After experiencing one of the most difficult losses and continuing to navigate the journey of grief, Dan Wyatt reflects on the peaks and troughs of life, the support that is out there during the low points, and the surprisingly therapeutic nature of putting it all down on the page

This first continuing professional development article in this 2-part series on decision-making explores this process in prehospital and paramedic practice and the complex world of how clinicians make decisions in often challenging and time-critical situations in prehospital settings. It gives a brief overview of the neuroanatomy involved in decision-making, problem-solving and critical thinking as well as Bloom's taxonomy and its application to prehospital practice. While it is outside the remit of this paper to incorporate all theories regarding decision-making, it will explore some key concepts and frameworks around it.

Background: Paramedics are increasingly involved in providing emergency mental healthcare through specialist mental health paramedic roles or expanded responsibilities within generalist roles. Methods: This article reviews the relevant academic literature to critically evaluate the opportunities and challenges of greater paramedic involvement in mental health. Findings: Potential benefits include prompt crisis response, improved service integration, and enhanced accessibility. However, challenges exist around limited mental health training, role ambiguity, care continuity, and stakeholder concerns. Conclusion: Realising the benefits of paramedics in mental healthcare requires investment in education, clear protocols, strong governance, and collaboration with mental health professionals and service users to ensure safety and quality.

Background: Sepsis mortality rates increase if prompt treatment is not administered. The Sepsis Six care bundle advocates the early administration of broad-spectrum intravenous antibiotics to reduce mortality and morbidity but this is not routinely practised nationally in UK prehospital settings, although UK ambulance services regularly attend septic patients. Aims: A literature review was conducted to investigate knowledge around paramedics' ability to recognise and treat prehospital sepsis with intravenous antibiotics in the UK and the impact of this on patient outcomes. Methods: A search was conducted and the three eligible studies included underwent a structured critical appraisal and thematic analysis. Findings: Three themes emerged: diagnostic accuracy; administration of prehospital antibiotics; and impact on patient outcomes. Conclusion: There is a significant gap in evidence in this field in the UK, and it was difficult to make generalised recommendations from the studies. Paramedics have the potential to be highly accurate in the recognition of sepsis and administer intravenous antibiotics when following a protocol. No major studies measure patient outcomes following prehospital intravenous antibiotics administration by paramedics in the UK and large empirical studies should be conducted to assess the effectiveness of this.

This reflective account discusses a case where a patient refused a safeguarding referral after disclosing domestic abuse to a student paramedic on an MSc programme. The author examines the medical, ethical and legal evidence when determining whether the right path was taken in caring for this patient. It is argued that the care delivered was lawful and ethical but the student paramedic did not have sufficient awareness of the support options available to those experiencing domestic abuse. Their oversimplification of the dilemma to the patient having capacity to refuse referral omitted key aspects of the medico-legal framework, potentially to the detriment of the patient's care. Reflective learning has allowed the author to recognise the limits of his understanding of the complex medico-ethico-legal framework surrounding domestic abuse, consent, coercion and controlling behaviour. In response, he has established a new methodology to assess the underlying reasons for refusing a safeguarding referral.