Volume 11 Issue 1
Sir Roger Bannister: pioneer of the cardiovascular autonomic nervous system
In this new four-part 2021 Neurocardiology series, Helen Cowan looks at Sir Roger Bannister's life and some of his important findings with regards to cardiovascular disorders of the autonomic nervous system.
Reforming the paramedic profession? Two weeks with paramedics in Germany
While paramedics in Anglo-American emergency medical services enjoy relative autonomy, paramedic practice in the Franco-German model deployed in Germany depends heavily on emergency physician input. Increasing demand, especially from low-acuity incidents, causes challenges in these countries. To address this, German politicians plan to implement extensive emergency care reforms and consider an update of regulations around paramedic practice. A 2-week placement allowed for practice observation, discussions with stakeholders and a review of various resources to identify current issues in Germany. These include legal discrepancies, significant local differences in scope of practice, limited career opportunities and influence on clinical guidelines. Although the update and reforms are intended to resolve some of these problems, a groundbreaking evolution of the profession from its current restrictions is not expected. Possible development of the emergency physician role and associated specialities as a response to emergency care challenges is less debated.
Making marks as a woman in paramedicine
After becoming Australia's first woman to achieve a doctorate in paramedicine, Louise Reynolds reflects on her journey, the challenges she was faced with and the sometimes tough decisions along the way
Obstetrics and birth: effects of experiences and gender bias on student test scores
Objectives: Paramedic education requires all students have the experience of attending childbirth. Obstetric (OB) experiences are limited for students in hospitals and even more so in the field. Gender bias may exist in hospital OB rotations for paramedic students but research on this is limited. This study is intended to examine whether a sex bias exists in field or hospital placements and if that bias correlates to OB test scores. Methods: Using data from Fisdap, numbers of OB experiences were analysed and compared to individual student sex and experience type (hospital clinical, field or skills laboratory). The number of experiences were compared to that student's score on the OB section of the Fisdap paramedic readiness examinations version 3 (PRE3) or version 4 (PRE4). Results: Of 12 090 paramedic students, male (n=5625) and female (n=2682) students who took the PRE3 had equal average scores of 0.76 and male (n=2498) and female (n=1285) students who took the PRE4 had average scores of 0.77 and 0.79 respectively. Students who took the PRE3 saw a mean of 4.32 births, a majority of which were in hospital (3.68); there was minimal difference in experiences between male and female students in field or skills laboratory settings, but women saw more births in hospital settings (3.92) than men (3.43). Students who took the PRE4 saw a mean of 4.54 births, a majority of which were in hospital (3.8) and there was minimal difference in experiences between male and female students in field or laboratory settings but women students saw more births in hospital (4.06) than men (3.54). Conclusions There is no correlation between the number of OB emergency encounters by paramedic students and their OB test scores. However, a potential gender bias exists as female students tend to have more labour and birth experiences in hospital settings than their male counterparts, while number of experiences in lab and field settings were similar.
Appropriateness of oral clopidogrel for prehospital STEMI management
Introduction: Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. Aims: The purpose of this study is to examine and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance services should use the drug as part of standard practice. Methods: A literature review was conducted to identify articles relating to the administration of clopidogrel in the prehospital setting. Fourteen peer-reviewed journal articles and eight clinical practice guidelines from international ambulance services were included in this review. Results: According to this literature review, clopidogrel has been deemed safe, effective and practical for widespread use in the prehospital environment for the management of STEMI. However, some disagreement has arisen over whether clopidogrel is a more favourable anticoagulant than ticagrelor and prasugrel. Conclusion: Anticoagulants such as clopidogrel should be strongly considered as a standard treatment regimen in the prehospital management of STEMI across international jurisdictions.