It takes a system to save a life

Adobe Spark (3)Last month saw pre-hospital and emergency care professionals from around the globe gather for the first European Emergency Medical Services (EMS) Congress in Copenhagen. Opened by Her Royal Highness Crown Princess Mary of Denmark, the 3-day event aimed to set new standards for research and treatment, as well as to establish an EMS Leadership Network in Europe, targeted at strengthening cross-national collaboration. Running under the theme of ‘It takes a system to save a life’, presentations emphasised the need for cooperation between the dispatch centre, ambulance services and the emergency departments for lives to be saved.

Denmark has made an impressive contribution to the field of resuscitation medicine. The congress was used as a platform to highlight the latest figures from the Danish Cardiac Arrest Registry, which collects nationwide data relating to out-of-hospital cardiac arrest. They revealed that in Denmark nearly one in four survive sudden cardiac arrest in public spaces. This is due, in part, because of the remarkable increase in the number of bystanders performing CPR before the arrival of EMS (19.4%–65.8% from 2001–2014). This is worth taking note, as approximately 1 in 8 out-of-hospital cardiac arrest patients survive if bystander CPR is initiated, compared to 1 in 30 when it is not. This provides a valid argument for implementing CPR training in schools, as well as illustrating how involvement of the community should be an integral part of any EMS.

The congress was also used to launch the Global Resuscitation Alliance, a network focused on collaborating to increase survival from sudden cardiac arrest. This agreement, signed in Copenhagen at an Utstein meeting prior to the congress, constitutes the culmination of three decades of international work, and is a major and decisive step in global efforts to save more lives from sudden cardiac arrest. Participants of the alliance have committed themselves to the ambitious target of increasing survival rates by 50%.

Alongside the scientific programme, sponsored symposia and workshops offered delegates the opportunity to expand their knowledge on areas such as managing the everyday critically ill patient, and improve their competence with a hands-on procedural cadaver lab.

Additionally, 13 teams from around the world competed in the European EMS Championship. The competition consisted of scenario-based events that tested each team’s ability to manage patients in various circumstances with common critical medical conditions and trauma. London Ambulance Service NHS Trust (LAS) walked away with the top prize, fighting off stiff competition from Turkey and Denmark in the final. Judges praised LAS for their extraordinary skills and team work in the final scenario: a canoe accident on a Copenhagen beach.

This would easily have been enough to satisfy those attending the congress, yet a number of excellent social events were also added to the mix. From morning runs and swims to an emergency management scenario at Copenhagen City Hall Square and a Gala Dinner, organisers went to every effort to ensure the event was a success. Delegates will undoubtedly be itching to return in 2017.

Taken from International Paramedic Practice, published 22 June 2016.

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Caring for Calais

Photo Credit: Rose Oloumi

Photo Credit: Rose Oloumi

Earlier this month I accompanied a group of student paramedics who were spending their weekend providing first aid at the refugee and migrant camp on the outskirts of Calais, France. Situated adjacent to a motorway and in the vicinity of a chemical factory, the camp is colloquially referred to as the ‘Jungle’ by outsiders, as well as those who have been forced to call it home. While semi-permanent structures made of converted shipping containers were introduced by the French Government at the beginning of the year, the vast majority of people live in makeshift shelters and tents in squalid, overcrowded conditions. Current figures estimate the number of refugees and migrants living in the area as anything between 6000 and 8000, with many more arriving each day.

Médecins du Monde (Doctors of the World) have provided essential medical help to refugees and migrants living in and around Calais and Dunkirk since 2003. Médecins Sans Frontières (Doctors without Borders) have provided aid more recently and run a health clinic that is open Monday to Friday within the main Calais camp. However, there is no official system in place over the weekend. As a result, health professionals offer their time and services, providing first aid from three caravans located within the ‘Jungle’. Patients are predominantly treated for minor ailments such as colds, lice and the various coughs referred to as ‘Jungle lung’, as well as bruises, cuts and broken bones sustained from attempts at crossing the border into the UK. In the case of more serious incidents, patients are transported to an emergency department in the city.

Shadowing the paramedics for two days as they wandered through the camp providing care, one was made acutely aware of how desperate circumstances for those living there are. The recent demolition of the southern part of the camp highlighted the general sentiment that the refugees and migrants are not welcome there. However, by evicting them from their homes the police are simply moving the problem, not addressing it. For the refugees and migrants, this means the Sisyphian task of constantly having to rebuild their homes.

