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Found 67 results
  1. News Article
    Two paramedics have been sentenced to five years in prison for stealing medication from terminally ill patients. Ruth Lambert, 33, and Jessica Silvester, 29, of the South East Coast Ambulance Service (Secamb), preyed specifically on people receiving end-of-life care packages, Kent Police said in a statement. The pair, who live together at Gap Road in Margate, accessed addresses of patients in the east Kent area through their work and posed as nurses to gain access to patients’ homes to steal morphine and other painkillers. They worked in tandem, one researching the addresses and sending details to the other who would visit and steal the medication, police said, with victims being targeted in Thanet, Canterbury, Whitstable, Faversham and Herne Bay. Evidence gathered from the pair’s mobile phones showed they had also conspired to steal from Secamb by taking medication from ambulances when on duty. Detective sergeant Jay Robinson, from Kent Police, described the offences as “an astonishing abuse of position”. “Many of their victims have since passed away and will never know that justice has been done,” he said. “Our investigation was carried out, knowing we had to represent those victims and do the very best for them.” Dr Fionna Moore, medical director for Secamb, added that Lambert and Silvester’s behaviour was a “clear and targeted abuse of their position and does not reflect the commitment and integrity of our staff”. Read full story Source: The Independent, 12 January 2022
  2. News Article
    Chest pains for a 63-year-old man might typically mean a hospital trip to check it out. But after Clive Pietzka's 999 call, an advanced paramedic practitioner carried out tests and discharged him. The Welsh Ambulance Service Trust (WAST) job is one of those in a growing team who work to keep people out of hospital. Solutions like this are being sought following ambulance queues for hospital and worst ever performance figures. Mr Pietzka, from Barry, who has a heart problem, said initially he did not want to call an ambulance because of high demand. "They're very busy with Covid and everything else. But the GP practice said to call 999," he said. However, on this occasion a rapid response vehicle - a car with a single paramedic - came within 15-20 minutes and tests were performed, without a hospital trip. Advanced paramedic practitioner John McAllister who attended said he sees people more medical low acuity cases rather than emergency and trauma conditions. "I use assessment techniques and diagnostic tools to assess patients, formulate a diagnosis then put a plan in place," he said. "It's about trying to treat them at the right time and the right place, without having to take them to A&E." Adding to the pressure of the pandemic and winter demand, a shortage of social care workers to support patients' safe discharge means a large number of patients find themselves in hospital longer than medically necessary. The knock-on impact means it is becoming harder for new patients to be treated and admitted. Penny Durrant, the service manager for the clinical support desk at WAST regional headquarters in Cwmbran, said current challenges had led to growth in her team. She said it was a "recognition of needing to do something different". Read full story Source: BBC News, 21 December 2021
  3. News Article
    Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month. BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident and emergency staff. This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls. At Royal Cornwall, 25 ambulances were queuing by the afternoon, three for at least 10-and-a-half hours, at Derriford, in Plymouth, 20 were queuing up to 11 hours in an overflow car park and the longest wait at Heartlands was more than five hours. "We're right on the fringe of collapse right now," a paramedic who has worked in emergency care for more than a decade said. "People are phoning and being told that they're not going to get an ambulance for six or nine hours. And that's happening routinely - that is happening pretty much every shift." "It would be wrong to say that there are times when I haven't shed a tear... for the people we haven't been able to help because it's been too late," the paramedic said. "They may have died anyway but there are definitely cases that I've been to where we should have been to them sooner and less harm would have come to them." Read full story Source: BBC News, 15 July 2022
  4. News Article
