Academic literature on the topic 'Pre-hospital practitioners'

BackgroundThe concept of situation awareness (SA) has become a core theme throughout human factors research. SA is a cognitive process, put simply, it refers to a person’s ability to be aware of what’s going on and to anticipate what will happen next. In an acute pre-hospital setting, practitioners are required to make decisions quickly and often under pressure, these decisions depend on their SA. However, we do not yet know if the type of incident affects a person’s SA. Despite the importance of SA in medicine, few studies have examined SA in the pre-hospital setting. The aim of this study was to determine whether pre-hospital responders are more situationally aware in a familiar or unfamiliar environment using simulated scenarios.MethodThis observational study recruited 22 pre-hospital responders to participate two simulated scenarios; one familiar and the other unfamiliar. Following completion of the simulation participants individually completed a modified SAGAT questionnaire to quantitively analyse SA across 10 different factors.ResultsThe results showed that participants were more situationally aware in an unfamiliar environment (mean familiar: 18.75, mean unfamiliar: 22.75, P value = 0.003). However, participants felt more confident completing the familiar scenario (mean familiar = 4.09 compared to mean unfamiliar=3.87).ConclusionPre-hospital responders were more situationally aware in an unfamiliar environment, one reason for this could be due to the lack of experience in these environments practitioners may be more vigilant. Regardless of whether the environment is familiar or unfamiliar, responders are often exposed to complex environments where patients with serious injuries have to be managed and good SA is essential for safely managing a patient. Due to the small sample size and limited knowledge on this topic there would be a value in conducting more research considering the importance of SA in pre-hospital medicine.

Aim. To develop and evaluate the implementation of a communication board for paramedics to use with patients as an augmentative or alternative communication tool to address communication needs of patients in the pre-hospital setting. Method. A double-sided A4-size communication board was designed specifically for use in the pre-hospital setting by the Queensland Ambulance Service and Disability and Community Care Services. One side of the board contains expressive messages that could be used by both the patient and paramedic. The other side contains messages to support patients’ understanding and interaction tips for the paramedic. The communication board was made available in every ambulance and patient transport vehicle in the Brisbane Region. Results. A total of 878 paramedics completed a survey that gauged which patient groups they might use the communication board with. The two most common groups were patients from culturally and linguistically diverse backgrounds and children. Staff reported feeling confident in using the board, and 72% of interviewed paramedics agreed that the communication board was useful for aiding communication with patients. Feedback from paramedics suggests that the board is simple to use, reduces patient frustration and improves communication. Conclusion. These results suggest that a communication board can be applied in the pre-hospital setting to support communication success with patients. What is known about the topic? It is imperative that communication between patient and paramedic is clear and effective. Research has shown that communication boards have been effective with people with temporary or permanent communication difficulties. What does this paper add? This is the first paper outlining the development and use of a communication board by paramedics in the pre-hospital setting in Australia. The paper details the design of the communication board for the unique pre-hospital environment. The paper provides some preliminary data on the use of the communication board with certain patient groups and its effectiveness as an alternative communication tool. What are the implications for practitioners? The findings support the use of the tool as a viable option in supporting the communication between paramedics and a range of patients. It is not suggested that this communication board will meet the complete communication needs of any individual in this environment, but it is hoped that the board’s presence within the Queensland Ambulance Service may result in paramedics introducing the board on occasions where communication with a patient is challenging.

