Irish Journal of Paramedicine
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Interprofessional Role of Cadaver Laboratory Experience in Paramedic Education at Creighton University
Full text linkThis brief report introduces and provides a reflection on the interprofessional role of an annual cadaver laboratory experience in the paramedic program at Creighton University, United States. Similar experiences in paramedic education have been noted to be beneficial in increasing paramedic student’s knowledge of anatomy and ability to perform procedures. Learners that participated in this report and reflection reported gains in their education and appreciation of other professions that support previous research on the topic and the value of this distinct experience.
Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?
Full text linkBackgroundDementia is a disease affecting 55,000 Irish people. (1) It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent. These people are at risk of having their pain underassessed and undermanaged. (2) A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed. Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.IntroductionAdults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3) It is estimated between 40% and 80% of dementia patients regularly experience pain. (4) Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients >8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants. There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.ObjectiveThis research aimed to identify observational pain assessment tools used in this cohort. The most consistently recommended tools were identified. The suitability of these tools for use in the pre-hospital setting assessed.FindingsLiterature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting. The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language. These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:Abbey Pain Scale6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)Doloplus 215 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)PAINAD5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6) ConclusionThe ability to self report pain is deemed “gold standard”. Patients with mild to moderate disease, and indeed, some with severe disease, may retain the ability to self report. An observational tool is required when dementia has progressed to the point where the patient becomes unable to self report or becomes non-verbal. It is in these patients where undetected, misinterpreted or inaccurate assessment of pain becomes frequent. (7) The aim of any tool is to gain a good assessment of pain, however, the pain scale used should be suitable to the clinical setting. The feasibility of an assessment tool is an important factor along with reliability and validity. No one assessment tool could be recommended over another. Abbey and PAINAD have potential for use pre-hospital, however, further research, clinical evaluation and trial in an ambulance service is required
Moving towards the next level...
Full text linkSince the turn of the century, significant progressive changes have taken place in the provision of prehospital emergency care in Ireland. Few would have dared to imagine the scale of advancement both in terms of education and scope of practice that has taken place since the bells tolled to herald the arrival of the new millennium. Academically, paramedics in Ireland who for over 20 years have been qualified at diploma level now have the opportunity to qualify with an honours bachelor of science degree, and the possibility of progression to masters and doctoral degrees should they feel so inclined. From a clinical perspective, the Advanced Life Support service that is available nationwide today has evolved from an emergency service provided by EMTs just a few short years ago.In order to make the step up to the next level in our development as a bona fide recognised profession, it is essential that we embark on the journey of the development of our own body of knowledge in relation to our education, our practice and our profession as a whole. This editorial will explore some issues related to this
EMS Gathering 2018 & Irish College of Paramedics Scientific Symposium 2018 Abstract Supplement
No full textAbstracts for oral and poster presentations at the EMS Gathering 2018 held in Cork, Ireland on 11th-13th September and the Irish College of Paramedics Scientific Symposium 2018 held in Cork, Ireland on 15th September 2018
Thermal variations in the patient compartment of an emergency ambulance: A feasibility study in an Irish context.
Full text linkBackgroundThe unpredictability of the nature of the next call is a basic feature of Emergency Services; the call could vary from a trauma victim, to a hypothermic patient or a prehospital birth. All patients (other than those who are pyrexic) have in common the need for a warm environment to prevent deterioration in their condition. Multiple observation studies found that patients suffering from various levels of trauma, arrived in the Emergency Department with hypothermia. Hypothermia, a core temperature <35°C, affects multiple organ systems, and is associated with poor outcomes including death. Also, cold has been reported as negatively impacting the comfort of an ill or injured patient. It is currently assumed that the ambulance patient compartment’s heater (Air Top Evo 40, Webasto™, Gilching, Germany), produces enough heat to offer thermal comfort and to help prevent further decrease of body temperature in the hypothermic patient. However, what is not clear is for how long and to what ambient temperature the ambulance’s patient compartment needs to be heated, to provide the ambulance’s furniture with sufficient stored energy to maintain the patient at an appropriate temperature for the duration of their transport to hospital. We consider how current practices and behaviours may need to be adapted to improve patient comfort and outcomes.ObjectivesThis study is to determine the feasibility of measuring and monitoring temperatures in a new generation Emergency Ambulance. The overarching objective, is to optimise patient comfort, outcome and prevention of hypothermia.MethodsUsing thermocouples, a data logger and a thermal camera to record temperatures at strategic locations in the patient compartment, we recorded the variation of temperature in a typical new generation Emergency Ambulance compliant with the CEN - EN 1789:2007 standard. Thermal imaging and temperature logging studies were conducted on in May/July 2018. Temperature was logged for 24 hours. The locations examined were the stretcher mattress surface, low and high blanket storage lockers and the outdoor ambient air. The vehicle was located outdoor, facing west-north-west.Anticipated outcomeThis study will provide us with data that can be used to improve patients’ thermal comfort through behaviour and practice change.ResultsThe thermal camera images show a significant variation of surface temperature throughout the patient compartment. Preliminary temperature logging experiments show a measurable difference in temperatures at the areas of interest relative to the outside temperature over 24 hours. Some variations in rates of cooling and warming in each area have been observed during the cool – heat period; the stretcher mattress is the slowest to rewarm.ConclusionThe proposed method of measuring temperature variation in targeted locations in the patient compartment of a new generation ambulance proves efficient and could be used in further studies
Even better than the real thing? Using video assisted structured reflection in Simulated Clinical Scenarios and Real-Life Clinical Experiences in the Flipped Classroom.
