British paramedic journal最新文献

The notion of a paramedic (as a title protected in law) has recently entered its third decade, but the history of the paramedic is considerably older than that. Who are we as a profession? What does it mean to be a paramedic? What makes us who we are? These intriguing and yet seldom asked philosophical questions are at the heart of this article, which is intended to provoke discussion and serve as a foundation for further inquiry into questions of identity and philosophy in paramedicine. Literature pertaining to paramedic professional identity was explored and contextualised within current paramedic practice. Although the overall picture is complex, four key areas for discussion emerged: the history of the paramedic profession; role diversity; the influence of ambulance work; and the education and training of paramedics. The influence of ambulance work permeates all areas, suggesting that it is central to the development of paramedic professional identity. This discussion article is an exploration of the unique contexts and experiences that are associated with the process of being and becoming for paramedics.

Introduction: The current Joint Royal Colleges Ambulance Liaison Committee guidelines in the United Kingdom provide clear national guidance for low-voltage electrical injury patients. While patients can be considered safe to discharge with an apparently 'normal' initial electrocardiogram (ECG), some evidence questions the safety profile of these patients with a risk of a 'delayed arrhythmia'. This review aims to examine this as well as identifying the frequency and common arrhythmias that require patients to be conveyed to hospital for further monitoring post electrical injury. It will also aim to improve the understanding of potentially clinically significant arrhythmias that may require clinical intervention or even admission within an in-hospital environment.

Methods: A systematic review using three electronic databases (CINAHL, MEDLINE, AMED) was conducted in January 2022. A preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was used to identify relevant studies with a suitable quality to support a critical review of the topic. A modified Critical Appraisal Skills Programme quality assessment checklist was used across suitable studies and a descriptive statistics approach was adopted to present the findings.

Results: Seven studies, largely retrospective reviews, met the inclusion criteria. The findings showed 26% of patients had an arrhythmia on initial presentation (n = 364/1234) with incidences of sinus tachycardia, sinus bradycardia and premature ventricular contractions. However, making definitive statements is challenging due to the lack of access to individual patients' past ECGs. Within these arrhythmias' ST segment changes, atrial fibrillation and long QT syndrome could be considered potentially significant, however associated prognosis with these and electrical injuries is unknown. Only six (0.5%) patients required treatment by drug therapy, and a further three died from associated complications. Most patients with a normal ECG were discharged immediately with only a limited follow-up. No presentation of a 'delayed arrhythmia' was identified throughout the studies.

Conclusion: The data for low-voltage electrical injuries are limited, but the potential arrhythmias for this patient group seldom require intervention. The entity of the 'delayed arrhythmia' may not be a reason to admit or monitor patients for prolonged periods. Further studies should consider the safety profile of discharging a patient with a normal ECG.

Introduction: A qualitative exploration into the views, opinions and decision-making of paramedics involved in undertaking pre-hospital 12-lead electrocardiograms (PHECGs) for stroke patients was undertaken, in order to gain a deeper understanding of the clinical and occupational context that the paramedics work within, the acceptability of the paramedics in using PHECGs for stroke patients and the consequences and influences of their decision-making.

Methods: Data were collected via semi-structured interviews and analysed using the framework method, with the underpinning theoretical framework of cognitive continuum theory. A purposive sample of 14 paramedics was recruited and interviewed.

Results: Five themes were generated from the analysis of the interviews: (1) 'time is brain': minimising delays and rapid transport to definitive care; (2) barriers and facilitators to undertaking PHECGs for stroke patients; (3) recognising and gaining cues; (4) maintaining patient dignity, self-protection and fully informed consent; and (5) education, experience and engagement with evidence.

Conclusion: The study showed mixed views on the usefulness of PHECGs, but all participants agreed that PHECGs should not cause additional delays. Paramedic decision-making on recording PHECGs relies on intuitive and quasi-rational cognitive modes, and requires a number of clinical, logistical and ethical considerations. The findings suggest careful consideration is needed of the benefits and potential drawbacks of incorporating PHECGs into pre-hospital stroke care.