Introduction: Pre-hospital clinicians can expect to encounter patients with agitation, including acute behavioural disturbance (ABD). These situations carry significant risk for patients and emergency medical services. Advanced paramedics within the London Ambulance Service (LAS) are frequently tasked to these incidents. At present, little evidence exists regarding clinical decision-making and management of this patient group. We sought to explore the demographics of patients presenting with potential ABD and quantify the degree of agitation, physical restraint, effectiveness of chemical sedation and any associated complications.Methods: A retrospective analysis of pre-hospital clinical records for patients coded with ABD and attended by LAS advanced paramedics between 1 October 2019 and 30 September 2020. Sedation assessment tool (SAT) scores were used as the primary outcome measure.Results: A total of 237 patient records were identified. Of the patients, 147 (62%) were physically restrained and 104 (44%) were chemically sedated. Sedation was more commonly administered where patients were exposed to physical restraint. High SAT scores were associated with the administration of sedative agents and at higher doses. Of patients undergoing sedation, 89 (85%) had a SAT score reduction of 2 points or a final score ≤ 0. The mean SAT score reduction was 2.72. Three cases of minor injury were reported following physical restraint.Conclusion: Advanced paramedics undertook sedation in less than half the cohort, suggesting that other strategies such as communication and positioning were utilised. Most patients were managed into a state between being restless and rousable, largely negating the need for ongoing physical restraint during hospital transfer. Appropriately trained advanced paramedics can utilise sedation safely and effectively in selected cases.

Abstract Introduction Best-practice burns first aid is well defined as 20 minutes of cool running water (CRW) within three hours of injury and an expectation of burn care in Australia. This study aims to identify barriers to applying this intervention and assess burn first aid knowledge amongst Australian paramedics. Methods Using multiple methods we assessed; 1) burn first aid adequacy in a cross-sectional study of health care professionals, utilizing a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Logistic regression models were used to evaluate the relationship between first aid adequacy between health services (eg. Paramedics and emergency departments). Then 2) paramedics completed a questionnaire containing demographic and clinical expertise and environment as well as recording immediate first aid management across five multiple choice burn case scenarios Results Overall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW were very young age and early adolescence (p< 0.001) rural location ( P = 0.045), low socioeconomic status ( P = 0.030) amongst others. Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients. Paramedic questionnaire responses (n=326) identified 56% of paramedics answered all burn case scenarios correctly. Respondents who treated a burn within six months scored higher on burn first aid scenarios compared to paramedics who had not recently treated a burn (p=0.004). Conclusions : deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. First aid delivery was significantly worse in children aged 0-2, adolescents aged 15-16, those living rurally, and the socioeconomically disadvantaged.

Background There are currently limited avenues for routine feedback from hospitals to pre-hospital clinicians aimed at improvements in clinical practice. Objective The aim of this study was to pilot a method for selectively identifying cases where there was a clinically significant difference between the pre-hospital and in-hospital diagnoses that could have led to a difference in pre-hospital patient care. Methods This was a single-centre retrospective study involving cases randomly selected through informatics extraction of final diagnoses at hospital discharge. Additional data on demographics, triage and diagnoses were extracted by explicit chart review. Blinded groups of pre-hospital and in-hospital clinicians assessed data to detect clinically significant differences between pre-hospital and in-hospital diagnoses. Results Most (96.9%) patients were of Australasian Triage Scale category 1–3 and in-hospital mortality rate was 32.9%. Of 353 cases, 32 (9.1%; 95% CI: 6.1–12.1) were determined by both groups of clinical assessors to have a clinically significant difference between the pre-hospital and final in-hospital diagnoses, with moderate inter-rater reliability (kappa score 0.6, 95% CI: 0.5–0.7). Conclusion A modest proportion of cases demonstrated discordance between the pre-hospital and in-hospital diagnoses. Selective case identification and feedback to pre-hospital services using a combination of informatics extraction and clinician consensus approach can be used to promote ongoing improvements to pre-hospital patient care. What is known about the topic? Highly trained pre-hospital clinicians perform patient assessments and early interventions while transporting patients to healthcare facilities for ongoing management. Feedback is necessary to allow for continual improvements; however, the provision of formal selective feedback regarding diagnostic accuracy from hospitals to pre-hospital clinicians is currently not routine. What does this paper add? For a significant proportion of patients, there is a clinically important difference in the diagnosis recorded by their pre-hospital clinician compared with their final in-hospital diagnosis. These clinically significant differences in diagnoses between pre-hospital and in-hospital clinicians were most notable among acute myocardial infarction and trauma subgroups of patients in this study. What are the implications for practitioners? Identification of patients who have a significant discrepancy between their pre-hospital and in-hospital diagnoses could lead to the development of feedback mechanisms to pre-hospital clinicians. Providing pre-hospital clinicians with this selective feedback would be intended to promote ongoing improvements in pre-hospital assessments and thereby to improve service delivery.

