Paramedic Practice Research Articles

Validity and Reliability of the Transport Triage Tool.

Standards for interfacility transport in the United States recommend that each transport request be triaged to ensure that each patient is transported by an appropriate mechanism and by the appropriate clinicians in order to meet the patient's intratransport needs. No instrument currently exists to meet that need. The Transport Triage Tool, a novel instrument, has been designed to determine the clinician (paramedic, registered nurse, or advanced practice registered nurse) who will best meet the patient's needs during transport. To assess psychometric elements-that is, validity and reliability-of the Transport Triage Tool when used by health care professionals in determining which clinician is appropriate for interfacility transport. A 3-step process was used to initially evaluate the reliability and validity of this tool when assigning a lead clinician during transport. Content and predictive validity were evaluated. Both intrarater and interrater agreement were used to examine reliability. Predictive validity was supported by an area under the receiver operating characteristic curve of 0.847 and a Youden index of 0.31. Percentage agreement and Cohen κ were reasonable across all periods of testing. The Transport Triage Tool has acceptable predictive validity and reliability; however, this preliminary evaluation indicates that further refinement is needed. Large tertiary centers that offer variations in transport team composition may be able to use the Tool in its present form to train and evaluate individuals who make decisions regarding interfacility transport, although additional testing and evaluation are recommended.

Empathy in paramedic practice: an overview

Empathy is generally considered to be the understanding of another person's reactions, thoughts, feelings and problems, and being able to relay this sense of understanding back to the individual. Empathy in healthcare is associated with improved communication, reduced stress, lower complication rates and better clinical outcomes. Low empathy is associated with decreased patient satisfaction and provider burnout. The burden of emotional work in paramedic practice and coping strategies may be contributory factors to lower empathy. Some evidence suggests that the empathy of paramedic students varies between patient groups and can decline over time. Empathy is an interpersonal skill that can be learned and improved upon. In paramedic practice, it is complex and inadequately studied. Its relationship to patient care, paramedic burnout and wellbeing require investigation. Several strategies to teach empathy should be considered by educators.

Social media in paramedic practice

Journal of Paramedic PracticeVol. 11, No. 4 EditorialSocial media in paramedic practiceTom MallinsonTom MallinsonEditorial board member of the Journal of Paramedic PracticeSearch for more papers by this authorTom MallinsonPublished Online:8 Apr 2019https://doi.org/10.12968/jpar.2019.11.4.143AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Baron A, Townsend R. Live tweeting by ambulance services: a growing concern. J Para Pract. 2017; 9(7):282–286. https://doi.org/10.12968/jpar.2017.9.7.282 Link, Google ScholarCollege of Paramedics. Social Media Guidance. Bridgwater: College of Paramedics; 2019 Google Scholar FiguresReferencesRelatedDetails 2 April 2019Volume 11Issue 4ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 8 April 2019 Published in print 2 April 2019 Information© MA Healthcare LimitedPDF download

Fascia iliaca compartment block versus IV morphine for femoral fracture pain

Background: Femoral trauma in the UK is increasing. The fascia iliaca compartment block (FICB) could be a more effective, safer way to ease pain and distress from femoral trauma in the prehospital environment than the current practice of intravenous morphine. Aim: To conduct a systematic review to accumulate evidence concerning prehospital FICB for patients with femoral fracture. Methodology: A systematic review was conducted using the CINAHL, Medline, AMED, PubMed and Embase databases. In addition, a hand search of the Journal of Paramedic Practice and the Australasian Journal of Paramedicine was performed. The search was carried out from 28 March–24 April 2018. Results: Twenty-eight papers were sourced by the methodology, of which four met the inclusion criteria and were subsequently analysed. Conclusion: This review shows that prehospital FICB can be efficacious in a number of prehospital environments and is feasible for a variety of patients with a range of femoral fractures. Additionally, FICB has limited reported adverse side effects in the prehospital environment and would appear to be safe. However, evidence comparing the efficacy of a prehospital FICB to intravenous morphine use for pain management in femoral fractures is limited. This review indicates that more research in this area would be beneficial.

