Volume 11 Issue 2
Vein cannulation success rates by German paramedics: a single-centre study
Introduction: Gaining intravenous (IV) access is vulnerable to errors and failure, and this study analysed IV procedures by paramedics in the federal state of Hesse in Germany to examine these. Methods: This was a single-centre, observational, pilot study survey on gaining vascular access. As well as identifying the success and failure rate of IV attempts, factors associated with a higher risk of failure were analysed using logistic regression, Χ<sup>2</sup> or Fisher's exact test. Results: A total of 207 vascular access attempts were included in the analysis, of which 90.34% were successful. Significantly associated with higher risk of failure were patients' age (OR 1.05; 95% (CI 1.02–1.10); p=0.041), or when two (OR 3.94; 95% CI (2.39–6.20); p≤0.001) or more than three attempts (OR: 3.26 [95% CI: 1.35; 5.17]; p=0.003) were needed rather than one. In contrast, risk of failure was significantly lower when patients indicate a good (OR 0.02; 95% CI (0.00–0.15); p≤0.001) or moderate (OR 0.04 (95% CI 0.01–0.17); p≤0.001) vein status compared to a bad vein status. Failure rates were higher when paramedics were working a night shift (OR 0.06; 95% CI (0.00–0.98); p=0.005) rather then during the day. Conclusion: A proportion of IV access attempts by paramedics are unsuccessful and, if paramedics are to provide invasive interventions, non-IV options for drug administration should be available.
A review of cases received by the Nepal Ambulance Service over one year
Nepal Ambulance Service (NAS) callout data was examined to aid future research into Nepali prehospital care, and identify trends and areas within NAS that may benefit from further training. A retrospective search was carried out of the NAS covering of the calls received and attended by NAS covering a period of 12 months. A total of 5486 cases from the NAS database were included. The data showed there had been a rise in NAS cases over the 12-month period, with 152 more cases being logged in July 2019 than in August 2018, an overall increase of 38.48%. The rise is fairly uniform and consistent month-on-month, except for February 2019, when there was an unexplained reduction. This rise is fairly uniform and consistent, except for February 2019, when there was an unexplained reduction. Respiratory and trauma were the most numerous types of case. The increase in cases is most likely because NAS is growing in popularity. Based on the findings of this paper, it would seem that NAS is set to continue its upward trajectory of callouts. Further research on this service is warranted.
Focused ultrasound in out-of-hospital cardiac arrest by advanced paramedics
Background: This study describes and evaluates advanced paramedic practitioner (APP) use of focused cardiac ultrasound (FoCUS) in out-of-hospital cardiac arrest (OHCA), and relates ultrasound findings with decisions to terminate resuscitation. The authors report characteristics of patients who do/do not undergo a FoCUS examination by APPs, ultrasound probe positions used and whether FoCUS findings were associated with decisions to terminate resuscitation or to convey patients to an emergency department (ED) with ongoing resuscitation. Method: A retrospective, observational cohort study of all adult medical OHCA patients attended by APPs in Greater London during 2018 was carried out using data from EMS and APP databases. Results: Twenty-eight APPs attended 1444 OHCA patients in 2018, of whom 744 underwent FoCUS. The subcostal probe position was used most frequently (74%), followed by the parasternal long axis (19%), with significantly smaller use of the parasternal short axis and apical windows. Absence of spontaneous cardiac motion (SCM) was associated with resuscitation being terminated (333 out of 391; 85%) and the presence of SCM was associated with conveyance to the emergency department (213 out of 264 patients; 80%). All decisions to terminate resuscitation were within the APP scope of practice. Conclusion: The authors believe this is the largest prehospital study involving FoCUS in OHCA. An association between FoCUS findings and decisions made to either convey patients to hospital or terminate resuscitation was found. The SC window was most used and ROLE decisions were deemed to be in accordance with local guidance and practice.
Orthostatic hypotension: the last 20 years
In the second article of the new Neurocardiology series, Helen Cowan looks at the history of orthostatic hypotension