Critical Care Paramedics Research Articles

The Effect of Team Configuration on the Incidence of Adverse Events in Pediatric Critical Care Transport

ObjectiveSpecialty pediatric transport teams are widely used for pediatric interfacility transport in the United States, with little industry consensus on optimal team configuration. The aim of this study is to assess the quality of the nurse/paramedic specialty team configuration as indirectly measured by the rate of adverse events in these transports. MethodsRetrospective analysis of pediatric transport data from a hospital-based dedicated pediatric/neonatal transport team was conducted for patients transported in 2016. Data were categorized by general characteristics of transport and analyzed for the occurrence of adverse events. ResultsFive hundred sixty-four cases were analyzed. Cases were described by team configuration and then by transport mode, duration, time, patient age and acuity, and disposition. The overall rate of adverse event incidence was 8.3%, chiefly centered in device and process domains. There was no significant difference in the rate of adverse events between team configurations. ConclusionThere was no significant difference in the rate of adverse event occurrence in nurse/paramedic team configurations versus nurse/nurse configuration. Using critical care paramedics on pediatric transport teams enables a larger volume of patients to be transported to definitive care without concerns for decrease in quality or safety.

Abstract 13: The Feasibility and Development of a Mobile Stroke Unit in a Community Setting

Introduction: Time is brain, the faster a stroke patient is treated the better the outcome. Mobile Stroke Units (MSU) are an innovation in care allowing a specialized team to treat the patient in a pre-hospital setting. As hospitals consider the addition of a MSU, the feasibility of the program must be carefully explored, along with the challenges that come with developing a program. This abstract aims to discuss one hospital’s journey to develop and implement a MSU to bring cutting edge care to the community. Hypothesis: A hospital can operate in partnership with local EMS to provide stroke care to patients in the pre-hospital setting. Methods: A community hospital conducted a feasibility study to determine the effects of a MSU within their local EMS region. This study involved reviewing market share and trends, as well as, financial metrics. Following the feasibility study, an investment was made to develop a MSU program. Program development consisted of 5 main teams: Compliance/Regulatory, EMS, Communications/Marketing, Operations, and Vehicle Acquisition. Focus was also placed on staffing the MSU with a critical care nurse, critical care paramedic, CT technologist, and a paramedic driver. This team received specialized training, along with local EMS, to care for the stroke patient in the pre-hospital setting. The MSU is equipped with a CT scan and IV alteplase or prothrombin complex concentrate. Additionally, the use of telemedicine is used to include the neurologist and radiologist in the care of the pre-hospital stroke patient. Results: The Mobile Stroke Program was successfully launched by this community hospital within 8 months of project kickoff to Go-Live. In the first 6 months of operations, the MSU has been dispatched 182 times and has transported 102 patients from all 6 towns within the EMS region. Endorsement of the MSU services to the community was received from all six Fire Chiefs within the EMS system. Conclusions: A community hospital in partnership with local EMS and Department of Regulation can be successful in determining the need, scope, and program criteria for a MSU. This approach can support an expedited timeline while assuring the highest standard of stroke care.>

A retrospective analysis of ketamine administration by critical care paramedics in a pre-hospital care setting.

Objective:This project aims to describe pre-hospital use of ketamine in trauma by South East Coast Ambulance Service critical care paramedics and evaluate the occurrence of any side effects or adverse events.Methods:A retrospective analysis of patients receiving pre-hospital ketamine for trauma between 16 March 2013 and 30 April 2017. Administrations were identified from Advanced Life Saving Interventions and Procedures reports submitted by the clinician and, later, from an electronic database. Each was scrutinised for patient demographics, doses and reports of side effects or adverse events.Results:A total of 510 unique administrations were identified. Following the exclusion of 61 records, 449 (88.0%) administrations remained. The most common indication for administration of ketamine was lower limb injury, with 228 (50.8%) administrations. Ketamine was only administered intravenously, and the median dose of ketamine for all administrations was 30 mg (interquartile range 20–40 mg). The gender split was dominated by males who accounted for 302 (67.3%) administrations compared to 147 (32.7%) females. The median age of patients was 44 years (interquartile range 28–58 years), with women on average being older than men. Telephone calls to a consultant were made for 243/449 (54.1%) of the administrations, reflecting a need for sanctioning of the drug, advice on dosages or indications, for example.Conclusions:Critical care paramedics within a well governed system are able to safely administer ketamine within an approved dosing regimen under a Patient Group Direction. Median doses are in keeping with nationally approved guidelines. Reported side effects were within the described frequencies in the British National Formulary. Prospective studies are now needed in order to confirm the safety and efficacy of ketamine administration among the advanced paramedic population.