Objective: To determine the barriers to the maintenance of COVID 19 cross infection control protocols among medical and dental practitioners Methodology: A cross sectional study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore from July 2021 to July 2022 on medical and dental practitioners. The sampling technique employed was convenient sampling. Medical and dental practitioners irrespective of their age, gender and specialty of practice were included in the study. Data was collected using a pre-validated questionnaire with a Cronbach alpha value of 0.7. Results: There was s statistically significant difference in the scores of barriers to maintenance of COVID 19 cross infection control protocols of overcrowding in the hospital (p= ≤0.001), limitation of infection control material (p=≤0.001), insufficient training in infection control (p=0.05), lack of handwashing (p=0.022), not wearing a mask while examining the patient (p=≤0.001) and lack of knowledge about mode of transmission of COVID 19 (P=0.036) Conclusion: The barriers faced to maintenance of cross infection control protocols pertaining to the hospital administration were reported to be higher for medical practitioners in comparison to the dental practitioners. The barriers faced to maintenance of cross infection control protocols pertaining to the attitude and practices of health care workers were also higher for medical practitioners in comparison to the dental practitioners. Keywords: Cross infection control, COVID 19 pandemic, medical practitioners, dental practitioners

Ketamine is an effective drug for battlefield analgesia. Recent evidence suggests that it can be safely and effectively used by Level 6 Pre-Hospital Emergency Care (PHEC) practitioners. This article presents a review of the evidence, and outlines the future use of ketamine for provision of analgesia and sedation in combat casualties.

The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis.

Aim: Using a mixed methods approach, this thesis seeks to explore the attitudes of emergency care staff towards young people (aged 12− 18 years) who self-harm and to gain an understanding of the basis of attitudes that exist. Background: This thesis has drawn on Strauss et al’s (1964), concept of the hospital as a negotiated order, a perspective that has latterly been applied to the organisation of hospital A&E services (Sbaih1997a&b 1998a&b, 2001, 2002). As the fundamental premise of emergency care work is the rapid assessment of patients’ needs, categorisation is an essential element of this work. This thesis therefore also draws on the sociological theories which have examined the categorisation of patients as ‘good’ or ‘bad’, as earlier sociological work has clearly demonstrated that practitioners working in emergency services judge patients based on their reasons for accessing the service (Roth 1972, Jeffery 1979, Dingwall & Murray 1983); patients who self-harm are amongst those adversely judged. However the extent to which these categorisations extend to young people was not wholly clear. Findings from earlier research that had considered this were inconclusive and inconsistent (Dingwall & Murray 1983, White 2002). Methods: A mixed methods approach, using a triangulation convergent design was employed. Staff employed in four emergency departments in South East London and five London Ambulance complexes that served these departments were surveyed; data from 143 questionnaires were analysed using SPSS. Qualitative data were obtained through semi-structured interviews with 12 practitioners, seven nurses and five paramedics, with thematic analysis undertaken. The two data sets were integrated and analysed to identify where the two data sets were consistent and whether/where discrepancies existed. Results: Findings from this study indicate that age, i.e. being a young person, does influence attitudes towards self-harm. Young people are less adversely judged as their self-harm is seen as symptom of distress, a coping mechanism or response to a stressor out with a young person’s control, thus as a consequence, attitudes towards young people who self-harm are benign. The findings lend support to previous research which has indicated that as an occupation, nurses have less positive attitudes than their peers working in emergency services. Although not statistically significant, the nurses surveyed in this study obtained lower scores on the scale used to measure attitudes than their medical and paramedical colleagues. The data from the interviews illustrated the difficulties and frustration the nurses faced in managing the care of young people who self-harm, which centred on the pressure to ‘move young people on’, pressures that were exacerbated by the need to do this within four hours. The paramedics interviewed did not face these challenges. Nurses faced considerable difficulty in securing admission to a children’s ward; the accounts of the nurse interviewees suggested that their ward colleagues expected and anticipated that young people who had self-harmed would be challenging in terms of their behaviours, whereas no such expectation existed with other adolescent patients. To this end the diagnostic label of self-harm had negative connotations Conclusions: The findings from this study have extended existing knowledge in relation to practitioners’ attitudes towards young people who self-harm, providing as they do an insight into how young peoples’ immaturity and diminished agency, contribute to the framing of young people as vulnerable, thus their self-harming behaviour is less adversely judged. A negotiated order perspective remains a relevant lens through which to analyse and explore the organisation of hospital services and specifically the work of the A&E department; the findings of the research presented in this thesis have revealed how young people who self-harm, through both their actual and perceived behaviours, disrupt the organisation of children’s accident and emergency care, thereby distorting its ‘shape’. The ambiguity of adolescence as a life-stage is reflected in the attitudes and perceptions of the study participants and is also reflected in health policy and guidelines, which is particularly exemplified by inconsistency in how the emergency care needs of young people between the ages of 16– 18 years generally, and young people who self-harm specifically, are addressed. This inconsistency and ambiguity in turn serves to impede young people’s progress through emergency services following an episode of self-harm.

