Emergency medicine journal : EMJ
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Comparative Study
Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians.
Emergency medical services in the UK are facing the challenge of responding to an increasing number of calls, often for non-emergency care, while also providing critical care to the few severely ill or injured patients. In response, paramedic training in the UK has been extended and there are regional strategies to improve prehospital critical care (PHCC). We describe the clinical competencies of three groups of prehospital providers in the UK with the aim of informing future planning of the delivery of PHCC. ⋯ Paramedics possess a considerable number of competencies which allow them to diagnose and treat a variety of conditions. CCPs and PHCC physicians possess a few additional critical care competencies which are potentially life-saving but are required infrequently and can carry significant risks. Concentration of training and clinical exposure for a small group of providers in critical care teams can help optimising benefits and reducing risks of PHCC.
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Paramedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP). ⋯ There is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome.
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Randomized Controlled Trial Comparative Study
Basic life support skill improvement with newly designed renewal programme: cluster randomised study of small-group-discussion method versus practice-while-watching method.
For the basic life support (BLS) renewal course, we have devised a new educational programme entitled a small-group-discussion (SGD) programme using personalised video-based debriefing. ⋯ The new SGD renewal programme is more effective than the PWW programme for improving skills in BLS renewal training.
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Randomized Controlled Trial
Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): results from the pilot randomised controlled trial.
High blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited. ⋯ http://www.clinicaltrials.gov. Unique identifier: NCT01066572.
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Review Case Reports
BET 2: transtracheal ultrasound to confirm tracheal intubation in cardiopulmonary arrest.
A shortcut review was carried out to establish whether transtracheal ultrasonography can reliably identify tracheal placement of and endotracheal tube during cardiac arrest. Using the reported searches, 260 papers were found of which one presented the best evidence to answer the clinical question. ⋯ It is concluded that transtracheal ultrasonography may be a supplementary tool for establishing the correct tracheal tube placement in cardiac arrest. Further work is needed.