Irish Journal of Paramedicine
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Thoughts, Ethics and Actions in EMS photography
Full text link“Photography can only represent the present. Once photographed, the subject becomes part of the past.” Berenice Abbott (July 17, 1898 – December 9, 1991). To me photography is about capturing a moment, a single moment in time, a single image. Most of us these days are amateur photographers with our camera phones. A picture tells a thousand words they say. A bride on her wedding day, a child killed by a bombing, a beautiful mountain range, a riot, boats , hurricanes...anything you take a photo of is a moment in time, a split second… then it is history.So what role does photography have in Emergency Medical Services (EMS)? It's about education, history, promoting, documenting, recording. Looking back on old photographs we can see how far we have come in terms of equipment, personnel, and training. Without the photos we would have no reference point. It’s a sobering thought that the photos we take today in good faith may in fact be the warnings of tomorrow. Who doesn’t love to look back at photographs when they first started in EMS? Looking to pick out who is still in the job, who has lost the most hair and maybe who has passed away. Sitting around a table, having a cup of coffee with your colleagues, talking about a call you just did, maybe a bad call, someone breaks the tension; “Time for a photo?” Most will smile and join in, some will refuse - each to their own, but a time will come when you look back on these photos remembering not only the bad call but also remembering who had your back that day.Formal EMS events provide a means to mingle and connect and a chance for a photographer to capture a moment in time, the atmosphere, the faces, the colour, the pomp. But in fact, this is also recording history of the EMS staff at that moment in time.Of course there is a graphic side to EMS photography. Photographers will be held to account to portray individuals and scenes with the utmost respect to the patient and their families.(1) Passers-by can be opportunistic and sometimes thoughtless at crisis scenes.(2) So we ask...is it okay to photograph a person in their last few minutes? Graphic photos taken by EMS personnel can be used as a training tool, a reference point and a visual aid when you get to the emergency department. Like a T- boned car, a bullseye impact in the windscreen… a picture tells a thousand words. But where is the line drawn…or is there a difference?The National Press Photographers Association (NPPA) Code of Ethics Summary guide expresses this nicely as: “Photographic and video images can reveal great truths, expose wrongdoing and neglect, inspire hope and understanding and connect people around the globe through the language of visual understanding. Photographs can also cause great harm if they are callously intrusive or are manipulated”.(3
Empathy Levels in Canadian Paramedic Students: A Longitudinal Study
Full text linkBackgroundEmpathy in healthcare delivery is an essential component to providing high-quality patient care. Empathy in paramedics and paramedic students has been subject to limited study to date. This study aimed to determine the empathy levels demonstrated by first year paramedic students over the course of their first year of study.MethodsThis study employed a longitudinal design of a convenience sample of first year paramedic students in a community college program in Ontario, Canada. The Medical Condition Regard Scale (MCRS) was used to measure empathy levels across four medical conditions: intellectual disability, suicide attempt, substance abuse and mental health emergency. Surveys were conducted three times approximately 2-3 months apart; before first semester field placements (Nov/17), after first semester field placements (Jan/18) and near the end of second semester field placements (Mar/18).ResultsA total of 20 students completed all three surveys. Females, respondents aged 22-24, and participants with previous post-secondary education demonstrated higher mean empathy scores than their counterparts. Substance abuse was associated with the lowest mean empathy score for every demographic. Mean scores for intellectual disability, attempted suicide and mental health emergency decreased from the first survey to the last. Mean scores for substance abuse increased from 43.3 (SD±8.2) to 46.45 (SD±7.04).ConclusionResults from this study suggest that in general, empathy levels among paramedic students decline over the course of their education. Male paramedic students are less empathetic than their female counterparts, and those with previous post-secondary education displayed higher mean empathy scores. The findings in this research support previous findings, and suggest that paramedic education programs may benefit from the inclusion of additional empathy training and education.
Refusal to travel in the National Ambulance Service: A retrospective examination of calls from 2017.