Asthma is a leading cause of pediatric hospital admissions. Parents of children under the age of 18 with asthma require education to recognize and manage the signs and symptoms of the disease. Parent education has shown to decrease their children's hospital admission and readmission rates. The purpose of this pilot project was to develop an asthma educational module for the parents of children with asthma and obtain parent feedback on the content. Families with children under the age of 18 who had been admitted to the hospital with a diagnosis of asthma, an asthma exacerbation, or status asthmaticus were invited to participate. A nurse practitioner provided three parents with information on the signs, symptoms, and medication management of asthma, as well as hands-on demonstration of inhaler use. Twenty-eight staff nurses provided verbal feedback on module content, including educational benefit and readability for parents. Parent and staff verbal feedback indicated the module was both a useful and effective tool for asthma education. Clinical leaders plan to expand the pilot study on two additional pediatric units using the same module used in the pilot program with intent to analyze readmission rates. The project promotes social change through parent empowerment to care for their child in the home environment.

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009
Trauma is a pandemic that has a significant negative impact on the lives of its victims and national economies. This descriptive study was conducted on 103 private medical general practitioners in Limpopo Province. Ethical approval for the study was obtained from the University of the Witwatersrand Committee for research on Human Subjects (Medical). Approval protocol number M050230. The aim of the study was to determine the state of pre-hospital trauma care: training and preparedness of and practice by private medical general practitioners (GPs) in Limpopo Province. Data was collected by means of an anonymous, confidential, self-administered questionnaire. The objectives were to determine demographic features of the respondents; determine the status of emergency pre-hospital trauma training, preparedness and practice amongst the respondents; and to determine their incentives and disincentives to trauma medicine training, preparedness and practice in Limpopo province. The response rate was 36%. Fifty five per cent (55%) of the respondents had received trauma training since they commenced work as GPs. The proportion of GPs who said that they received trauma training while working in hospitals casualty departments was 52%. The number of respondents who completed ATLS was 24 (23%). Five (21%) of those who had completed ATLS updated their qualifications during years 2001 to 2005. Of the GPs surveyed 46% were not aware of ATLS course offered by the College of Emergency Care at Polokwane City. The majority of the respondents graduated as medical practitioners from the university of Pretoria (38%) and MEDUNSA (31%). But undergoing trauma management training was not associated with the medical schools from which 4 respondents graduated as medical practitioners (p=0.767; Fisher’s exact=0.827; Pearson chi2 = 4.9075). The medical schools from which respondents graduated as medical practitioners was also not related to the amount of private medical practice that comprised emergency care (p= 0.372). Undergoing trauma training was not associated with the age of a GP (p value= 0.120; Fisher exact=0.127). Sex was not found to be associated with trauma training (p=0.895; Fisher exact=1.000). Sex also had no link to the proportion of medical practice comprising emergency care (p-value=0.153; Fisher ‘s exact=0.214; Pearson Chi2). Even though location of GP’s practice was reported to be both an incentive and disincentive to trauma management training it was found not to be associated with trauma management training (p=0.393; Fisher exact=0.426; Pearson chi2 =1.5687) There was no association between location of GP’s practice and preparedness for trauma management. The exception to the finding was in terms of availability of chest drains where the p-value was 0.001. It was found that 31% of respondents who indicated that they had chest drains were based in rural areas while about 6% were practicing in urban areas. Availability of morphine and other analgesics (p-value=0.025, Fisher’s exact=0.038, Pearson Chi2 (1)=5.0165) were associated with preparedness for trauma. There was no association between type of GP practice and trauma management training (Pearson Chi2 (2) =2.1242. p- value = 0.346. Fisher’s exact = 0.429). Almost 95% of those who stated that they spent at least 50% of their time in private general medical practice were full-time. Being in full-time private general medical practice did not necessarily translate into a higher proportion of the practice that comprised trauma care. It was found that 64% of the respondents who were in full-time private general medical practice had an emergency trauma care burden of less than 10% compared to 36% that had a proportion of 10% and more. Amongst part-time practitioners the percentage of those whose burden of trauma care was less than 10% was equal to that of those with 10% and more. The findings implied lack of an association between time