Safety matters: an important issue

While patient safety and treatment are the foremost concerns for practising paramedics, personal safety is often overlooked. Due to the nature of work undertaken by paramedics, the likelihood that they will encounter hostile and dangerous situations is high. The prevalence of binge drinking, which has become

an increasing part of UK culture, has meant that many paramedics working night shifts are faced with inebriated and potentially aggressive patients. This combined with psychotic, confused or panicked patients, emphasises that

this is very much a real problem that needs to be taken into consideration. Only recently has it emerged that staff of the London Ambulance Service (LAS)

have been advised not to visit more than 200 homes without police assistance. The information comes following a freedom of information request, which revealed that

of 390 households on LAS’ Location Alert Register, 226 fell under its most serious classifications (Savage, 2013). The alert register is divided into four categories, with the 226 homes falling under categories one and two, where physical violence, threats with a weapon or ‘aggravated verbal abuse’ lead to the need for a police call-out. As in any other occupation, paramedics should not be expected to work when placed under abuse or in hazardous environments. It therefore begs the question as to the level of risk paramedics are taking when dealing with dangerous patients, as well as a number of ethical concerns regarding when a paramedic should or should not treat a patient.

This issue of the Journal of Paramedic Practice addresses this notable concern for pre-hospital professionals. Robert Kaiser argues that not enough is being done to reduce operational risks for paramedics. He calls for the urgent need of UK Home Office certified stab-resistant vests for all front-line ambulance professionals, disagreeing with many Ambulance Trusts that body armour can be perceived as too confrontational, aggressive or authoritative. Providing recent statistics for the number of physical assaults of ambulance personnel, Kaiser presents a convincing defence for increased personal protective equipment provision.

The conventional advice that is given to those unsure of what to do in dangerous situations is to withdraw and summon support. However, as Iain Bourne points out, this is something which is not always possible or appropriate. Bourne’s article introduces paramedics to the Instant Aggression Model, a guide for the helping professional to help them through dangerous encounters as they happen, moment by moment. By providing paramedics with a step-by-step account of how to act depending on an aggressor’s actions, it is hoped that readers will be able to use this information to positive effect in the workplace.

It might not be possible to eliminate the dangers faced by paramedics, but being aware of potential threats and knowing how to act in hostile circumstances is an integral way to reduce risk.

References:

Savage J (2013) London paramedics need police assistance ‘at 200 homes’. BBC News. http://www.bbc.co.uk/news/uk-england- london-23501832 (accessed 2 September 2013)

Taken from Journal of Paramedic Practice, published 9 September 2013.

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London paramedics require assistance at 200 homes

Staff of the London Ambulance Service (LAS) have been advised not to visit more than 200 homes without police assistance.

The information comes following a freedom of information request, which revealed that of 390 households on LAS’ Location Alert Register, 226 fell under its most serious classifications.

The alert register is divided into four categories, with the 226 homes falling under categories one and two, where physical violence, threats with a weapon or ‘aggravated verbal abuse’ lead to the need for a police call-out.

However, LAS paramedics were told that they should only delay treatment to patients and await police arrival if they felt they were personally at risk.

Leo Nakhimoff, a paramedic for LAS, was assaulted whilst on duty last year:

‘When you’re going about your daily job treating patients you don’t expect to get attacked with a fence post—it was completely unprovoked,’ he said.

‘It affected me quite badly at the time and I questioned whether I wanted to continue working as a paramedic. It’s now at the back of my mind when I get called to similar incidents.

‘At the end of the day, we’re here to help people and we don’t want to be in fear of being attacked.’

Taken from Journal of Paramedic Practice, published 28 August 2013.

Heatwave sees number of ambulance call outs increase

The current heatwave affecting the UK has meant that ambulance services throughout the country have experienced a significant rise in their number of call outs, with the London Ambulance Service seeing a 20% increase in 999 calls categorised as life-threatening.

The heat poses a considerable threat to those who are more vulnerable, notably older people, babies, children, people with mental health problems, chronic conditions and those on certain medication.

Apart from the conventional conditions associated with high temperatures such as dehydration and sunburn, hot weather can exacerbate existing heart and respiratory problems, and can lead to potentially life-threatening conditions such as heat stroke.

As part of an effort to create awareness of the health risks associated with hot weather, NHS England has issued a number of tips in the hope of reducing the number of medical emergencies. Among these tips, it has been advised that the sun should be avoided during the hottest part of the day, appropriate levels of sun cream should be applied, and sufficient fluids should be taken on board.

In other services, London’s Fire Brigade have announced their highest number of grass fires since 2006.

Taken from Journal of Paramedic Practice, published 23 July 2013.

LAS improves out of hospital cardiac arrest survival rates

As part of a call to action from health secretary Jeremy Hunt to reduce the number of avoidable deaths in the UK, the Department of Health has published an outcomes strategy on cardiovascular disease (CVD), which will support the NHS and local authorities in delivering improved outcomes for those with or at risk of CVD.

The announcement comes following The Lancet’s recent report on the UK’s health performance, which highlighted that the UK was a long way behind many other countries.

CVD affects the lives of millions of people and is one of the largest causes of death and disability in the UK. However, fast responses to emergencies can save lives and, in some cases, reduce disability.

According to the strategy about 50 000 out of hospital cardiac arrests (OHCA) occur each year in England. Due to a variety of reasons, such as co-morbidity, resuscitation may be inappropriate, and so attempted resuscitation by ambulance services occurs in less than 50% of cases.

However, there is significant variability between ambulance services in rates of successful initial resuscitation (13-27%) and survival to hospital discharge (2-12%) following an OHCA. If survival rates were increased from the overall average (around 7%) to that of the best reported (12%), it is estimated that an additional 1 000 lives could be saved each year.

The strategy revealed that since 2004/2005 the London Ambulance Service (LAS) has improved overall OHCA survival to hospital discharge from a rate of 4% to 11% in 2011/2012. This is as a result of quicker response times; taking heart attack and cardiac arrest patients direct to heart attack centres; and improving bystander resuscitation.

Despite improvement in the LAS, variation in the quality of acute care in other parts of the country mean that much can still be done if patient mortality from CVD is to see considerable change.

The CVD outcomes strategy claims that the NHS Commissioning Board (CB) will work with the Resuscitation Council, the British Heart Foundation and others to promote automatic external defibrillator (AED) site mapping/registration and first responder programmes by ambulance services, and consider ways of increasing the numbers trained in cardiopulmonary resuscitation (CPR) and using automated AEDs.

Taken from Journal of Paramedic Practice, published 14 Mar 2013.