paramedic case study essay

“Someone’s been shot": An EMS case study

There are critical decisions made in the prehospital emergency care of unstable patients with penetrating trauma.

The crew heard a “Pop, pop, pop” nearby, and knew it wasn’t just a car backfiring. The dispatch was for “someone shot,” and they were two blocks away. Law enforcement worked quickly to secure the area, and asked that EMS approach quickly. A young man was on the ground, unconscious. He was warm. There was no blood. A rapid assessment found multiple wounds in his chest, and he would respond to painful stimuli. He had a weak pulse, and agonal respirations.

The trauma protocol called for a rapid removal, and the police were nervous because a high powered automatic weapon was used and the perpetrator might still be in the area.

The patient was strapped on a backboard and moved to the ambulance, where the paramedic could do a full secondary assessment. The injured man had no head wounds, but there was blood in the mouth and coming up from the airway. The neck veins were distended. The victim was breathing in a very shallow fashion, and the paramedic noted that the right side of the chest “felt like a full balloon.”

He carefully removed the muscular man’s shirt, making sure he did not cut through the bullet holes. There was no air moving into that side of the chest on auscultation. He had two wounds on that side of his chest: there was an additional open wound to his left anterior chest, which caused a 4x4cm open area to be blown away. This was covered initially with a large trauma dressing. There was an additional wound to his upper left thigh. He had no other wounds to the extremities or his back, and he withdrew all four extremities from painful stimuli. The paramedic was able to barely palpate a carotid artery pulse, so he moved immediately to primary interventions.

As the ambulance began to move on a 20-minute transport to the trauma center, the crew communicated a “trauma alert,” critical in the case of an unstable penetrating trauma patient. The paramedic arranged equipment for a quick set of life-saving interventions.

The trauma protocol called for the paramedic to “restore perfusion,” which is an important concept. In penetrating trauma, this means performing techniques that will allow the most important organs to have adequate blood supply, but not accelerating hemorrhage or fulfilling any specific numbers for blood pressure or pulse or oxygen saturation.

To do this, the paramedic would need to:

• Control the airway and ventilate using a bag-valve-mask
• Apply a seal to the chest wound, and decompress any tension pneumothorax
• Infuse enough fluid to restore critical perfusion
• To infuse fluids in a patient with open chest wounds, the paramedic would try to get intravenous access above and below the diaphragm. This is usually done below the diaphragm using an intraosseous infusion device .
• Use pressure infusers to give rapid fluid boluses

The important first interventions are to ventilate and secure an airway. The EMT inserted an oral airway and started bagging the patient with high flow oxygen. It was very difficult to ventilate, so the paramedic knew he would have to seal the chest wound quickly and decompress the chest. He needed an occlusive dressing to the left chest wound that would seal it, and that would adhere to the skin despite the blood, sweat, and hair on the man’s chest. A new generation of occlusive dressings is available for that purpose, and one version of the dressing is available with a pressure relief valve system that would allow air to escape from the open wound, but would not allow it to get sucked back into the chest. These dressings have been used in recent war zones, and have been designed to be quickly applied and transparent, so that the trauma team can visualize the wounds once the patient arrives at the hospital.

The SAM Chest Seal is the self-adherent occlusive dressing that the paramedic applied to the open left chest wound. The hydrogel adhesive was strong and flexible, so it adhered to the skin in the presence of blood, hair, and diaphoresis. With the cap removed, the dressing functions as a valve chest seal with one-way outward flow. Once in place, the paramedic performed a needle decompression of the right chest, due to the EMT’s ongoing difficulty trying to ventilate the patient, the lack of air flow and chest wall movement on that side, and the feeling that the chest “was like a tight balloon.” The man had a muscular chest wall, so the paramedic inserted one of the three inch long needle and catheter devices into the second intercostal space, and had to almost bury the needle to the hub before he could get into the pleural space. He heard a large rush of air, followed by a “thank you” from the EMT that is was now much easier to bag the patient.

The patient had a large antecubital vein in the right arm, so a large catheter was inserted and a normal saline infusion started with the bag put in a pressure infusion cuff. The paramedic then inserted an intraosseous needle into the patient’s right tibia, away from the injured left leg. He started another infusion of normal saline with a pressure infusion cuff.

The patient continued to have blood coming up from his mouth, so the paramedic quickly performed an endotracheal intubation. The blood was coming from the patient’s lungs, so the paramedic relayed that information to the trauma center, and the crew suctioned the airway on a regular basis to keep the blood from occluding the tube and compromising ventilation.

After about 2 liters of fluid, the patient developed a regular pulse on the pulse oximeter, with a saturation of about 94%. His diaphoresis disappeared, and the wound on his left thigh began to bleed more profusely. The paramedic considered applying a tourniquet, but instead started with direct pressure, and the bleeding was controlled. The victim started to stir around a little.