Full text linkBackgroundThis paper explores the attitudes of practitioners to the use of video assisted structured reflection in simulated clinical scenarios and real-life clinical experiences in the context of a Flipped Classroomto encourage and support reflection and reflective practice among pre-hospital emergency care practitioners in Ireland. It also examines the experiences of practitioners who participated in this process.MethodologiesThis paper is part of a larger project which consisted of tree cycles of action research. Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with various stake-holders. These included all three clinical levels of pre-hospital emergency care practitioners and educators from emergency service providers, private ambulance services, and voluntary organisations.FindingsWhen combined, a simulation experience with audio-visual recording and a structured model of reflection in the context of a Flipped Classroom has become a powerful learning experience. The process of a simulation experience with audio-visual recording, and a structured model of reflection appears to dovetail very nicely with the concept of the Flipped Classroom. The review of footage from audio-visual recording in the real-life clinical context provides a reliable and accurate means of evaluating clinical performance. Concerns were raised about the potential for abuse and misuse of audio-visual recordings. There are perceptions that audio-visual footage of real-life clinical experiences could potentially be used for unintended purposes such as, disciplinary procedures.RecommendationsSince the process of combining a simulation experience with audio-visual recording and a structured model of reflection in the context of a Flipped Classroom has shown great promise as a learning experience, a larger scale pilot study is proposed. Develop a pilot programme with student practitioners during their undergraduate internship, and evaluate its findings. Develop a policy which clearly defines the use of audio-visual recording footage prior to the commencement of the pilot programme. A Learning Contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of the process
Pit Crew Approach to Pre Hospital Trauma Resuscitation
Full text linkIntroductionPre hospital trauma care is often delivered by dual crewed ambulances supported by additional resources as necessary and available. Coordinating resuscitation of a critically injured patient may require multiple simultaneous actions. Equally, a large number of practitioners can hinder patient care if not coordinated.AimsTo describe a multi disciplinary, scaleabe approach to pre hospital trauma care suitable for small and large multi disciplinary teams. Methods The MCI medical team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team, which provides medical cover at Motorcycle road racing events in Ireland. The MCI medical team has significant experience of major trauma and routinely performs prehospital anaesthesia for trauma patients. We have evolved a pit crew approach to trauma care with pre defined roles and interventions assigned to a five person team, three clinical members, a scribe and a team lead. The approach is both scalable and collapsible, meaning that if multiple patients are present, roles can be merged; if additional clinical input is required, roles can also be supplemented. Each team member carries equipment and medications specific to their role, allowing efficiencies at the patients side.ResultsThe pit crew approach to pre hospital trauma care has evolved over a decade and is routinely implemented at motorcycle road races in Ireland.ConclusionsThe pit crew trauma approach, although applicable to a pre defined five person team in unique circumstances, may also be applicable to ad hoc clinical teams that typically form in the pre hospital arena
Fit for duty: The health status of New South Wales Paramedics
Full text linkIntroductionParamedics are health care workers who respond to medical emergencies. Paramedics exhibit high rates of injury and illness with markers of poor health. The aims of this study were to explore the self-reported health status of paramedics in New South Wales, Australia, and to compare it with that of the Australian general population and to examine paramedics’ attitudes towards exercise.MethodsIn 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey composed of the Medical Outcomes Survey Short Form 36 (SF-36), measures of attitudes towards exercise and demographic information. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.ResultsOf the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female). Mean age and mean years of service were 41.5 ± 9.5 (SD) and 13.6 ± 9.0 respectively. Male paramedics scored higher than females (p<0.001) in the Vitality domain of the SF-36, and regional paramedics had a higher General Health domain score than metropolitan paramedics (p<0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m2 ± 3.99 vs. 26.81 kg/m2 ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p<0.001) but lower in summary scores for mental and physical health (p<0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m2 vs. 26.47 ±5.42, p<0.001). Paramedics reported lack of time, family commitments, and lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.ConclusionsParamedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life. High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that paramedics are “fit for duty”. Ambulance management should foster innovative health promotion programs and paramedics need to recognise and value good health
