Irish Journal of Paramedicine最新文献

{"title":"Even better than the real thing? Using video assisted structured reflection in Simulated Clinical Scenarios and Real-Life Clinical Experiences in the Flipped Classroom.","authors":"C. O'Connor, J. O’Hara","doi":"10.32378/IJP.V3I2.159","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.159","url":null,"abstract":"BackgroundThis paper explores the attitudes of practitioners to the use of video assisted structured reflection in simulated clinical scenarios and real-life clinical experiences in the context of a Flipped Classroomto encourage and support reflection and reflective practice among pre-hospital emergency care practitioners in Ireland.  It also examines the experiences of practitioners who participated in this process.MethodologiesThis paper is part of a larger project which consisted of tree cycles of action research.  Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with various stake-holders.  These included all three clinical levels of pre-hospital emergency care practitioners and educators from emergency service providers, private ambulance services, and voluntary organisations.FindingsWhen combined, a simulation experience with audio-visual recording and a structured model of reflection in the context of a Flipped Classroom has become a powerful learning experience. The process of a simulation experience with audio-visual recording, and a structured model of reflection appears to dovetail very nicely with the concept of the Flipped Classroom. The review of footage from audio-visual recording in the real-life clinical context provides a reliable and accurate means of evaluating clinical performance. Concerns were raised about the potential for abuse and misuse of audio-visual recordings. There are perceptions that audio-visual footage of real-life clinical experiences could potentially be used for unintended purposes such as, disciplinary procedures.RecommendationsSince the process of combining a simulation experience with audio-visual recording and a structured model of reflection in the context of a Flipped Classroom has shown great promise as a learning experience, a larger scale pilot study is proposed. Develop a pilot programme with student practitioners during their undergraduate internship, and evaluate its findings. Develop a policy which clearly defines the use of audio-visual recording footage prior to the commencement of the pilot programme. A Learning Contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of the process.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122983655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on Reflective Practice among Pre-Hospital Emergency Care Practitioners in Ireland.","authors":"C. O'Connor, J. O’Hara","doi":"10.32378/IJP.V3I2.155","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.155","url":null,"abstract":"BackgroundThis paper examines the level of engagement of Irish pre-hospital emergency care practitioners with reflection and reflective practice.  It also explores the attitudes of practitioners to reflection and to methodologies designed to support reflective practice such as reflective discussion and video-assisted structured reflection.  Finally it outlines the main barriers to reflection, both individually and collaboratively, and reflective practice gaining widespread acceptance as key learning strategies among pre-hospital emergency care practitioners and educators in Ireland.MethodologiesThis paper is part of a larger project which consisted of three cycles of action research.  Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with various stakeholders.  These included all three clinical levels of pre-hospital emergency care practitioners and educators from emergency service providers, private ambulance services, and voluntary organisations.FindingsMany practitioners consider themselves to be reflective practitioners.  However, very few of them use a structured model of reflection. Reflection, and reflective practice are not part of the education standards for practitioners in Ireland, and consequently receive very little attention in most education programmes. Practitioners within voluntary organisations perceived that reflective practice was encouraged by their organisation in greater numbers than those from other organisations. Collaborative forums were perceived to be beneficial, although concerns were raised about their potential for abuse and misuse.  These concerns appear to emanate from a lack of trust within certain organisations.RecommendationsReflective practice to be included in the education standards for all levels of practitioners in Ireland. Develop and roll-out an education programme for existing practitioners regarding reflection, reflective learning, reflective practice, and structured models of reflection, as part of their CPC requirements. Provide education for all EMS course faculty regarding reflection, reflective learning, reflective practice, and structured models of reflection. A learning contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of any collaborative forums. Further research to explore the reasons for lack of trust within organisations should be undertaken. Further research is recommended to explore the reasons for the disparity of opinion between volunteer and professional organisations regarding the encouragement of reflective practice.