    There are plans for a major overhaul of how people are rescued from car wrecks amid growing evidence that current methods where people wait to be cut free may be harmful. Last year there were 127,967 casualties and 1,560 deaths in England caused by motor vehicle collisions. During the same period, more than 7,000 patients needed to helped out of the vehicle through a process known as extrication, where rescue crews use “Jaws of Life” and other tools to pry apart the wreckage, and then carefully lift people out. “Since at least the 1980s, firefighters have been trained with movement minimisation as the absolute paradigm,” said Dr Tim Nutbeam, an NHS emergency medicine consultant, and medical lead for the Devon air ambulance. “They’ve been told that one millimetre of movement could turn someone into a wheelchair user, so will often disassemble the car around the patient, to avoid movement of the neck.” Yet, doing so takes time – 30 minutes on average – and if that person has another serious injury, such as a head, chest, or abdominal injury, every minute counts. Nutbeam began researching the issue and discovered that trapped patients were almost twice as likely to die as those who were rapidly freed from the wreckage. Further, that the prevalence of spinal injuries among such patients was, in fact, extremely low – just 0.7% – and in around half of these cases, they had other serious injuries needing urgent medical attention. “Our absolute focus on movement minimisation works for maybe 0.3% of patients, but it extends the entrapment time for 99.7% of them,” Nutbeam said. “Potentially hundreds of people in this country have died as a result of extended entrapment times, and if you multiply that worldwide, it’s many, many people.” Read full story Source: The Guardian, 6 July 2022
  5. News Article
    Paramedics have begun looking after patients inside an A&E unit, in an initiative by the health service to stop ambulances queueing outside hospitals and ease the strain on overstretched casualty staff. The scheme has led to patients being handed over much more quickly at a hospital that was one of the worst in England for sick people being stuck, sometimes for many hours, in the back of an ambulance. Queen’s hospital in Romford, in east London, has set up an ambulance receiving centre (ARC) near its main casualty unit in which two London Ambulance Service paramedics are on duty round the clock to help look after patients who would otherwise be trapped outside or in a corridor, waiting to be seen. Patients who end up in the new six-cubicle unit behind the A&E nurses’ station have a better experience while they wait and are more comfortable – and safer – because they can have their relatives with them, eat and drink and use the toilet more easily. Almost 2,000 patients have passed through the ARC since it opened last November, saving nearly 13,000 hours of ambulance crews’ time and enabling them to respond to emergency calls more quickly. However, some A&E doctors regard the scheme as merely “a sticking plaster”, given that queues of ambulances have become common outside many hospitals and that casualty units are treating the lowest percentage of patients within four hours on record. Read full story Source: The Guardian, 3 July 2022
  6. News Article
    Student paramedics are missing out on learning how to save lives because they are wasting hours in ambulances outside A&E instead of attending calls, it has been revealed. The College of Paramedics and ambulance directors say the hold-ups mean trainees are missing vital on-the-job experience, leading to fears over the safety of patients. Will Boughton, of the College of Paramedics Trustee for Professional Standards, said handover delays had become a problem for trainees’ development and exposure to real-life experience, meaning training had become “unpredictable”. If steps weren’t taken to increase training opportunities and address wider quality concerns in education, “it is very possible that patient safety may be at risk due to missed experience during practice education”, he warned. “A student could complete a regular shift and see lots of patients, getting lots of things in their portfolio signed off, or they could be the unlucky ambulance that joins the back of a queue and is then at hospital X for however many hours waiting to release that patient, so and it varies from county to county and service to service,” he said. Read full story Source: The Independent, 22 June 2022
  7. Content Article
    The data included in the review identified that 10% of patients experience a PSI in prehospital care. The review also provides more detailed insights into the prevalence of PSIs and associated harm in prehospital care, and the authors argue that this evidence justifies giving the same level of attention to patient safety in prehospital care as is given to secondary care. They also state that the review gives direction as to how to advance methods for identifying PSIs and harm in prehospital care.