What is most disheartening on a personal level is that the current situation in places such as Calais in France or Idomeni in Greece appears somewhat hopeless. While countless people offer their time, money and professional expertise to provide care and support for the thousands of refugees and migrants who have come to Europe seeking work or asylum, it does not get to the root of the problem. It reminded me of a line in Nigerian novelist Chinua Achebe’s book Anthills on the Savannah: ‘While we do our good works let us not forget that the real solution lies in a world in which charity will have become unnecessary.’ This dispiriting quote is notably poignant in light of what the Western media has dubbed the ‘migrant crisis’. The lack of willingness for many European countries (including Britain) to grant asylum to people, many of whom have fled their country as a result of their lives or human rights being seriously at risk, means the end result will be the continued living, for many, in conditions that no person should have to experience. Refugees have been present in Calais since 1999 and they continue to be in Calais in 2016. How long will this continue and when will this change?

Taken from International Paramedic Practice, published 30 March 2016.

Managing mass-casualty incidents

As first responders, emergency medical services (EMS) play a key role in the management of mass-casualty incidents, being responsible for the triage, treatment, and transportation of patients to emergency care. Sadly 2015 has been littered with reports in the media of incidents involving large numbers of casualties. For example, the US alone has seen 353 mass shootings this year, the most recent on 2 December at the Inland Regional Center in San Bernardino, California, where 14 people were killed and 17 injured (Mass Shootings Tracker, 2015). Additionally, November will be remembered for the worst attack on France since World War II and the deadliest in the European Union since the Madrid train bombings in 2004. On Friday 13 November, multi-site terrorist shootings in Paris left 130 people killed and over 300 in intensive care. A state of emergency was declared by President François Hollande, and temporary border checks introduced.

Beyond mass shootings, the extent of natural disasters will be most remembered by the 7.8-magnitude earthquake that hit Nepal’s capital Kathmandu and its surrounding areas on 25 April. Here thousands of people lost their lives with many more thousands left injured and homeless.

While the difference between the types of mass-casualty incidents and number of casualties attended by EMS can vary considerably, their fundamental role remains the same. Key to the effective management of these situations is leadership, teamwork and professionalism. Although the outcome of the attacks in Paris left the country devastated, it is worth highlighting the proficiency at which the EMS organised an effective medical response to the attacks, which ensured that many lives could be saved. Triage and pre-hospital care for victims of the attacks was organised by the emergency medical services (service d’aide médical d’urgence, SAMU). SAMU were mobilised immediately following discovery of the attacks, and the crisis cell at the Assistance Publique-Hôpitaux de Paris (APHP) was opened. The APHP crisis unit has the ability to coordinate 40 hospitals with a total of 100 000 health professionals, a capacity of 22 000 beds and 200 operating rooms (Hirsche et al, 2015). Remarkably, it was reported that there were only four deaths (1%) among the 302 injured patients, including two deaths on arrival at hospital (Hirsch et al, 2015).

What is clear from reading about the medical response to these attacks is that professionalism and preparedness lay at the heart of the successful patient outcomes. It is also worth noting that many lessons can be learned from the subsequent scientific publications following mass-casualty incidents, and the role they play in the improvement of medical strategies. Additionally, the importance of effective and unified EMS in mass-casualty situations cannot be underestimated. While the challenge for EMS in managing scenarios involving multiple casualties will remain, through teamwork, adequate training and effective leadership, we can ensure the maximum number of lives can be saved.

References

Hirsch M, Carli P, Nizard R et al (2015) The medical response to multisite terrorist attacks in Paris. Lancet. Published online first. doi: 10.1016/S0140-6736(15)01063-6

Mass Shooting Tracker (2015) Mass shootings in 2015. http://www.shootingtracker.com/wiki/Mass_Shootings_in_2015 (accessed 16 December 2015)

Taken from International Paramedic Practice, published 22 December 2015.

What we can learn from each other

As globalisation continues to rise year on year, the benefit of international learning and collaboration has become increasingly apparent. Within health services, the sharing of research between countries undoubtedly helps improve medical practice, policy and education, both on a national and international level.

Within paramedicine, organisations such as International Paramedic have been created to: ‘address the challenges and opportunities facing the paramedic profession by looking to best practice and current evidence shared by its international members who are not limited by the geopolitical barriers of province, state, region or country’ (Acker, 2014).

International exchange programmes are a regular occurrence within higher education institutions, due to their ability to offer students intercultural awareness and the development of global issues related to the student’s field of study (Lord et al, 2013). Within paramedicine, a number of successful exchange programmes have been documented (Owen and Woodyatt, 2012; Ashton et al, 2013; Jones and McGillis, 2013; Lord et al, 2013; Rice, 2014).

The advent of the internet and social media has also helped health professionals, such as paramedics, develop their personal learning network. While a certain level of quality control must be ensured, the ability for information to be readily shared and discussions of issues relating to pre-hospital practice to be had, offers a great opportunity for personal development.