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122510324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refusal to travel in the National Ambulance Service: A retrospective examination of calls from 2017.","authors":"E. Byrne, S. Selby, Paul Gallen, A. Watts","doi":"10.32378/IJP.V3I2.149","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.149","url":null,"abstract":"Introduction When a member of the public calls for an ambulance through the 999/112 system, the only permitted course of action for the responding National Ambulance Service (NAS) staff is to convey the patient to an emergency department. Regardless of the clinical level, NAS staff do not have the authority or scope of practice to discharge the patient from the scene or make any other arrangements for the treatment of that person(1). The patient, meeting certain criteria, can refuse treatment or transport (RTT) of their own volition(1). Mortality rates for non-conveyed patients vary from 0.2%-3.5% within 24hours and are twice those of patients discharged from an emergency department(2, 3). In 2017, the refusal to travel rate in Ireland jumped from 7-8% of calls (2012-2014) to a national average of 11.3% (24,735) of total AS1 calls(4). Although this level of non-conveyance would still be below international norms the rate of increase was concerning(3).Aim.A quality improvement initiative necessitated identification of baseline RTT information.MethodsRetrospective data collection was conducted on all calls closed with a ‘refusal to travel’ or ‘refusal of treatment’ occurring between 1st Jan 2017 and 9th Nov 2017 and was gathered from the National Emergency Operations Centre (NEOC).ResultsThe top three dispatch classification that resulted in RTT were falls, unconsciousness or near fainting, and generally unwell patients. This was followed by chest pain, seizures, traffic incidents and breathing problems. It was noted that the time at which RTT calls occurred peaked nationally between 2000 and 2059. In the Southern area, peak RTT occurred between 2000-2059h and 0000-0100. 33.6% of RTT calls in the Southern Area were designated as Delta calls. This designation requires an advanced life support and a blue light response and is the call level with the second highest acuity below an Echo call, the designation for Cardiac or Respiratory arrest.ConclusionsThe NAS specifically utilises a risk adverse triage system. Examination of dispatch priorities may be warranted. The peak close of RTT calls between 2000-2059 may align with a shift changeover at 2000. Further study is required.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124325598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It’s good to talk! Reflective Discussion Forums to support and develop Reflective Practice among Pre-Hospital Emergency Care Practitioners in Ireland.","authors":"C. O'Connor, J. O’Hara","doi":"10.32378/IJP.V3I2.157","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.157","url":null,"abstract":"BackgroundSince the mid 1980’s, reflective practice has become formally acknowledged and adopted as a key strategy for learning and has become one of the cornerstones of medical education for doctors, nurses, and many of the allied healthcare professions. In the education of pre-hospital emergency care practitioners in Ireland, it is only in the last decade that the notion of reflective practice has been tentatively approached.  Indeed until recently it has largely been ignored by practitioners and educators alike, who have been slow to engage with this new way of learning. This paper explores the attitudes of practitioners to the use of a reflective discussion forum to encourage and support reflection and reflective practice among pre-hospital emergency care practitioners in Ireland.  It also examines the experiences of practitioners who participated in a collaborative reflective discussion forum.LiteratureThe research was informed by reviewing literature from a number of areas including:  Adult Learning, Reflective Practice, Educational Research directly relating to Emergency Medical Services (EMS), and EMS & Nursing Journals and publications.MethodologiesThis paper is part of a larger project which consisted of three cycles of action research.  Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with participants in the reflective discussion forum.  These included all three clinical levels of pre-hospital emergency care practitioners and the three hierarchical levels within the organisation.FindingsThe collaborative reflective discussion forum was found to be beneficial.  Among the benefits cited were, the opportunity to draw on the experience of more experienced colleagues, the development of critical thinking skills, and the potential for use as part of a mentoring process.  It was also felt that the collaborative nature of the forum had the potential to improve workplace relationships through the empowerment of the staff. Concerns were raised regarding the potential for abuse and misuse, particularly in relation to the areas of patient confidentiality and a lack of trust within organisations.RecommendationsThe establishment of a regular Reflective Discussion Forum within organisations as a key learning strategy. Any collaborative forum must be chaired by a trusted, experienced and highly skilled facilitator. A learning contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of any collaborative forum.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131874068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.","authors":"E. Byrne, S. Selby, Paul Gallen, A. Watts","doi":"10.32378/IJP.V3I2.145","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.145","url":null,"abstract":"IntroductionEvery patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.AimFor patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.MethodsAll NAS incidents closed with a refusal of treatment or transport, from 1st Jan 2017 to 9th November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.Results31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.ConclusionClinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128869908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There A Role For Paramedics In Primary Care In Ireland: An Exploratory Study","authors":"F. Feerick, C. Armstrong, R. O’Connor, M. Dixon","doi":"10.32378/IJP.V3I2.133","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.133","url":null,"abstract":"BackgroundParamedics are reported to be the most underutilised profession working within rural areas, due to the paucity of service requirements. (O’ Meara et al 2012). Infrequent opportunities to practice particular skills can lead to reduction in levels of confidence and