Volume 1 Issue 1

Resuscitation from out-of-hospital cardiac arrest in an under-resourced environment

Published data on the epidemiology of out-of-hospital cardiac arrest (OHCA) come mostly from developed countries. Few studies have described the nature of OHCA in developing countries, where resources guaranteeing rapid access to cardiac arrest cases may not be available. A retrospective case series on OHCA in Johannesburg, the first study of this type in an African population, showed that response times were comparatively long; less than half of patients were resuscitated and rates of shockable rhythms and return of spontaneous circulation were lower than those reported in most other published studies. These results are most likely caused by lack of resources; in the form of emergency vehicles, in a region with a very busy emergency medical service, providing prehospital care to a large population. Other factors caused by poor emergency service management tend to complicate this picture and exacerbate the response time problem. Although paramedic learning programmes in South Africa are of a high standard and prepare qualifying practitioners to treat OHCA cases adequately, a lack of effective emergency medical service management and organization means that these human resources cannot be put to good use in improving OHCA outcomes. To improve OHCA outcomes, under-resourced emergency medical services should focus on fundamental aspects of the system to guarantee rapid access to patients, rather than more advanced scopes of practice for paramedics.

Prehospital care data for traffic injury prevention: what Pakistani research tells us

Pakistan is facing an increasing burden of road traffic injuries (RTI). Previous studies showed that prehospital care data could be useful in RTI burden assessment. Recently, an advanced prehospital care system based on international guidelines was established in Pakistan. Our situational analyses indicated several discrepancies in their data—for example, using single sheets for recording multiple patient data thus facilitating missing information; subjective reporting of outcome (stable or okay); no electronic data entry, and underused global position system tracking for identifying crash locations. Furthermore, no stakeholders were identified to use this data for prevention purposes. In conclusion, the great potential for prehospital care data has not been explored in Pakistan, and devoting appropriate structural and human resources could be the key for future RTI advocacy and decision-making for prevention purposes.

Organizational models of prehospital care: experiences from Austria

When comparing the well-established model of functional-organization structures with the model of process-orientated organization structures, problems are perceived in the efficient coordination of all system partners in the prehospital emergency medical system (EMS). A lack of communication, documentation and feedback, a large number of unnecessary emergency missions, undue workload and costs in some areas of the system negatively effect motivation, efficient teamwork and satisfaction of staff and patients. Therefore and in the context of quality management, a restructuring of prehospital emergency medicine towards a process-orientated approach is highly recommended. The approval of the Ethics Committee of Innsbruck Medical University was received on 21 June 2007.

Paramedics in prehospital emergency medical systems across Europe

Emergency medical services (EMS) vary across Europe, with two predominant models: the Anglo-American model which uses mainly paramedics in a prehospital setting, where ‘the patient goes to the doctor’; and the Franco-German model which uses mainly physicians in a prehospital setting, where ‘the doctor goes to the patient’. No perfect model exists, and each country has an EMS model based upon the needs of the community and the available economic resources. This overview shows that the EMS in Europe are modern, efficient and structured in the same way. The dispatch centre, the means and the response times are similar; the biggest differences concern the personnel who staff ambulances and their training, although they all have to perform the same emergency procedures and manage similar types of patient. The role of emergency medical technicians (EMT) is vital in all prehospital EMS systems. However, the training of EMT with equal skills is very different, with great variations as a function of each country. European harmonization appears to be necessary, even if it seems difficult.

Management of heat emergencies in the military setting

The Australian Defence Force (ADF) has long battled in hot and arduous environments. From the trenches of Tobruk during World War II and the thick jungle of Vietnam through to current theatres of war such as the rugged mountains of Afghanistan. Australian soldiers are exposed to the constant threat of heat illness, and while avoidable in training settings, it cannot be prevented in some combat situations. Prevention however, is a key factor in the exclusion of heat illness cases, a matter that the ADF has worked hard to highlight through mandatory annual training. It is for this reason that military heat casualty rates remain low in the ADF. This article provides some useful assessment tools which help to differentiate between the different levels of heat illness; and furthermore, underlines the critical stages of heat illness and includes literature on the aetiology, pathophysiology, clinical manifestations and prehospital care management of heat illness.

Mental health legislation: an era of change in paramedic clinical practice and responsibility

For emergency health professionals, the response to a mental health emergency in the community is often brief in nature and centred on quickly ascertaining whether a patient is psychiatrically or physically unwell. For paramedics, mental health emergencies are often challenging because of the ambiguous nature of clinical presentations, lack of collaborative information such as a patient's medical history and back up assistance. Mental health emergencies require paramedics to possess advanced interpersonal skills and patient assessment competencies. With the introduction of new emergency powers across Australian state and territory-based mental health legislation, the roles and responsibilities of paramedics across some jurisdictions has changed significantly. In response to these changes, a number of ambulance services have introduced specific mental health training programmes in an attempt to prepare their workforce to meet and fulfil their legislative responsibilities. In spite of this, the role of paramedics in the care and management of the mentally ill has attracted limited attention in the research literature. This article examines the role of the paramedic with respect to mental illness, what is known about paramedics' clinical decision-making practices, and the opportunities for future development of their scope of practice. It identifies the need for further research to explore the clinical decision-making processes are used by paramedics when fulfilling their mental health legislative responsibilities.