spent in private general medical practice and proportion of the practice that constitutes trauma care (p=0.621). The commonest method of updating trauma management skills was through personal study (37% of respondents) followed by attendance of trauma meetings (24% of respondents). Trauma trained GPs tended to have a higher proportion of their practices that comprised emergency trauma care (p-value = 0.030; Fisher’s exact =0.050) than those who had not. The frequently used sources of trauma management information were personal experience (58%) of the respondents followed by continuing medical education (50% of respondents). Almost 50.8% of the respondents reported that they were fairly skilled to manage in a pre-hospital setting various types of injuries. Minor soft tissue injuries were the type of trauma that 68% of the respondents said that they could manage excellently. Incentives factors to both trauma training and practice were high trauma prevalence (33.3% of respondents-training: and 20.7% of respondents-practice); performance improvement (20% of respondents-training: 12.1% of respondents respectively-practice); adequate and managed trauma care facilities (17% of respondents-training: 10.4% of respondents-practice); trauma care support (6.7% of respondents-training: 6.9% of respondents-practice); the need to improve trauma knowledge and skills (17% of respondents-training: 17.2% of respondents-practice) and; strategic GP practice location (7% of respondents-training: 6.9% of respondents-practice). Major disincentives to both trauma training and practice were lack of time for trauma care (28.9% respondents-training: 14.9% respondents practice); unsupportive staff (10% respondents-training: 14.9% respondents-practice); perceived high cost of trauma care and poor rewards (15.6% respondents-training: 11.7% respondents-practice); substandard and inaccessible trauma care facilities (15.6% respondents-training: 24.5% respondents-practice); under-utilized trauma knowledge and skills (6.7% respondents-training: 4.3% respondents-practice); 6 restrictive healthcare regulations and policies (2.2% respondents-training: 2% respondents-practice); and low number of trauma patients seen (11.1% respondents-training: 3.2% respondents-practice). In terms of preparedness for trauma the respondents were ill-prepared for trauma as evidenced by insufficient trauma equipment and drugs. Whereas almost all the respondents (frequency 102 or 99%) had stethoscopes only 7% had cricothyrotomy set. Only 18% of them had needle with one-way valve and chest drains. The trauma drug that appeared to have been the most widely stocked was adrenaline with a frequency of 96 or 93%. It was followed by aspirin with a frequency of 95 or 92%. Ketamine and zidovudine were drugs that were least stocked by the respondents. Their frequencies were 27 or 26%) and 33 or 32% respectively. The other equipment that was infrequently available at GPs’ rooms was goggles (frequency 46%) suggesting poor adherence to safety measures. There were low levels of preparedness to manage trauma patients independently with 43% reporting that they could independently adhere to universal safety measures. Whereas 52% of the respondents stated that they had received training in CPR 54.5% stated that they were equipped and prepared to open and protect the airway; 43% could independently provide adequate breathing while 45% of them could restore and maintain sufficient circulation, indicating a need to improve levels of CPR training. It was recommended that more general practitioners in Limpopo province should be trained and involved in trauma care. It was further recommended that awareness should be raised about the ATLS offered at the College of Emergency Care in Polokwane City. Further research is needed to explore how trauma trained GPs could be better equipped, prepared and supported in the management of trauma. There was also a need to address the disincentive factors to trauma training, preparedness and practice while strengthening the incentives. Given the critical shortage of advanced emergency practitioners (such as paramedics) in Limpopo province, there was perhaps a need to consider how GPs, with their 7 advanced medical qualifications and strategic positioning within communities, could be better deployed in pre-hospital trauma care.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the degree of Master of Science in Medicine, 2014
The earliest possible initiation of reperfusion therapy is necessary to reduce morbidity and mortality from acute STEMI. Therefore improving the time to thrombolysis where percutaneous coronary interventional facilities are limited or do not exist is critical. The most effective system would integrate three key components to deliver continuous patient care, including: 1) from time of call for help through to emergency response; 2) transportation to and admission to hospital; 3) assessment and initiation of thrombolytic therapy. The purpose of this prospective study is: to develop a chest pain awareness education programme appropriate for the South African context; to assess safe initiation of thrombolytic therapy by emergency care practitioners for STEMI; and to compare the performance of emergency care practitioner thrombolysis with historical control data.