Drowsy and dangerous? Fatigue in paramedics: an overview

<p><strong>Background</strong></p><p>Fatigue is a complex phenomenon that has effects on physical characteristics, cognition, behaviours, and physical and mental health. Paramedicine crosses the boundaries of many high-risk industries, namely medicine, transport and aviation. The effects of fatigue on paramedics thus need to be explored and considered in order to begin to identify appropriate interventions and management strategies.</p><p><strong>Aim</strong></p><p>The aim of this article was to provide an overview of fatigue in paramedics and its potential effects on various areas of paramedic practice and paramedic health, and to outline potential solutions to assess and manage the risk of fatigue in paramedics as suggested by the literature.</p><p><strong>Methods</strong></p><p>We conducted unstructured, non-systematic searches of the literature in order to inform an overview of the literature. An overview is a summary of the literature that attempts to survey the literature and describe its characteristics. We thematically structured the review under the following headings: defining occupational activity and health status; clinical performance and patient safety; shift length and time at work; effects on paramedic health; effects on driving abilities; fatigue risk management; and, fatigue proofing.</p><p><strong>Discussion</strong></p><p>Fatigue should be considered in the context of overall paramedic health status and paramedic occupational activity. The nature of paramedic shift work, and the associated occupational activity place paramedics at increased risk from fatigue. Shift work may also contribute to sleep disorders among paramedics. Fatigue is associated with increased errors and adverse events, increased chronic disease and injury rates, depression and anxiety, and impaired driving ability.</p><p><strong>Conclusion</strong></p><p>The issue of fatigue in paramedicine is complex and has serious consequences for patients and paramedics. Paramedic services and paramedics need to work collaboratively to identify and action appropriate measures to reduce the effects of fatigue on the wellbeing of the workforce and mitigate its effects on clinical performance and safety.</p>

End-of-life demand is highly volatile and shows unexpected trends

Journal of Paramedic PracticeVol. 11, No. 3 CommentEnd-of-life demand is highly volatile and shows unexpected trendsRodney P JonesRodney P JonesEmail for correspondence:E-mail Address: [email protected]Statistical Advisor, Healthcare Analysis & Forecasting, Leominster, UKSearch for more papers by this authorRodney P JonesPublished Online:13 Mar 2019https://doi.org/10.12968/jpar.2019.11.3.122AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Chen R, Yin P, Wang L et al.. Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. Br Med J. 2018; 363: k3965. https://doi.org/10.1136/bmj.k4036 Google ScholarEkamper P, van Poppel F, van Duin C, Garssen J. 150 Years of temperature-related excess mortality in the Netherlands. Demograph Res. 2009; 21:385–426. https://doi.org/10.4054/DemRes.2009.21.14. http://www.demographic-research.org/Volumes/Vol21/14/ (accessed 25 February 2019) Google ScholarJones R. End of life care and volatility in costs. Brit J Healthc Manage. 2012; 18(7):374–381 Link, Google ScholarJones R. Environmental volatility and healthcare costs. Brit J Healthc Manage. 2013; 19(4): 198–199. Link, Google ScholarJones R. Recurring outbreaks of an infection apparently targeting immune function, and consequent unprecedented growth in medical admission and costs in the United Kingdom: A review. Brit J Med Medical Res. 2015a; 6(8):735–770. https://doi.org/10.9734/BJMMR/2015/14845 Crossref, Google ScholarJones R. Simulated rectangular wave infectious-like events replicate the diversity of time-profiles observed in real-world running 12-month totals of admissions or deaths. FGNAMB 2015b; 1(3):78–79. https://doi.org/10.15761/FGNAMB.1000114 Google ScholarJones R. Rising emergency admissions in the UK and the elephant in the room. Epidemiology: Open Access. 2016; 6(4): 1000261. https://doi.org/10.4172/2161-1165.1000261 Crossref, Google ScholarJones R. Year-to-year variation in deaths in English Output Areas (OA), and the interaction between a presumed infectious agent and influenza in 2015. SMU Med J. 2017. 4(2):37–69. https://tinyurl.com/yczo4pvf (accessed 25 February 2019) Google ScholarJones R. Periods of unexplained higher deaths and medical admissions have occurred previously – but were apparently ignored, misinterpreted or not investigated. Eur J Internal Med. 2018; 40: e18–e20. https://doi.org/10.1016/j.ejim.2017.11.004 Crossref, Google ScholarJones R. The nearness to death effect and why NHS pressures are going to intensify. J Para Pract. 2019a; 11(1):28–30 Link, Google ScholarJones R. Ignorance isn't bliss: behind the unequal distribution of end-of-life demand and cost. J Para Pract. 2019b; 11(2):77–79 Link, Google ScholarJones R, Kellet J. The way healthcare is funded is wrong: it should be linked to deaths as well as age, gender and social deprivation. Acute Med. 2018; 17(4):189–193 Google ScholarMarie Curie. Emergency admissions: Data briefing. 2018. https://tinyurl.com/yxvdwykx (accessed 25 February 2019) Google ScholarOffice for National Statistics. Deaths registered monthly in England and Wales. 2018. https://tinyurl.com/ybfk4pk2 (accessed 25 February 2019) Google ScholarTrudeau R. Monthly and daily patterns of death. Health Reports. 1997; 9(1):43–50 Google Scholar FiguresReferencesRelatedDetailsCited byWill the winter of 2019/20 have unusually high service demand? Part 2: StrategyRodney P Jones13 December 2019 | Journal of Paramedic Practice, Vol. 11, No. 12Will the winter of 2019/2020 have unusually high service demand? Part 1: LessonsRodney P Jones5 November 2019 | Journal of Paramedic Practice, Vol. 11, No. 11NHS winter workload and on/off switching of deathsRodney P Jones8 April 2019 | Journal of Paramedic Practice, Vol. 11, No. 4 2 March 2019Volume 11Issue 3ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 13 March 2019 Published in print 2 March 2019 Information© MA Healthcare LimitedPDF download

