British paramedic journal最新文献

Background: Health inequalities and poorer outcomes have been identified for patients with dark skin tones. The reasons are multi-factorial, but may include delayed treatment due to a lack of recognition of early clinical signs of physiological deterioration. Within the medical literature there is a light skin tone bias, leading to healthcare professionals having insufficient knowledge regarding the assessment of patients with different skin tones, which may result in reduced confidence and create patient safety issues. The aim of this scoping review was to explore the confidence levels of healthcare professionals when assessing patients of different skin tones.

Methods: The methodology followed scoping review frameworks set out by Arksey and O'Malley (2005), the Joanna Briggs Institute (Peters et al., 2020) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018). Searches for literature were performed between February and June 2022 using electronic databases EBSCO (Academic Search Complete, the Allied Complementary Medicine Database, e-journals, MEDLINE, CINAHL), British Nursing Index (ProQuest), Scopus, Web of Science, Zetoc, UpToDate, Google Scholar, NICE Evidence, ResearchGate, Opengrey and the British Association of Dermatologists. No date range was specified, expanders were left on and the findings were screened using inclusion and exclusion criteria. Included papers were synthesised using narrative synthesis.

Results: Thirteen papers were identified, and the extracted data charted by the paper's origin, sample size, profession and confidence levels. Our synthesis revealed reduced confidence in assessing, managing and diagnosing skin conditions in dark skin tones. A lack of training was cited by different health professionals, but undertaking tailored training and experiential learning increased confidence.

Conclusions: There is a safety issue for patients with dark skin tones, as healthcare professionals lack clinical confidence in managing and treating all ethnicities equally. Tangible diversity within healthcare training is required, supported by inclusive skin tone imagery and appropriate terminology within medical literature.

Introduction: Mixed methods research, a methodology entailing the integration of qualitative and quantitative data within a single study, offers researchers the ability to investigate complex processes and systems in health and healthcare. The collective strength gained through the data combination can provide an enhanced understanding of research problems, providing an ideal solution to understanding complex clinical issues in a range of settings. In pre-hospital practice, where often uncontrollable variables and environmental considerations increase healthcare complexity, mixed methods has emerged as a valuable approach to research.

Aims: Given the exponential growth of pre-hospital mixed methods research since the publication of our first systematic review in 2014, we aim to provide an update. Our review will explore how mixed methods is utilised in pre-hospital research and identify what standards of reporting are achieved.

Methods: This systematic review update will search MEDLINE, CINAHL Complete, Embase and Scopus bibliographic databases from 1 January 2012 to 15 March 2023, using an updated pre-hospital search strategy. Study screening will be performed in duplicate. Articles reported in English, explicitly stating the use of 'mixed methods' in the pre-hospital ambulance setting, including helicopter emergency medical services and community first-responder services, will be included. Data related to underpinning philosophy or theoretical framework, rationale for utilising mixed methods, background of the corresponding author, mode of data integration, model of publication and adherence to reporting standards, utilising the good reporting of a mixed methods study (GRAMMS) guidelines, will be extracted and analysed. All extracted data from study articles will be summarised in a table, allowing analysis of included studies against specified criteria.

The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase 'see and treat' opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients' blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated.

Background: Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic.

Objectives: This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia.

Methods: The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5).

Results: In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being.

Conclusions: The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life.

Background: Information governance and resource challenges can impede pre-hospital clinicians from accessing and reflecting upon clinical information from the hospital phase of care, to ascertain how appropriate their diagnoses and management were. The authors performed a 12-month service evaluation of a hospital-to-pre-hospital feedback system, in which clinical information was requested by pre-hospital clinicians, and returned by a small team of hospital-based clinicians, while meeting information governance standards.

Method: Pre-hospital clinicians in one ambulance station and one air ambulance service accessed patient information from a hospital, via a mediating senior pre-hospital colleague (a facilitator). Case-based learning conversations between the facilitator and clinician followed, using a report from the hospital. Evidence of benefit to the pre-hospital clinicians was prospectively collected using Likert-type scales, regarding general satisfaction, likelihood to change practice and effects on well-being. Reports aimed to be generated by the hospital within 14 days.