With these signs of improving perfusion, he takes the pressure infusers off the bags, and cuts the fluid administration rate back to about 100cc per hour. As they arrive in the trauma center Emergency Department, the victim has a pulse rate of 110, an oxygen saturation of 96%, and is moving all four extremities. The trauma team assumes care of the patient, with a plan for rapid transport to the operating room.

After weeks of treatment, and multiple operations the patient was able to leave the hospital.

Decision making in cases of critical penetrating trauma There are critical decisions made in the prehospital emergency care of unstable patients with penetrating trauma. The key assessments and interventions are summarized as:

Integrity of the body and important body portions : Penetrating wounds to the face, neck and chest create immediate and profound airway problems. Where possible, the patient should be positioned to control his or her own airway. Spine immobilization should be dictated by mechanism of injury and evidence of trauma to the spine. Many patients with penetrating wounds away from the spinal column can be managed without immobilizing the spine, and that may simplify airway management. Chest and neck integrity is necessary for preventing major bleeding, and allowing the patient to both ventilate and perfuse. Loss of integrity, particularly with major bleeding, can be addressed by direct pressure, the new adherent dressings, or another occlusive dressing.

Airway : Where needed, airways using oral, nasal, or cricothyroid routes are lifesaving. With some facial injuries, before bleeding and swelling progress, the EMT can perform an oral or digital intubation to secure the airway. In some cases, the patient will need a needle or surgical cricothyrotomy, which can be performed by paramedics in some systems. Crews that are managing critical airways across long prehospital care timelines must be prepared with a number of options for airway management.

Ventilation : The chest wall must be intact for the patient to breathe, and the pleural space cannot be filled with air or blood. Filling those spaces with air creates a life threat to the patient, and the air must be removed with a needle or a chest tube. A tension pneumothorax also creates filling problems for the heart, and perfusion will decrease.

Oxygenation : Lung integrity is important for oxygenation. Supplemental oxygen is usually helpful. Perfusion is the ability of the body to provide critical oxygenation to cells and remove waste products, and the compromise of perfusion is called “shock”. Enhancing both volume and oxygen delivery to the patient is needed to restore or maintain perfusion in the traumatized patient.

Surgical intervention : EMS providers should be experienced in their work with local hospitals or the trauma center, and capable of “making the call” in a timely manner that a crisis is en route and will need to be managed at the ED.

James J. Augustine is an emergency physician and Fire/EMS medical director, and a clinical professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio. He is chair of the National Clinical Governance Board for US Acute Care Solutions, based in Canton, Ohio. Dr. Augustine currently serves a medical director role with fire rescue agencies in Ohio and Florida.

In addition, he has been a member of national groups and organizations overseeing emergency medical services, emergency service quality improvement, benchmarking and best practices and disaster preparation.

Essay Service Examples Health Hospital

Patient Care And Management In The Pre-Hospital Environment

• Proper editing and formatting
• Free revision, title page, and bibliography
• Flexible prices and money-back guarantee

Our writers will provide you with an essay sample written from scratch: any topic, any deadline, any instructions.

Cite this paper

Related essay topics.

Get your paper done in as fast as 3 hours, 24/7.

Related articles

Most popular essays

Research methodology describes the action of how to proceed, identify, select and analyze...

• Waste Management

Hospital waste is a type of waste that is produced in small amounts but transports a great...

• Personal Experience
• Volunteering

My interest in Radiotherapy stems from my independent research into cancer treatment, in which I...

When looking into and exploring Canada’s history, most Canadians have come to believe that it is a...

Nursing is such a rewarding career and a noble profession where you can have the real chance to...

• Grandfather

Beep… down the sterile lonesome hallway. Beep… a lapse of space and time. Beep… the final, last...

• Critical Reflection

“It’s green”. Years later those are the words that still go through my mind. They were the words...

• Disaster Recovery Plan

Mass casualty incidents (MCI) caused by both natural and man-made factors are on an increasing...

A recent definition of the hospital is an “institution where sick or injured are given medical or...

Join our 150k of happy users

• Get original paper written according to your instructions
• Save time for what matters most

Fair Use Policy

EduBirdie considers academic integrity to be the essential part of the learning process and does not support any violation of the academic standards. Should you have any questions regarding our Fair Use Policy or become aware of any violations, please do not hesitate to contact us via [email protected].

We are here 24/7 to write your paper in as fast as 3 hours.

Provide your email, and we'll send you this sample!

By providing your email, you agree to our Terms & Conditions and Privacy Policy .

Say goodbye to copy-pasting!

Get custom-crafted papers for you.

Enter your email, and we'll promptly send you the full essay. No need to copy piece by piece. It's in your inbox!