Global patient experience of paramedic practice

Background: Paramedics occupy an ever-increasing role within healthcare and the development of this role should be informed by the voice of patients. This systematic literature review seeks to explore patient experience during a paramedic intervention. Methods: Using a ‘state of the art’ review style, a systematic search was conducted of the literature published between 2006 and 2018. Following PRISMA guidelines, a total of seven articles meeting the inclusion criteria were identified. A definition of experience which incorporates several dimensions was used to frame the search. Results: Three themes were identified, with the available literature focusing mainly on satisfaction. Satisfaction is improved through certainty and clarity of the progression through treatment and is high among patients of paramedics. Conclusion: Our understanding of patient experience in paramedic interventions is largely limited to an understanding of satisfaction. While this may provide some useful insights, other facets such as the lived experience and physiologic aspects are underrepresented in the current evidence base.

Palliative care in paramedic practice: A retrospective cohort study

Background: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. Aim: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. Design: This is a retrospective cohort study. Setting/participants: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. Results: A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64–83). The most common paramedic assessments were ‘respiratory’ (20.1%), ‘pain’ (15.8%) and ‘deceased’ (7.9%); 74.4% (n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. Conclusion: Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

Homelessness: implications for paramedic practice

Homelessness: implications for paramedic practice

Human factors in student paramedic practice

Human factors affect paramedic practice and training. However, although there are frequent references to human factors in the literature, little evidence on this is available on those that influence student paramedic development. A personal experience as a student paramedic highlighted certain human factors unique to the role, most notably how interactions between students and mentors can affect a student's practice. Following this, the awareness and effect of human factors within the student paramedic role were investigated. Discussions regarding human factors that influence a student paramedic's development on practice placements remain in their infancy. The student paramedic role is unique and challenging, and involves developing a level of resilience that continues post registration. Because of the role's emotive nature, students need to increase their awareness and management of human factors to prevent them from affecting their practice. Equally, educators need to have a greater focus on encouraging and teaching coping strategies. Practitioners who work with students do so whether they choose to be a mentor or not and many may feel unprepared for the role. Interactions between students and clinician mentors are complicated and future research will be required to determine the best approach to aid student development in the placement environment.

