamentary and Health Service Ombudsman, 2011; DH, 2013b), it responsibly aims to aid in the implementation of aspects of the recommendations capturing the current drive towards improved demonstrable compassion in UK care delivery
    • A lesson on adaptability

      Daubney, Ellie (2020-09-07)
      Having just completed her final year as a student paramedic, Ellie Daubney shares some surprising lessons learned and her recent shifts in perspective towards patient care as she undertakes a new role as a temporary newly qualified paramedic during COVID-19. Abstract published with permission.
    • Look at the patient and follow your gut

      Elsey, Abbygail (2019-08-07)
      In this month's issue, Abbygail Elsey shares the best advice she received as a student paramedic, and how it is only now making its impact in her role as a new clinician. Abstract published with permission.
    • Management of an isolated neck-of-femur fracture in an elderly patient

      Eaton, Georgette (2012-07)
      Abstract published with permission. Femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered in a step-wise approach and should be progressive to the patients' needs. Pain relief should be sought through the variety of options open to paramedics and should be initiated immediately. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive adequate analgesia and fluid replacement before any definitive treatment at hospital.
    • New kid on the block: starting as an NQP

      Elsey, Abbygail (2019-02-04)
      In 2018, our new Student Column shared perspectives from first, second and third year students across UK paramedicine programmes. This year, we will follow Abbygail Elsey, on a quarterly basis, as she takes the first steps of her journey as a newly qualified paramedic at South Central Ambulance Service after her recent graduation from Edge Hill University. Abstract published with permission.
    • Occupational stress, paramedic informal coping strategies: a review of the literature

      Mildenhall, Joanne (2012-06)
      Abstract published with permission. Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.
    • Our role in a family's crumbling world

      Elsey, Abbygail (2019-05-07)
      Newly qualified paramedic at South Central Ambulance Service, Abbygail Elsey, shares a personal experience of loss and provides a reminder of just how much a paramedic's role matters to the families who call you to the scene of their loved one's death Abstract published with permission.
    • Paramedics and medicines: legal considerations

      England, Ed (2016-08)
      Abstract published with permission. This article will cover: l The relevant legislation relating to medicines and ambulance services l The restrictions that apply to different organisations or individuals regarding the possession of medicines l Regulations on the administration and supply of medicines l Patient Group Directions and Patient Specific Directions. The law in relation to the possession of medicines, administration to patients and the supply of medicines is separate. This article also provides guidance to ambulance services and ambulance clinicians on available options to ensure good patient access to medicines in England. The laws described also apply in Scotland and Wales but there are some different national processes. The law both enables and restricts access to medicines. However, it does require interpretation and a pharmacist can help with this. Where interpretation is contentious then organisations may obtain a legal opinion. Legal opinions can also differ, and can only be resolved in court.
    • The pathophysiology of labyrinthitis

      Mildenhall, Joanne (2010-07)
      Labyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo, and fever. Subsequently, it is an illness commonly diagnosed by health care practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly. Abstract published with permission.
    • Point-of-care blood tests in decision-making for people over 65 with acute frailty

      McPherson, Melinda (Dolly) (2019-03-13)
      Background: National ‘see, treat and discharge’ rates for paramedics have increased. However, despite the rise in demand on paramedic decision-making, there have been few improvements to prehospital diagnostics. Patients aged over 65 years presenting with acute frailty syndromes are a notably complex clinical patient group for whom informed risk stratification in clinical reasoning is paramount. Methods: This was a single-site quality improvement project using point-of-care blood testing (POCbT) to help inform decision-making for patients aged above 65 years with acute frailty syndromes. Results: This quality improvement project showed a self-reported improved confidence in clinician decision-making and patient disposition with the use of POCbT. This confidence was validated by improved discharge on scene and recontact rates. An unintended outcome of the project was the accumulation of practical knowledge on the use of POCbT in the prehospital arena. Conclusion: Continued use of POCbT in the prehospital environment has promise but this is not without limitations. Prehospital services wishing to implement POCbT should focus on demographic identification, staff training and interpretation of results. Abstract published with permission.