Pavement burns are more common in locations familiarised with high temperatures and a dry climate zone, but have not previously been reported in temperate climates. We present two cases of patients who suffered pavement burns in the United Kingdom during an unprecedentedly hot day in July 2022. The first case involved a 66-year-old male who suffered partial and full thickness burns requiring excision and skin grafting. The second case involved a 58-year-old female with partial thickness burns also requiring excision and skin grafting. Both patients had pre-existing co-morbidities and their pavement burns were precipitated by heat stroke. Pavement burns represent a mechanism of injury that necessitates increased operative management, length of hospital stay and cost per surface area burned when compared to flame or scald burns (Silver et al., 2015). As a result of global warming, we anticipate extreme heat events, and subsequently pavement burns, to increase in incidence in the United Kingdom. There is opportunity for education of the public and health professionals for prevention.

Background: Evidence-based practice (EBP) represents the conscientious and judicious use of the best contemporaneous evidence in partnership with patient values and clinical expertise to guide healthcare professionals. As a result, EBP is a recommended component of undergraduate education and considered fundamental for improving patient outcomes. EBP principles have thus become deeply rooted in higher education curricula, but only in recent years has this begun to permeate the world of paramedic practice. Despite this paradigm, the impact of EBP may be limited because ambulance clinicians may struggle with implementation, as a variety of barriers influence translation and application.

Methods: A survey study aimed to gain insight into the epistemological and metacognitive barriers impacting student experience in order to help improve teaching and learning practices.

Results: A sample of 64 students, across two different undergraduate paramedic science programmes, were recruited. Of these, 70% of BSc (Hons) students versus 33% of DipHE students agreed to some extent or greater that EBP represented minimal benefit in real-world practice due to Trust policy and the guidelines set out by the Joint Royal Colleges Ambulance Liaison Committee (Welch's t = 2.571, df = 26, p = 0.016 two-sided). Furthermore, 25% felt standard operating procedures negatively impacted their ability to implement EBP, and 39% reported their EBP learning had improved their ability to implement improved levels of patient care.

Conclusion: A disparity between theoretical learning and EBP implementation was identified. EBP may not dovetail with standard operating procedure within UK ambulance Trusts, resulting in confusion among student paramedics as to the true worth of EBP.

This article discusses the creation and evolution of a unifying pledge designed to encapsulate the identity of paramedics and convey the essence of belonging to this professional group.

Introduction: Menopause is a key workplace issue. Many women will experience symptoms through their later working life. The ambulance service constitutes an employment setting that, dependent on the roles of female staff, can impact on the severity of menopause symptoms and experiences (Prothero et al., 2021). This study aimed to explore female ambulance staff experiences of the menopause transition and suggest ways to improve support offerings.

Methods: A qualitative interpretive approach was adopted, involving 12 UK ambulance services. Participants were identified via purposive sampling, and semi-structured interviews were conducted from February to July 2022 via an online platform or telephone. Recordings were transcribed verbatim and analysed using an inductive thematic approach.

Results: Twenty-two female participants, aged between 42 and 62 years, were interviewed, and represented all phases of the menopause: peri-menopause (n = 9); menopause (n = 5); post-menopause (n = 3); and unsure (n = 5). Fourteen participants had front-line (patient-facing) or emergency operation centre-based roles, while seven were employed in service support roles. Ten themes were identified: impact on work role; awareness and preparedness for menopause transition; personal impact of symptoms; desired support; appropriate sickness and menopause policy; managerial development; compassion and dignity; impact of working environment; impact on safety; and lack of choice. Lack of understanding and support from colleagues and line managers were identified as the key issues. This is included under the managerial development and compassion and dignity themes.

Conclusions: The varying range of menopausal symptoms and their severity impacted on women's performance at work. The experience of working while going through the menopause could be challenging. Employers should adopt a menopause policy which includes training and awareness for all staff, and suitable for front-line as well as service support staff. There is a need to create a culture where the menopause is not taboo, and women feel able to talk about their symptoms.

Background: Patients presenting to the ambulance services with cardiovascular complaints are common, and as such, represent a notable proportion of paramedic clinical practice. Numerous texts refer to a system-based approach to cardiovascular assessment, however the application by paramedics is scarcely researched. As such, this article aims to quantify paramedic confidence levels regarding an examination of a patient with a cardiovascular complaint.

Methods: An online cross-sectional survey was conducted, recruiting paramedics from one ambulance trust within the United Kingdom and analysing their confidence levels of assessing a patient with a cardiovascular complaint. Paramedics were recruited using purposive sampling and asked to complete an online questionnaire exploring their confidence levels among cardiovascular assessments, which were subsequently quantified to summarise confidence levels expressed by these respondents.