In this issue of International Paramedic Practice, Rayneau et al recount their experience competing at the Šumava National Park of the Czech Republic for the Pilsen Cup of Paramedics. This is a yearly competition for student paramedics from the Czech Republic and Slovakia, based around remote medicine, patient assessment, treatment and extrication techniques, which this year was open to three students outside the participating countries. The authors praised the event, highlighting that to their knowledge there is little in the way of this type of intensive training used in the UK. As a result of taking part in this event, Coventry University staff and students are in talks about producing something similar in the UK. This is just one example of the potential benefit of international learning.

It is apparent that many opportunities exist for international learning, whether through research, attending conferences, or the sharing of information electronically. Through international collaboration, the development of the profession on a global scale can be achieved and patient care improved.

References

Acker J (2014) International Paramedic: connecting the world. International Paramedic Practice 4(1): 3–4

Ashton K, Davies R, Corkhill S (2013) International student paramedic exchange: the student perspective. Journal of Paramedic Practice 5(5): 286–9

Jones P, McGillis W (2013) International learning: bridging the gap through exchange programmes. International Paramedic Practice 3(2): 53–5

Lord B, Williams J, Jones S, Chittenden M (2013) A pilot international exchange programme for paramedic students. Journal of Paramedic Practice 5(8): 470–5

Owen T, Woodyatt A (2012) Observations from a student exchange programme: UK and Sweden prehospital care. Journal of Paramedic Practice 4(2): 105–10

Rice A (2014) The transnational delivery of paramedic education: the Gibraltar case study. Journal of Paramedic Practice 6(2): 90–92

Taken from International Paramedic Practice, published 23 July 2015.

Surge in overseas recruitment

Ambulance services within the UK are increasingly looking overseas to recruit staff as a result of a nationwide shortage of paramedics. The need for the drive has been brought on, in part, following the recommendation for paramedics to be added to the shortage occupation list for the first time (Migratory Advisory Committee, 2015). Significant increases in demand for ambulances in the UK following the shift in focus to treat people at home rather than in A&E; high staff attrition due to work pressures and stress brought on by longer working hours; and growing opportunities for paramedics to take on roles in alternative areas, have all contributed to the shortage.

While only one paramedic was recruited from overseas from 2013–2014, 183 have already been recruited from 2014–2015, with additional recruitment planned for the rest of the year (Renaud-Komiya and Calkin, 2015). Many of the staff now employed by the London Ambulance Service NHS Trust (LAS) have come over from Australia and New Zealand, where paramedics share a similar skillset with the UK. There is also the added benefit of a mutual language. Conversely, South Central Ambulance Service NHS Foundation Trust has turned to Poland to help combat their shortage of paramedics. The assessment process within the LAS involves completing a clinical paper, a lifting assessment, and a practical assessment on advanced life support, as well as an oral interview.

However, it is worth noting that the migration of healthcare workers brings with it ethical issues, as services abroad may suffer as a result of their own falling numbers (Peate, 2014). An article in the Herald Sun referred to the ‘aggressive’ campaign being undertaken by LAS as an attempt to ‘poach’ Victorian paramedics (Van den Berg, 2014).

The UK is not alone in looking overseas for recruitment. Many paramedics who trained in the UK now work in countries such as Australia or the United Arab Emirates. However, the extent at which paramedics from other countries are being targeted for recruitment is certainly an anomaly within the UK. While it certainly offers a short-term solution for the current shortage ‘crisis’, it is questionable whether it presents a real answer to the problem. It is undoubted that national investment is needed in the paramedic profession.

That being said, the positives of overseas recruitment shouldn’t be overlooked. Working abroad, even if only temporarily, offers opportunities for intercultural awareness and the development of global perspectives of issues, as well as an insight into alternative pathways of care, service provision and paramedic practice to one’s own country.

References

Migratory Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 26 March 2015)

Peate I (2014) Ethical recruitment and employment of internationally educated paramedics. Journal of Paramedic Practice 6(10): 500–501. doi: 10.12968/jpar.2014.6.10.500

Renaud-Komiya N, Calkin S (2015) Trusts forced to look overseas to plug paramedic gaps. HSJ. http://tinyurl.com/pqeo4k5 (accessed 27 March 2015)

Van den Berg L (2014) London in bid to lure Victorian paramedics. Herald Sun. http:// http://www.heraldsun.com.au/news/victoria/londonin- bid-to-lure-victorian-paramedics/storyfni0fit3- 1227011369042 (accessed 17 September 2014)

Taken from International Paramedic Practice, published 8 April 2015.

Expanding the role of paramedics

As populations worldwide continue to grow and life expectancy rises, there has been a corresponding demand placed on health care services. Emergency medical services (EMS) in particular have found themselves under increasing pressure, with some ambulance services experiencing a rise in the number of emergency calls received by as much as 8% annually (Department of Health, 2004).