Reporting Abuse

I was working an evening shift in the emergency department of a children's hospital when emergency medical services delivered a profoundly disabled child with mental status changes and fever. After we moved the patient from the ambulance cot to the stretcher and started to assess the child, the paramedic motioned for me to come out into the hall away from the family. In the pocket of his uniform shirt where his pen would normally be, there was a fondue fork. He took it out and handed it to me and told me that he saw it lying on the child's nightstand and thought it was weird, but he thought it might be important so he picked it up. John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CMTE, is the Chief Operating Officer of the International Board of Specialty Certification (IBSC) and a past-president of the International Association of Flight and Critical Care Paramedics Association (IAFCCP) and serves as their legal advisor.

PP21 Can paramedics correctly recognise cardiac arrhythmias and does recency of training have an impact?

BackgroundParamedics increasingly utilise alternative care pathways and direct referrals to reduce Emergency Department admissions. The National Institute of Clinical Effectiveness (NICE) Transient Loss of Consciousness (TLoC) guidelines are one such...

Vehicular Manslaughter

Rome, GA, Friday, June 16, 2017—One person died in a wreck involving a Puckett EMS ambulance Friday morning. Emergency officials were dispatched to Martha Berry in front of Berry College to a wreck with injuries around 4:30 am. According to Captain Chris Dehart with the Rome City Police, the ambulance was traveling southbound on Martha Berry and left the roadway and traveled around 300 yards striking 2 trees before coming to rest on its side. According to Deputy Coroner Gene Proctor, the victim was identified as 55-year-old Tony Patterson of Rome. Patterson was being transported by Puckett EMS from a Lafayette nursing home to the Floyd emergency room for treatment. The driver of the ambulance and the medic in the back of the vehicle were injured but are in stable condition. 1 Victim identified in crash involving ambulance killing one, injuring two others. http://www.wrganews.com/common/page.php?id=104811&is_corp=1Date accessed: June 16, 2017 Google Scholar John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CMTE, is the Chief Operating Officer of the International Board of Specialty Certification (IBSC) and a past-president of the International Association of Flight and Critical Care Paramedics Association (IAFCCP) and serves as their legal advisor.

Conflict of Interest

Do you have a second job? Do you volunteer for a charity? Do you have a brother who is in politics? Did a vendor buy you a lavish dinner? Did you have a secret discussion with a Russian official? All of these situations could create a conflict of interest. John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CFC, CMTE, is a member of the board of directors for the Board for Critical Care Transport Paramedic Certification (BCCTPC) and legal advisor and member of the board of directors for the International Association of Flight and Critical Care Paramedics (IAFCCP).

Paramedic management of out-of-hospital cardiac arrest secondary to hyperkalaemia

Hyperkalaemia is a potentially life-threatening metabolic emergency and is the most common electrolyte disorder associated with death. The author attended an incident where a patient suffered asystolic cardiac arrest from hyperkalaemia and was subsequently resuscitated successfully to hospital discharge with good neurological outcome. This piece intends to review all relevant available literature with the aim of developing recommendations to aid paramedics in managing cardiac arrest secondary to Hyperkalaemia. Despite the lack of current good-quality evidence for pharmacological interventions, systematic reviews available have led to the development of clear guidelines. The use of calcium chloride and sodium bicarbonate is recommended, and these are both carried by Critical Care Paramedics (CCPs). Salbutamol therapy has the strongest evidence base of any intervention available out of hospital. It should be considered after the use of the aforementioned medications if the patient achieves ROSC. Consideration must also be taken as to whether the patient would benefit from being moved to hospital to reach vital interventions such as insulin/dextrose therapy and dialysis.