The nearness to death effect and why NHS pressures are going to intensify

Journal of Paramedic PracticeVol. 11, No. 1 CommentThe nearness to death effect and why NHS pressures are going to intensifyRodney P JonesRodney P JonesSearch for more papers by this authorRodney P JonesPublished Online:12 Jan 2019https://doi.org/10.12968/jpar.2019.11.1.28AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Hanlon P, Walsh D, Whyte B et al.. Hospital use by an ageing cohort: an investigation into the association between biological, behavoural and social risk markers and subsequent hospital utilization. J Public Health Med. 1998; 20(4):467–476 Crossref, Google ScholarJones R. What government data on death rates fail to show. Brit J Healthc Manag. 2017a; 23(8):572–573 Link, Google ScholarJones R. Deaths and medical admissions – what is happening in the UK? Fractal Geometry Nonlinear Anal Med Biol Med Biol. 2017b; 3(1): in press. https://tinyurl.com/yb2n86kr (accessed 6 January 2019) Google ScholarJones R. Year-to-year variation in deaths in English Output Areas (OA), and the interaction between a presumed infectious agent and influenza in 2015. SMU Med J. 2017c; 4(2):37–69. https://tinyurl.com/yczo4pvf (accessed 6 January 2019) Google ScholarJones R. Outbreaks of a presumed infectious pathogen creating on/off switching in deaths. SDRP J Infect Dis Treat Ther. 2017d; 1(1):1–6. https://tinyurl.com/yb58846n (accessed 6 January 2019) Google ScholarJones R. Role of social group and gender in outbreaks of a novel agent leading to increased deaths, with insights into higher international deaths in 2015. Fractal Geometry Nonlinear Anal Med Biol Med Biol. 2017e; 3(1): in press. https://doi.org/10.15761/FGNAMB.1000146. https://tinyurl.com/ydancach (accessed 6 January 2019) Google ScholarJones R. Different patterns of male and female deaths in 2015 in English and Welsh local authorities question the role of austerity as the primary force behind higher deaths. Fractal Geometry Nonlinear Anal Med Biol Med Biol. 2017f; 3(1): in press. https://doi.org/10.15761/FGNAMB.1000145. https://tinyurl.com/yd9929ad (accessed 6 January 2019) Google ScholarJones R. Deaths and medical admissions in the UK show an unexplained and sustained peak after 2011. Eur J Intern Med. 2018a; 47: e14–e16. https://doi.org/10.1016/j.ejim.2017.09.021 Crossref, Google ScholarJones R. Will 2018 set a record for deaths? Brit J Healthc Manag. 2018b; 24(9):464–465 Link, Google ScholarJones R. Periods of unexplained higher deaths and medical admissions have occurred previously – but were apparently ignored, misinterpreted or not investigated. Eur J Intern Med. 2018c; 40:e18–e20. https://doi.org/10.1016/j.ejim.2017.11.004 Crossref, Google ScholarMoore P, Bennett K, Normand C. Counting the time lived, the time left or illness? Age, proximity to death, morbidity and prescribing expenditures. Soc Sci Med. 2017; 184:1–14 Crossref, Google ScholarNHS Digital. Hospital admitted patient care activity, 2017/18. 2018. https://tinyurl.com/y8w8lm5y (accessed 6 January 2019) Google ScholarOffice for National Statistics. Deaths by single year of age tables – UK. 2018a. https://tinyurl.com/y7v5nvvf (accessed 6 January 2019) Google ScholarOffice for National Statistics. Subnational population projections for England, 2016-based. 2018b. https://tinyurl.com/y9d7p2ub (accessed 6 January 2019) Google ScholarPayne G, Laporte A, Deber R, Coyte P. Counting backward to health care's future: Using time-to-death modleing to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Q. 2007; 85:213–257 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byWill the winter of 2019/20 have unusually high service demand? Part 2: StrategyRodney P Jones13 December 2019 | Journal of Paramedic Practice, Vol. 11, No. 12Will the winter of 2019/2020 have unusually high service demand? Part 1: LessonsRodney P Jones5 November 2019 | Journal of Paramedic Practice, Vol. 11, No. 11End-of-life demand is highly volatile and shows unexpected trendsRodney P Jones13 March 2019 | Journal of Paramedic Practice, Vol. 11, No. 3Ignorance isn't bliss: behind the unequal distribution of end-of-life demand and costRodney P Jones4 February 2019 | Journal of Paramedic Practice, Vol. 11, No. 2 2 January 2019Volume 11Issue 1ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 12 January 2019 Published in print 2 January 2019 Information© MA Healthcare LimitedPDF download

Understanding Complaints about Paramedics: A Qualitative Exploration in a Uk Context