• Free Samples
• Premium Essays
• Editing Services Editing Proofreading Rewriting
• Extra Tools Essay Topic Generator Thesis Generator Citation Generator GPA Calculator Study Guides Donate Paper
• Essay Writing Help
• About Us About Us Testimonials FAQ
• Studentshare
• Health Sciences & Medicine
• The Paramedic Cases

The Paramedic Cases - Essay Example

• Subject: Health Sciences & Medicine
• Type: Essay
• Level: Ph.D.
• Pages: 2 (500 words)
• Downloads: 7
• Author: bhand

Extract of sample "The Paramedic Cases"

The Paramedic CasesCase 1How are you going to manage this patient as the first crew responding?The primary assessments of this patient point to the fact that she is having low blood pressure which in this case is the major cause of palpitation. The first aid move should be to make the patient maintain the sitting position or make her lie down. In the case of lying down, I will make sure that the head is elevated by putting pillows underneath her head (Carline, Lentz and MacDonald, 2004, p. 100).

The next thing will be giving her electrolyte solution or a mixture of water and salt. In the recliner chair, I will raise the upper part of her body with minimal movement to avoid decreasing the blood pressure further. Additionally, I will cover her calf and thigh with elastic stockings so as to prevent blood form flowing to the feet and hence, maintain a high volume of blood in the upper section of her body (Thygerson, Gulli, Krohmer. & American Academy of Orthopaedic Surgeons, 2006, p. 121).

Describe how the patient is to be taken out of the house and placed on to the stretcherIn the first place, since the patient is conscious, begin by informing the patient that you need to transfer her from the recliner chair to a wheelchair so that she can be taken outside of the house to a stretcher (Spry, 2009, p. 59). The next step is to place one of your arm under the shoulder of this patient, and the other arm supporting her thigh on the opposite side. Count up to three then lift the patient carefully from the recliner chair to the wheel chair.

In case she is strong enough, allow her to participate in the movement with a lot of care not to cause a further decline in her blood pressure. Case 2 Since the patient is unconscious, there is little he can contribute towards his transfer from the bed to the outside of the house. The first move is to find stability on you. While the patient is still lying in bed, place one of your arm under the shoulder of this patient, and the other arm supporting his thigh on the opposite side (Landau-Stanton and Clements, 1993, p. 112). You need to makes counts up to three then swing the patient’s feet to one side of the bed carefully so that he is in a sitting position.

In that sitting position, ensure one of his arms is placed firmly on your shoulders while you are as well seated on the bed. Place one of your arms under his thighs to ensure that there is balance. Rise steadily lifting him with you and go through the stairs to the outside where a stretcher can be utilized. Case 3 In this case, a wheel chair will be of great help. Put a wheel chair at the base of the stairs and get the patient out of his bedroom to the wheelchair through the following procedure; place one of your arm under the shoulder of this patient, and the other arm supporting his thigh on the opposite side to get him in a sitting position on his bed (American Academy of Orthopaedic Surgeons, 2010, p. 83). With his arm on your shoulders, ensure that he leans on you to reduce the weight being put on his back.

Help him steadily down the staircase to the wheel chair. At this point, you can utilize the wheelchair to move down the concrete driveway leading to where the stretcher can be used. In making the move down the drive, ensure to frequently use the wheelchair’s brakes to avoid injury to the patient. Bibliography:Thygerson, A., Gulli, B., Krohmer, J. & American Academy of Orthopaedic Surgeons, 2006, First Aid, Cpr, and Aed, Standard, California, Jones & Bartlett Publishers.American Academy of Orthopaedic Surgeons, 2010, Emergency Care and Transportation of the Sick and Injured, California, Jones & Bartlett Learning.

Landau-Stanton, J. and Clements, C.D., 1993, Aids, Health, and Mental Health: A Primary Sourcebook, Volume 1, New York, Psychology Press.Spry, C., 2009, Essentials of Perioperative Nursing, California, Jones & Bartlett Learning.Carline, J.D., Lentz, M.J. and MacDonald, S.C., 2004, Mountaineering First Aid: A Guide to Accident Response and First Aid Care, Chicago, the Mountaineers Books.

• Cited: 0 times
• Copy Citation Citation is copied Copy Citation Citation is copied Copy Citation Citation is copied

CHECK THESE SAMPLES OF The Paramedic Cases

Civil liability and self-defence, occupational safety and health - kuwait oil company, information technology and the nhs, principles of basic and clinical pharmacology, non-compliance of emergency care's hygiene standards, problem identification and quality improvement at stop it limited, evacuation strategies of high-rise buildings, respond appropriately in the emergency situations.

