Month: May 2012

Patient Safety

“It’s so horribly simplistic – it doesn’t involve technology, doesn’t involve enormous capital investment, doesn’t involve restructuring healthcare bottom to top, and doesn’t involve government legislation. What it does involve is profoundly courageous and powerful leaders, compassionate caregivers, and the fearless humility to admit when one is wrong.”

—John Lewis

 

from:

Bigham B. L., Morrison, L. J., Maher, J., Brooks, S. C., Bull, E., Morrison, M., Burgess, R., Atack, L., & Shojania, K. (2010). Patient safety in emergency medical services: Advancing and aligning the culture of patient safety in EMS. Edmonton, AB: Canadian Patient Safety Institute, Emergency Medical Services Chiefs of Canada, and Calgary EMS Foundation.

http://www.patientsafetyinstitute.ca/English/research/commissionedResearch/patientSafetyinEMS/Documents/Patient%20Safety%20in%20EMS%20Full%20Report.pdf

Nebulised Naloxone

A recent blog post by Dr. Cliff Reid (@cliffreid) alerted me to a study done in the USA on nebulised naloxone.

An interesting concept, and laudable that needle-less approaches for these tricky patients (dodgy veins, high risk of blood borne disease) are being trialled – I have written on intranasal application of medication previously.

I had a read of the paper accessed via my uni library (so that’s where all the tuition fees end up), seemed decent enough on first glance.

Two questions did arise though:

  1. In my experience, for a nebuliser to work, the mask (and therefore the patient) needs to be upright. Most patients who would require ‘naloxonisation’ would present lying down. I am not a fan of wrestling patients, deadweight or not. Is there a way of administering a nebule whilst the patient is in a horizontal position?
  2. Opiates/opioids have the effect of decreased respiration – both rate and depth. I’m sure this would have an effect on the uptake of the medication. It may be a good addition to include a T-piece, which would enable ventilatory support via a Bag-Valve Mask, thus increasing respiration depth and rate, and amount of naloxone administered.
What do you think? Do you have experience with any of the above? Leave a comment, tweet me or email me!
I have written an email to the authors of the paper…stay tuned for any responses.

Cab Stories

The radio crackles, the screen in the ambulance jumps in to life as we are diverted from our lower priority call.

The surroundings light up in a mixture of red, white and blue LEDs, stopping traffic while we U-turn the ambulance towards this trauma call.

More information is sent our way: Patient has been stabbed with a stool.

After a short moment whilst I try to envisage such a scene, I turn to my partner and say: “We’ll need a stool sample”.

To which the reply comes: “Probably won’t be too difficult, they should have some stool hanging out of them”.

Experience and clinical reasoning

I would like to share an article with you that I recently found. Please feel free to access the full article (link in the reference) after you have hopefully found interest in the two quotes below.

The paradox of experience

Although experience is often considered as a reliable indicator of physicians’ expertise, many researchers state that experience is not necessarily synonymous with expertise. Several studies underpin this assessment, in many fields of medicine. They show that the physicians’ level of performance in daily clinical tasks is not constantly correlated with their level of experience.

Or, as they say: “Have you got ten years experience, or one year experience repeated ten times?”

I came across this article whilst searching for clinical reasoning – the reasons behind the decisions we make day in, day out. The main focus of this article is not the above quote (but it backs up so much we have all experienced), but the journey in how decisions are made; intuition vs. structured analytical reasoning. May I quote a little more?

Indeed, experimental studies show in both novice and expert physicians that using purely analytical or purely non-analytical strategies leads to lower diagnostic performance than when subjects are asked to use a combination of both processes

There you go. Nice to have the research back you up: walk in to a patients house, get a feel for the situation, get your facts right (history, vital signs etc.), and then compare your subconscious intuitive thoughts with your data that you have consciously acquired and structurally processed – et voila – your patient will benefit.

Now if only there were such a study in a paramedical environment…

– ~ –

Reference:

Pelaccia, T., Tardif, J. Triby, E., & Charlin, B. (2011). An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Medical Education Online 2011, 16: 5890 – DOI: 10.3402/meo.v16i0.5890

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060310/pdf/MEO-16-5890.pdf

Naming Conventions

Recent misunderstandings and differences in opinion have reminded me of the multitude of names (and misnomers) applied to our line of work.

For clarification and standardisation, I am using the International Paramedic recommendations:

  • The Paramedic is the professional practitioner
  • A Paramedic Service is the provider of emergency medical services staffed by paramedics; and
  • Paramedicine is the discipline and the area of medical study and knowledge.

Source: International Paramedic. Initiation Document (2011), retrieved from http://internationalparamedic.org