This handbook is the invaluable guide to providing high-quality care in a pre-hospital environment. Evidence-based and reflecting new developments in regulation and practice, this second edition is designed to provide key information for all immediate care practitioners, including doctors, paramedics, emergency medical technicians, and community responders. The text has been cross-referenced with the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) handbook and appropriate national clinical guidelines to ensure full clinical relevance. Reflecting the major advances in delivery of pre-hospital care, including the greater survival benefits for heart attacks and major trauma when delivering patients directly to higher levels of care, the evolution of the paramedic role into critical care paramedics, roadside rapid sequence induction of anaesthesia, and the introduction of mechanical chest compression devices, this new edition is the ideal companion for those involved in delivering pre-hospital care. It also links to relevant online databases and mobile apps that can assist with calculations, and contains key algorithms and formulae to ensure good care.

Many doctors are attracted to pre-hospital emergency medicine (PHEM) because of the variety of challenges that it presents. With limited time and resources, the doctor is expected to assess and treat a range of medical and traumatic pathologies in patients of any age, without delaying transport to the most appropriate location for definitive care. This must be done in spite of what is usually a suboptimal environment, e.g. in a ditch at the roadside, on a rainy building site, or in a crowded town centre. Recognizing the limitations of what can be achieved on scene is a key skill that must be balanced against the increasing range of lifesaving interventions at the disposal of pre-hospital teams. While PHEM has been practised by a variety of doctors for many years, it has only recently gained General Medical Council (GMC) subspecialty recognition. A formal training programme may now be undertaken by trainees with base specialties of acute medicine, anaesthetics, emergency medicine, and intensive care medicine, leading to a dual certificate of completion of training. The challenging nature of the pre-hospital environment, the high-risk nature of the interventions that can be undertaken, and the lack of availability of immediate assistance on scene mean that PHEM is a service delivered by consultants and senior trainees. Medical students and foundation doctors who may be interested in PHEM training should seek to spend time in the above mentioned acute specialties, as well as looking for opportunities to observe alongside some of the services that operate nationally. The following questions represent a small selection of the range of scenarios that may be faced by a PHEM practitioner on a day-to-day basis.

Pain management is an essential part of effective pre-hospital care. The provision of analgesia should be regarded as normal practice that requires careful patient assessment, appropriate analgesic selection, and careful monitoring of the patient for both clinical effectiveness and adverse reactions. The method and choice of analgesia will vary depending on the skills of the practitioner. The chapter covers choices of analgesia, management of the airway (including moving the cervical spine) and anaesthesia.