• TERMS & CONDITIONS
• PRIVACY POLICY
• COOKIES POLICY

• Teesside University Student & Library Services
• Subject LibGuides

Paramedic Practice

• Writing Assignments
• Finding Books
• Finding Journal Articles
• How to Reference
• Distance Learners This link opens in a new window
• Community Statistics
• Using Other Libraries on Placement
• Reading Lists Online
• Structured Searching in CINAHL This link opens in a new window
• Systematic Reviews This link opens in a new window

Help with writing assignments

You can improve your skills at writing assignments for your subject area in a number of ways: 

• We have a wide range of self-service online resources that will help you develop your writing and study skills and support your assignment work: Learning Hub Skills Guides. 
• We run workshops on academic writing, as well as on other types of writing (including critical writing and reflective writing).  See Succeed@Tees workshops  for more information, including a list of dates and times.

Guidance on academic writing

Evidence-based.

• Bringing it all together
• Finally ...

• Writing an assignment takes time, more time than you may expect.  Just because you find yourself spending many weeks on an assignment doesn’t mean that you’re approaching it in the wrong way.
• It also takes time to develop the skills to write well, so don’t be discouraged if your early marks aren’t what you’d hoped for.  Use the feedback from your previous assignments to improve.
• Different types of assignments require different styles, so be prepared for the need to continue to develop your skills.

We’ve broken down TIME into 4 key elements of academic writing: Targeted, In-depth, Measured and Evidence-based.

• What is an academic piece of work

Your assignment needs to be targeted .  It should:

• Be focused on the questions and criteria
• Make a decision
• Follow an argument
• How to be targeted
• Academic keywords or clue words

Your assignment needs to be in-depth .  You should consider your questions and criteria thoroughly, thinking about all possible aspects, and including the argument both for and against different viewpoints.

You should:

• Identify topic areas
• Plan your assignment
• Think about your introduction and conclusion
• How to be in-depth
• How to read quickly

An academic writing style is measured. By this, we mean that it’s:

• Emotionally neutral
• Formal – written in the third person and in full sentences
• How to be measured

Your assignment needs to be evidence-based . You should:

• Reference all the ideas in your work
• Paraphrase your evidence
• Apply critical thinking to your evidence
• How to be evidence-based
• How to paraphrase

Once you’ve found all your evidence, and have decided what to say in each section, you need to write it up as paragraphs.  Each paragraph should be on a single topic, making a single point.  A paragraph is usually around a third of a page. 

We find Godwin’s (2014) WEED model very helpful for constructing paragraphs.

W is for What

You should begin your paragraph with the topic or point that you’re making, so that it’s clear to your lecturer.  Everything in the paragraph should fit in with this opening sentence.

E is for Evidence  

The middle of your paragraph should be full of evidence – this is where all your references should be incorporated.  Make sure that your evidence fits in with your topic.

E is for Examples

Sometimes it’s useful to expand on your evidence.  If you’re talking about a case study, the example might be how your point relates to the particular scenario being discussed.

D is for Do

You should conclude your paragraph with the implications of your discussion.  This gives you the opportunity to add your commentary, which is very important in assignments which require you to use critical analysis. 

So, in effect, each paragraph is like a mini-essay, with an introduction, main body and conclusion.

Allow yourself some TIME to proofread your assignment.  You’ll probably want to proofread it several times. 

You should read it through at least once for sense and structure, to see if your paragraphs flow.  Check that your introduction matches the content of your assignment.  You’ll also want to make sure that you’ve been concise in your writing style. 

You’ll then need to read it again to check for grammatical errors, typos and that your references are correct.

It’s best if you can create some distance from your assignment by coming back to it after a few days. It’s also often easier to pick out mistakes if you read your work aloud.

• How to proofread

Online support for academic writing

We have a skills guide dedicated to academic writing , with an online tutorial and an  Adobe visual guide  to support you.

School Guidelines for Academic Writing and Presentation of Assessed Written Work

• School of Health & Life Sciences Student Guidance for the Presentation of Assessed Written Work (2021)

Tutorials for academic writing and study skills support

Academic Writing and Study Skills Tutorials are available to all students. They are a confidential one-to-one or small group appointment with a member of the Library Team lasting up to 30 minutes. They are available in person on campus, via Teams and email.

In order to ensure that the students who need them most have access to a tutorial, we will support you to engage with our online services and drop-ins before we make you a tutorial appointment.

Requesting a tutorial

• Tutorials are booked for you by our Learning and Skills Development Team. To request skills support email: [email protected]
• Our Team will help you to define what support you need and will initially guide you through our online materials and encourage you to engage with our Study Skill Drop-ins
• If after trying out this support for yourself, you would like further support you can email us again at [email protected] and we will make a tutorial appointment for you
• We will refer you for up to three appointments per semester (1 appointment per assignment)
• Appointments could be with a range of library staff so be aware that you may not see the same adviser at each one-to-one
• Depending on demand there may be a waiting list for one-to-one appointments

What can a tutorial help you with? We can help you to develop your own independent study skills in many aspects of academic writing. This could be helping you to develop your own skills to:

- Understand your tutor’s feedback on a marked assignment and act upon that feedback for future assignments - Understand your School’s Assessment Criteria for an assignment - Improve your time management and plan for your assignment submission dates - Structure your assignment - Develop your critical thinking and writing - Develop your independent proof-reading skills and the skills for you assess that your work is of a quality appropriate  for submission

You can bring your assignment plan or a piece of work with you as an example and we will use it to inform our advice on how to develop the independent skills that will improve your confidence and performance.

