Presented by: Iain Wilkinson, Stephen Collins, Georgie Gill

 

Special Guests: Silas Houghton-Budd, Emily Reynolds, Carol Robertson, James Yates

 

Broadcast date: 11th January 2022

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Blog post by Sarah Russell, Palliative Care Nurse, BMJ Evidence based Nursing. 

 

‘Now, every time I assess a dying person, I think not only of the pathology, radiology, diagnosis, and medication, but also of the meaning of those last breaths for them and those that care about them. Last breaths symbolise the relationship between life and death, between living and dying and how people want to use those last breaths…

 

“The space between, 

the space behind,

The space in front

All empty and full.

Last breath in,

Last breath out,

Now gone.”

 

(Russell 2021)

Learning Outcomes: 

Knowledge:

  • To develop a better understanding of the role played by paramedics within the multidisciplinary team relating to the care of older adults
  •  
  • Consider the wide variety of roles taken on by paramedics, and understand that not all pre-hospital care takes place in ambulances 
  •  
  • Recognise the frailty services provided by paramedics out of hospital, and how they are often instrumental in keeping older patients in the safety of their own homes when hospital admission is not required.
  •  

Skills

  • Learn to take more effective handovers from paramedics, by gaining a fuller understanding of what exactly they have been able to do with the patient before they arrive at the doors of the Emergency Department
  •  
  • Improve our communication with members of the paramedic service, and make use of the information they have helpfully gained from getting to know the patients and their families prior to hospital admission
  •  

Attitudes:

  • Reinforce to all healthcare staff that paramedics are a vitally important part of the patient journey, and not a separate pre-hospital entity
  •  
  • Challenge stereotypes that paramedics only drive ambulances
  •  
  • Gain a better appreciation for the scope of the work done in the community by ambulance staff and frailty teams along side primary care in aiming to prevent ED presentations and inpatient admissions for frail older people

Definitions

Paramedic = Someone who works autonomously as a generalist clinician across a range of healthcare settings, usually in emergency, primary or urgent care. They may also specialise in clinical practice, education, leadership or research. (Eaton et al, 2019)

 

“A paramedic is a registered healthcare professional who works autonomously, often in uncontrolled environments, drawing on critical and dynamic decision making to assess and manage an undifferentiated and unpredictable caseload safely and effectively.” (College of Paramedics, 2020)

 

Paramedics have four key characteristic skills; Managing uncertainty, Broad capabilities, Gate keeping clinicians, Integrated working. 

 

Conveyance= the transfer of patients, medical and clinical personnel, equipment and associated records from one healthcare facility to another, as well as the initial journey from the scene.

 

Lucas device= a mechanical chest compression-decompression system, which enables automated and continuous closed chest compression, without unduly limiting other invasive procedures. This device enables the team to maintain chest compressions when there are fewer team on scene or during transport to advanced lifesaving therapies at hospital such as ECMO or PCI.

There are over 28,000 paramedics working in the UK today

 

48% of paramedics in the UK work on frontline ambulances

 

A 2021 survey showed that 70% of paramedics in the UK have feared for their own safety or felt threatened while carrying out their duties (College of Paramedics, 2021)

 

  • The same survey showed that 49% of paramedics have suffered physical abuse, and 80% had been verbally abused while working. 
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  • 89% reported that their job was taking a toll on their mental health.

Some examples of non-ambulance Paramedic roles:

HEMS Paramedic

 

Expedition Medic

 

Motorsport Paramedic

 

Coastguard Paramedic

 

Sports Medicine

 

Offshore Paramedic

 

Military or Marine Paramedic

Resuscitation Practitioners


Advanced Clinical Practioners (Frailty, Stroke, Emergency Medicine, Urgent Care)


Primary Care Paramedics


Research Paramedic


Event Paramedic


and lots lots more!!

