Emergency medicine journal : EMJ
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The paramedic profession, along with the broader structure and mission of NHS emergency ambulance provision, is undergoing significant but rather undefined change. The clinical scope of the paramedic role has broadened, and the opening of new patient pathways has enabled a broader range of treatment and referral options for attending ambulance crews. Ambulance trusts have moved to an all-graduate intake for new paramedics, and significant advances have been made in establishing the classic steps of a 'professionalization project' (such as the growth of the College of Paramedics, the development of peer-reviewed practitioner journals, and the introduction of advanced paramedic roles.) Some of these changes are contentious, however, and many of the fundamentals of ambulance work and occupational culture remain unchanged to a significant degree. ⋯ Based on qualitative interviews and ethnographic observation of ambulance crews and of mid-level ambulance trust managers, the paper provides an in-depth exploration of the culture of everyday working life in (anonymized) ambulance trusts. We identify several broad conceptions among staff as to the essence and purpose of emergency ambulance provision, of ambulance trusts as employers, and of the goals and potential pitfalls of the professionalization project. The paper thus explores the multifaceted meanings of 'professionalism' and considers the broad challenges facing the profession at large and NHS trusts as employers as both confront unsettling forms of change.
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Traditionally, paramedics do not learn the diagnosis of a patient once handed over at the Emergency Department (ED). In this pilot study, a system of feedback from the ED was provided to a group of paramedics using secure email. The diagnosis given in ED and discharge destination of their patients was provided in an anonymised format. ⋯ Receiving this feedback enables paramedics to audit the quality of their work. They find this beneficial and there is the potential to improve skill in diagnosis. Further studies in this area are suggested.
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Falls occur increasingly frequently with age. 35% of people aged over 65 fall each year rising to 50% at age 85. Many patients fall repeatedly. 56% of patients attending an emergency department were recurrent fallers, and 55% of patients presenting with an acute fracture had previously fallen. Fracturing bones is closely linked to falling and carries great costs both for the NHS and the individual. ⋯ GPs are quite often aware of their frequent falling patients, home adaptations had been made, often are already taking medications for osteoporosis, they have personal alarms, home carers who visited frequently and fall assessments had been carried out. Additionally, paramedics felt that some patients do not want to be helped and felt there is a limit to what can be done to prevent people from falling in their own homes. This presentation will provide an insight into the levels of care and professionalism that paramedics demonstrate when attending people who fall in everyday practice.
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The Medical Research Council (MRC) guidance for the development and evaluation of complex interventions describes such an intervention as one which has several interacting components; the MRC recommends that complex interventions are developed through literature identification, modelling of processes and theory development. We describe the utilisation of this guidance to develop the SAFER 2 (Support and Assessment for Fall Emergency Referrals) study intervention-a multi-centre randomised controlled trial (RCT) looking to improve the care Ambulance Services provide to elderly patients who fall. ⋯ Thorough intervention development and effective implementation are vital to the success of SAFER 2 and other studies in this field. In order to produce generalisable evidence about clinical and cost effectiveness that is reproducible, the intervention needs to be clearly defined with input and agreement from study stakeholders.
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The Welsh Government's strategy to improve Chronic Conditions Management includes improving care coordination and patient self-management to reduce unscheduled care use. Welsh health boards have responsibility for implementing the strategy since 2008. In 2011, integrated working between health and social care professionals was piloted in Carmarthenshire, part of Hywel Dda Health Board. ⋯ People with multiple and complex chronic conditions appear confident about self managing their health. Integrated working across providers seems to work best for patients who are least or most ill; otherwise people with multiple conditions complain that care is disease-specific not patient-focused. Accessing treatment should be considered as a component of care because difficult travel arrangements are preventing people attending appointments.