Student Paramedics Research Articles

Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?

Objective. Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration. Design. A randomized control trial examining the ability of rescuers to draw up drugs from four different drug presentations (a Minijet prefilled syringe, an Aurum prefilled syringe, and glass and plastic ampoules with needle and syringe) was undertaken with participants wearing and not wearing the National Health Service (NHS) CBRN-PPE. Each participant underwent the procedure once in “normal clothes” and twice while wearing the CBRN-PPE. The speed and accuracy of each participant were measured as well as the participant's perceived risk of suit damage associated with the four different drug presentations. Participants. The participants constituted a non-homogenous group of emergency nurses, nurse lecturers, paramedic lecturers, and student paramedics. A total of 81 participants were recruited; one participant withdrew due to claustrophobia. All participants had used all four drug preparations prior to being enrolled into the study. Results. Wearing the CBRN-PPE had a negative effect on drawing up drugs in the first attempt while wearing the CBRN-PPE, typically taking 63.8% longer time than without (95% confidence interval: 55.3–72.9%). Improvements were noted on second attempts. The choice of drug presentation had an effect on the time taken to draw up the drugs, with Aurum being overall the fastest and glass ampoules the slowest (p-values < 0.001). All participants rated the prefilled syringes as the easiest and the safest to use, and the glass ampoules with needles and syringes as the most difficult to use and the ones most likely to puncture the CBRN-PPE. During the drawing-up process, varying amounts of “drug” were lost, although in two-thirds of the attempts all 10 mL was drawn up. The lowest volume was lost from the prefilled syringes and the maximum volume of fluid was lost from the glass ampoules. Conclusions. The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.

Becoming a reflective practitioner: frameworks for the prehospital professional

The concept of reflective practice within healthcare is not new. Reflection is a process which enhances learning and knowledge acquisition and is popular among health professionals. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Reflective practice is undertaken for a variety of reasons including self-development, and as a means of demonstrating accountability to the Health Professions Council (HPC). The HPC recognize reflective practice as one option that will contribute towards satisfying continuous professional development requirements for the paramedic. This article discusses origins of reflection and critical inquiry, drawing upon the work of influential characters who have allowed the reflective paradigm to become what it is today. It further discusses reflective practice, critiquing three popular models and in addition, identifies alternative models of reflection specifically designed to be used by those who work within the prehospital care setting.

A Training Program for Novice Paramedics Provides Initial Laryngeal Mask Airway Insertion Skill and Improves Skill Retention at 6 Months

Major resuscitation councils endorse the use of the laryngeal mask airway (LMA) by paramedics for lifesaving airway interventions. Learning and maintaining adequate skill level is important for patient safety. The aim of this project was to develop a training program that provides student paramedics with initial knowledge and experience in LMA insertion skills but equally important to provide ongoing skill retention. After ethics approval and informed consent, 55 first year Paramedic degree students watched a manufacturer's LMA instruction video and practiced insertion in three different part task trainers. Six months later, subjects were randomized to an intervention (reviewing the video and 10 minutes unsupervised practice) or control group before participating in a high-fidelity simulated clinical scenario. For equity of training, the control group received the intervention after the scenario. Main outcomes measured were time to insertion; success rate; and LMA skill retention (sum of LMA orientation; cuff inflation; bite block; securing; patient positioning; and overall subject performance). Fifty subjects completed the study. Those in the intervention group displayed significantly shorter insertion times (P = 0.029), fewer attempts to achieve success (P = 0.033), and had significantly higher LMA skill performance levels (P = 0.019) at 6 months. We devised a short intervention based on our training program using a video and practice in part task trainers. In an assessment using high-fidelity simulation, we demonstrated significant improvements in maintenance of LMA insertion skills in student paramedics at 6 months. Our model of just-in-time assessment and reinforcement of training prevents skill decay and has implications for healthcare skills training in general.