Full text linkIntroduction When a member of the public calls for an ambulance through the 999/112 system, the only permitted course of action for the responding National Ambulance Service (NAS) staff is to convey the patient to an emergency department. Regardless of the clinical level, NAS staff do not have the authority or scope of practice to discharge the patient from the scene or make any other arrangements for the treatment of that person(1). The patient, meeting certain criteria, can refuse treatment or transport (RTT) of their own volition(1). Mortality rates for non-conveyed patients vary from 0.2%-3.5% within 24hours and are twice those of patients discharged from an emergency department(2, 3). In 2017, the refusal to travel rate in Ireland jumped from 7-8% of calls (2012-2014) to a national average of 11.3% (24,735) of total AS1 calls(4). Although this level of non-conveyance would still be below international norms the rate of increase was concerning(3).Aim.A quality improvement initiative necessitated identification of baseline RTT information.MethodsRetrospective data collection was conducted on all calls closed with a ‘refusal to travel’ or ‘refusal of treatment’ occurring between 1st Jan 2017 and 9th Nov 2017 and was gathered from the National Emergency Operations Centre (NEOC).ResultsThe top three dispatch classification that resulted in RTT were falls, unconsciousness or near fainting, and generally unwell patients. This was followed by chest pain, seizures, traffic incidents and breathing problems. It was noted that the time at which RTT calls occurred peaked nationally between 2000 and 2059. In the Southern area, peak RTT occurred between 2000-2059h and 0000-0100. 33.6% of RTT calls in the Southern Area were designated as Delta calls. This designation requires an advanced life support and a blue light response and is the call level with the second highest acuity below an Echo call, the designation for Cardiac or Respiratory arrest.ConclusionsThe NAS specifically utilises a risk adverse triage system. Examination of dispatch priorities may be warranted. The peak close of RTT calls between 2000-2059 may align with a shift changeover at 2000. Further study is required
Re: Helicopter EMS in Cork: a paramedicine perspective
Full text linkResponse to Knox, S. (2018). Helicopter EMS in Cork: a paramedicine perspective. Irish Journal of Paramedicine, 3(2). doi:http://dx.doi.org/10.32378/ijp.v3i2.113 Dear Editor,I read Dr. Shane Knox’s commentary “Helicopter EMS in Cork” (1) in the current edition of the Journal with interest. Firstly, to be clear, I have the utmost respect for paramedics. The commencement of an EMS helicopter in Cork is a landmark step forward in prehospital care. The ‘Toyota’ reference made in the Knox article is in relation to a misquote published in the Irish Times from a recent RTE Radio interview I gave around the staffing model of a Helicopter EMS (HEMS). The reference I made to Toyota was in fact with respect to the physician-paramedic HEMS model that is the norm in Australia, Northern Ireland, Scotland, England, Wales and mainland Europe. I don’t view a physician-paramedic team as a Rolls-Royce, platinum or gold standard model, but rather more like a Toyota; attainable and highly durable. In August 2015, the College of Paramedics (UK) stated “The College of Paramedics support proposals for a HEMS service in Northern Ireland, with a view that this service should be integrated within a trauma network in Northern Ireland and consist of a specialist pre-hospital Doctor and Paramedic team.” (2) The HEMS in Northern Ireland is now staffed with this model by the Northern Ireland Ambulance Service (NIAS). The Irish government recently endorsed the development of a Trauma System for Ireland. Inherent to any trauma system is enhanced prehospital trauma care capability. Albeit the air ambulance will certainly bring speed, it will not bring enhanced skills without a doctor-paramedic team that will save additional lives, nor will it meet the PHECC dispatch standards for emergency calls by road (dual paramedic). The doctor-paramedic model can provide advanced prehospital critical interventions such as balanced emergency anaesthesia, mechanical ventilation, finger thoracostomy, blood transfusion and eye, life and limb-saving procedures (e.g. lateral canthotomy, resuscitative thoracotomy) as well as enhanced system activation