Student health care practitioners are often apprehensive about simulated examinations as they have never undertaken an examination like this before and often do not know what to expect. The purpose of the chapter is to explore the OSCE process and help you to understand and plan for your own OSCE. OSCE examinations may be organized very differently depending upon the subject of the examination and your own university’s preference. Most simulated examinations are held in clinical skills rooms or simulation suites at the student’s university campus. Very occasionally they may be held off site at another location, e.g. a hospital teaching room. The examination structure may vary dramatically (Bloomfield et al. 2010) and may be: ● Multiple short stations, ● Complex single stations, ● Unmanned station. These are also known as ‘short case’ OSCE stations. A typical short station OSCE will involve the student health care practitioner ‘rotating’ around a number of different stations. It is likely that within each examination room several skills will be assessed at any one time and part of the assessment will involve moving from station to station to ensure that students complete all skills/knowledge assessments that are required. This format allows examiners to assess a range of skills during one simulated examination period (Ahuja 2009). The number of stations will depend upon the university’s examination structure but it may be that there are up to five stations to attend. Some universities ask students to rotate around more than this (in some occasions up to 20). This type of OSCE is very common in pre-registration nursing OSCEs (Bloomfield et al. 2010). Simulated examinations may be held in one room or students may be required to move from room to room to ensure all skills are assessed. This type of OSCE is usually used to examine the more complex skills and may be used in the final year to test more complicated skills such as assessment of the sick patient. You should be aware that you may also be asked to undertake OSCE in your post-registration nurse education.

Respiratory illnesses commonly cause sickness absence, unemployment, medical attendance, illness, and handicap.¹ Collectively these disorders cause 19 million days/year of certified sickness absence in men and 9 million days/year in women (with substantial additional lost time from self-certified illness) and, among adults of working age, a general practitioner consultation rate of 48.5 per 100/year with more than 240 000 hospital admissions/year. Prescriptions for bronchodilator inhalers run at some 24 million/year, and mortality from respiratory disease causes an estimated loss of 164 000 working years by age 64 and an estimated annual production loss of £1.6 billion (at prices in 2000). Respiratory disease may be caused, and pre-existing disease may be exacerbated, by the occupational environment. More commonly, respiratory disease limits work capacity and the ability to undertake particular duties. Finally, individual respiratory fitness in ‘safety critical’ jobs can have implications for work colleagues and the public. Within this broad picture, different clinical illnesses pose different problems. For example, acute respiratory illness commonly causes short-term sickness absence, whereas chronic respiratory disease has a greater impact on long-term absence and work limitation; and the fitness implications of respiratory sensitization at work are very different from non-specific asthma aggravated by workplace irritants. Occupational causes of respiratory disease represent a small proportion of the burden, except in some specialized work settings where particular exposures give rise to particular disease excesses. The corollary is that the common fitness decisions on placement, return to work, and rehabilitation more often involve non-occupational illnesses than occupational ones. By contrast, statutory programmes of health surveillance focus on specific occupational risks (e.g. baking) and specific occupational health outcomes (e.g. occupational asthma). In assessing the individual it is important to remember that respiratory problems are often aggravated by other illnesses, particularly disorders of the cardiovascular and musculoskeletal systems.

This research aimed to study the effect of awareness on the acceptability of human papillomavirus vaccination with belief acting as a moderator between the two variables. Quantitative research was conducted in a hospital with a specific focus on gynecological operations and family planning. The method of data collection comprised of a questionnaire, which was filled out by 50 women from various religious and cultural backgrounds. SPSS was used to conduct statistical analysis. The univariate, bivariate, and multivariate analyses indicated that the results were not conclusive with the hypothesis. The participants had no pre-existing information regarding vaccinations and the knowledge of the diseases being studied as opposed to the hypothesis. This research brings focus towards a deeply neglected area of reproductive healthcare in Pakistan. This includes a lack of awareness amongst the population regarding HPV. Lack of concrete and accurate knowledge directly affects the amount of awareness present in Pakistan regarding HPV, which is close to zero, as indicated by this study. This absence of awareness means that we, as healthcare practitioners, cannot research the current topic and expect it to produce any conclusive results.