British Paramedic Journal

Evaluation of a new Out-of-Hospital Newborn Life Support (OHNLS) course in the United Kingdom: a survey study

Michael Bradfield — 2024-12-01

Background: Unplanned out-of-hospital births (UOHBs) are associated with poorer outcomes for babies, especially those born prematurely. The current Newborn Life Support (NLS) course offered by Resuscitation Council UK (RCUK) is not designed to address the challenges associated with birth in the out-of-hospital setting. A new out-of-hospital newborn life support (OHNLS) course was developed to address these challenges. This study aimed to evaluate the impact of this course on attendees’ knowledge and confidence in providing resuscitation, supporting transition and stabilisation of a newborn in an out-of-hospital setting.

Methods: A survey study of attendees of the OHNLS proof of concept course; multidisciplinary staff from midwifery, ambulance, nursing and medical backgrounds from the from the South West of England.

Results: All 33 attendees completed the post-course multiple choice questionnaire, 32 completed the pre-course survey, 31 completed the post-course survey and 18 completed the follow up survey. Percentage of participants reporting feeling ‘very confident’ in their ability to deliver optimal resuscitation support to a newborn baby out-of-hospital increased from 3% (1/32) pre-course to 52% (16/31) post-course, with a significant difference in confidence across topics between pre- and post-course surveys (n = 21, Z = -4.014, p < 0.0001) and pre-course and follow up surveys (n = 13, z = -3.18, p < 0.001). There was no significant difference between post-course survey and follow up (n=11, z = -0.4, p = 0.34). Post-course survey data showed self-reported increases in knowledge across all aspects of newborn life support in an out-of-hospital setting.

Conclusions: The format of the OHNLS course addresses the needs of the target candidate group and findings suggest improved short-term knowledge and confidence in the immediate management of babies born in an out of hospital setting. Further evaluation is required to determine whether such training has a long-term impact and translates into improved outcomes.

Telesimulation-Based Learning compared to E-learning in Prehospital Practice: An Observational Study.

Chloe Scott — 2024-12-01

Background: Prehospital training at scene is often difficult due to the acute nature of the role. Distance learning can resolve the dilemma of how to provide high quality education where the number of participants are small and widely scattered. E-learning is an established teaching modality that has been widely used to deliver education whereas telesimulation is a novel teaching tool that has been evolving throughout the last decade.

Aim: The aim of this study was to evaluate the experience of e-learning compared to telesimulation for prehospital practitioners.

Method: Twenty-six prehospital responders were randomly allocated to either complete an e-learning or telesimulation session based on acute paediatric asthma. Each participant completed a post-session satisfaction questionnaire for quantitative and qualitative analysis. For the telesimulation session all participants attended remotely whilst the faculty were based on-site. The e-learning module was accessed by the participants via the internet.

Results: The participants from the telesimulation group were more likely to agree that the style of teaching is suited to them (p= 0.033) and agree that the session was engaging (p= 0.044). Participants demonstrated high levels of interest to participate in future telesimulation sessions. Participants could successfully recall learning events from the training session and state how this would change their future practice and improve patient outcomes.

Conclusion: Telesimulation and e-learning can help learners with restricted availability and geographical challenges to access simulation-based education and online learning in future and can allow a continuity of education flexibility. It allows learners to work as a multi-disciplinary team despite being scattered across a large geographical area.

‘Endless variation on a theme’: A Document Analysis of International and UK Major Trauma Triage Tools

Gordon Fuller — 2024-12-01

Introduction

Triage tools are used within trauma networks to identify which injured patients should be bypassed and pre-alerted to major trauma centres. Despite the importance of treating the ‘right patient in the right place at the right time’ there has been no consensus on triage tool structure or content. This study aimed to identify, collate, review, summarise and recognise patterns across established major trauma triage tools.

Methods

UK and international triage tools used between 2012 and 2021 were identified through literature review and correspondence with trauma networks. A conceptual content analysis was then undertaken using an inductive codebook, comprising concepts of triage tool structure, intended population, inclusion criteria, and included variables and thresholds. Thematic analysis was also performed to identify higher-level patterns within the data, with emerging patterns becoming categories for analysis. A narrative synthesis of findings was then undertaken.