Results: All 59 appropriate requests had reports returned. Of the reports, 59.5% were returned in 14 days or less. The median duration was 11 days (interquartile range 7-25). Learning conversations were completed in 86.4% (n = 51) of these cases, and of those, clinician questionnaires were completed in 66.7% (n = 34). Of the 34 questionnaire respondents, 82.4% (n = 28) were very satisfied with the returned information. A total of 61.1% (n = 21) were either likely or very likely to change their practice following the hospital's information, and 64.7% (n = 22) reported similar or very similar impressions to the hospital's eventual diagnosis. Regarding mental health, 76.5% (n = 26) reported positively or very positively affected mental health, while 2.9% (n = 1) reported adversely affected mental health. All of the respondents, 100% (n = 34) were either satisfied or very satisfied with the learning conversation.

Conclusion: While hospital-based clinical information was successfully and securely provided to pre-hospital clinicians, these pilot data suggest it is not possible to meet the self-imposed, empirical 14-day target with four to five voluntary doctors. Sustained performance may improve with allocated or paid time to report the requests. The validity of these data is limited by a poor response rate, a non-validated questionnaire and potential for selection bias. Validation using multiple hospitals and greater numbers is the appropriate next step. Responses suggest that this system identifies areas for improvement, reinforces good practice and improves the mental well-being of the participating clinicians.

Introduction: Newly qualified paramedics (NQPs) may experience emotional turbulence as they transition to professional practice. This may negatively affect confidence and have an adverse effect on attrition. This study highlights the initial transitory experiences of NQPs.

Methods: The study utilised a mixed-methods convergent design. Qualitative and quantitative data were collected simultaneously and triangulated to more fully interpret participants' experiences. A convenience sample of 18 NQPs from one ambulance trust was used. The Connor-Davidson Resilience 25-point Scale questionnaire (CD-RISC25) was administered and analysed using descriptive statistics. Semi-structured interviews were conducted simultaneously and analysed using Charmaz's constructivist grounded theory approach. Data were collected from September to December 2018.

Results: There was a range of resilience scores, with a mean of 74.7/100 (standard deviation 9.6). Factors relating to social support were scored highly, and factors relating to determinism and spirituality were scored lower. Qualitative data constructed a process whereby participants were navigating a new identity across three spheres simultaneously: professional, social and personal identity. Attending a catalyst event such as a cardiac arrest was a trigger for starting to navigate this process. Participants had different pathways through this transitional period. Participants who found this process particularly turbulent seemed to have lower resilience scores.

Conclusion: The transition from student to NQP is an emotionally turbulent time. Navigating a changing identity seems to be at the centre of this turbulence, and this is triggered by a catalyst event such as attending a cardiac arrest. Interventions which support the NQP in navigating this change in identity, such as group supervision, may improve resilience and self-efficacy and reduce attrition.

Background: Falls in older adults are an important issue internationally. They occur from complex interactions between biological, environmental and activity-related factors. As the sexes age differently, there may be sex differences regarding falls. This study aimed to determine the clinical effectiveness of a falls rapid response service (FRRS) in an English ambulance trust and to identify sex differences between patients using the service.

Methods: A cross-sectional study between December 2018 and September 2020. Patients aged ≥ 60 years who had fallen within the study area were included. The FRRS comprised a paramedic and occupational therapist and responded 07:00-19:00, 7 days per week. Anonymised data regarding age, sex and conveyance were collected for all patients attended by the FRRS and standard ambulance crews. Clinical data regarding fall events were collected from consenting patients attended by the FRRS only.