What tutorials are not able to help with and why

• We cannot read your work ahead of a tutorial, however, you can bring a piece of work with you to your appointment for us to refer to in the session
• As your work needs to be entirely your own, we will not check draft assignments for you in order to approve their quality before submission but we will support you to develop these skills for yourself
• In order to protect your academic integrity we cannot proof-read your work for you i.e. check the content, structure, spelling or grammar, but we will help you to develop the valuable skills to successfully proof read your own work
• << Previous: Distance Learners
• Next: Community Statistics >>
• Last Updated: Jun 24, 2024 2:27 PM
• URL: https://libguides.tees.ac.uk/paramedic

Home — Essay Samples — Life — Paramedic — The Importance of Paramedics

The Importance of Paramedics

• Categories: Paramedic

About this sample

Words: 821 |

Published: Mar 20, 2024

Words: 821 | Pages: 2 | 5 min read

Table of contents

Introduction, the critical role of paramedics in healthcare, skills and training required to become a paramedic, impact of paramedics on patient outcomes.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Dr. Karlyna PhD

Verified writer

• Expert in: Life

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

4 pages / 1642 words

2 pages / 808 words

3 pages / 1579 words

2 pages / 1019 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Paramedic

The desire to become a paramedic is rooted in a genuine passion for helping others, adaptability under pressure, a desire to make a difference, interest in medical knowledge, effective communication skills, problem-solving [...]

The aim of this case study is to give a detailed analysis of the theories applied while discussing the career development of a person who is from Pakistan. The main reason of the case study is to give the meaning to the [...]

Agriculture accounts for 17.5% of India’s GDP and about half of the total employment (2015-16). Two-thirds of India’s population depends on agriculture and related activities for livelihoods. Indian government plays a vital [...]

In his essay Panopticism, Michel Foucault discusses power and discipline, the manipulation there of, and their effect on society over time. He also discusses Jeremy Benthams Panopticon and other disciplinary models. However, [...]

I strongly agree with the statement above that people work more productively in teamwork than individually. For my part, through cooperation in teamwork, we can not only divide our work and emphasize specialization to achieve [...]

Everyone wants to be in a stable position in their lifestyles. Some of the major goals of a person's career aspirations are to build prestige, obtain responsibilities, financial credits, and authority. However, there are often [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Search menu

ECG case series for paramedics: January 2024

Respecting an autonomous decision to refuse life-saving treatment: a case study

‘in which autonomous patients are choosers who act intentionally, with understanding, and without controlling influences that determine their actions’. .

ECG case series for paramedics: December 2023

Confidence levels of students before and after a minor illness/injury placement

Research by Credland et al (2019) addressed the need for non-ambulance placements within the paramedic programme, such as walk-in centres, minor injury units, cardiac assessment units and general...

Psychological vulnerability and suicidality within the ambulance service: a review

A methodical literature search was conducted to identify peer-reviewed evidence. It began with a broad search of Google Scholar using the terms ‘paramedic suicide’ and ‘paramedic suicidality’..

ECG case series for paramedics: November 2023

Impact of paramedics carrying just-in-case end-of-life care medication

A review of parenteral medicines commonly prescribed at the end of life (Johnstone, 2017) was undertaken. This identified the appropriate JIC medications to manage the symptoms of severe COVID-19...

Disaster preparedness of health professionals at mass gatherings: a scoping review

Scoping reviews, as their name implies, are used to determine how much progress has been made in a particular area of research. In order to explore the question ‘What is known about the preparedness...

Competence of UK paramedics in performing standard paramedic skills

The aim of this study was to observe the performance of clinical skills of paramedics ranging in complexity and frequency of exposure. This was done to achieve the following objectives:.

Mass casualty triage: using virtual reality in hazardous area response teams training

The VR simulation scenario was designed based on the primary triage of casualties using the NASMeD triage sieve (NARU, 2014). Recent evidence suggests that newer, more accurate triage tools are...

Prehospital end-tidal carbon dioxide measurement

The most common method of measuring EtCO2 in clinical practice is the infrared analyser. Rays from a source of infrared light are passed through a sample of gas as a detector analyses the degree of...

Spotlight on Research

Everybody has an opinion on NHS 111, especially those working in ambulance services. Following piloting, the system was formally launched in 2014 to alleviate the burden on emergency departments and...

• 10

Showing 1 to 12 of 317 results

Paramedic Case Study : Assignment

Added on   2020-10-22

About this Document

End of preview

Want to access all the pages? Upload your documents or become a member.

