• Does a paramedic practitioner self-tasking dispatch model benefit their self-sufficiency in patient management? A cross sectional study

      Cotterill, Liam; Halter, Mary (2020-10)
      Paramedic Practitioner (PP) scope of practice is not comprehensively understood by Emergency Operations Centre (EOC) staff and tasking may be suboptimal. In one UK ambulance trust in November 2018, one PP team was enabled to remotely monitor live incidents and, alongside some continued EOC-dispatch, to self-task to incidents they judged would benefit from their additional knowledge and skills. Evidence on self-tasking benefit was found from helicopter emergency services only. https://emj.bmj.com/content/37/10/e11.2 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2020-999abs.24
    • Effective clinical feedback provision to ambulance clinicians: a literature review

      Eaton-Williams, Peter; Mold, Freda; Magnusson, Carin (2020-03-12)
      Background Clinical feedback provision to health professionals is advocated to benefit both clinical development and work engagement. Aim This literature review aims to develop recommendations for effective clinical feedback provision by examining mechanisms that exist specifically for ambulance clinicians. Method: A systematic search of contemporary literature identified 15 research papers and four articles, which were included for review and narrative synthesis. Findings The initial identification of practice that requires improvement, together with an understanding of the practitioners' baseline attitudes, is important. While minimising resource demands will improve sustainability, repeated interaction with clinicians will benefit effectiveness. Provision should be balanced and timely, and who delivers feedback is significant. Clinical outcome feedback not restricted to specific conditions requires further consideration of which incidents will initiate feedback and what information will be supplied. Conclusion Feedback has been shown to improve clinical performance but demonstrating subsequent benefits to patient outcomes has proved more difficult. Abstract published with permission.
    • Experts' perspectives on professionalism in paramedic practice: findings from a Delphi process

      Gallagher, Ann; Snook, Verity; Horsfield, Claire; Rutland, Stuart; Vyvyan, Emma; Juniper, Joan; Collen, Andy (2016-09)
      Abstract published with permission. This article reports findings from a Delphi process which aimed to enable an expert panel to reach consensus in the following areas: the meaning of ‘professionalism’ in the context of UK paramedic practice; enablers of professionalism in paramedic practice; interventions or approaches likely to promote or sustain paramedic professionalism; and values that underpin paramedic professionalism. The research project was the Consensus towards Understanding and Sustaining Professionalism in Paramedic Practice (CUSPPP) project. The Delphi panel consisted of 12 experts from education, leadership, management and senior clinical roles, as well as a service user. The data from each of the three rounds were distilled to statements using a basic content analysis and subjected to team review. Statements that achieve 75% (where participants agreed or strongly agreed on a Likert scale) were considered to have reached consensus. The data highlight the view that responsibility for paramedic professionalism goes beyond individuals, with organisations having a key role in providing support and debriefing opportunities and demonstrating the value of human rather than material resources. Further research relating to the topic of paramedic professionalism is necessary, and a crucial component of this is to also capture the views and experiences of service users and the general public.
    • Exploring paramedic perceptions of feedback using a phenomenological approach

      Eaton-Williams, Peter; Mold, Freda; Magnusson, Carin (2020-06-01)
      Abstract published with permission. Objectives: Despite widespread advocacy of a feedback culture in healthcare, paramedics receive little feedback on their clinical performance. Provision of ‘outcome feedback’, or information concerning health-related patient outcomes following incidents that paramedics have attended, is proposed, to provide paramedics with a means of assessing and developing their diagnostic and decision-making skills. To inform the design of feedback mechanisms, this study aimed to explore the perceptions of paramedics concerning current feedback provision and to discover their attitudes towards formal provision of patient outcome feedback. Methods: Convenience sampling from a single ambulance station in the United Kingdom (UK) resulted in eight paramedics participating in semi-structured interviews. Interpretative phenomenological analysis was employed to generate descriptive and interpretative themes related to both current and potential feedback provision. Results: The perception that only exceptional incidents initiate feedback, and that often the required depth of information supplied is lacking, resulted in some participants describing an isolation of their daily practice. Barriers and limitations of the informal processes currently employed to access feedback were also highlighted. Formal provision of outcome feedback was anticipated by participants to benefit the integration and progression of the paramedic profession as a whole, in addition to facilitating the continued development and well-being of the individual clinician. Participants anticipated feedback to be delivered electronically to minimise resource demands, with delivery initiated by the individual clinician. However, a level of support or supervision may also be required to minimise the potential for harmful consequences. Conclusions: Establishing a just feedback culture within paramedic practice may reduce a perceived isolation of clinical practice, enabling both individual development and progression of the profession. Carefully designed formal outcome feedback mechanisms should be initiated and subsequently evaluated to establish resultant benefits and costs.
    • The impact of paramedic shift work on the family system: a literature review

      Anderson, Lucy (2019-08-07)
      Aim: The current review investigates the impacts of paramedic work on the family system. Paramedics are taking time off or leaving through stress, and career decisions could be influenced by this perceived impact. Method: A systematic literature review was conducted and the literature critiqued. Two themes were identified: emotional labour and work-family fit. Results: Paramedics rely on families for emotional support, putting them at risk of vicarious trauma. The historical male coping culture of paramedic practice deters processing at work, detrimentally carrying this processing into the home environment. Additionally, several shift characteristics contribute to work-family conflict, child-rearing conflict and difficulties maintaining a social life. Conclusions: Key organisational culture change is needed from denigrating staff for showing emotions and struggling to find work-life balance, to one that improves experiences at work and therefore at home as well. Recent movement towards almost equal gender balance may present a particular opportunity to deliver culture change. Further research is required to better understand the impact that shift work has on the family. Abstract published with permission.
    • A national survey of ambulance paramedics on the identification of patients with end of life care needs