ECMO retrieval: A case for Critical Care Paramedic integration into the team

ECMO retrieval: A case for Critical Care Paramedic integration into the team

ECMO transport: The role of Critical Care Paramedics

Background: Transport of patients on ECMO has been demonstrated to be safe, if undertaken by well-trained teams. 1–3 Incorporating an Ambulance Service Critical Care Paramedic (CCP) into the team provides a seamless team dynamic during retrieval improving safety. 4 The CCP helps to co-ordinate logistics, monitors patient and team safety and provides an additional resource for advanced life support during ECMO patient transport. In addition, they provide a link to decision-making and execution of patient movement systems and help access any additional resources within the Ambulance Service. Seamless team dynamics: The success of each retrieval depends as much on team dynamics as on the technical skills of the individual specialties represented in the team. 5 In recognition of the central role of the Ambulance Service in ECMO transport, CCPs were included in the working group, training and development process for ECMO at Hamad Medical Corporation in Doha, Qatar. Based on their experience, they led the desig...

Building Qatar severe respiratory failure ECMO program

Building Qatar severe respiratory failure ECMO program

Drones Rule!

In late August of 2016, the Federal Aviation Administration (FAA) published its new rules regarding unmanned aircraft systems (UASs), better known to the public as drones. Drones are being touted as the solution for everything from bringing packages to your door, increasing the reach of news coverage, finding lost hikers, and even delivering medication or an automated external defibrillator to a remote site. The UAS industry estimates that the rules will generate more than $82 billion for the US economy and create more than 100,000 new jobs over the next 10 years. The Association for Unmanned Vehicle Systems International believes that $13.6 billion and 70,000 jobs will be created in the first 3 years alone. 1 With 1 announcement, the FAA just created an $82 billion market and 100,000 new jobs at Inc.com. http://www.inc.com/yoram-solomon/with-one-rule-the-faa-just-created-an-82-billion-market-and-100000-new-jobs.html. Accessed August 3, 2016. Google Scholar On the other hand, the widespread use of UASs creates a new wrinkle in aviation safety. The FAA lists 583 separate aircraft versus drone incidents reported from August 2015 through January 2016. 2 FAA releases updated UAS sighting reports. https://www.faa.gov/news/updates/?newsId=85229. Accessed August 4, 2016. Google Scholar Although the majority of the incidents are minor, with pilots or bystanders reporting drones that are flying in restricted airspace without necessarily endangering anyone, it emphasizes that drones are everywhere and are a hazard to helicopter emergency medical services (HEMS). John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CMTE, is a member of the board of directors for the Board for Critical Care Transport Paramedic Certification (BCCTPC) and legal advisor and member of the board of directors for the International Association of Flight and Critical Care Paramedics (IAFCCP).

Validation of the pre-hospital Qatar Early Warning Score (QEWS) to determine transport priority