Introduction This research set out to understand the context and explore the reasons for the disproportionate number of complaints raised against paramedics to the United Kingdom professional regulator – the Health and Care Professions Council – relative to other health professions. Methods This paper reports on qualitative findings from one aspect of a mixed-methods study which included a case analysis, Delphi study and literature review. One-to-one semi-structured interviews conducted with 15 stakeholders drawn from practitioners, educators, representatives and regulators, and three focus groups held with 16 practitioners and service users were used to gain an in-depth understanding of the possible reasons for complaints about paramedic practice. Results Five themes were generated from a thematic analysis of the data: the impact of public perceptions and expectations; the challenges of day-to-day practice; the effect of increasingly pressurised services; the organisational and cultural climate which impacts paramedics’ work; and the evolving nature of the profession. Conclusion This study highlights the complex and changing nature of paramedic practice. It provides an insight into the ways in which the character, practice and environment of the profession contribute to a disproportionate number of complaints.

Evaluating the Knowledge and Practices of Nurses and Paramedics in Blood Transfusion Services - A survey in the states of Tamil Nadu and Pondicherry, India.

BACKGROUND:Blood transfusion service is an important part of our healthcare system whose aim is to provide safe, effective blood components for the patient's requirement. The laboratory technicians and nurses working in the blood bank form the core for the effective functioning of blood bank. The study was to analyze the knowledge, attitude, and practice of nurses and paramedics such as laboratory technicians working in blood banks and whether intervention of a training program had any benefit to the participants.MATERIALS AND METHODS:This study was conducted in our department which is a regional training center approved by the National AIDS Control Organization for training medical officers, laboratory technicians, and staff nurses working in blood banks. There were a total number of 48 government run hospital blood banks who participated in the study and we conducted six training programs for 43 nurses and 64 laboratory technicians working in blood banks from the southern states of Tamil Nadu and Pondicherry in India. The training program was for 5 days for technicians and 3 days for nurses with theory sessions followed by hands on practical classes regarding the daily activities in blood bank. They were given a pre-evaluation questionnaire to test their knowledge, attitude, and practice followed by a post evaluation questionnaire after conducting the training program.RESULTS:The mean percentage score in the pre evaluation test before the training program for nurses and technicians was 47% and 53% while after the training program; the mean percentage was 66.8% and 77% which was statistically significant in both the groups. The correct blood bank practices followed by nurses and laboratory technicians overall were 67% and 75%, respectively. The technicians and nurses scored poorly in blood bank practices related to hemovigilance.DISCUSSIONS:Regular and standardized training can lead to improvements in the knowledge, skills, and practice of nurses and paramedics who provide blood transfusion services. The constraints faced by the nurses and paramedical personnel needs to be addressed for the overall betterment of blood transfusion services.CONCLUSIONS:The increase in the knowledge subsequently contributed to a better practice in the technicians. The concept of haemovigilance and error reporting has to be stressed on the nurses and paramedics to improve their good practices.

Australasian Paramedic Clinical Practice Guidelines for Managing Cardiac Arrest: An Appraisal

Introduction There are 10 government-regulated ambulance services (paramedic provider services) in Australasia who are members of the Council of Ambulance Authorities (CAA). These CAA-member services each produce clinical practice guidelines (CPGs), which guide the practice of their paramedics. Common to each set of CAA-member CPG is a guideline that addresses cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia (pulseless VT/VF). This study sought to answer the question: ‘Are current CAA-member CPGs developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices, can be recommended for clinical use?’ Methods This question was addressed by performing a comparison of existing CAA-member CPGs for pulseless VT/VF against the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. All CPGs were anonymised and sent to each appraiser along with the AGREE II appraisal sheet. Appraisals were conducted independently for each CPG and returned to the lead author for collation. The anonymised results were then shared among all appraisers for consideration and discussion. Appraisers were free to change their appraisal after considering the comments from the other appraisers, and results were then converted into a final percent score for each CPG in accord with the recommended AGREE II instrument methodology. One appraisal question, in addition to the AGREE II criteria was added to each appraisal; the response to this was analysed separately. Results Nine CPGs were evaluated according to the AGREE II instrument. The appraisers gave passing marks to only two of the six domains in the AGREE II instrument: Domain 1 – Scope and Purpose (73%), and Domain 4 – Clarity of Presentation (74%). Less than passing marks were awarded for Domain 2 – Stakeholder Involvement (27%). Scores of less than 10% were awarded for Domain 5 – Applicability (8%) and Editorial Independence (1%). Conclusion Based on the findings of this paper, the authors conclude that it cannot be assumed that current CAA-member paramedic CPGs are developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices can be recommended for clinical use. However, most of the authors agree that the CPGs reviewed could be recommended for clinical use with relatively minor modifications. It would be useful to determine whether end users of the CAA-member CPGs agree on the importance of characteristics of CPGs that the AGREE II instrument appraises.