  8. Content Article
    This study from Rachel Beldon and Joanne Garside looked at the contributory factors for burnout in the ambulance service to inform recommendations for positive change. 94% of ambulance staff in this study reported a sense of personal achievement within their professional role; however, more than 50% were experiencing varying levels of burnout with 87% displaying moderate or high levels of depersonalisation towards their work. Causes of stress were complex: themes attributed were a perceived lack of management support, the public's misuse of the ambulance service, involuntary overtime and a poor work-life balance. Burnout poses a genuine threat to retention in the ambulance service and needs addressing. Proactive screening, better communication between practice staff and management and access to counselling services are recommended. This problem of burnout is beginning to be acknowledged but further evidence is needed to understand it in more depth in order for effective solutions to be developed.
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  10. Content Article
    I don’t ‘do’ mental health. Growing up, my family always had a stiff upper lip, told me to "take a breath and get on with it". It was seen very much as a weakness. If I was ever feeling upset about something that had happened at work, they would always retort back with a story far more gruesome and awful than mine. My family are all healthcare professionals. Dinner table talk usually turned to horror stories of car crashes, attempted murders, limbs falling off, wounds and cardiac arrests. Very interesting and often led to great discussions, but didn’t explore how we felt about being involved in the worst days of other peoples' lives. My family spoke of these incidents as if they were viewing through glass, an invisible wall. They distanced themselves. This is how they dealt with the horror of healthcare. From their behaviour and how they dealt with ‘work’, I followed suit. It seemed to work. Something bad would happen – a traumatic cardiac arrest at the roadside, a stabbing of a young man, a four car pile up with three dead at the scene, a murdered child – I would then go back to my family home on days off, have dinner and we would swap stories. We would all try and out do each other, a bit like a game of gruesome top trumps. But I could not brush off what I had seen. I saw the trauma that was inflicted on survivors, the pain people had been through, the raw emotions from other during the worst day of their lives, the conditions people lived in. I was seeing this daily, not once a month or once a year, daily. It was bound to take its toll. All was going well, or so I thought. Until my life got in the way. I have two boys: 13 and 11 years old. Starting out in the world. I have been able to keep them safe; I keep them away from these horrors I see. I have protected them from the society we live in. The knife crime, the drugs, the violence, but as they grow up they have become more independent. They want to go out alone, they mix with other groups of kids I don’t know. No longer can I call the parents of a child I deem ‘suitable’ for a play date. I am relying on my children to make the right choices. I felt out of control. Whereas at work, I am in control. I may not have control about which job I go to, but I have control on how I manage the patient, I have drugs to ease pain and can give immediate treatment. I feel as if I am in a ‘bubble of professionalism’. What happens at work, stays at work (or my parent's dinner table). But here in the real world, there is no bubble. I tried bringing my feelings about the loss of control and fear around bringing up boys in 2020 at the dinner table. "That’s life," announced my dad. "We got through it and you're OK," said mum. And that was that. My feelings were deemed as mundane, not good enough to discuss. Before I knew it, the conversation had moved on to a patient who needed helicoptering off a rugby field with a broken leg. I wasn’t sleeping. I couldn’t concentrate. I had this weird pain in my chest. All I could think of was the safety of my boys. I replayed scenarios of them getting run over, getting into a fight and getting