Traditionally, EMS systems have focused on providing patient care for acute illnesses and emergencies. However, studies have suggested that 10–40% of EMS responses are for non-emergent situations (Joint Committee on Rural Emergency Care and National Association of State EMS Officials (JCREC and NASEMSO), 2010). The need for an EMS role, which can improve individual and community health, reduce unnecessary hospitalisations and emergency department visits, and reduce health care costs, has led to the introduction of community paramedic programmes in the United States, Canada, Australia and New Zealand. In the United Kingdom, similar work has been carried out by paramedic practitioners and/or emergency care practitioners, although without the same level of community engagement found in the community paramedic role.

The inaugural meeting of the International Roundtable on Community Paramedicine (IRCP) in 2005 gave the opportunity for the international exchange of ideas on integrating rural EMS providers into rural health care delivery systems (IRCP, 2014). The IRCP has continued to meet annually, promoting the international exchange of information and experience related to the provision of flexible and reliable health care services to residents of rural and remote areas using novel health care delivery models, and acting as a resource to Government agencies, emergency service providers, and others (IRCP, 2014).

In this issue of International Paramedic Practice, O’Meara conducts a scoping review of the emergence of community paramedics and their potential impact. His findings illustrate that although there are few empirical studies on community paramedics, with much of the literature consisting of commentaries and opinion papers, there is still an emerging research literature that is contributing to the development of community paramedicine programme models and the evaluation tools that will contribute to the future evolution of the model.

Also in this issue, Raynovich et al present the findings of a survey of community course offerings and planned offerings sent to every recipient of a standardised community paramedic curriculum. The responses indicated that many community paramedic courses were in the planning stages by programmes that had received the standardised curriculum, both in the United States and Internationally.

Both these papers illustrate the need for further research to examine the impact of community paramedicine, but also highlight the potential of extended scope of practice of paramedics who are based in the community.

References:

Department of Health (2004) Statistical Bulletin Ambulance Services, England 2003–04. DH, London, UK

International Roundtable on Community Paramedicine (2014) IRCP History. http://www.ircp. info (accessed 20 May 2014)

Joint Committee on Rural Emergency Care, National Association of State EMS Officials (2010) Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders. National Conference of State Legislators December 2010

Taken from International Paramedic Practice, published 21 May 2014.

Paramedics and professionalisation

Since the birth of organised pre-hospital emergency care the question of its professionalisation has been met with ambiguity. From its origins in military history as a transport service to its development into the current practitioner role that has become an integral part of the health care sector, the need for its recognition as a profession has become increasingly important.

One of the main concerns regarding professionalisation is that it has no clear definition. Sociologists of professions will dispute the requirements necessary for an occupation to be seen as a profession and so it remains questionable as to how much it relies simply on perception. According to Evetts (2012), professionalisation involves the protection of practitioners of an occupation by only making it possible to practice that occupation if you are trained in that particular category of knowledge. However, surely professionalisation extends beyond mere training?

Within the UK, the Health and Care Professions Council (HCPC) was formed as a statutory regulator of health and care professionals, standardising the education and training received by members of the National Health Service (NHS) workforce and moving that training into the university sector (HCPC, 2013). The HCPC liaises with professional bodies for all the professions that the registrar is responsible for. These organisations do work which may include promoting the profession, representing members, curriculum frameworks, post-registration education and training and continuing professional development (HCPC, 2013). The College of Paramedics (then the British Paramedic Association) was set up as the professional body for the ambulance profession. According to the College of Paramedics, having a professional body has given them the opportunity to change the way that education, training and associated awards are established (College of Paramedics, 2013).

In this issue of International Paramedic Practice, Pip Lyndon James looks at the issue of professionalisation for Australian paramedics. She comments on how at present the Australian paramedic discipline is not considered a full profession by the national or state governments. Despite frequent public misassumption that paramedicine is a registered, highly-regulated industry credited with professional status, this is currently not the case.

It is clear that steps are gradually being taken to reach this ultimate aim. Moving in the direction of other health disciplines, such as medicine and nursing, the advent of paramedic degrees worldwide that are replacing the traditional older in-house training conducted by ambulance services is surely a move in the right direction. While paramedicine has not yet received the professional status it deserves, it is important to bear in mind the distinction between professionalism and professionalisation. Until paramedicine receives professionalisation, it is integral that paramedics continue to act in a professional manner, adhering to codes of conduct and striving towards ongoing professional development.

References:

College of Paramedics (2013) About us. http://www.collegeofparamedics.co.uk/about_us/ (accessed 21 August 2013)

Evetts J (2012) Similarities in Contexts and Theorizing: Professionalism and Inequality. Professions and Professionalism 2(2)

Health and Care Professions Council (2013) Aims and vision. http://www.hcpc-uk.org/aboutus/aimsandvision/ (accessed 21 August 2013)

Taken from International Paramedic Practice, published 28 August 2013.