The impact of paramedic shift work on the family system: a literature review.

Aims:More paramedics than ever are taking time off or leaving the ambulance service through stress; career decisions could be greatly influenced by the perceived impact of shift work on families. Through three key themes of physical injury, emotional labour and work–family fit, this review explores how paramedic shift work impacts the family system and how this could influence retention and recruitment of staff.Methods:A systematic literature search was conducted using key terms and Boolean operators, and strict inclusion and exclusion criteria. Twenty-two papers were deemed to be relevant. These were critiqued using a framework addressing both quantitative and qualitative research for the novice researcher in healthcare. In turn each theme was reviewed and discussed.Results:Due to the variety of roles required of a paramedic combined with the unpredictable environments in which they work, paramedics are at high risk of sustaining a work-related injury. Families raise concerns about paramedics’ safety at work, and the financial and psychological implications of sustaining an injury concern paramedics themselves. Additionally, links have been found between paramedic shift length and risk of occupational injury.Paramedics rely heavily on families for emotional support owing to the nature of incidents attended at work. The male coping culture ingrained into paramedic practice deters this at work. As family members are often uneducated in emotional processing techniques, this puts them at risk of vicarious trauma. Additionally, techniques employed by paramedics to cope with emotional distress are carried into the home environment to its detriment.Several shift characteristics (length, pattern, weekend work, high weekly work hours, inflexible schedules and low job satisfaction) contribute to work–family conflict, relationship problems, child rearing conflict and difficulties in maintaining a social life.Conclusion:Changes are required in the organisational culture, from one which denigrates staff for reporting injuries, for showing emotions and for struggling to balance their home life with work, to one which improves paramedics’ experience at work and therefore their home life too. Investment in education programmes for families on how to enable emotional processing and the risks this carries will improve the picture for families. Flexible work arrangement is an area of organisational reform that could greatly improve job satisfaction, staff retention and recruitment, and ultimately improve family life.Further research into the areas of paramedic shift work that impact the home system, especially in the UK, is needed to better understand some of the issues with staff retention and recruitment.

Identifying barriers to the administration of pre-hospital analgesia to adult trauma patients by UK paramedics: a qualitative interview study.

Aims:The early delivery of effective analgesia is considered to be an important component of pre-hospital trauma care; however, the provision of analgesia by pre-hospital clinicians is often inadequate. While a number of studies have explored the underpinning attitudes and barriers to the paramedic administration of analgesia in various patient groups, specific barriers which prevent the paramedic administration of pre-hospital analgesia to adult trauma patients in the UK are poorly defined. The aim of this small study was to identify and define potential barriers to analgesia administration in this specific population. In doing so, this study will increase awareness and will form an important basis for future work aimed at improving the delivery of pre-hospital analgesia to adult trauma patients in the UK.Methods:Twenty paramedics employed in an urban ambulance service in the UK volunteered to participate and were recruited into this study. Semi-structured interviews were conducted with participants during 2018 in order to explore the potential barriers to analgesia administration. An inductive thematic analysis was undertaken on interview transcripts and potential barriers were defined from the themes identified, by reviewing the coded data within each theme.Results:All of the participants completed the study which identified 12 potential barriers to the paramedic administration of pre-hospital analgesia to adult trauma patients. These barriers were diverse in nature and related to factors including the patient presentation, paramedics’ perceptions of pain, the cautious use of analgesics, paramedics’ scope of practice, organisational procedures and clinical guidelines, as well as factors relevant specifically to the pre-hospital environment. Some of these barriers may be modifiable through improved paramedic education and training or by widening of the paramedic scope of practice, whereas others may not be modifiable.There were a number of limitations to this study including the use of volunteer self-selection which may present a source of self-selection bias, the recruitment of paramedics from a single system which reduces the generalisability of the results and the absence of a second researcher.Conclusion:The identification of these potential barriers should form a basis for future work aimed at improving the paramedic delivery of pre-hospital analgesia to adult trauma patients. While many of the barriers identified may be present across pre-hospital care systems, some may be specific to the system in which this study was undertaken, to other urban systems or to paramedic practice in the UK.