Physical fitness of paramedic students during vocational training - a follow-up study
Full text linkIntroduction: Paramedics’ work includes periods of physically light activity, but also involves short periods of relatively intense physical activity. Even during their studies paramedic students’ days involve a lot of sitting, i.e. physically sedentary behaviour. We initiated a programme to motivate paramedic students to be physically active during their studies. In this study we report physical fitness among paramedic students who for one year participated in brief physical activity counselling consisting of both verbal and a written individually tailored exercise programMethods: A total of 40 paramedic students (26 female, 14 male) had participated voluntarily in a physical activity programme alongside their studies. Subjects’ maximal oxygen consumption and muscle strength were measured at baseline and at one-year follow-up. According to the results of the baseline tests all students were given an individual exercise programme, which included aerobic and muscle strength training.Results: Sixty-five percent (26/40) of the students participated in the follow-up examinations. At baseline male students had higher mean maximal oxygen consumption (VO2Max) and, as expected, greater absolute muscle strength than their female counterparts (all p-values <0.05). During the follow-up females had improved their VO2Max on average by 2.4 ml/kg/min. Furthermore, females on average improved the number of squats by 4.2 [95% Confidence Interval (CI) 0.01 to 8.33] repetitions, and males improved the number of push-ups (mean improvement 4.8, 95% CI 1.93 to 7.57), and left arm grip strength (mean improvement 4.0 kg, 95% CI 1.39 to 6.53).Conclusions: It seems to be possible to maintain, and even slightly improve paramedic students’ physical fitness with a self-directed, guided, home exercise programme. This approach could enhance prospective paramedics’ willingness to develop the necessary physical qualities long-term throughout their clinical careers.
General Practitioners, Paramedics and the Primary Care Team; the Potential for Mutual Benefit
Full text linkBackgroundGeneral practice is entering a challenging phase. Increased workload and complexity with an increasing consultation rate is coming about as a result of an ageing population, extension of care that is free at the point of delivery to more people, and the trend to move routine care of chronic illness from secondary care to primary care[1]. This is all coming about at a time when the GP population is ageing and doctors graduating from GP training are choosing to emigrate or work part time[2].It will be difficult to continue this work without changes to current practice. In the past nurses have been employed by GPs to help deliver care [3], however there is a shortage of nurses that challenges this model. It has been suggested that the unique skillset of Paramedics would complement those of GPs [4]. Various models of paramedics working primarily in primary care have been described. This practice of paramedics working with and under the guidance of GPs would be expected to have the benefit of keeping patients out of hospital and managed in the community . The skillsets of paramedics would be kept up by appropriate deployment in the community, especially in quieter country areas where their presence is necessary geographically for emergencies, but they do not get to practice their skills at an optimum rate. Barriers exist to such deployment but can be overcome resulting in a well-functioning PCT with good levels of interprofessional collaboration and generally positive effects [5]. Paramedics have shown a willingness to be engaged in such work [6].Proposed methodologyQuestionnaire survey of GPs associated with the UL GEMS (ULEARN) based on what skills they would use that would be shared by paramedics. Attitudinal study of GPs and paramedics on their attitudes towards this novel way of practice.Anticipated outcomesGPs and paramedics have shown flexibility in the past. Literature review indicates that this is ongoing. It is anticipated that this would mean that respondents would attitudinally favour this move to make paramedic practitioners an integral part of the primary care team