#NotAllParamedicsWearGreen

Resources and other useful information:

 

The Resus Room podcast (co-hosted by James Yates)

 

The PREMED Podcast, previously known as the Pre-Hospital Podcast (co-hosted by Silas Houghton-Budd) 

 

‘What is a paramedic?’ (including a helpful intro to the Not All Paramedics Wear Green campaign)

 

College of Paramedics Survey 2021

NHS Ambulance Services, National Audit Office Report 2017- 

 

‘Becoming a paramedic’, NHS Careers- 

 

‘Last Breath’ poem, Sarah Russell, BMJ Evidence Based Nursing 

NHS Key Skills Framework.

Core


  • Communicate with people on a range of matters.
  • Contribute to own personal development.
  •  

Health and Wellbeing


  • Enable people to meet ongoing health and wellbeing needs. 
  • Plan, deliver and evaluate care to meet peoples health and wellbeing needs. 

Foundation Curriculum 

Year One

2.6 Communicates clearly in a variety of settings

 

Works effectively within the healthcare team for the benefit of patient care

 

Makes clear, concise and timely written and oral referrals to other healthcare professionals within the hospital

 

2.7 Works effectively as a team member 

Acts as a member of the multidisciplinary professional team by supporting, respecting and being receptive to the views of other healthcare professionals

 

3.9 Recognises, assesses and initiates management of the acutely unwell patient

 

Initiates prompt appropriate management to stabilise/prevent further deterioration in patients with common acute presentations (including mental health) and seeks timely senior help with the further management.

 

Communicates with the patient, relatives and carers and ensures they are supported.

 

3.18 Recognises and works within the limits of personal competence. 

Recognises and works within limits of competency

Uses clinical guidelines and protocols, care pathways and bundles

Foundation Curriculum 

Year Two

1.2 Delivers patient centred care and maintains trust 

Discusses management options with patients and responds to their ideas, concerns and expectations

2.7 Works effectively as a team member

Anticipates and identifies problems for the next clinical team/shift and takes pre-emptive action where required

 

3.10 Recognises, assesses and manages patients with long term conditions

Encourages and assists patients to make realistic decisions about their care and helps them to construct and review advance/long-term care plans

GP Training Curriculum

Making decisions

Recognise the importance of a problem-based approach, taking in the ‘big picture’, rather than a disease-based approach to the care of older people, who often have complex physical, psychological and social problems

 

Working with colleagues and in teams

Be able to co-ordinate teamwork in primary care including involvement of family members nearby, or at a distance

 

Organisational management and leadership

Have an organisational approach that allows easy access to the primary healthcare team for older people, appropriate timing of appointments, sign-posting to appropriate team members, and the systematic management of chronic conditions and co-morbidities

 

Core Medical Trainee

Managing patient conditions and promoting patient self-care

Define the role of rehabilitation services and the multi-disciplinary team to facilitate long-term care


Management and NHS Structure

Understand the local structure of NHS systems in your locality recognising the potential differences between the four countries of the UK


Geriatric medicine competencies: 

  •  
  • Recognise importance of multi-disciplinary assessment
  • Elucidate in older patients co-morbidities, activities of daily living, social support, drug history and living environment
  • Recognise the often multi-factorial causes for clinical presentation in the elderly and outline preventative approaches
  • Recognise that older patients often present with multiple problems (e.g. falls and confusion, immobility and incontinence)

Internal Medicine Training Curriculum 

Generic CiP 1:

Able to function successfully within NHS organisational and management systems

Generic CiP3: 

Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement

Geriatrics and Higher Specialty Training Curriculum

27. Comprehensive geriatric assessment

Have knowledge of the range of agencies that can provide care and support both in and out of hospital and how they can be accessed

 

30. Rehabilitation and Multidisciplinary Team Working

Principles of rehabilitation and comprehensive assessment

Roles and expertise of different members of interdisciplinary team

 

40. Community practice including Continuing, Respite and Intermediate Care

Frailty

Models of intermediate care/community geriatrics including evolving role of day hospitals and care home medicine

 

44. Care of older people living with frailty

Clinical presentation of frail older people

Advocacy for frail older people