stabbed, being involved in a car crash. I wouldn’t go on unnecessary journeys in case we crashed and they died. I was just about coping with work. I did not have the capacity to take stress from any other angle. So, when I needed to step up to the plate at home, bringing up kids, it was all too much. Getting help I made an appointment with a GP. I’m never ill, so don’t see a regular one. Any GP would do. I wanted some help, but wasn’t sure what help was available. I felt embarrassed about going. I didn’t tell anyone. Once I was in there, I just burst into tears. I’ve seen GPs behind closed doors, people do it all the time. I bet they get sick of it. I was now one ‘of those’ people. She heard my symptoms; she heard the causes. With that she wrote a prescription for Sertraline (a drug for anxiety) and an offer to sign me off sick for 2 weeks and I was out the door with a follow up in 3 weeks. Looks like I am labelled now, and it took less than 10 minutes. Were pills the answer? Surely there are other therapies I could try? I don’t want time off. It won't make it better. After opening up to a colleague at work, it seems myself and my family are suffering with moral injury. The term ‘moral injury’ has been used to describe the psychological effects of ‘bearing witness to the aftermath of violence and human carnage’ (Litz et al., 2009[1]). Carnage sounds like a normal shift to me. The symptoms of moral injury are strongly linked to feelings of guilt and shame and can manifest as social isolation and emotional numbing. This was my mechanism for coping with the stress at work. Numbing the emotions, not allowing my emotions to show themselves in fear that I would not be able to do my job. I’m no good to anyone being a blubbering wreck am I, everyone else is OK, so I must hold it together. Binned the pills I was told about ‘talking therapies’ that my employer can refer me to – for free. I went to my line manager. We spoke at length about how I felt, and she referred me to the talking therapy provided by my Trust. While I waited for the appointment date, I opened up to friends. Found out I am not alone. Seems we are all struggling in different ways. Being able to speak freely with a trained counsellor has really helped. I have strategies to help me with anxiety and stress, I have started the NHS couch to 5K and have started to feel so much better. I have not taken the pills offered by the GP. I’m sure some people need them; I feel I don’t need them at the moment. We know that we need to have more and better conversations about our mental wellbeing, and it is worth thinking about what kinds of conversations might be useful; certainly a game of top trauma trumps isn’t a good idea while eating sausage and mash. It is true what the literature suggests, that paramedics are suffering from increasing rates of post-traumatic stress disorder (PTSD) (Regehr et al., 2002[2]), but it is also true that not all those who are psychologically affected by their work, even in lasting ways, will reach the threshold for a diagnosis of PTSD. Some people will become ill as a result of their work, and some will become distressed; moral injury offers a different way of thinking about the psychological harms that may result from the practice of prehospital and emergency medicine (Murray, 2019[3]). This may give paramedics and other ambulance staff the opportunity to think about the impacts of their work in ways which do not threaten their ability to do it. Ensuring there are opportunities to sit down and talk through their jobs in the course of a working day, or night, could be the best place to start (Murray, 2019[3]). References 1. Litz BT, Stain N, Delaney E et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev 2009;29(8):695–706. 2. Regehr C, Goldberg G, Hughes J. Exposure to human tragedy, empathy and trauma in ambulance paramedics. Am J Orthopsychiatr 2002;72(4):505–13 3. Murray E . Moral injury and paramedic practice. Journal of Paramedic Practice 2019;1(10).
  11. Content Article
    About the author Jo Mildenhall is a Doctoral Research Student at Manchester Metropolitan University; and Paramedic Team Leader, South Central Ambulance Service NHS Trust, Newbury Ambulance Station.
