Prehospital care is defined as the phase of patient care from the point of injury or illness to the place of definitive treatment. As such, it is imperative that the patient is transported to the right place of care within the right time frame via the right mode of transportation by the right personnel. In this article, the authors explore seven components that are essential in the initial stage of any prehospital care system development—the components of manpower, training, communication, transportation, facilities, access to care and coordinated patient record keeping. The authors then address issues and challenges in these seven components within the Malaysian context. Because of geopolitical and logistic differences from one locality with another, it is not possible for a, ‘one-size-fit-all’ solution to these issues and challenges within Malaysia. Ultimately, any effort to develop the prehospital care system should not be a mere stop gap measure, rather, it should address fundamental root problems in order to ensure sustainability and continuity of effort.
As part of the prehospital unscheduled and emergency care course at the University of Worcester, the authors were selected to take part in an exchange programme arranged between the University of Worcester, England and Halmstad University in Sweden. The exchange took place in January 2011 and lasted two weeks, during which time the authors were based with the Halland Regional Ambulance Service. Halland is a county on the west coast of Sweden, directly south of Gothenburg. It has an area of approximately 2100 square miles or around the same size as Devon. The total population, however, is just over 299 000 (Statistics Sweden, 2010), making the total population density slightly less than half that of Devon. The county is divided into six regions, each centred on a town of the same name (Statistics Sweden, 2010) and in which the ambulance stations are located. During the programme, the authors were based in the town of Varberg and attended incidents as supernumerary crew members. They were also permitted to treat patients, provided this did not exceed levels of competency, complied with local protocols, and was agreed by the responsible clinician. During the visit, observations were made regarding all aspects of ambulance operations. The majority of practice was found to be very similar to the UK, however, a number of important differences were found and these are analysed and contrasted with UK practice. The authors would like to thank the staff and management of the Halland ambulance service for their hospitality, warm welcome and for their generosity in passing on their knowledge. They would also like to thank the staff of the universities of Worcester and Halmstad, without whom the exchange would not have taken place.
Simulation as a credible mode of advanced clinical education is becoming well established throughout Europe, North America, and Oceania; however, similar developments are becoming increasingly visible outside of these continents. Educational concepts using simulation are better understood when people see beyond the ‘tool’, however technologically advanced it might be (Alinier, 2007a) and start to recognize the importance of the ‘technique’ employed to use it (Gaba, 2004). Reported activities emerging from Africa and predominately Asia is continuing to grow. From psychiatry objective structured clinical examination (OSCE) training in Iran (Taghva et al, 2010); the use of virtual patient simulators in Japan (Taguchi and Ogawa, 2010); to using simulators to teach advanced cardiac life support (ACLS) to paramedics in India (Delasobera et al, 2010), simulation as a form of clinical education is advancing globally. This article aims to highlight the recent advancement of simulation through examples of workshops and research occurring outside of Europe, North America, and Oceania, and begins to highlight some of the current simulation education centre projects that are being planned across the globe. Categories of simulation within this article refer to simulation education using standardized patients, patient simulators, mannequins, part-task trainers, computer-based simulation, and virtual reality simulators, primarily used for surgical skills training. This article aims to give readers a glimpse into some of the projects and research that is occurring within simulation education outside of the western world.
Paramedics make many decisions while caring for patients in the out-of-hospital setting, including clinical judgments, such as assessment, treatment and transport decisions. As the decisions paramedics make can have an impact on patient safety and clinical outcome, it is important to focus on which clinical decisions are most important, when paramedics are required these, and how paramedics make clinical decisions, that is, what thinking strategies they rely on. This article will present the results of two recent Canadian studies, and will discuss the implications for paramedic clinical practice, education and research on this topic.
This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decision-making in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.