Irish Journal of Paramedicine
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Do RATs save lives? A retrospective analysis of out-of-hospital cardiac arrest in an English Ambulance Service
Full text linkoai:ojs.irishparamedicine.com:article/165Study aimThis study aims to determine the impact of the red arrest teams (RATs) on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.MethodsA retrospective cohort study analysing routinely collected data was undertaken. All adult (≥18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between the 1st October, 2015 and 30th September, 2017 were included if the patient was resuscitated, and the cause of the arrest was considered to be medical in origin. Multivariable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.ResultsDuring the 2-year data collection period, 15,151 cardiac arrests that were attended by Yorkshire Ambulance Service. After removing ineligible cases, 5,868 cardiac arrests remained. RATs attended 2,000/5,868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, minimum 1, maximum 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95%CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95%CI 0.99–1.29), compared to the odds of not having a RAT present, although neither results are statistically significant.ConclusionThe presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHC
Breakfast Education Sessions - a novel approach to learning
Full text linkIntroductionThe need for continuing professional development is well recognized and is supported by professional bodies in all healthcare disciplines. It can be difficult to access CPD for those who work shift. AimsTo create a multidisciplinary learning environment within a National Ambulance Service (NAS) station. To describe the participants responses to the education sessions by the participants of the sessions: on whether they thought they were helpful, they learned anything and if they thought it contributed towards team building. MethodsThe National Transport Medicine Programme (NTMP) has recently become a service within the National Ambulance Service (NAS), under the new name of the NAS Critical Care & Retrieval Services (NASCCRS). This service is responsible for transporting critically ill neonates, children & adults with a multidisciplinary team. The Breakfast education sessions were planned a number of months in advance with the purpose of creating a multidisciplinary learning environment. The sessions lasted for no more than 1 hour from 730am-830am once a month. The sessions often focused on topics that the teams encountered during their clinical work. The sessions were also started to further enhance and build the multidisciplinary team combining of the NAS staff and the NASCCRS medical teams. The participants were sent a questionnaire to assess their attitudes towards the sessions. ResultsThe majority of the participants (78%) were very satisfied with the sessions, they thought they were educational, useful and inclusive. All of the participants believed it was a very well or extremely well way of building a multidisciplinary team, and 67% will use these sessions for their CPD. All free text comments were positive and encouraged more of these type of sessions. ConclusionsThe breakfast education sessions created by the team at the National Ambulance Service Critical Care & Retrieval Services are a novel idea to learn, build teams and more importantly eat breakfast! We plan to extend the sessions with a view to streaming them in the future
Advanced Paramedic Delivered Finger Thoracostomy
Full text linkIntroduction & AimsTension pneumothorax is a potentially fatal but reversible injury encountered in major trauma and traumatic cardiac arrest. Needle decompression has been the standard treatment approach pre hospital in Ireland and internationally. However, concerns exist regarding the effectiveness of this approach due to anatomy and body habitus. We aim to describe the training, introduction and experience of finger thoracostomy by advanced paramedics within a pre hospital service in Ireland.MethodsFinger thoracostomy has been advocated as an alternative pre hospital treatment which is both diagnostic and therapeutic. Paramedic delivered thoracostomy is commonplace in pre hospital critical care services internationally. 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 pre hospital anaesthesia for trauma patients. We introduced a training module on finger thoracostomy, comprising: theory, practical instruction and assessment for advanced paramedic members of the team.Results & ConclusionsAdvanced paramedic members of the team we trained to deliver finger thoracostomy in predefined circumstances when operating as part of the MCI medical team. To date, advanced paramedic delivered finger thoracostomy has been utilised on three occasions. Introduction of advanced paramedic delivered thoracostomy is a feasible and effective technique for the treatment of tension pneumothorax within a closely governed system
Is There A Role For Paramedics In Primary Care In Ireland: An Exploratory Study