• Advanced search

Advanced Search

Contribution of paramedics in primary and urgent care: a systematic review

• Find this author on Google Scholar
• Find this author on PubMed
• Search for this author on this site
• Figures & Data

Background Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.

Aim To provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.

Design and setting A systematic review.

Method Searches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice , and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.

Results In total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.

Conclusion Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

• allied health personnel
• ambulatory care
• extended roles
• primary care
• urgent care
• INTRODUCTION

Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings, away from their traditional ambulance service employer. These settings include acute hospital trusts, forensic health care, minor injury units, GP services, and urgent care centres. 1 – 4

The NHS Long Term Plan 5 further advocates the use of paramedics in primary care and the new 5-year framework for general practice contracts outlines funding support for ‘first contact community paramedics’ to be employed within primary care settings from 2021. 5 This may be appealing to some paramedics wishing to further develop their professional practice in this setting; 6 therefore, they are among the group of allied health professionals who are attractive to GP surgeries based on this funding. As paramedics transition into these roles within primary care, their knowledge and skill set will undoubtedly change and grow, 7 – 9 offering career development outside of the ambulance service.

The aim of this review was to describe the key reported findings from the current published UK literature available in this field, and to identify gaps in the evidence base since the last systematic review on the subject. 10

This is a systematic review, conducted using guidance from the Joanna Briggs Institute. 11 Findings are reported according to the extension for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 12 Prior to commencing this review, a study protocol was developed and registered with PROSPERO (ref: CRD42018109414).

Information sources

A sensitive search strategy was developed for MEDLINE (Ovid, January 2004 to third week of January 2019) and then translated to other databases. These were CINAHL (EBSCO, January 2004 to third week of January 2019); Embase (Ovid, January 2004 to third week of January 2019); National Institute for Health and Care Excellence (January 2004 to first week of February 2019); and Cochrane Database of Systematic Reviews (Cochrane Library, Wiley; January 2004 to third week of January 2019). Reference lists were screened and forward citation searches conducted for included studies. The Journal of Paramedic Practice (January 2004 to first week of March 2019) was hand-searched.

Search strategy

Databases were searched using free-text keywords and subject headings for the two key concepts: paramedic and general practice/primary care (see Supplementary Box S1 for details). Search terms describing scope of practice were not added because the aim was to retrieve all studies focusing on paramedics in primary care, regardless of clinical presentation or assessment. The search was limited from January 2004, to capture studies published since the last systematic review on the subject. 10 No methodological filters or language limits were applied.

How this fits in

Study selection

A priori definitions and justifications for the screening criteria are outlined in Supplementary Box S2. Studies were selected for inclusion against the following criteria:

Population: paramedics working within the UK only.

Concept: information relating to role, scope of practice, work within health and social care systems, patient and carer satisfaction, clinician satisfaction, and costs.

Context: working fully or partly in primary care settings, out-of-hours, urgent care centres, minor injury units, or walk-in centres.

Study design: any literature (quantitative or qualitative) that presents information relevant to the purpose of this review was considered for inclusion.

Titles and abstracts were screened in order to include or exclude records according to eligibility criteria. Duplicate studies were excluded using reference management software Mendeley (version 1.19.4). The full text of potentially eligible studies was retrieved and originally assessed for eligibility by one author. Full-text studies were independently screened by a second author. Comparisons of study selections were made between both authors. Where any discrepancy arose, they were discussed with a third author until a consensus had been reached.

Data extraction

To extract data from included studies, an amended data extraction form was adapted from the Joanna Briggs Institute’s standardised template 11 and included:

objectives;

population;

study methodology;

study citation; and

findings relating to the themes of the previous review, 10 including role, scope of practice, education, and commissioning.

Information was obtained from published studies. No authors were contacted for further information as reported methods and results were clear. Data extraction was undertaken by one author and discussed among the remaining authors.

Data from all included studies were discussed between all authors. The included studies were described and summarised in a tabular form. Then, a coding framework was iteratively developed to present the key findings from the data extraction. A narrative synthesis was used to describe the nature and scope of the reported findings within the studies identified. In keeping with this methodology, quality appraisal of included studies was not carried out. 11

A total of 6765 citations were identified through database searching (see Supplementary Figure S1 for details). Following screening of titles and abstracts against the inclusion and exclusion criteria, 202 full-text studies were retrieved. After applying inclusion and exclusion criteria, 24 relevant full-text studies were identified. No new studies that had not already been considered were found upon screening the reference lists of these studies. The main reasons for exclusion were studies that reviewed practice outside of the UK ( n = 137); where the paramedic was working within the ambulance service only ( n = 22); and where the population could not be identified as being a paramedic because of the term ‘emergency care practitioner’ encompassing both nurse and paramedic disciplines ( n = 14). There was complete agreement on inclusion/exclusion decisions from independent screening against eligibility criteria at the full-text stage.