Background: Ambulance Paramedics are dispatched to all calls while Critical Care Paramedic (CCP) units only attend potentially “life threatening” cases (Priority 1). Ambulance Paramedics (AP) triaged patients based on clinical judgment and experience creating a risk of Priority 1 under or over-triage. QEWS was designed to supplement priority decision-making process based on physiological values used as a trigger to identify patients with a potential risk of deterioration. The objective of this study was to undertake a comparison of the QEWS score calculated from retrospective vital signs data to that of the priority decision-making by ambulance crews. Methods: In our retrospective study, data entered into the Ambulance Service clinical database over a nine-month period before QEWS implementation was analysed for comparison of the priority decision made by the crew for each patient versus the calculated QEWS value based on the first set of six relevant vital signs (Heart rate, Respiratory rate, Systolic blood pressure, Temperature, Oxygen saturation, AVPU). Only cases with patients over 18 years old were included. Results: Of 34,908 retrieved cases, 27,915 (79.97%) had sufficient data to retrospectively determine QEWS. The mean age was 38.62 (+15.84) years and 21,453 (76.85%) were male patients. Priority decision-making correlated in 25,850 cases (92.6%), with 286 (1.11%) Priority 1 and 25,564 (98.89%) Priority 2 patients. In 1,662 cases (5.95%), QEWS retrospectively triaged patients higher and in 1.44%, QEWS triaged patients lower. Conclusions: Physiological variables are an established predictor of risk regarding a patient's condition. Hospital-based early warning scores have been validated and implemented successfully. Only one published pre-hospital scoring system has been validated for triage. Under-triage appears to be a common problem in medical patients. QEWS potentially could address this under-triage issue and appears to be a valid scoring system to implement for prioritising patients to routine or urgent transport, or CCP intervention.

Civilians in a War Zone

Earlier this year, I attended a dramatic and moving talk at SMACC DUB (Social Media and Critical Care in Dublin) entitled “Oh s**t, they're bombing our hospital!” 1 http://www.smacc.net.au/speakers-abstract/kathleen-thomas/. Accessed June 11, 2016. Google Scholar by Kathleen Thomas. Dr. Thomas was working with Médecins Sans Frontières (Doctors without Borders) as the intensive care unit/emergency department supervisor of the Kunduz Trauma Center in northern Afghanistan when US military forces mistakenly bombed the hospital. Her talk was not a narrative of the event as much as it was a passionate call to action to stop attacks on medical facilities in violation of the Geneva Conventions and other international humanitarian law. Dr. Thomas listed attacks in the ongoing conflicts in Afghanistan, Syria, and Yemen that demonstrate a growing disregard for the rules of war. Attacks on hospitals and other traditional safe places may indicate a shift in the respect for, and adherence to, international humanitarian law. When we lose respect for the rule of law, we are left with anarchy. Compromising the sanctity of a medical facility results in a scenario in which whole populations are denied access to lifesaving medical care in areas of conflict. John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CMTE, is a member of the board of directors for the Board for Critical Care Transport Paramedic Certification (BCCTPC) and legal advisor and member of the board of directors for the International Association of Flight and Critical Care Paramedics (IAFCCP).

Industrial paramedic: an emerging speciality?

The role of paramedic, from its humble beginnings as an entirely ambulance-based profession (and under the solely-NHS employment umbrella), has produced numerous speciality grades in recent years. Within the UK, some of these are represented by the College of Paramedics; however, others are unfortunately not, as yet. For example: the roles of CCP, ECP/PP (critical care paramedic, emergency care practitioner/paramedic practitioner), military paramedic, HEMS (helicopter emergency medical service) and coastguard paramedics, HART (hazardous area response team) paramedics and offshore paramedics are well recognised and established specialised disciplines, often with their own separate, university-based courses to ‘top up’ on the existing paramedic Bachelor of Science. Some specialities, such as remote area and emergency department paramedics, are less well understood and represented. The purpose of this article is to describe the role of the industrial paramedic. It will outline why the skill-set of this role is unique in comparison with those mentioned above, and will debate the case for stand-alone recognition and specific training for this speciality.

Two Girls Falsely Imprisoned After Mother Killed

The title of the article grabs you and draws you in with promise of mystery and intrigue, but this column is more of a history lesson. While researching a separate issue, I stumbled across an event from over 25 years ago related to a motor vehicle crash in Mexico. 1 Scofield v Critical Air Medicine, Inc. (1996) [45 Cal App 4th 995]. Google Scholar The dispute pitted a fixed wing operator against a man whose wife had been killed and his critically injured son needed neurosurgical care in the United States. All the details here are taken directly from Scofield v Critical Air. 2 Scofield v Critical Air Medicine, Inc. (1996) [45 Cal App 4th 997]. Google Scholar John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CFC, CMTE, is a member of the board of directors for the Board for Critical Care Transport Paramedic Certification (BCCTPC) and legal advisor and member of the board of directors for the International Association of Flight and Critical Care Paramedics (IAFCCP).

