British paramedic journal最新文献

Introduction: Paramedics in the UK are moving from emergency ambulance services into primary care, where they are employed to boost the clinical workforce. Whereas there is emerging research that seeks to understand the contribution of paramedics to the primary care workforce, there is none regarding the perceptions paramedics have regarding their role in primary care.

Methods: An analytic auto-ethnography was undertaken, utilising a peripheral membership approach for online communities used by paramedics on Facebook, Reddit and Twitter (now X). Over a 3-month period (December 2021 to February 2022), the primary researcher reflected on the conversations, comments and opinions posted within these communities within a reflexive (immersion) journal, considering them against the context of her own experience.

Results: Paramedics in primary care, who are generally isolated due to their geographical isolation from each other, utilise online social spaces to foster a community of practice. These forums are used to discuss their clinical role, education and experiences, as well as to consider their place within the primary care workforce.

Conclusion: This is the first application of this methodology within online social spaces utilised by UK paramedics. This article also presents novel use of a peripheral membership approach within an analytic auto-netnography in public online spaces for researcher-practitioners.

Introduction: Dark humour, often known as black comedy or gallows humour, is a distinct kind of humour that explores subjects that are generally taboo or uncomfortable. Identifying the function and impact of black humour is important given the prevalence of life-or-death situations, crucial clinical judgements and emotionally charged situations in the pre-hospital environment. The primary aim is to investigate the world of dark humour within the setting of experienced paramedics.

Methods: A qualitative approach was employed. Ten paramedics, each with over 24 months' experience, were recruited via word of mouth and snowball sampling. Semi-structured interviews were conducted between October 2023 and January 2024, and data were studied using thematic analysis.

Results: Four themes were identified: the perceptions of dark humour from the public, students and colleagues; the use of dark humour in building resilience and improving perseverance; the negatives to mental health of prolonged use of black humour; and the benefits of humour use to develop camaraderie within the ambulance service.

Conclusion: The study explored the views of a small sample of paramedics on this subject. Dark humour was identified as both a beneficial coping mechanism for resilience and a means of fostering camaraderie. Conversely, a chronic reliance on dark humour can have negative mental health implications. Utilising the usage of coping mechanisms such as dark humour as a yardstick to measure mental well-being could be an important first step in adopting a more holistic approach to mental health within the paramedic community.

Introduction: Triage tools are used within trauma networks to identify which injured patients should be bypassed and pre-alerted to major trauma centres. Despite the importance of treating the 'right patient in the right place at the right time', there has been no consensus on triage tool structure or content. This study aimed to identify, collate, review, summarise and recognise patterns across established major trauma triage tools.

Methods: UK and international triage tools used between 2012 and 2021 were identified through literature review and correspondence with trauma networks. A conceptual content analysis was then undertaken using an inductive codebook, comprising concepts of triage tool structure, intended population, inclusion criteria and included variables and thresholds. Thematic analysis was also performed to identify higher-level patterns within the data, with emerging patterns becoming categories for analysis. A narrative synthesis of findings was then undertaken.

Results: In total, 53 major trauma tools were identified, comprising 19 UK tools and 35 published international tools. Most triage tools (n = 42/53, 80%) were developed by expert opinion, were paper based and shared a common structure of multiple domains, with constituent triage predictors assessed in parallel. A minority of tools were statistically derived prediction models, operationalised either as simple scores (n = 10, 19%) or as an electronic application (n = 1, 1%). Overall, 173 distinct triage variables were used, with the median number of constituent triage variables per triage tool being 19 (range 3-31). Four distinct patterns of triage tools were identified during thematic analysis, which differed in terms of format, number of triage variables, thresholds, scope for clinical judgement and relative diagnostic accuracy.

Conclusion: Many diverse major trauma triage tools were identified, with no consensus in format, structure or content. Quantification of constituent variables and identification of distinct categories of triage tools may guide the design of future triage tools.

Introduction: UK ambulance services employ diverse models of care, resulting in 40-60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60 years and over) remain high (60-70%), despite most being mild. This research aimed to explore ambulance clinicians' perceptions, experiences and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions.

Methods: This study used a mixed-methods sequential explanatory design comprising an online survey and one-to-one interviews with patient-facing ambulance clinicians in the UK. The survey, distributed through nine ambulance services and via social media, gathered data about clinicians' experiences, confidence levels and perceptions when assessing older adults with head injuries. It focused on exposure frequency, confidence in assessing asymptomatic patients, perceived risks of medications and confidence in available decision tools. The subsequent interviews delved deeper into the survey responses.