Charting the results

For the characteristics of the 24 included studies selected for review (all of which were published in English) see Supplementary Table S1. Study design varied across the included studies, with seven including primary research, 13 – 19 two of secondary research, 20 , 21 and the remaining comprising either a case study ( n = 4), 22 – 25 commentary ( n = 4), 26 – 29 report or strategic plan ( n = 6), 5 , 30 – 34 or protocol for future research ( n = 1). 35

Key findings were iteratively grouped into the following headings:

description of the clinical role;

clinical work environment;

reduction in GP workload;

patient satisfaction;

clinical activities in primary care; and

education and training.

Description of the clinical role

Across the studies, the job title of the paramedic working in primary care differed, either being ‘paramedic’, 16 , 23 , 27 – 30 , 32 , 34 ‘specialist paramedic’, 18 , 19 , 24 ‘paramedic practitioner’, 14 , 17 , 22 , 36 ‘emergency care practitioner’, 14 , 21 , 26 , 35 ‘advanced paramedic’, 32 , 33 or ‘community paramedic’. 5 , 31 , 33

The variety of titles was reported to be confusing for patients in two studies, 13 , 17 as well as other clinicians within primary care, 19 , 21 , 29 with concerns relating to the role, scope of practice, and autonomy of these paramedics.

Clinical work environment

In addition to variation in title, variation in clinical environment, in which paramedics were deployed, was also found. The studies reported paramedics working in commissioned home-visiting services, 14 , 17 , 18 , 25 , 30 , 35 minor units 15 , 20 , 21 , 24 , 30 (including first aid units, minor injury units, minor departments in hospitals, and walk-in- centres), general practice, 5 , 14 , 15 , 19 , 22 , 27 , 28 , 31 , 33 , 34 and out-of-hours. 13 , 16 , 24

In some studies, paramedics retained the ambulance service as their main employer and rotated through primary care settings. 15 , 18 – 21 , 24 , 29

Reduction in GP workload

All studies reviewed reported the paramedic contributing to the primary care workforce through working within a multidisciplinary team. In some cases, the role of paramedics in primary care settings was specifically reported to decrease GP workload by assessing and treating urgent, non-complex patients. 5 , 18 , 22 , 23 , 27 , 28 However, two studies highlighted that patients may still prefer to see their registered GP, rather than a paramedic. 17 , 18

Another two of the included studies raised the issue that patients may not have a straightforward consultation with a paramedic if treatment needed to be clarified with a medical doctor, 14 , 15 thereby adding an extra step to the patient journey. In some areas, there was an expectation that the paramedic report to a more senior clinician for all patient cases. 23 , 26 , 33 Such referrals were reported as lengthening consultation time with little gain to the patient, and the paramedic role in these cases is of more limited value.

Other studies highlighted that the time paramedics spent with patients was generally longer than their physician or nursing counterparts within primary care, 13 , 15 , 16 , 19 , 21 and so researchers questioned the benefit of their attendance from an economic standpoint. The slightly longer home-visits by paramedics was deemed a positive by patients in one study. 17 Another study 21 showed that the length of patient contact differed between clinical settings, typically being longer when paramedics were employed by ambulance services rather than in primary care. Reasons for this were not explored in the study, but it is worth noting that the pressure to see patients within a specific timeframe does not exist in the ambulance service, unlike in primary care.

Only one study associated paramedic roles in primary care with an overall cost saving, 15 although this finding was an estimate and the study was authored in 2006; therefore, its relevance to today’s NHS is ambiguous.

Patient satisfaction

Three studies used retrospective comparators 37 to record patient satisfaction following treatment by a paramedic. 13 , 17 , 18 Although these studies document high satisfaction levels from patients who were visited by a paramedic in their home, in two studies a small minority of patients remained keen to be assessed by their GP, 17 , 18 and other patients remained unclear about the purpose of the assessment undertaken by the paramedic. 13

Clinical activities in primary care

The role of the paramedic in primary care varied little across studies, highlighting that paramedics who undertake roles in primary care (under whichever title) generally undertake similar roles that focus on the undifferentiated, undiagnosed patient. These include minor injury and illness clinics, 15 , 19 , 22 – 24 , 28 , 33 , 34 home-visiting, 14 , 17 – 19 , 22 , 23 , 25 , 28 , 30 , 33 , 35 and using paramedic-specific skills (such as 12-lead electrocardiogram [ECG] interpretation) to assist in general health assessment. 22 – 24 , 28 , 29 , 31 , 34 There was no mention of paramedics providing high-acuity care within these settings, but it was acknowledged that one of the advantages brought by paramedics was their ability to provide high-acuity or emergency care. 23 , 24 , 27 , 28

Four case studies 14 , 22 – 24 and one report 34 presented typical days for paramedics working in primary care settings of GP surgeries and a rural first aid unit. The type of work undertaken across these case studies is similar, indicating that paramedics working in clinical primary and urgent care roles tend to adopt a similar working day.