Critical care paramedics: who's doing what?

Journal of Paramedic PracticeVol. 8, No. 6 Spotlight on ResearchCritical care paramedics: who's doing what?John TalbotJohn TalbotSearch for more papers by this authorJohn TalbotPublished Online:6 Jun 2016https://doi.org/10.12968/jpar.2016.8.6.312AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References von Vopelius-Feldt J, Wood J, Benger J (2014) Critical care paramedics: where is the evidence? A systematic review. Emerg Med J 31(12): 1016–24. doi:https://doi.org/10.1136/emermed-2013-202721 Crossref, Google ScholarBernard SA, Nguyen V, Cameron P et al. (2010) Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg 252(6): 959–65. doi: https://doi.org/10.1097/SLA.0b013e3181efc15f Crossref, Google ScholarJashapara A (2011) Clinical Innovation in Prehospital care: an introduction to Critical care Paramedics in the United Kingdom. University of London, Royal Holloway Google ScholarMcQueen C, Crombie N, Hulme J et al. (2015) Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice. Emerg Med J 32(1): 65–9. doi: https://doi.org/10.1136/emermed-2013-202890 Crossref, Google ScholarSchmidt U, Frame SB, Nerlich ML (1992) On-scene helicopter transport of patients with multiple injuries-comparison of a German and an American system. J Trauma 33(4): 548–53; discussion 553–45. doi: https://doi.org/10.1097/00005373-199210000-00010 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 June 2016Volume 8Issue 6ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 6 June 2016 Published in print 2 June 2016 Information© MA Healthcare LimitedPDF download

Intra-aortic Balloon Pump-Dependent Patient Transports by Critical Care Paramedics

ObjectiveTransport of intra-aortic balloon pump (IABP)-dependent patients between hospitals is increasingly common. The transports are typically time-sensitive and require personnel familiar with IABP operation and management of a potentially unstable patient. This study examined transports performed by specially trained critical care paramedics in a large air medical and land critical care transport service. MethodsThis retrospective, descriptive review prospectively collected data for IABP-dependent patient transports in Ontario, Canada in a 10-year interval beginning September 2003. Call records and patient care reports were reviewed to capture demographic, patient care, adverse events, and transport-related data. Adverse events, including resuscitation medication, procedure, and patient instability, were independently reviewed by 2 investigators. ResultsThere were 162 IABP-dependent patients transported. Seventy-one were performed by land critical care transport vehicles, 60 by helicopter, and 31 by fixed wing aircraft. The mean patient age was 63.7 ± 13.8 years; the majority (72.2%) were men. Fifty-nine patients (36.4%) were inotrope or vasopressor dependent, and 46 (28.4%) were intubated and mechanically ventilated. The most common indications for IABP insertion were acute myocardial infarction requiring prompt surgical intervention (n = 70), bridge to definitive care (n = 41), and cardiogenic shock (n = 37). The mean transport time was 92.7 ± 79.4 minutes. There were 48 adverse events in 35 patients, most commonly hypotension (systolic blood pressure < 90 mm Hg, n = 18) and tachyarrhythmia requiring therapy (n = 12). There were 3 IABP-related events and 3 cases in which the transport vehicle was inoperable resulting in a transport delay. One patient with cardiogenic shock died before departing the sending hospital. Paramedics managed all events without assistance from other health care personnel. ConclusionSpecially trained critical care flight paramedics can safely transport potentially unstable IABP-dependent patients to definitive cardiac surgical care.

The search and rescue helicopter paramedic: an emerging role

The search and rescue helicopter paramedic: an emerging role

STOCKLIST—A STUDY OF CLINICAL SKILLS OF CRITICAL CARE PARAMEDICS IN THE UK

IntroductionThe Critical Care Paramedic (CCP) is a relatively new advanced practitioner. CCPs provide advanced clinical skills, knowledge and expertise for primary response and critical care retrieval and transfer. In the...