• Evaluation of the use of portfolios in paramedic practice: part 1

      Armitage, Ewan (2011-05)
      Abstract published with permission. 2009 saw the first audit of paramedic portfolios by the Health Professions Council (HPC) and later this year, the second national audit will take place. In the first of a two-part evaluation of the use of portfolios in paramedic practice, the history of professional portfolios is chartered including their current position within the paramedic profession. A number of contemporary issues with portfolios are identified, including format and how they relate to a paramedic's continuing professional development. The impact of the Knowledge and Skills Framework on portfolio use is also discussed.
    • Hepatitis C

      Malpas, Michael (2011-05)
    • Occupational Emergency Medicine

      Armitage, Ewan (2011-06)
    • Evaluation of the use of portfolios in paramedic practice: part 2

      Armitage, Ewan (2011-06)
      Abstract published with permission. This second of a two-part evaluation on the use of portfolios in paramedic practice, focuses on what constitutes evidence of a paramedic's competence and ultimate fitness to practice. A variety of evaluation models are identified to help in this process and this is developed further with reference to some educational theories. In the final part of the evaluation, the author proposes a number of recommendations concerning the use of portfolios within the paramedic profession and draws on the issues identified in the first part of the evaluation to summarize the current position of paramedic portfolios.
    • Hospital Emergency Response Teams

      Armitage, Ewan (2011-07)
    • Management of the ruptured abdominal aortic aneurysm: challenges facing paramedics

      Smith, Neil (2011-07)
      Abstract published with permission. An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest before arriving at the emergency department and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner's knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia with specific reference to the issues associated with aggressive fluid resuscitation, and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner's with an insight into how prehospital interventions affect the patients’ ultimate outcome and postoperative quality of life.
    • ABC of Patient Safety

      Armitage, Ewan (2011-10)
    • Sickle cell disease: acute complications and management

      Hodges, Ross (2011-11)
      Abstract published with permission. Sickle cell disease is a genetic blood disorder resulting in the sickling of red blood cells (RBC) when exposed to certain conditions. Historically, sickle cell care has been poor and often delayed, but in recent years, several key publications have helped provide guidance and uniformity on how to manage acute crises, ensuring all patients receive a high level of care. The sickling of RBC can lead to acute complications, some of which are potentially life-threatening. The sickling can occur anywhere in the body, producing a wide array of symptoms. For this reason, it is paramount that prehospital clinicians conduct a thorough assessment and, where appropriate, initiate treatment prior to arrival at the hospital. The most common symptom that clinicians will need to manage is severe pain. Many patients will have an individualized treatment plan detailing how they are best managed following an acute crisis and where possible it should be followed.
    • Lecture notes: emergency medicine

      Armitage, Ewan (2011-12)
    • Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident

      Malpas, Michael (2011-12)
      During a multiple casualty chemical, biological, radiological and nuclear incident it is imperative that triage is accurately undertaken to use resources effectively and give the greatest chance of survival to those who need it. This reflection explores an option to assist in this matter by proposing a colorimetric breathing detection system, while remembering that this it is untested, may be a useful aid. https://emj.bmj.com/content/emermed/28/12/1061.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/emj.2011.113019
    • PaRAMeDIC: a randomized controlled trial of a mechanical compression device

      Smyth, Mike (2012-01)
      Abstract published with permission. Survival from out-of-hospital cardiac arrest (OHCA) is influenced by the quality of cardiopulmonary resuscitation (CPR). However, research shows that in the out-of-hospital environment, and particularly during ambulance transport, CPR quality is frequently sub-optimal. Mechanical compression devices can deliver high quality CPR, yet there is an absence of high quality evidence to demonstrate improved clinical or cost effectiveness outcomes. The PaRAMeDIC trial will compare manual CPR with mechanical CPR in adult patients with non-traumatic OHCA. Objectives: the primary objective is to evaluate the effectiveness of mechanical chest compressions using the LUCAS (Lund University Cardiopulmonary Assistance System)-2 on mortality at 30 days post-OHCA. Secondary objectives include survived event (return of spontaneous circulation at hospital admission), quality of life and cognitive function at 3 and 12 months, survival at 12 months and cost effectiveness. Method: the trial is a pragmatic, cluster randomized controlled trial. Ambulance vehicles are randomized to control or LUCAS arms. Patient allocation is determined by the first ambulance vehicle which arrives first on scene (manual CPR vehicle or LUCAS CPR vehicle). The trial will assess the clinical and cost effectiveness of the LUCAS-2 device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942).
    • Lights, camera, disciplinary action?

      Mursell, Ian (2012-02)
      Abstract published with permission. There seldom appears to be a day go by without the opportunity to watch ourselves or colleagues in the latest episode of ‘Emergency Hero Rescues’ or similar ‘real life’ television programmes. However, the growth of such shows and inherent public interest in the emergency services brings to light the question of whether such media coverage is of benefit or risk to our profession. For many of us, watching such programmes is a guilty pleasure, we don't want to watch, but are strangely drawn to them. How many times have you found yourself ‘tutting’ at the TV or shaking your head pointing out the error of our peer's actions? Regardless of our reactions to such programmes, public interest is difficult to deny and as such, television coverage of prehospital care is a subject for careful consideration.
    • Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome

      Perkins, Gavin D.; Brace, Samantha J.; Smythe, Mike; Ong, Giok; Gates, Simon (2012-04)
      Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited. https://heart.bmj.com/content/heartjnl/98/7/529.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/heartjnl-2011-300802
    • Leadership within the ambulance service: rhetoric or reality?

      Taylor, James; Armitage, Ewan (2012-08)
      Abstract published with permission. Just as part 1 of this article (Armitage and Taylor, 2012) introduced the concept of management and leadership, specifically within the context of the ambulance service, part 2 will stimulate further discussion in connection with the development of leadership related knowledge, skills, experience and behaviours among paramedics. Throughout the piece, the need for leadership development at an organisational and professional level will be promoted, and the authors will explore why leadership and leadership development is a key component to paramedic practice, as well as considering how ‘human factors’ and ‘non-technical’ skills are central to a sucessful process of leadership. The NHS Leadership Framework will be reviewed and the authors will consider how it can be used by individuals, organisations and the paramedic profession as a whole to drive leadership development in the future.
    • ABC of resuscitation

      Armitage, Ewan (2012-08)