such as prehospital massive transfusion activation and bringing a patient direct to theatre from helipad (code crimson). Recently, Mark Winter, an operations manager of Wales Air Ambulance (doctor-paramedic EMRTS team) said: “One of the things we talk about in our world is ‘unexpected survivors’-those patients who have had emergency front line treatment at the roadside or at the home who otherwise would have to be taken to the hospital, where it might have been too late.” (3) The similar EMRS in Scotland is increasing coverage as I write this to meet the demands of the newly developed Scottish Trauma Network. I’m sure the patient needs are the same in Ireland as they are in Northern Ireland or Great Britain. A doctor-paramedic team extends critical care to life-threatening prehospital and medical emergencies such as STEMI with cardiogenic shock requiring safe intubation and ventilation, central inotropic support or controlled mechanical ventilation and targeted BP control in neurological emergencies (e.g. subarachnoid haemorrhage, stroke with coma). This team responds rapidly to prehospital or hospital tasking and can provide intensive care level stabilisation and support anywhere. Certainly as Knox points out many of the interventions/skills that can be brought to the scene can also be performed by critical care paramedics (e.g. MICA in Victoria). This expertise does not occur overnight and takes years to develop. In my opinion, in Ireland a critical care paramedic model can only develop in the environment of a physician-paramedic team in terms of training, curriculum development and governance. There are excellent Irish advanced paramedics and prehospital specialist doctors in Ireland and abroad who together would make an excellent team that would serve the community and patient needs to the highest level. Now is the time.
Strategies for incorporating patient safety education in paramedic education using the IHI Open School
Full text linkIntroductionEvery year, thousands of patients die and millions are harmed by medical care provision. Paramedics care for patients in dynamic, and challenging environments every day, which creates conditions that are ideal for mistakes to occur and for harm to be caused as a result. Knowledge of patient safety is recognised as a competency for paramedics in several jurisdictions, yet general awareness among paramedics of patient safety issues remains poor. The Institute for Healthcare Improvement (IHI) Open School courses were identified as a potential solution to this identified gap. These courses have been successfully integrated into various health professions education programs in other institutions; however, no literature was discovered which discussed the integration of these courses into paramedic education.MethodsEight online courses from the 13-course IHI Basic Certificate in Quality and Safety were embedded into the curriculum of a professional issues class in a paramedic diploma program in Ontario, Canada. Courses were completed outside of classroom time over one semester, and a percentage of activity marks for the class were awarded to students on the completion of the eight courses. Students provided a copy of certificates to prove completion of training.ResultsIn this pilot program, 41 paramedic students in the class (98%) completed all 13 courses, and were awarded the IHI Basic Certificate in Quality and Safety. Students described the courses as “highly applicable to paramedicine and pre-hospital care”. In addition, students state that completing the certificate gave them knowledge of “the means by which change can be enacted”. The completion of the courses outside of class time was achievable, and feedback from students has been overwhelmingly positive. An additional 43 students are currently enrolled in the courses, with completion expected by December 2018.ConclusionThe IHI Open School courses are an easy to implement strategy for paramedics looking to gain a brief, concise education on quality and patient safety. It is our goal to integrate the IHI Open School Basic Certificate across all classes in the two-year diploma program. We hope this will lay a foundation for professional practice that is based on safe, high-quality care provision
It’s good to talk! Reflective Discussion Forums to support and develop Reflective Practice among Pre-Hospital Emergency Care Practitioners in Ireland.