competence that can have significant risk and safety ramifications for practitioners and patients. (Mulholland et al 2014). Traditionally paramedic practice provides emergency care and transport within the community, but current ambulance service models within rural Ireland may be inefficient and  contributing to hospital overcrowding and increased healthcare costs. (Lightfoot, 2015). Alternative models of healthcare are implemented within alternative rural jurisdictions such as Australia and Canada that aims to address issues of practitioner underutilisation, skill retention and healthcare personnel shortages. (Wilson, et al 2009).RationaleIreland’s population is ageing, with increased co-morbidities and reports of current and predicted workforce shortages in general practice. (Smyth et al 2017). With rising demands on general practitioners (GPs), measures to increase their supply and retention has become a challenging problem. Potential solutions to this will require immediate change to established work practices, to cater for current and predicted healthcare needs. (H.S.E, 2015). Paramedics with advanced skills (APs) could alleviate some of the shortages identified and enhance paramedic profile by transferring some tasks deemed appropriate from GPs to APs within both urban and rural communities. This process is globally known as task shifting where some competencies are transferred to alternative healthcare practitioners with less training. (WHO, 2007).AimTo ascertain the attitudes and opinions of paramedics and GPs associated with GEMS - UL, towards a new concept of joint collaboration in primary care that should be of  mutual benefit to both groups, and also to identify potential barriers.MethodologyQuestionnaire survey of graduate Paramedics and General Practitioners associated with University of Limerick Graduate Entry Medical School and Paramedic Studies to identify competencies that GPs would deem appropriate to reassign to APs and ascertain both groups’ opinions towards this new concept of joint collaboration and practice.ConclusionStudies report successful outcomes in similar models of joint collaboration to support shortages of GPs in rural healthcare. (Reaburn, 2017). Collaboration on this scale has been shown to be beneficial for enhancing the paramedic profession within the wider healthcare system while providing essential support within primary care and general practice. Potential benefits have been reported with reduced emergency department admissions and early intervention in the management of chronic disease. (Blacker et al, 2009).","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128251242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thermal variations in the patient compartment of an emergency ambulance: A feasibility study in an Irish context.","authors":"D. Gaumont, C. Armstrong, G. Armstrong","doi":"10.32378/IJP.V3I2.147","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.147","url":null,"abstract":"BackgroundThe unpredictability of the nature of the next call is a basic feature of Emergency Services; the call could vary from a trauma victim, to a hypothermic patient or a prehospital birth. All patients (other than those who are pyrexic) have in common the need for a warm environment to prevent deterioration in their condition. Multiple observation studies found that patients suffering from various levels of trauma, arrived in the Emergency Department with hypothermia. Hypothermia, a core temperature <35°C, affects multiple organ systems, and is associated with poor outcomes including death. Also, cold has been reported as negatively impacting the comfort of an ill or injured patient. It is currently assumed that the ambulance patient compartment’s heater (Air Top Evo 40, Webasto™, Gilching, Germany), produces enough heat to offer thermal comfort and to help prevent further decrease of body temperature in the hypothermic patient. However, what is not clear is for how long and to what ambient temperature the ambulance’s patient compartment needs to be heated, to provide the ambulance’s furniture with sufficient stored energy to maintain the patient at an appropriate temperature for the duration of their transport to hospital. We consider how current practices and behaviours may need to be adapted to improve patient comfort and outcomes.ObjectivesThis study is to determine the feasibility of measuring and monitoring temperatures in a new generation Emergency Ambulance. The overarching objective, is to optimise patient comfort, outcome and prevention of hypothermia.MethodsUsing thermocouples, a data logger and a thermal camera to record temperatures at strategic locations in the patient compartment, we recorded the variation of temperature in a typical new generation Emergency Ambulance compliant with the CEN - EN 1789:2007 standard. Thermal imaging and temperature logging studies were conducted on in May/July 2018. Temperature was logged for 24 hours. The locations examined were the stretcher mattress surface, low and high blanket storage lockers and the outdoor ambient air. The vehicle was located outdoor, facing west-north-west.Anticipated outcomeThis study will provide us with data that can be used to improve patients’ thermal comfort through behaviour and practice change.ResultsThe thermal camera images show a significant variation of surface temperature throughout the patient compartment. Preliminary temperature logging experiments show a measurable difference in temperatures at the areas of interest relative to the outside temperature over 24 hours. Some variations in rates of cooling and warming in each area have been observed during the cool – heat period; the stretcher mattress is the slowest to rewarm.ConclusionThe proposed method of measuring temperature variation in targeted locations in the patient compartment of a new generation ambulance proves efficient and could be used in further studies.