Results

In total 53 major trauma tools identified, comprising 19 UK tools and 35 published international tools. Most triage tools (n=42/53, 80%) were developed by expert opinion, were paper based, and shared a common structure of multiple domains, with constituent triage predictors assessed in parallel. A minority of tools were statistically derived prediction models, operationalised either as simple scores (n=10, 19%) or as an electronic application (n=1, 1%). Overall, 173 distinct triage variables were used, with the median number of constituent triage variables per triage tool was 19 (range 3 to 31). Four distinct patterns of triage tools were identified during thematic analysis, which differed in terms of format, number of triage variables, thresholds, scope for clinical judgement and relative diagnostic accuracy.

Conclusions

Many diverse major trauma triage tools were identified, with no consensus in format, structure, or content. Quantification of constituent variables and identification of distinct categories of triage tools may guide design of future triage tools.

A qualitative exploration of the views of paramedics regarding the use of dark humour

Jennifer Mercer — 2024-12-01

Abstract

Background: Dark humour, often known as black comedy or gallows humour, is a distinct kind of humour that explores subjects that are generally taboo or uncomfortable. Given the prevalence of life-or-death situations, crucial clinical judgements, and emotionally charged situations in the pre-hospital environment, identifying the function and impact of black humour is important.

Aims: The primary aim is to investigate the world of dark humour within the setting of seasoned paramedics.

Methods: A qualitative approach was employed. Ten experienced paramedics were recruited via social media. Semi-structured interviews were conducted, and data analysed using appropriate qualitative methods.

Results: Four themes were identified, the perceptions of dark humour from the public, students, and colleagues; the use of dark humour in building resilience and improving perseverance; the negatives of prolonged use to mental health; and finally, the benefits of humour use to develop camaraderie within the ambulance service.

Conclusion: The study explored the views of a small sample of paramedics on this subject. Dark humour was identified as both a beneficial coping mechanism for resilience and a means of fostering camaraderie. Conversely, the chronic reliance on dark humour can have negative mental health implications. Utilizing the usage of coping mechanisms such as dark humour as a yardstick to measure mental wellbeing could be an important first step in the adoption of a more holistic approach to mental health within the paramedic community.

Paramedic perceptions of barriers and facilitators to the use of ambulance service appropriate care referral pathways in Northern Ireland: a qualitative study.

Karl Bloomer — 2024-12-01

Abstract

Background

Demand for emergency ambulances is increasing every year. Traditionally, the only option for attending paramedics was to transport patients to the emergency department (ED). However, the ED is now generally regarded as just one of a range of options available to paramedics that ensure people receive the most appropriate care.

Ambulance conveyance rates to ED in Northern Ireland (NI) has only occasionally fallen below 75% of incidents. A study examining a diabetic specific Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than comparable ambulance services, and data analysis has shown that over 70% of potentially eligible patients experiencing a fall are not receiving a falls referral.

Aim

This study aimed to identify what paramedics perceive the barriers and facilitators to the use of appropriate care pathways (ACP) in NI are.

Methods

In this single-centre qualitative study, participants were recruited using convenience sampling. Data were collected through semi-structured interviews until data saturation was reached after 11 interviews. They were recorded, transcribed verbatim and thematically analysed.

Findings

Six main themes emerged during analysis. The participants discussed their perceptions of the barriers and facilitators of utilising ACPs under the auspices of clinical issues, cultural issues, risk, person centred practice, inter-professional communication and operational infrastructure.

Conclusion

The study provides insight into perceived barriers and facilitators to the use of ACPs. The themes identified are consistent with existing literature that calls for standardised pathways across regions. Future research should investigate the link between the NHS 111 service and ambulance demand. In order to facilitate the complex decision making involved in referral, relevant knowledge and skills should be embedded in paramedic education. Efforts should be made to improve inter-professional communication and awareness of the paramedic scope of practice and knowledge base.

A national perspective of ambulance clinicians’ perceptions, experiences and decision-making processes when assessing older adults with a head injury: a mixed-methods study

Jack William Barrett — 2024-12-01

Introduction

UK ambulance services employ diverse models of care, resulting in 40-60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60+) remain high (60-70%) despite most being mild. We aimed to explore ambulance clinicians' perceptions, experiences, and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions.