Improving Simulation Debriefing in Paramedic Education: The Paramedic Debrief Model

Introduction Simulation training is widely used in paramedic education. Quality of debriefing is central to optimising learning from educator-facilitated simulation training. There is considerable variation in the provision of simulation debriefs by paramedic educators, often leading to a varied perception of the quality of debrief by both students and tutors. There are currently no standardised debrief tools specific to paramedic practice. The purpose of this study was to provide a rationale and theoretical framework for the development of a paramedic specific model for simulation debrief, the Paramedic Debrief Model (PDM), that reflects the key elements of optimal debrief practice, feedback and reflective learning principles and that is aligned to a construct of paramedic competencies. Methods A systematic literature review was conducted that focussed on two areas: best practice, principles and models for simulation debrief and constructs for paramedic competencies. Emergent theme analysis was used to identify key components of effective simulation debrief and a construct of paramedic competencies that could be incorporated into the debriefing tool. Results It was identified that an optimal simulation debrief transitions sequentially through the elements of reaction, recollection, reflection, analysis and application. The construct of paramedic competencies best aligned with paramedic education consist of eight elements: communication, resource utilisation, ethics, situational awareness, decision making, patient assessment, history gathering and procedural skills. These themes were combined to create the PDM. Conclusion The study identified the key elements of an optimal simulation debrief and incorporated a construct of paramedic competencies to create the PDM. The PDM offers an evidence-based, structured approach to paramedic simulation debriefing and has potential to be utilised as an optimal strategy for facilitating simulation debriefs in paramedic education.

Paramedics' perceptions of their scope of practice in caring for patients with non-medical emergency-related mental health and/or alcohol and other drug problems: A qualitative study.

BackgroundParamedics are called on frequently to provide care to patients with mental health and/or and alcohol and other drug (AOD) problems, but may have mixed views about how this fits within their role.AimsTo explore paramedics’ experience of caring for patients with non-medical emergency-related mental health and/or AOD problems, understand their perceptions of their scope of practice in caring for these patients, and ascertain if their practice should be extended to incorporate education with these patients.MethodA convenience sample of 73 paramedics from most Australian states and territories—recruited through an online survey—participated in individual audio-recorded, qualitative interviews, conducted by telephone. The interviews were part of a mixed method study comprising qualitative interviews and online survey. A Framework Method of analysis to analyse the qualitative data.ResultsThree themes and sub-themes were abstracted from the data about participants’ experiences and, at times, opposing viewpoints about caring for patients with non-medical emergency-related mental health and/or AOD problems: caring for these patients is a routine part of paramedics’ work, contrasting perspectives about scope of practice in caring for this group of patients, competing perspectives about extending scope of practice to incorporate education with this cohort of patients.ConclusionsParamedics need more undergraduate and in-service education about the care of patients with mental health and/or AOD problems, and to address concerns about extending their scope of practice to include education with these patients. Thought should be given to introducing alternative models of paramedic practice, such as community paramedicine, with a focus on supporting people in the community with mental health and/or AOD problems. There is a need for a change in workplace and organisational culture about scope of practice in caring for patients with these problems. Extending paramedics’ role could, potentially, benefit people with these problems by improving the quality of care, reducing the need for transportation to emergency departments, and decreasing clinicians’ workloads in these departments.

Developing transcultural awareness: student perspectives of a placement in Johannesburg South Africa

Elective placements are a relatively new aspect of paramedic practice, with few opportunities for student paramedics to experience this internationally. This article shares reflections from a student's perspective gained from experience of a 3-week elective placement in Johannesburg, South Africa, working on a frontline ambulance and fast response vehicle. It explores international differences in paramedic practice, reviews two case studies and discusses the importance of scene management and how diagnostic overshadowing can influence care. Furthermore, the different scope of practice and approach to health care in South Africa as compared with the UK where the author is based is investigated, depicting how cultural differences can affect not only the treatment available, but also the impact on patient morbidity and mortality. A transcultural awareness of prehospital practice is beneficial for gaining new perspectives on the management of unique patients and varied situations in the prehospital setting, allowing for the ongoing development of future paramedic practice.

Internationalising paramedic practice

Internationalising paramedic practice