      Eaton-Williams, Peter; Barrett, Jack; Mortimer, Craig; Williams, Julia (2020-12-01)
      Objectives: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire. The questionnaire initially explored current practice and awareness, employing multiple-choice questions. The Gold Standards Framework Proactive Identification Guidance (GSF PIG) was then presented as an example of EoLC assessment guidance, and further questions, permitting freetext responses, explored attitudes towards performing this role. Results: 1643 questionnaires were analysed. Most participants (79.9%; n = 1313) perceived that they attended a patient who was unrecognised as within the last year of life on at least a monthly basis. Despite 72.0% (n = 1183) of paramedics indicating that they had previously made an EoLC referral to a General Practitioner, only 30.5% (n = 501) were familiar with the GSF PIG and of those only 25.9% (n = 130) had received training in its use. Participants overwhelmingly believed that they could (94.4%; n = 1551) and should (97.0%; n = 1594) perform this role, yet current barriers were identified as the inaccessibility of a patient’s medical records, inadequate EoLC education and communication difficulties. Consequently, facilitators to performing this role were identified as the provision of training in EoLC assessment guidance and establishing accessible, responsive EoLC referral pathways. Abstract published with permission.
    • Paramedic management of shock in trauma: unlocking the potential

      Hitt, Andy (2010-08)
      Globally, traumatic injury is a leading cause of death for patients under 45 years old. A consequence of serious or poorly managed trauma is shock—a clinical syndrome that is both preventable and treatable if spotted in time. Heightened pathophysiological awareness and a review of diagnostic methods may promote early circulatory support rather than aggressive resuscitation. This could reduce the risk of iatrogenic complications and avoid unnecessary delay. The aim of this article is to critically appraise the treatment options currently available to UK paramedics and postulate realistic improvements based on underlying pathophysiology. Abstract published with permission.
    • Professionalism in paramedic practice: the views of paramedics and paramedic students

      Gallagher, Ann; Vyvyan, Emma; Juniper, Joan; Snook, Verity; Horsfield, Claire; Collen, Andy; Rutland, Stuart (2016-09)
      Abstract published with permission. Paramedic practice is complex and involves decision-making in situations that are often complex and pressured. A high level of professionalism is required to respond appropriately. There has been little previous research in this area. The aim of the Consensus towards Understanding and Sustaining Professionalism in Paramedic Practice project was to develop an in-depth understanding of professionalism in paramedic practice (CUSPPP). This article reports findings from the qualitative component of the CUSPPP project. Interviews were conducted with clinical managers, specialist paramedics and student paramedics. A favourable ethical opinion was obtained from the University of Surrey Ethics Committee. Data were analysed thematically and three themes identified are discussed in this article: components of paramedic professionalism; professionalism enablers; and professionalism inhibitors. Components of paramedic professionalism include: the conduct of paramedics; the role of regulation; professional education; and values for paramedic practice. Paramedic professionalism enablers and inhibitors relate to three levels: individual, organisational and regulatory/societal levels. On-going education and interventions that promote paramedics’ well-being should be discussed with ambulance trusts and collaboration established to promote the development of educational materials and further research.
    • Rudolf Juchems — A pioneer of cardiopulmonary resuscitation in Germany

      Böttiger, Bernd W.; Chamberlain, Douglas; Bossaert, Leo; Juchems, Markus (2009-10)
    • Stocklist — a study of clinical skills of critical care paramedics in the UK

      Walmsley, Jim; Turner, Janette (2015-05)
      Introduction The Critical Care Paramedic (CCP) is a relatively new advanced practitioner. CCPs provide advanced clinical skills, knowledge and expertise for primary response and critical care retrieval and transfer. In the UK it is currently an undefined role with no common code of practice, clinical governance or national guidance. The aim of this study was to explore the current use of CCPs and assess the views of a range of stakeholders on the required skills and role development within a British context. Methods A web based survey design was used to collect information on CCP use and views on skills, role and scope of practice. The survey asked questions on current or intended use of CCPs and skills used. Respondents were asked to rate a list of 23 clinical skills on whether they were essential, desirable or irrelevant; importance of a set of standards and statements about the role of CCPs in the ambulance service. Stakeholders approached included ambulance services, professional bodies, charitable organisations and academic departments. Results From 198 invitations there were 141 responses (70%) and 70% were from ambulance trusts. Half of responders said they currently used CCPs. The top 5 essential skills were concerned with airway management. Views on core standards and the CCP role are summarised in the table. Conclusions The survey confirmed the CCP role is currently undefined and used variably in practice. There was agreement on the need for core skills and standards but the nature of these is still a matter for debate. https://emj.bmj.com/content/emermed/32/5/e5.1.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-2015-204880.13
    • Therapeutic hypothermia in cardiac arrest

      Hart, Lindsay; Newton, Paul (2017-03)
      Abstract published with permission. Therapeutic hypothermia (TH) following cardiac arrest is commonplace in many hospitals. It is thought to improve survival rates and offer neuroprotective benefits. However, its use in the pre-hospital arena is still uncertain. The objective of this literature review is to collect and consider evidence and address these uncertainties with a view to offering recommendations for practice. A systematic search was undertaken, and from the literature reviewed, there was no unanimous evidence that pre-hospital TH improves patient survival or neurological outcomes. It is clear that all of the different modes of initiating TH that were evaluated were effective in reducing patient temperature on arrival at hospital.