Volume 9 Issue 2

A description of a unique paramedic role in a Canadian emergency department

Background: Paramedics are known for their role in prehospital emergency medical services. In response to healthcare system overcrowding, and increased demands on emergency departments, roles for paramedics have emerged in hospitals. Aims: The authors describe a well established paramedic role in the emergency department of a busy regional referral centre, highlighting the successes and challenges of the programme. Methods: In this phenomenological study, six paramedics employed at the Charles V. Keating Emergency and Trauma Centre were interviewed. Interviews were analysed using thematic content analysis. Findings: Paramedics at the centre are involved in resuscitation, trauma, critical care transport, airway management, and procedural sedation. Performing procedural sedation is an important part of the role and is perhaps where paramedics have had their greatest impact within the department. Conclusions: The diverse scope of practice paramedics maintain at this centre allows them to work where the need is highest within the department, ultimately improving department flow.

A novel approach to problem-based learning in a paramedicine programme

Background: Many paramedicine, nursing and medicine programmes use problem-based learning (PBL) to help bridge the gap between clinical theory and real-world practice. Aim: This paper describes a novel approach to PBL that has been used in a large, university-based paramedicine programme. Methods: Over a 3-year period, an applied pharmacology tutorial was progressively redesigned by a cross-disciplinary team of practising paramedic, pharmacy and educational design academics. Findings: A multi-space approach to PBL is described in six stages. Discussion: The pedagogical basis of the approach is examined. Strategies used within this subject are recommended for further evaluation and consideration.

An out-of-hospital perspective on hyperventilation syndrome

Hyperventilation and tachypnoea both involve breathing at an increased rate. There are a variety of causes of hyperventilation and conditions associated with it, including acute and chronic hyperventilation syndrome (HVS). The characteristics of HVS are not well defined. It results from a reduction in carbon dioxide and altered pH in the body from overbreathing. Symptoms vary between individuals but usually include altered sensations in the extremities, nausea and headache. Diagnosing patients with this condition can be difficult; diagnostic tools include the hyperventilation provocation test, voluntary overbreathing, the Nijmegen questionnaire and the exclusion of physiological causes in the acute situation. There are various prehospital patient presentations and differentiating between potential underlying causes is vital to appropriate treatment and patient safety. Treatments vary in nature, depending on the desired effect and the clinician's scope of practice. Some aim to reduce the frequency and intensity of attacks while others combat the attack when it strikes. This review briefly discusses some treatments available to a clinician with a basic skill level. There is a lack of evidence in this area, and research with a focus on the out-of-hospital environment is recommended. Because of controversy over existing research regarding the definition of HVS, a review of all sources was conducted to produce a definition. This suggests that HVS is a collection of physical and biochemical reactions from an unnecessarily increased respiratory rate that occurs because of an unknown or benign aetiology which can be triggered by anxiety in the absence of other external factors.