Methods

This study used a mixed methods sequential explanatory design comprising an online survey and one-to-one interviews with patient-facing ambulance clinicians in the UK. The survey, distributed through nine ambulance services and via social media, gathered data on clinicians' experiences, confidence levels, and perceptions about assessing older adults with head injuries. It focused on exposure frequency, confidence in assessing asymptomatic patients, perceived risks of medications, and confidence in available decision tools. The subsequent interviews delved deeper into survey responses.

Results

We recruited 385 participants, predominantly male paramedics (62%), with a median age of 35 and eight years of ambulance service experience. Participants reported frequent encounters with older adults with head injuries and expressed high confidence in assessing visible injuries but lower confidence in neurological examinations. Participants found NICE and JRCALC guidelines satisfactory, and reported confidence in conveying patients to the ED but less confidence in alternative referrals or discharges. The interviews revealed two overarching themes: guideline-based care and patient-centred care, with sub-themes emphasizing the importance of shared decision-making, collaboration with other healthcare professionals, and safety-netting strategies.

Conclusion

While clinicians express confidence in using clinical guidelines for ED conveyances, they often find guidelines overly prescriptive and struggle to translate them for individual cases. There is a need for more patient-centred, holistic decision-making, especially considering the unique aspects of head injuries in older adults. Challenges include fear of poor outcomes, limited feedback on patient outcomes, and lower confidence in making referral or discharge decisions. Specific guidelines tailored to this demographic and improved support services may aid in reducing unnecessary ED conveyances.

Using an analytic auto-netnographic approach to explore the perceptions of paramedics in primary care

Georgette Eaton — 2024-12-01

Purpose: Paramedics in the United Kingdom (UK) are moving from emergency ambulance services into primary care, where they are employed to boost clinicians within the workforce. Whilst there is emerging research that seeks to understand the contribution of paramedics to the primary care workforce, what is not known is the perceptions paramedics have regarding their role in primary care.

Design/methodology/approach: An analytic auto-ethnography was undertaken, utilising a peripheral membership approach for online communities used by paramedics on Facebook, Reddit and Twitter. Over a 3-month period (December 2021- February 2022), the primary researcher reflected on the conversations, comments and opinions posted within these communities within a reflexive (immersion) journal, considering them against the context of her own experience.

Findings: Paramedics in primary care, who are generally isolated due to their geographical isolation from each other, utilise online social spaces to foster a community of practice. These forums are used to discuss their clinical role, education, and experiences – as well as consider their place within the primary care workforce.

Originality: This is the first application of this methodology within online social spaces utilised by UK paramedics. This paper also presents novel use of a peripheral membership approach within an analytic auto-netnography in public online spaces for researcher-practitioners.

Chemsex: an emergency medical service perspective

Peter Kingsley — 2024-12-01

Background

Chemsex behaviours are described as the use of specific drugs before or during planned sex to facilitate, initiate, prolong, sustain, and intensify the encounter. It exists primarily, but not exclusively, within a subgroup of gay, bisexual and other men who have sex with men.

Chemsex is a largely hidden activity, taking place out of sight of wider society. Participation carries significant mental and physical health risks and can be fatal. When something goes wrong at a chemsex meet, emergency medical services (EMS) can expect to be called to respond.

Chemsex invokes a complex interaction between healthcare, social care, addiction medicine, sexual health and criminal justice.

Objective

EMS are uniquely placed as the only element of healthcare that sees chemsex participants within the event context. This article seeks to equip the emergency responder with key knowledge to prepare them for what can be challenging and complex calls.

Methods

Utilising a professional practice review format, the author has drawn on literature from a range of sources including peer reviewed journals, health advocacy groups, and specialist and mainstream media. This is combined with their personal experience of responding to many chemsex-related emergency calls as an advanced paramedic practitioner in critical care working in a large UK city.

Results

Key aspects of chemsex, including who engages in it and why, together with an overview of the activity involved are discussed with a focus throughout on the EMS perspective. Certain commonly used slang terms are included for awareness. Drugs are described and linked to toxidromes, with some key insights into how physical indicators on-scene can guide the clinician to understand when an event may relate to chemsex, and why this is important. The article also discusses important considerations for EMS when co-responding with the police.