  12. Content Article
    The PRSB have collaborated with the Royal College of Physicians Health Informatics Unit on this project. Clinical leadership was provided by clinicians from the Royal College of Emergency Medicine and the College of Paramedics (CoP). The standard has been developed with the support of professionals and patients. This resource includes: The standard Information model Information model (as Excel spreadsheet) Documentation Ambulance handover standard final report v1.0 Implementation guidance v1.0 Clinical Safety Case Report v0.3 - Currently being approved through the NHS Digital Clinical Safety Group Hazard log v0.7
  13. Content Article
    I work in, both, the work imagined and prescribed, but practice in the world of work done. It’s interesting working in both worlds and has made me ask these questions: Why this happens? What are the consequences? How can we manage this disconnect? Real-life scenario What happened? A patient on a ward needs a nasogastric tube (NGT) for feeding and giving medication due to an impaired swallow following head and neck surgery. The nurse prints off the policy for placing an NGT from the Trust's infonet. The nurse inserts the NGT and checks the policy on how to test if it is in the correct position. The tube could be in the stomach (the right place) or it could be placed in the lungs (not a great place for medicines and feed to go!). The nurse calls the nurse in charge for support. It’s been a long time since she has placed an NGT and she wants to check she iss doing the right thing. The senior nurse arrives, before the feed is commenced. The senior nurse notices that the policy that the nurse is using is out of date. Checking the position of NGTs had changed. The senior nurse prints out the updated policy – NGT was in the correct position. This was a near miss event. So what? If an NGT is in the lung and you give medication and liquid feed there is a high chance the patient would contract fatal pneumonia at worst or a protracted stay on the intensive care unit on a ventilator at best. In both these cases, it would need to be declared to the regulators as they are classed as serious incidents. What next? This incident was one of many near misses that were collected over four shifts. This incident was discussed with the Deputy Chief of safety within that Trust. His first reaction was: "When was this? We had a Datix last year of the same incident – why has this happened again and why don’t I know?" It was true, there were a few similar incidents last year and an action plan was put in place to mitigate another incident like this happening again. All the old policies were to be removed from the infonet and replaced with the updated versions. Not only this, the Trust was now moving towards a web-based search facility that enables the clinician to have all the updated evidence for policies, antibiotic therapies, prompt charts, documentation and prescribing advice. The guide would be updated and the old policies would automatically be replaced, thus mitigating clinicians using out of date policies and procedures. The document management system was put in place to ensure it is easier to do the right thing. So, if this forcible function was in place, how did this incident happen again? Not all staff know about the new document system. Some nurses think this search facility is for doctors only. Nurses are prohibited to use their mobile phones on the ward. Clinicians not always able to get to a computer. It takes too long to update when opening the browser – therefore people are using it offline. The final point is an interesting one. Making it easy to do the right thing is one of a number of aspects that a safe system is comprised of; however, if part of that system i.e. the Wifi is not set up to support the change, that system is at risk of a ‘work around’. Work arounds are what healthcare staff do to enable them to get through that shift without immediate detriment to themselves or the patient, make swift complex decisions easily and to ‘tick the box’. Time is a precious commodity, especially when you are a frontline worker. We know the document management system will have the updated policy; we wait for the download. We wait. We wait a bit longer. Eventually it loads. Remembering it takes a long time, we save it and use it ‘offline’ for future access. By using the guide offline makes it quick and easy. We are using Trust policy; however, that policy may now be out of date. So what? Implementation of this online guide was made to make our lives easier and safer for patients and ourselves. Due to an oversight of how clinicians ‘actually’ use and interact with this change in the work environment, it could have an adverse outcome for patients. How would the safety team know this was happening? Near misses seldom get reported. Chance meetings in corridors, chance conversations overheard, a reliance on staff that may know the answer – if we ‘fixed’ the problem for that near miss, why should we report it? No harm came to the patient after all. We have a good culture of reporting in the Trust; however, our safety team are overwhelmed with incidents to investigate. The current system is set up to investigate when harm has happened rather than seeking out ways to prevent harm. I’m part of the problem, so I can be part of the solution? I would welcome any support on this. Does anyone have any solutions or strategies in place where frontline staff are involved in the reporting of near miss events and are part of the solution to mitigate them?
  14. Content Article
    Did you known that once a paramedic hands over the care of their patient to the hospital they don't tend to learn how beneficial their treatments were or how accurate their diagnosis was? As you can imagine this makes continually improving in order to provide the best possible healthcare to patients very challenging. The Princess Alexandra Hospital (PAH), East of England Ambulance Service Trust (EEAST), and Essex and Herts Air Ambulance Trust (EHAAT) are working together to change that. With support from the Health Research Authority's Confidentiality Advisory Group (CAG) and under the supervision of the PAH Patient Panel, they have started a new project which allows the ambulance and air ambulance staff who look after a patient to find out relevant and proportional information. This will help with lifelong learning and reflection, seen as vital to learning by both the General Medical Council who oversee doctors and the Health and Care Professions Council who oversee ambulance staff.
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