Results: A total of 385 participants were recruited, predominantly male paramedics (61%), with a median age of 35 years and a median of eight years of ambulance service experience. Participants reported frequent encounters with older adults with head injuries, and expressed high confidence in assessing visible injuries but lower confidence in conducting neurological examinations. Participants found NICE and JRCALC guidelines satisfactory, and reported confidence in conveying patients to the ED but less confidence in alternative referrals or discharges. The interviews revealed two overarching themes: guideline-based care and patient-centred care, with sub-themes emphasising the importance of shared decision making, collaboration with other healthcare professionals and safety-netting strategies.

Conclusion: Although clinicians express confidence in using clinical guidelines for ED conveyances, they often find such guidance overly prescriptive and struggle to translate them for individual cases. There is a need for more patient-centred, holistic decision making, especially considering the unique aspects of head injuries in older adults. Challenges include fear of poor outcomes, limited feedback on patient outcomes and low confidence in making referral or discharge decisions. Specific guidelines tailored to this demographic, as well as improved support services, may aid in reducing unnecessary ED conveyances.

Introduction: Pre-hospital practitioners based at rural and geographically spread-out regions often find it difficult to access education and training for continuous professional development. Distance learning can resolve the dilemma of how to provide high-quality education where the number of participants is small and widely scattered. E-learning is an established teaching modality that has been widely used, whereas telesimulation is a novel teaching tool that has been evolving throughout the past decade. This study aimed to evaluate the experience of e-learning compared to telesimulation for pre-hospital practitioners.

Methods: This study was conducted from January to June 2021. Twenty-six pre-hospital responders were randomly allocated to complete either an e-learning module or a telesimulation session based on acute paediatric asthma. Each participant completed a post-session satisfaction questionnaire for quantitative and qualitative analysis. For the telesimulation session, all participants attended remotely, while the faculty were based on site. The e-learning module was accessed by the participants via the internet.

Results: Both modalities were positively received, with participants agreeing that the learning objectives were met. However, telesimulation was rated significantly higher in terms of engagement (p = 0.044) and suitability (p = 0.033). Qualitative feedback highlighted the immersive and realistic nature of telesimulation as key advantages, while e-learning was appreciated for its flow and stimulating questions.

Conclusion: Telesimulation and e-learning can help learners with restricted availability and geographical challenges. Telesimulation allows learners to work as a multi-disciplinary team despite being scattered across a large geographical area, while e-learning gives learners the flexibility to access education at a convenient time.

Aim: The aim of this professional practice article is to increase awareness and knowledge of chemsex among emergency medical service (EMS) clinicians.

Background: EMS clinicians can expect to be called on to respond to medical emergencies across the range and breadth of human behaviours, some of which will take them into areas they are unfamiliar with and/or that involve illegal activity. It is likely that many EMS clinicians would regard chemsex as one such area. A secretive activity, largely occurring out of sight of wider society, chemsex involves the planned use of specific drugs to enhance, prolong and sustain sexual experiences. Most chemsex is consensual, with participants engaging in it because they derive pleasure and enjoyment from the activity. Many do not regard their participation as problematic and so are highly unlikely to have previously discussed this aspect of their lives with a medical or harm-reduction professional. Engagement in chemsex does, however, carry significant risks of both mental and physical harms. When something goes wrong at an event, EMS can expect to be called to respond.In this article, chemsex scenarios are combined with literature drawn from a range of sources to explore multiple aspects of chemsex from the perspective of EMS clinicians.

Conclusion: Chemsex invokes a complex interaction between physical health, mental health, social care, addiction medicine, sexual health and criminal justice. In providing a community-based response, EMS clinicians are uniquely placed as the only element of healthcare that sees chemsex participants at the event location, often while the incident is still going on. Equipping responders with core knowledge of chemsex activities will ensure they are best able to provide a response that is knowledgeable, patient-centred and offers unconditional positive regard. Clinicians that are chemsex-aware will be in a better position to recognise and understand the drugs that may have been taken and their associated toxidrome and appreciate the significant risk of physical and mental trauma. They will also recognise they are in a unique and privileged position and feel confident to engage in harm reduction with this very high-risk and largely unseen cohort of patients.

Introduction: Unplanned out-of-hospital births (UOHBs) are associated with poorer outcomes for babies, especially those born prematurely. The current Newborn Life Support (NLS) course offered by Resuscitation Council UK (RCUK) is not designed to address the challenges associated with birth out of hospital. A new course was developed to address these challenges. This study aimed to evaluate the impact of this course on attendees' knowledge and confidence in supporting transition, resuscitation, stabilisation and onward transfer of newborns in an out-of-hospital setting.

