Volume 10 Issue 4

Does cricoid pressure have a detrimental impact on laryngoscopy and intubation?

Background: Cricoid pressure is used in anaesthetic practice to prevent regurgitation during anaesthetic induction; it is also used by some paramedics. However, it may have a detrimental impact upon laryngoscopy and intubation. Paramedics need to remove barriers to safe and prompt intubation of critically unwell patients. Aim: To determine if cricoid pressure has a detrimental effect on laryngoscopy and intubation. Methods: The PubMed and Cochrane Library databases were searched with a time frame filter between 1 January 2003 and 31 December 2018 and screened, leaving seven studies. Findings: Cricoid pressure is detrimental to laryngoscopy and intubation success rates for patients in the care of experienced providers in environments more optimal than those in which paramedics practise. One study produced statistically significant results; when cricoid pressure was applied, median intubation time was longer (27 seconds versus 24 seconds; p<0.001) and incidence of Cormack and Lehane grade III and intravenous views were doubled (10% versus 5%; p<0.001). Other studies were inconclusive. Conclusion: Cricoid pressure makes intubation more difficult, which may lead to higher rates of failed intubation and adverse events, especially when carried out by less proficient clinicians such as paramedics. Further pragmatic research is needed to test this hypothesis.

Hidden practice, hidden people?

Practitioner experiences in epidemics and pandemics in relation to COVID-19

Background: COVID-19 has been declared an international emergency by the World Health Organization. Despite personal concerns, frontline health professionals, such as paramedics, nurses and doctors, continue to treat patients. Ensuring these workers' mental wellbeing is supported during these stressful times is key to their maintaining good mental health in the longer term. Aim: To conduct a review of the literature exploring practitioners' attitudes during a pandemic. Methods: A scoping literature review was conducted to assess information on health professionals' attitudes during COVID-19 and previous pandemics, and to identify their main concerns and whether these were addressed. PubMed, CINAHL, the Cochrane Library and Google Scholar were searched and PRISMA guidelines were followed. Titles and abstracts were screened and emergent themes were identified and discussed. Results: 141 articles were screened; 15 articles were sourced through Google Scholar and reference lists. There were 18 articles in the final sample. There was a lack of published data on COVID-19 at the time of writing. Themes include that health professionals' mental health may be affected during a pandemic. Their biggest concerns are infecting family members and overcoming personal anxieties to continue treating patients. Key themes in protecting staff mental health during a pandemic include increasing their understanding of how to protect themselves and their families, better confidence in personal protective equipment and good managerial communication. Conclusions: Practitioners experience heightened stress levels during pandemics, which may affect their mental health. This has implications for workforce resilience. More research is needed on frontline staff attitudes during the COVID-19 pandemic to protect their mental health.

The role of the paramedic in identifying modern slavery

Background: Modern slavery is the recruitment or harbouring of people through the use of force and coercion for exploitation. Paramedics have significant potential and unique opportunities regarding the detection, prevention and combating of modern slavery. Aim: To analyse the literature relating to modern slavery and synthesise it for paramedic practice. Method: Following a structured literature review, a comparative analysis was undertaken of articles concerning the relationships between modern slavery and healthcare. Findings: Five major themes were identified: barriers to healthcare access; causes of missing the indicators of trafficking; clinician knowledge; the need for training and education; and trauma-informed practices. Conclusions: Paramedics are in an optimal position to identify and intervene in cases of modern slavery. The introduction of survivor-centred education is recommended to better understand the barriers to healthcare access.