Full text linkBackgroundSince the mid 1980’s, reflective practice has become formally acknowledged and adopted as a key strategy for learning and has become one of the cornerstones of medical education for doctors, nurses, and many of the allied healthcare professions. In the education of pre-hospital emergency care practitioners in Ireland, it is only in the last decade that the notion of reflective practice has been tentatively approached. Indeed until recently it has largely been ignored by practitioners and educators alike, who have been slow to engage with this new way of learning. This paper explores the attitudes of practitioners to the use of a reflective discussion forum to 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 a collaborative reflective discussion forum.LiteratureThe research was informed by reviewing literature from a number of areas including: Adult Learning, Reflective Practice, Educational Research directly relating to Emergency Medical Services (EMS), and EMS & Nursing Journals and publications.MethodologiesThis paper is part of a larger project which consisted of three cycles of action research. Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with participants in the reflective discussion forum. These included all three clinical levels of pre-hospital emergency care practitioners and the three hierarchical levels within the organisation.FindingsThe collaborative reflective discussion forum was found to be beneficial. Among the benefits cited were, the opportunity to draw on the experience of more experienced colleagues, the development of critical thinking skills, and the potential for use as part of a mentoring process. It was also felt that the collaborative nature of the forum had the potential to improve workplace relationships through the empowerment of the staff. Concerns were raised regarding the potential for abuse and misuse, particularly in relation to the areas of patient confidentiality and a lack of trust within organisations.RecommendationsThe establishment of a regular Reflective Discussion Forum within organisations as a key learning strategy. Any collaborative forum must be chaired by a trusted, experienced and highly skilled facilitator. A learning contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of any collaborative forum
Barriers perceived by volunteer EMTs in Participating in Continuous Professional Development in Ireland.
Full text linkIntroductionFollowing the relaunch in 2016 of mandatory Continuous Professional Competency (CPC) for Emergency Medical Technicians (EMT) by Pre-Hospital Emergency Care Council (PHECC) Ireland, the aim of this research was to explore volunteer EMTs perceived attitudes, barriers and confidence in relation to participating in CPC.MethodsA questionnaire for EMTs was distributed to the four main pre-hospital volunteer organisations and via the PHECC CPC coordinator social media account (Facebook) to gather information on attitudes towards CPC, perceived barriers to participating in CPC, and finally comfort level in completing the didactic aspects of CPC.ResultsIn total 341 eligible responses accounting for 15% of EMT registrants were analysed. 65% believed CPC was necessary for professional development, with 61% reporting it an important part of their practice. 57% believed CPC should be linked with maintaining PHECC registration, showing a decline of 38% against recent Irish research. The unique profile of respondents as volunteers highlights barriers commonly cited in the literature as having a more significant impact on CPC participation, most noteworthy over 80% cited time and access to relevant material/courses as impacting on participation. A 40/60 split between 2nd and 3rd level educational qualifications among respondents highlighted a marked difference in perceived confidence for completing didactic CPC elements among graduates with 2nd level reporting confidence at a third that of the level of 3rd level graduates. Compounding this finding, 52% of respondents reported receiving little or no training in CPC. Additionally, respondents cited restricted or no access to online journal or materials due to poor links via PHECC Registered Training Institutions or representative bodies to academic library access impacting on their ability to complete the didactic element of CPC.RecommendationsIt is recommended that the PHECC 2014 EMT Education and Training Standard be updated to include standardised CPC education for newly qualified EMTs. To fulfil case studies, reflective practice and literature reviews, volunteer EMTs require access to online journals and treatment information beyond the pre-hospital arena, all of which require immediate and viable solutions for successful completion of CPC by EMTs
Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools
Full text linkIntroduction: Frailty is recognised as a significant variable in the health of older adults. Early identification by paramedics of those at risk of frailty may assist in timely entry to an appropriate clinical care pathway. Early referral to such pathways has been shown to improve patient outcomes and quality of life, as well as deliver economic benefits. To date, little research has been completed regarding assessment of frailty by paramedic professionals using validated assessment tools. The objective of this study was to determine paramedicine students’ perceptions of screening tools to facilitate assessment and knowledge of frailty of older adults. The Edmonton Frail Scale (EFS) and the Groningen Frailty Index (GFI) were determined suitable for this purpose.Methods: The research adopted a mixed methods approach using a survey tool developed to gather both qualitative and quantitative data from students at the completion of a structured aged care clinical placement. Thematic analysis of the qualitative data identified key features of the tools, while a Likert-type scale was used to measure perspectives about the suitability of the tools for use in paramedic practice.Results: Thirty-seven paramedicine students were invited to participate in the study. Thirteen were able to use both tools to conduct frailty assessments and submitted survey responses. Student perspectives indicated both the EFS and GFI are potentially suitable for paramedicine and as clinical learning tools regarding geriatric assessments. Median time to administer the tools was eight minutes for the EFS and ten minutes for the GFI.Conclusion: Paramedicine students support a frailty assessment tool to assist clinical decision making regarding older adults. Further appraisal of validated frailty assessment tools by operational paramedics in a pre-hospital environment is warranted to determine absolute utility for Australian paramedics
Reflections on Reflective Practice among Pre-Hospital Emergency Care Practitioners in Ireland.