Methods: A convergent mixed-methods approach was used consisting of pre-, post- and follow-up surveys and a post-course multiple-choice questionnaire (MCQ). The surveys asked participants to rate their confidence, on a five-point Likert scale (from 'Underconfident/fearful' to 'Very confident') across seven domains of NLS, as well as making an individual assessment of provider confidence before and after the course. Free-text comments were collected and analysed using thematic analysis.

Results: Attendees comprised multidisciplinary staff from the South West of England. The pre-course survey was completed by 32 of the 33 participants, the post-course survey by 31 and the MCQ by all 33. A total of 18 participants completed the follow-up survey. Analysis showed a significant, positive change in confidence across NLS domains between the pre- and post-course surveys (p <0.0001).The follow-up survey data showed self-reported increases in knowledge and largely sustained confidence. The qualitative analysis revealed themes relating to the participants' feelings about managing babies born out of hospital.

Conclusion: The proof-of-concept OH-NLS course appears to address the learning needs of the target professional group, and the results suggest improved knowledge and confidence in the immediate management of babies born out of hospital. Further evaluation is required to determine whether such training has a long-term impact and translates into improved outcomes across a larger group of participants.

Introduction: Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at the point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive are the barriers and facilitators to the use of patient care pathways (PCPs) in NI.

Methods: In this single-centre qualitative study, participants were recruited using volunteer sampling. Data were collected through 11 semi-structured interviews until data saturation was reached. Online interviews were recorded, transcribed verbatim and thematically analysed.

Results: Five main themes were constructed during analysis. The participants discussed their perceptions of the barriers and facilitators to utilising PCPs in relation to risk, cultural issues, person-centred practice, inter-professional communication and operational infrastructure.

Conclusion: The study provides insight into perceived barriers and facilitators to the use of PCPs, while indicating the existence of a paramedic workforce dedicated to achieving the best outcomes for people in their care. The themes identified are consistent with existing literature that calls for standardised pathways across regions. Future research should investigate the link between the NHS 111 service and ambulance demand. In order to facilitate the complex decision making involved in referrals, relevant knowledge and skills should be embedded in paramedic education. Efforts should be made to improve inter-professional communication and awareness of the paramedic scope of practice and knowledge base. An intervention designed to reassure staff who have concerns regarding clinical risk may improve referral rates.

Introduction: Global demand for healthcare is escalating, prompting exploration of innovative strategies to augment service capacity. Independent prescribing (IP) helps to address this challenge, allowing non-medical professionals to prescribe medication. Paramedics in the UK were granted prescribing privileges in 2018, yet uptake remains low. Despite qualitative evidence indicating that paramedic prescribing is beneficial, quantitative comparisons of medication provision between prescribers and non-prescribers are lacking. Paramedics provide patients with non-emergency medication by three different routes: IP, using a patient group direction (PGD) or with prescriber support.Advanced paramedic practitioners who are not qualified as independent prescribers, rotating through ambulance and general practitioner out-of-hours services, offered an opportunity to quantitatively compare medication supply.

Methods: This study compares medication supply by three advanced paramedic practitioners using PGDs with three prescribing nurses in a Welsh general practitioner out-of-hours service. A cross-sectional design was employed to retrospectively review electronic patient clinical records between 1 December 2019 and 30 November 2020, including patients presenting with one of five generalised clinical conditions (urinary, soft tissue, respiratory, abdominal pain, ear). Descriptive analysis and non-parametric tests compared medications prescribed or supplied, how patients received medication and reasons for seeking prescriber support.

Results: A total of 397 patient records were analysed. Paramedics supplied medications more frequently with prescriber support (68.2%) than via PGD (27.9%). Nurses predominantly prescribed medication independently (99.3%). Medication provision was comparable when paramedics had prescriber support. Reasons for paramedic support-seeking included having no PGD available (34.1%) and PGD being excluded from use (28.4%).

Conclusions: Advanced paramedic practitioner medication supply using PGDs and prescriber support was comparable to that of prescribing nurse colleagues. However, autonomy restrictions highlight the need for paramedic prescribing in services where prescriber availability is limited. Further research evaluating the efficiency and cost-effectiveness of PGD use versus IP is necessary. Additionally, the qualitative benefits of IP, such as improved patient care and satisfaction, warrant due consideration when implementing future healthcare strategies.