Results: A total of 331 responses across one ambulance service were received in April 2021. Of these, 90.3% (299/331) reported a high level of confidence with the general cardiovascular assessment. Throughout all individual elements of assessment, over 50% of respondents indicated they feel confident with the examination, except when assessing heaves and thrills where 56.2% (185/329) and 55.1% (182/330) of respondents disagreed with feeling confident, respectively. A strong correlation was seen throughout the results between confidence levels and the reported occurrence of each type of assessment, which was demonstrated using Spearman's rank-order correlation.

Conclusions: High confidence levels for a cardiovascular examination were reported among the respondents of this survey. Paramedics have shown good confidence among all areas of a cardiovascular assessment, except with palpating the chest for heaves and thrills. There is an evident link between reported confidence levels and how often these assessments are completed, however there is still room for additional training and research within this area.

Background: Paramedic prescribing has been permitted in legislation from 2018. In 2019 one of the first cohorts of paramedic prescribers in the country was invited to share their experiences, thoughts and perceptions around the new and evolving role of paramedic prescribing practice.

Aim: To explore the opinions of student and newly qualified paramedic prescribers regarding the impact and effectiveness of paramedic independent prescribing on their clinical practice.

Design and setting: A qualitative study was undertaken within the North East of England with a group of experienced paramedics undertaking non-medical prescribing education.

Methods: A focus group and dyad interview were undertaken with a purposive sample of paramedics recruited from a higher education institution providing V300 independent and supplementary prescribing education. The focus group was undertaken with paramedics on the non-medical prescribing (NMP) programme of study. The dyad interview was undertaken with participants once qualified as prescribers, and actively prescribing. The focus group and interview were audio recorded, transcribed verbatim and subjected to thematic analysis to identify key themes.

Results: A total of n = 7 and n = 2 paramedics undertook the focus group and dyad interview, respectively. Paramedics in this sample represented a range of paramedic practice areas. Paramedic NMP students noted four key themes around role, expectations, governance and opportunities and challenges in relation to prescribing practice. The returning sample of paramedics, now practising as prescribers, noted themes of organisational and infrastructure challenges, monitoring of prescribing practice and the evolution of paramedic roles.

Conclusion: Paramedic prescribing is rapidly expanding and evolving into new clinical areas. As such, careful consideration should be given to not only the resourcing of prescribers as individuals, but also the wider organisational and technological support and structures needed to be in place to allow paramedic prescribers to fulfil their roles and utilise their advanced practice skills.

Introduction: The main pre-hospital screening tool used for stroke in Ireland and the United Kingdom is the FAST (face, arms, speech, time) test. However, posterior circulation stroke (PCS) patients may be FAST negative on exam, presenting with sudden dizziness, headaches, visual problems, nausea and vomiting and balance/co-ordination problems. There is a lack of research into paramedic recognition of PCS, and this study sought to evaluate recognition rates among paramedics (Ps) and advanced paramedics (APs) in Ireland.

Methods: A cross-sectional sequential exploratory design was chosen. An anonymous online survey was carried out, which informed focus group discussions. The survey contained six clinical vignettes, two of which were PCS presentations. Correct diagnosis, hospital destination and type of pre-alert were recorded. Focus groups were chaired by an independent moderator via Zoom. Recordings were transcribed and thematic analysis was carried out to create codes and themes.

Results: One hundred and fifty-one staff members (91 Ps, 60 APs) completed the survey (response rate 40%). Of these, 67% did not recognise PCS symptoms and 77% did not choose to transport to a stroke unit. For those correctly suspecting PCS, 42% requested resus at the stroke unit and 18% requested resus in the local emergency department (ED). Two focus groups of four practitioners (n = 8) took place. Three main themes were created: (1) comfort levels with posterior stroke, with subthemes of recognition and personal experiences; (2) education, with subthemes of clinical practice guideline (CPG) issues and training issues; and (3) hospital factors, with subthemes of pre-alerting and disconnect between hospital and emergency medical services. Participants were uncomfortable with PCS recognition and bypassing their local ED. More training was called for, with a dedicated CPG. Relationships with hospital staff affected willingness to pre-alert.

Conclusions: In this sample group, recognition of PCS and onward transfer to a stroke unit was low. Focus groups showed that practitioners were uncomfortable recognising PCS and bypassing a local ED without adequate training and a dedicated CPG. Relationships with hospital staff also affected pre-alert decisions.