Results: There were 1091 patients attended by the FRRS versus 4269 by standard ambulance crews. Patient characteristics were similar regarding age and sex. The FRRS consistently conveyed fewer patients versus standard ambulance crews (467/1091 (42.8%) v. 3294/4269 (77.1%), p = < 0.01). Clinical data were collected from 426/1091 patients attended by the FRRS. In these patients, women were more likely to reside alone than men (181/259 (69.8%) v. 86/167 (51.4%), p = < 0.01), and less likely to experience a witnessed fall (16.2% v. 26.3%, p = 0.01). Women had a higher degree of comorbidity specific to osteoarthritis and osteoporosis, while men were more likely to report a fear of falling score of 0 (35.3% v. 22.7%, p = < 0.01).

Conclusion: The FRRS is clinically effective regarding falls compared to standard ambulance crews. Sex differences existed between men and women using the FRRS, indicating women are further along the falls trajectory than men. Future research should focus on demonstrating the cost effectiveness of the FRRS and how to better meet the needs of older women who fall.

Background: Paramedics play a vital role in the emergency healthcare of people living with dementia. People with dementia often have complex needs, posing challenges for paramedics. Paramedics often lack the confidence and skills to assess people with dementia appropriately, and receive little, if any, dementia education.

Aims: To evaluate the impact of dementia education on student paramedics' preparedness to care, knowledge, confidence and attitudes towards dementia.

Methods: A 6-hour education programme on dementia was developed, implemented and evaluated. A pre-test-post-test design using self-completion validated questionnaires was used, to evaluate first-year undergraduate student paramedics' knowledge, confidence and attitudes towards dementia, as well as their preparedness to care for people with dementia.

Results: A total of 43 paramedic students attended the education programme, with 41 fully completed questionnaires being collected pre-training and 32 post-training. Students reported feeling significantly more preparedness to care for people with dementia after the education session (p < 0.001). They felt their knowledge (100%), confidence (87.5%) and attitudes (87.5%) towards dementia had significantly increased following the education session. Using validated measures, the impact of education was found to be the highest on dementia knowledge (13.8 vs 17.5; p < 0.001) and on confidence (29.14 vs 34.06; p = 0.001), with only a minimal effect on attitudes (101.5 vs 103.4; p = 0.485). The education programme itself was well-evaluated.

Conclusion: As paramedics are central to the emergency healthcare of people living with dementia, it is essential that the emerging paramedic workforce is equipped with the knowledge, attitudes and confidence to provide quality care for this population. We need to ensure dementia education is embedded in undergraduate curricula, and that consideration is given to the subjects, level and pedagogic approach taken to ensure positive outcomes are maximised.

Introduction: Hypothermia is an uncommon cause of cardiac arrest in the United Kingdom, and more commonly occurs in countries experiencing avalanches and significant winter climates; however, this case demonstrates that the presentation can occur in the United Kingdom. This case adds to a body of evidence that prolonged resuscitation can be successful in patients suffering a cardiac arrest secondary to hypothermia, leading to a good neurological outcome.

Case presentation: The patient suffered a witnessed out-of-hospital cardiac arrest following rescue from a free-flowing river, and underwent prolonged resuscitation. The patient presented in persistent ventricular fibrillation, unresponsive to defibrillation attempts. An oesophageal probe recorded the patient's temperature as 24°C. Rescuers were guided by the Resuscitation Council UK advanced life support algorithm to withhold drug therapy and limit defibrillation attempts to three, until the patient had been rewarmed to above 30°C. Appropriate triage of the patient to an extracorporeal life support (ECLS) capable centre allowed specialised treatment to be initiated, and culminated in successful resuscitation once normothermia was restored. After a short stay in intensive care, the patient was discharged for rehabilitation due to a hypoxic spinal cord injury before discharge home.

Conclusion: This case highlights that hypothermia is a reversible cause of cardiac arrest, which needs to be recognised and acted upon appropriately to provide the best possible chance for a positive outcome. Low-reading thermometers capable of identifying the temperature thresholds stated in the Resuscitation Council UK guidelines are required, to allow clinicians to adapt their practice according to the presenting situation. Tympanic thermometers are often limited to their lowest recordable temperature, and invasive monitoring such as oesophageal or rectal probes are not common in UK ambulance service practice. With the necessary equipment, patients can be triaged to an ECLS-capable centre, allowing them to receive the specialist rewarming that they require.