Full text linkBackgroundParamedics are reported to be the most underutilised profession working within rural areas, due to the paucity of service requirements. (O’ Meara et al 2012). Infrequent opportunities to practice particular skills can lead to reduction in levels of confidence and competence that can have significant risk and safety ramifications for practitioners and patients. (Mulholland et al 2014). Traditionally paramedic practice provides emergency care and transport within the community, but current ambulance service models within rural Ireland may be inefficient and contributing to hospital overcrowding and increased healthcare costs. (Lightfoot, 2015). Alternative models of healthcare are implemented within alternative rural jurisdictions such as Australia and Canada that aims to address issues of practitioner underutilisation, skill retention and healthcare personnel shortages. (Wilson, et al 2009).RationaleIreland’s population is ageing, with increased co-morbidities and reports of current and predicted workforce shortages in general practice. (Smyth et al 2017). With rising demands on general practitioners (GPs), measures to increase their supply and retention has become a challenging problem. Potential solutions to this will require immediate change to established work practices, to cater for current and predicted healthcare needs. (H.S.E, 2015). Paramedics with advanced skills (APs) could alleviate some of the shortages identified and enhance paramedic profile by transferring some tasks deemed appropriate from GPs to APs within both urban and rural communities. This process is globally known as task shifting where some competencies are transferred to alternative healthcare practitioners with less training. (WHO, 2007).AimTo ascertain the attitudes and opinions of paramedics and GPs associated with GEMS - UL, towards a new concept of joint collaboration in primary care that should be of mutual benefit to both groups, and also to identify potential barriers.MethodologyQuestionnaire survey of graduate Paramedics and General Practitioners associated with University of Limerick Graduate Entry Medical School and Paramedic Studies to identify competencies that GPs would deem appropriate to reassign to APs and ascertain both groups’ opinions towards this new concept of joint collaboration and practice.ConclusionStudies report successful outcomes in similar models of joint collaboration to support shortages of GPs in rural healthcare. (Reaburn, 2017). Collaboration on this scale has been shown to be beneficial for enhancing the paramedic profession within the wider healthcare system while providing essential support within primary care and general practice. Potential benefits have been reported with reduced emergency department admissions and early intervention in the management of chronic disease. (Blacker et al, 2009)
Driving me crazy: the effects of stress on the driving abilities of paramedic students
Full text linkBackgroundPrevious research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.MethodsParamedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.Results36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= <0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).ConclusionParamedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics
Rote learning: the ugly duckling of student paramedic education?
Full text linkThe intent of this commentary is to ask questions and stimulate discussion amongst academics and paramedic educators as to whether the inherent value of rote learning has simply been lost in the shadow of more recent learning and teaching practices
The Elephant in the Room (Clinical Image)
Full text linkPackaging is an important part of transfer medicine. Appropriate packaging in a “layered” manner is widely accepted as a safer way to move patients who may have various cables or tubes attached.In our practise we use modified ventilator airway tubing, approximately 0.5 metres in length with a slit down the longitudinal axis to contain these cables and/or tubes. This tubing has become colloquially known as “Elephant tubing”This tubing is typically used to contain ECG wires and medication giving sets. The Oxygen saturation probe wires and one intravenous access is typically left out during the transfer process in order to be able to access same.
Preparing The Critically Ill Adult Patient for Transfer
Full text linkBackgroundThe reorganisation of hospital services in Ireland, the development of hospital groups, centralisation of specialties and reconfiguring of smaller hospitals necessitates inter hospital transfer of patients requiring specialist care to an appropriate hospital that meets their clinical needs. In Ireland, in excess of 1000 adult critical care inter hospital transfers occur per annum(1). The ‘hub-and-spoke’ model is aligned with the hospital group structure and connectivity between hospitals is provided through agreed transport and retrieval services. These transfers are generally undertaken by local teams (usually an anaesthetic NCHD and a nurse) using an emergency ambulance and crew. Multidisciplinary team training is provided, by Critical Care Retrieval Services, using local resources in a framework enhancing safety and preparedness.Aims A critical care transfer checklist with a systematic approach provides a framework to address the elements of critical care, transport physiology changes and reduce potential adverse events when transferring critically ill patients (2). The use of transport specific adjuncts and packaging the patient systematically not only addresses transport issues e.g. temperature, but also facilitates emergency interventions en route.Conclusion Patient safety is a fundamental principle in healthcare and is the responsibility of healthcare practitioners to apply quality improvement methods to effect process and system improvements. The use of a systematic approach to patient management when transporting critically ill patients establishes a higher level of performance reduces cognitive dissonance and provides a framework for clinical teams and reduces the potential for human error (3).
Helicopter EMS in Cork: a paramedicine perspective
Full text linkThe intent of this commentary is to provide a paramedicine perspective on the new helicopter EMS service in the Southern region of Ireland, covering mainly Cork and Kerry. The recent discussions regarding the crew composition of the proposed Helicopter Emergency Medical Services (HEMS) in Cork require comment from paramedicine. Whilst we respect the opinion of other professions we feel it is important to provide an Irish perspective on behalf of members of the Irish College of Paramedics - Emergency Medical Technicians (EMTs) Paramedics, and Advanced Paramedics (APs)