Full text linkBackgroundThis paper examines the level of engagement of Irish pre-hospital emergency care practitioners with reflection and reflective practice. It also explores the attitudes of practitioners to reflection and to methodologies designed to support reflective practice such as reflective discussion and video-assisted structured reflection. Finally it outlines the main barriers to reflection, both individually and collaboratively, and reflective practice gaining widespread acceptance as key learning strategies among pre-hospital emergency care practitioners and educators in Ireland.MethodologiesThis paper is part of a larger project which consisted of three cycles of action research. Data was collected via an online survey questionnaire, and by conducting a series of semi-structured interviews with various stakeholders. These included all three clinical levels of pre-hospital emergency care practitioners and educators from emergency service providers, private ambulance services, and voluntary organisations.FindingsMany practitioners consider themselves to be reflective practitioners. However, very few of them use a structured model of reflection. Reflection, and reflective practice are not part of the education standards for practitioners in Ireland, and consequently receive very little attention in most education programmes. Practitioners within voluntary organisations perceived that reflective practice was encouraged by their organisation in greater numbers than those from other organisations. Collaborative forums were perceived to be beneficial, although concerns were raised about their potential for abuse and misuse. These concerns appear to emanate from a lack of trust within certain organisations.RecommendationsReflective practice to be included in the education standards for all levels of practitioners in Ireland. Develop and roll-out an education programme for existing practitioners regarding reflection, reflective learning, reflective practice, and structured models of reflection, as part of their CPC requirements. Provide education for all EMS course faculty regarding reflection, reflective learning, reflective practice, and structured models of reflection. A learning contract for all participants and faculty, including a confidentiality agreement, must be in place prior to the establishment of any collaborative forums. Further research to explore the reasons for lack of trust within organisations should be undertaken. Further research is recommended to explore the reasons for the disparity of opinion between volunteer and professional organisations regarding the encouragement of reflective practice
International Examination and Synthesis of the Primary and Secondary Surveys in Paramedicine
Full text linkBackgroundTo guide their care paramedics routinely rely upon two assessment and treatment algorithms, known as the primary survey and the secondary survey. No clear consensus of the concepts (assessments and interventions) that are, or should be, included in these algorithms exist internationally. Methods This paper evaluated Australasian paramedic clinical practice guidelines (CPGs), as well as six other international paramedic CPGs (USA, Ireland, UK, South Africa, Qatar, and the United Arab Emirates) in order to identify which concepts are currently described in best-practice recommendations for paramedics. The authors also contributed concepts that they felt were important additions based on their experience as veteran paramedics and paramedic educators.Results The resulting amalgamation of concepts identified in each term was then formed into two mnemonics which, together sequentially list approximately 100 specific clinical concepts that paramedics routinely consider in their care of patients. We describe these as the “International Paramedic Primary and Secondary Surveys”.Conclusion The primary and secondary surveys presented in this paper represent an evidence-based guide to the best practice in conducting a primary and secondary survey in the paramedic context. Findings will be of use to paramedics, paramedic students, and other clinicians working in remote or isolated practices