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Irish Journal of Paramedicine
Number of Followers: 3

This is an Open Access Journal

Open Access journal
ISSN (Online) 2009-938X
Published by Irish College of Paramedics

[1 journal]

A photo-elicitation study of paramedics’ perceptions of mental
illness.
- Authors: Jessica Zoe Houston, John Rae, Lyle Brewster
  Abstract: The number of people with mental illness who are treated by paramedics is increasing and there are a variety of factors that can affect how well this service demand is met. One such factor is paramedics’ perceptions of mental illness. Photo-elicitation was used to explore how paramedics felt about mental illness and to generate new ways of thinking about this important aspect of paramedicine practice and education. Highlighted is that paramedics can feel helpless and under-prepared in treating people with mental illness and that two concepts of ancient Greek origins — aporia and phronesis — offer a useful way forward in thinking about and responding to this.
  PubDate: 2020-12-11
  DOI: 10.32378/ijp.v5i1.225
  Issue No: Vol. 5, No. 1 (2020)
Clinical presentations and practitioner levels appropriate for the
introduction of ‘Treat and Referral’ into the Irish Emergency Medical
Service: a survey of consultants in emergency medicine.
- Authors: Brian Power, John Ryan, Gerard Bury
  Abstract: Objectives: Overcrowding in emergency departments (EDs) is an international issue and ambulance bypass is seen as one element of the solution to a complex problem. Irish EDs are not immune to this healthcare crisis, which, together with increased off-load delays for ambulances, is one catalyst for the introduction of Treat and Referral (paramedic non-ED disposition decision). The confidence of consultants in emergency medicine in paramedics and advanced paramedics offering Treat and Referral to patients presenting with hypoglycaemia or seizure was explored. Other specific clinical presentations were also investigated for suitability for Treat and Referral and a consensus was sought on an upper age limit for such patients. Methods: Public-sector consultants in emergency medicine in Ireland at the time of the study, were invited to complete an online survey. A 62% response was received from the targeted population. Results: Confidence was expressed in advanced paramedics offering Treat and Referral to patients with hypoglycaemia or seizure by the majority (78%) of respondents. However, confidence was reduced for paramedics (53%). Six of the twelve specific clinical presentations received clear support as suitable for Treat and Referral, with the remaining receiving reducing support and ‘falls in the elderly (without injury)’ was opposed. There was no consensus on an upper age limit for patients being offered Treat and Referral. Conclusions: Support for the highest level of EMS practitioner in Ireland, advanced paramedic, to expand their scope of practice to include Treat and Referral was identified. Clinical presentations have been identified that would be conducive to a Treat and Referral clinical care pathway. A trial implementation period may be essential to build confidence in the programme before a universal roll out.
  PubDate: 2020-12-11
  DOI: 10.32378/ijp.v5i1.233
  Issue No: Vol. 5, No. 1 (2020)
Defining mentorship in prehospital care: a qualitative analysis of the
characteristics of prehospital mentors
- Authors: Cheryl Cameron, Charlotte Pooler, Sharla King
  Abstract: Introduction: This study sought to begin to define the current understanding of the term mentor within the prehospital environment (emergency medical services or EMS) as described by nomination letters written by mentees for a newly launched prehospital mentor award.Methods: A new paramedic mentor award was created in the fall of 2015 to recognize outstanding mentors in prehospital care. In the spring of 2016, nineteen nomination letters were received from registered prehospital professionals detailing why their mentor should receive the mentor award. Written text from the nominations for this peer nominated award were analyzed using thematic and content analysis (n=19) to identify the current understanding of mentorship within emergency medical services, desirable qualities of prehospital mentors, and what a successful mentoring relationship looks like in the prehospital environment from the perspective of mentees. Results: Mentees and nominated mentors had varying years of experience, worked in diverse practice areas within prehospital care and represented varying scopes of practice. Three themes were identified from thematic analysis of the nomination letters 1) nominators seek to emulate their mentors, 2) mentors create a safe and nurturing environment, and 3) mentors act as advocates. In addition, content analysis was used to identify a number of desirable professional and personal traits of prehospital mentors.Conclusion: This study describes the qualities of prehospital mentors and identifies a number of common elements in a successful mentoring relationship (from the perspective of the mentee). These results highlight exceptional mentoring that is already occurring within the prehospital care environment. This research has the potential to provide guidance to those who aim to support both formal and informal mentoring within the prehospital care environment.
  PubDate: 2020-12-11
  DOI: 10.32378/ijp.v5i1.167
  Issue No: Vol. 5, No. 1 (2020)
Defining and recognising clinical deterioration in the prehospital setting
(PRECLuDE study): a systematic scoping review
- Authors: Emma Bourke-Matas, Emma Bosley, Paul Gowens, Karen Smith, Kelly-Ann Bowles
  Abstract: IntroductionEarly identification of high-risk patients in the prehospital environment is crucial as it enables early intervention, transportation, and may determine the trajectory of future care. Although early warning systems (EWS) in-hospital are well established, it remains unclear whether adaptations of these systems can simply be extrapolated to prehospital care. This scoping review aims to explore how the current literature defines and recognises clinical deterioration in the prehospital setting. MethodsIn December 2019, a systematic search of five databases using a combination of terms describing ‘paramedic’, were integrated with terminology relating to ‘recognition’ of ‘clinical deterioration’. Additional reference chaining was also undertaken. ResultsA total of eight papers met the inclusion criteria. Seven out of eight studies included a definition, however these were primarily ad-hoc and fundamentally formed to support the creation of varying EWS. The prevalence of prehospital clinical deterioration is poorly explored in the literature, with only two studies discussing the frequency deterioration (5.1%). Furthermore, studies reported that paramedics were inadequate at identifying clinical deterioration due to medical aetiology by comparison to trauma. Additionally, a number of articles reported an association between clinician experience and recognition of clinical deterioration. As the topic of prehospital clinical deterioration has rapidly moved to focus on the potential implementation of EWS, with few studies providing fundamental description of the concept and its characteristics, there is no standardised operational definition available in the literature. The development of this definition is crucial to assessing clinical deterioration and improving the efficacy of EWS. Not only could this lead to improving early identification of risk factors, but it can lay the foundations for the development of an effective EWS. ConclusionThis review has found that further quality research in this understated space is warranted to increase understanding and early identification of the deteriorating patient, prevent unnecessary harm, and ultimately, improve patient outcomes.
  PubDate: 2020-12-11
  DOI: 10.32378/ijp.v5i1.245
  Issue No: Vol. 5, No. 1 (2020)
Use, outcomes and policy on the placement of Automated External
Defibrillators on commercial aircraft for the management of in-flight
cardiac arrest: a scoping review
- Authors: Patrick Sheehan, Tom Quinn
  Abstract: ABSTRACTIntroduction Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).MethodsA scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.Results 9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery. Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.ConclusionDespite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.Keywords: cardiac arrest; defibrillators; AED; aircraft; flight
  PubDate: 2020-12-11
  DOI: 10.32378/ijp.v5i1.244
  Issue No: Vol. 5, No. 1 (2020)

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