The role of the paramedic in health promotion

‘The role of the paramedic in health education’, is a subject area identified in the College of Paramedics Paramedic Curriculum Guidance and Competence Framework (College of Paramedics, 2007). There is no specific guidance on the content or context of this particular subject; therefore student paramedics and paramedic lecturers have interpreted this and linked it to health topics seen as relevant to young people. It is known that people can die for want of first-aid and that many people do not know how to perform first-aid. Two innovative 1-hour workshops have been designed for delivery to secondary school children in which the topic of emergency first-aid is linked with knife crime and drug and alcohol abuse. This article describes the rationale and design of the programme and reports on its initial feedback. It is a programme that shows great promise, but will require further evaluation before it can be rolled-out further.

Surveys of Cultural Competency in Health Professional Education: A Literature Review

A literature review, in advance of designing a survey of cultural competency in Australian and New Zealand paramedic education courses, provides the focus of this paper. The review sought to explore the extent to which other health professions include cultural competency in their undergraduate curriculum. The literature review identified specific research papers that used survey methods to determine the status of cultural competency training in other health professions. With no paramedic specific information available to inform paramedic education, these research papers formed a basis for designing a survey that would examine the extent to which paramedic education includes cultural competency in its curricula. This paper is timely for informing paramedic education about surveys on cultural competency in health professional education. It is particularly timely for the paramedic profession, which is currently in transition from a vocationally based occupation to a professionally based discipline within a university setting; and, at a time when a small number of student paramedics are opting to take advantage of an Honours degree. Similarly, experienced paramedics are undertaking Masters and Doctoral research programs in prehospital and paramedic related issues. Such opportunities enable paramedics to extend their career prospects into academic research, an opportunity that was previously untenable. The process of reviewing the literature to develop a paramedic specific survey provides useful information for paramedics who may want to undertake similar research projects to examine other aspects of the curriculum. This paper, therefore, contributes to both developing an appreciation of the complex issues which arise from this process, and establishes an evidence base foundation for the paramedic discipline as it emerges within an academic and research orientated environment. The lessons learned in reviewing surveys might be useful for other health professions and emergency service researchers.

Airtraq vs standard laryngoscopy by student paramedics and experienced prehospital laryngoscopists managing a model of difficult intubation*

Two consecutive, randomised, cross-over trials compared intubation success rates in third-year paramedic students and experienced prehospital practitioners using the Airtraq or a Macintosh laryngoscope with flexible stylet in a manikin model of a Cormack and Lehane grade III/IV laryngoscopic view. First-time intubation rates for the Macintosh and Airtraq for students were 0/23 (0%) vs 10/23 (44%) (44% difference, 95% CI 26-63%, p < 0.001) and for experienced laryngoscopists were 14/56 (25%) vs 47/56 (84%) (59% difference, 95% CI 42-72%, p < 0.0001), respectively. First-time oesophageal intubation rates for students were 15/23 (65%) vs 3/23 (13%) (-52% difference, 95% CI -25 to -72%, p < 0.001) and for experienced practitioners 9/56 (16%) vs 0/56 (0%) (-16% difference, 95% CI -9 to -28%, p = 0.0014). Student paramedics and experienced prehospital laryngoscopists managing a manikin model of a grade III/IV view had increased first-time intubation rates and had lower rates of oesophageal intubation with the Airtraq compared with a standard laryngoscope.

Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics

This exploratory study contrasted and tested the predictive value of the reverse buffering hypothesis of social support and the information processing model of posttraumatic stress disorder (PTSD) in an investigation of trauma-related symptomatology (TRS) in a single sample of 42 student paramedics. Participants completed several anonymous self-report measures of PTSD symptomatology, peer social support, and attitude toward emotional expression. Regression-based path analyses did not support either theory of PTSD in this population. A path model of PTSD in student paramedics was subsequently developed, indicating that a direct relationship exists between duty-related trauma exposure, dysfunctional peer social support, and students' negative attitudes toward emotional expression. This new model accounted for 30% of the variance in student paramedics' TRS.