Pre-hospital Critical Care Conference

On 4 September, the School of Health and Social Work at the University of Hertfordshire hosted its conference for critical care paramedics: ‘Changing horizons in contemporary practice’. A platform for discussion of contemporary clinical and operational issues that shape the pre-hospital critical care landscape, the conference placed a particular emphasis on the role of the critical care paramedic.

Drawing a wide variety of speakers from clinical and academic backgrounds, the conference was attended by students, ex-students, educators, paramedics, critical care paramedics and those simply interested in this emerging field.

Following a welcome address by John Donaghy, lecturer in paramedic science at the University of Hertfordshire, the conference began with an overview of the evolution of the critical care paramedic from Professor Andy Newton, consultant paramedic and director of clinical operations, South East Coast Ambulance Service NHS Foundation Trust. Providing an outline of the history of critical care paramedics, pointing out comparisons to similar innovations in other countries, Newton highlighted the reduced cost of CCPs in comparison to doctors and the possibility of the introduction of a CCP exam in 24 months.

Newton was followed by Jim Walmsley, a student CCP for SECAmb and winner of the 2011 National Institute of Health Research Bursary. Walmsley presented findings from his survey-based study (S.T.O.C.K.L.I.S.T.) examining what clinical skills CCPs should possess within a British context. Walmsley explained the difficulty of a lack of consensus of a critical care title and the need for the identification of a core clinical scope of practice for CCPs. He argued that we must learn from other advanced practitioner roles such as emergency care practitioners and physician assistants.

Mark Whitbread, consultant paramedic within the London Ambulance Service, delivered a talk on the weakest link of sudden cardiac arrest, which he claimed is return of spontaneous circulation (ROSC). Whitbread explained the poor outcomes of patients who achieve ROSC and are delivered to the emergency department, suggesting the need for more cardiac centres with cardiac catheter labs where ROSC patients could be taken.

Tim Edwards, paramedic team leader with the London Ambulance Service and senior lecturer at the University of Hertfordshire, discussed paramedic advanced airway management in cardiac arrest. After providing a background and outlining current controversies, Edwards explained how paramedics don’t have enough practice in endotracheal intubation. For high success rates, paramedics need to carry out more than 20 ETIs per year—a figure that is rarely achieved. However, he highlighted the misconception by some that paramedic ETI success rates are always low and that unrecognised oesophageal intubation is common.

Professor Douglas Chamberlain, a retired cardiologist who needs no introduction, concluded the pre-lunch talks with a who, where, what, why and how of resuscitation. A concise and entertaining talk, he concluded by urging that: ‘We need more research and guided development to optimise survival.’

Doctor Neil Thomson, assistant medical director with the London Ambulance Service, continued the talks by discussing pre-hospital airway management in traumatic brain injury. Two important concepts taken away from this talk were that critical care is a process not a place, and that critical care is not about doing clever things, but about doing basic things well. Through good attention to detail, CCPs can optimise the chances of a decent neurological outcome.

Unfortunately Doctor Mark Bloch was unable to deliver a talk, despite being billed as one of the speakers. However, he was replaced by Dan Cody, critical care paramedic for East of England Ambulance Service NHS Trust, who gave an engaging talk on the pre-hospital use of ketamine. Looking at some of the myths surrounding the use of ketamine, he went on to illustrate how it is safe and effective, and applicable to specialist paramedic practice provided appropriate training and governance is given.

Rob Bentley, motorcycle response unit paramedic with the London Ambulance Service, gave an enlightening talk on the topic of pre-hospital resuscitative thoracotomy. A procedure that is uncommon to many paramedics, he outlined when and why it should be performed.

Allan McHenry, development lead for the critical care paramedic programme at South East Coast Ambulance Service NHS Foundation Trust, delivered the final talk of the day on developing clinical practice for the critical care paramedic. Outlining the case for specialisation in high acuity care, he claimed it is an important part of what CCPs do. Looking to the future, McHenry argued there is a need to expand the scope of paramedic practice as there is ‘still a need for paramedics to evolve.’ As doctors are too expensive to have in every CCP car, McHenry urged that ‘we need to develop the workforce we have to fill a gap in the care.’

Despite taking approximately three years to get off the ground, it is testament to the University of Hertfordshire that it was able to attract such a healthy number of delegates for its first critical care conference. For those interested in this exciting field, you would do well to sign up early should the conference return next year.

Taken from Journal of Paramedic Practice, published 25 September 2013.