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"34 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120972366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?","authors":"Liam Rooney","doi":"10.32378/IJP.V3I2.143","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.143","url":null,"abstract":"<p><span style=\"text-decoration: underline;\"><strong>Background</strong></span></p><p>Dementia is a disease affecting 55,000 Irish people. (1)  It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent.  These people are at risk of having their pain underassessed and undermanaged. (2)  A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed.  Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.</p><p><span style=\"text-decoration: underline;\"><strong>Introduction</strong></span></p><p>Adults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3)  It is estimated between 40% and 80% of dementia patients regularly experience pain. (4)  Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients >8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants.  There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.</p><p><span style=\"text-decoration: underline;\"><strong>Objective</strong></span></p><p>This research aimed to identify observational pain assessment tools used in this cohort.  The most consistently recommended tools were identified.  The suitability of these tools for use in the pre-hospital setting assessed.</p><p><span style=\"text-decoration: underline;\"><strong>Findings</strong></span></p><p>Literature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting.  The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language.  These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:</p><p><em>Abbey Pain Scale</em></p><p>6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)</p><p><em>Doloplus 2</em></p><p>15 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)</p><p><em>PAINAD</em></p><p>5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6)</p><p> </p><p><span style=\"text-decoration: underline;\"><strong>Conclusion</strong></span></p><p>The ability to self report pain is deemed “gold standard”.  Patients with mil","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126251289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why MICAS?","authors":"D. Menzies, A. Murphy","doi":"10.32378/ijp.v3i2.131","DOIUrl":"https://doi.org/10.32378/ijp.v3i2.131","url":null,"abstract":"IntroductionThe Mobile Intensive Care Ambulance Service (MICAS) was initiated in 1996 to assess, stabilise and transfer critically ill patients from a referring hospital to a receiving hospital to meet their clinical needs. Critically ill patients are transferred throughout Ireland to an increased level of care, repatriation for continuity of care following specialist treatment, specialist critical care services or in some instances, are considered too unstable to be transported by local staff.  In 2015, it was estimated that approximately 1000 ICU patients are transported per annum (Murphy, Dwyer). These numbers are likely to increase as a result of the reorganisation of health services, the development of hospital groups, the establishment of the hub and spoke critical care services and introduction of trauma centres. This increases the requirement of inter hospital transfers throughout the country.AimsThe aim of this audit was to establish the rationale for a critical care retrieval service and to evaluate the adverse events for inter hospital transport of critically ill patients in Ireland over a 3 year periodMethodsA retrospective chart review of all patients transported by MICAS between January 2015 and December 2017 was undertaken. Clinical records were reviewed for acuity and for adverse events.  Results339 patients were transported in this timeframe with 7% experiencing an adverse event overall.ConclusionThe MICAS data shows an increasing number of critically ill patients transferred by MICAS within the timeframe. The rationale for MICAS includes the provision by a specialist team with transport specific equipment with reduced adverse events.       ","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134647193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Paramedic Delivered Finger Thoracostomy","authors":"D. Menzies, S. O'Neill, J. Leonard, P. Butcher, P. Creevy, D. Irwin","doi":"10.32378/IJP.V3I2.129","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.129","url":null,"abstract":"Introduction & AimsTension pneumothorax is a potentially fatal but reversible injury encountered in major trauma and traumatic cardiac arrest. Needle decompression has been the standard treatment approach pre hospital in Ireland and internationally. However, concerns exist regarding the effectiveness of this approach due to anatomy and body habitus. We aim to describe the training, introduction and experience of finger thoracostomy by advanced paramedics within a pre hospital service in Ireland.MethodsFinger thoracostomy has been advocated as an alternative pre hospital treatment which is both diagnostic and therapeutic. Paramedic delivered thoracostomy is commonplace in pre hospital critical care services internationally. The MCI Medical Team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team which provides medical cover at motorcycle road racing events in Ireland. The MCI Medical Team has significant experience of major trauma and routinely performs pre hospital anaesthesia for trauma patients. We introduced a training module on finger thoracostomy, comprising: theory, practical instruction and assessment for advanced paramedic members of the team.Results & ConclusionsAdvanced paramedic members of the team we trained to deliver finger thoracostomy in predefined circumstances when operating as part of the MCI medical team. To date, advanced paramedic delivered finger thoracostomy has been utilised on three occasions. Introduction of advanced paramedic delivered thoracostomy is a feasible and effective technique for the treatment of tension pneumothorax within a closely governed system.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130701730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}