Education and training

Education standards for paramedics working in primary and urgent care were explicitly mentioned in eight studies. 14 – 16 , 19 , 21 , 26 , 34 , 38 However, none of the publications by NHS England 5 , 25 , 31 considered elements relating to education for paramedics working in primary and urgent care. Postgraduate education was outlined as a requirement for paramedics to work in primary and urgent care, 14 – 16 , 19 , 21 , 26 , 34 , 38 in line with the guidance outlined by the College of Paramedics; 39 however, there was little detail on the specific competencies required to work in these settings. One study 16 highlighted the importance of supervision and mentoring for paramedics as they entered primary or urgent care roles, whereas another 22 outlined how paramedics may also be used to provide mentorship to training physician assistants and nurses (for a brief summation of these findings, see Supplementary Box S3).

This review has set out the scope and content from the literature, published since the seminal study on the subject in 2005. 10 In the time since that review was published, the role of the ambulance service has changed substantially, and the role of the paramedic has subsequently evolved. Now, just 8% of 999 emergency ambulance calls are for people with life-threatening illnesses or injuries, 38 suggesting that a large proportion of patients access the ambulance service with lower-acuity presentations. This has subsequently caused a change in what is expected of a paramedic. As well as emergency care and advanced life support, paramedics now need to be skilled in managing acute-on-chronic long-term conditions, acute presentations of mental ill-health, social care assessments, and a range of undifferentiated urgent care presentations. 7 , 8 New legislation supports non-medical prescribing by advanced paramedics, allowing these paramedics to ‘complete’ patient care and avoid referrals for secondary assessments and treatment. With changing demand on the health and social care services, more higher education thresholds, and social dependence on the ambulance service, 40 the modern paramedic has evolved to become a generalist.

Strengths and limitations

These results should be considered in the light of some limitations. Despite creating and implementing a search strategy with the support of an information specialist, it is possible that relevant studies were missed. A decision was made to describe and map the evidence base. It was decided not to conduct formal meta-analysis exploring the effectiveness of paramedics in primary and urgent care, nor to critically assess the quality of the research.

Comparison with existing literature

There is some evidence in this review to suggest that paramedics may be able to apply their extended skills to safely assess and treat patients in primary care, 20 and that the role of paramedics working in primary and urgent care settings is received positively. 13 , 17 , 19 , 20 , 28 However, there is also evidence which demonstrates that patients perceive the role and responsibilities of paramedics in primary care settings as unclear, 13 , 17 perhaps not helped by the differences in title and scope of practice across clinical settings. 14 , 21 The College of Paramedics has made distinctions between ‘paramedics’, ‘specialist paramedics’, and ‘advanced paramedics’, 39 and advocated against the use of the term ‘emergency care practitioner’ to describe paramedics in extended roles. This review highlights both the variety of job titles paramedics working in primary and urgent care operate under, as well as the lack of uptake of the professional body’s recommendations on the job titles of registered paramedics. It is interesting to note that the two most recent documents by NHS England 5 , 31 refer to paramedics working within primary care under two different job titles (‘first contact community paramedic’ and ‘community paramedic’), neither of which are endorsed nor used by the professional body.

This review also indicates the variety of settings in which paramedics are working, and the broadly similar roles paramedics are employed in. Within these diverse settings paramedics are likely to encounter patients presenting with conditions of lower acuity. Such patients may not fully utilise the unique skill sets of seeing paramedics, who on the whole are trained to manage urgent and emergency presentations. 24 , 27 , 28 , 34

Implications for research and practice

What is clear from this review is the lack of standardisation across the UK. For example, the role of the paramedic in Northumberland 33 and Salford 22 is broadly similar to the role in Oxfordshire 24 in terms of scope of practice, but there are differences in the level of autonomy. The in-hours Northumberland model relies on GPs retaining oversight and control, whereas the in-hours model in Salford promotes greater autonomy, as does the out-of-hours role in Oxfordshire. There is no differentiation of autonomy in studies where paramedics worked in minor injury units, 15 , 20 , 21 , 30 and paramedics who rotated from the ambulance service were still expected to report to the senior clinician (usually the GP) while in the primary care setting. 16 , 19 , 32 , 34 This was generally attributed to the inability of paramedics to prescribe medicines at the time these studies were written. 22 , 28 The level of autonomy afforded to paramedics working in these settings requires further investigation if paramedics are to be employed optimally in the NHS. Although postgraduate education is deemed a necessity to work in primary and urgent care settings 14 – 16 , 19 , 21 , 26 , 34 , 38 , 39 the lack of standardisation makes the development of training programmes to prepare paramedics to work in these settings difficult.

The first 5-year framework for GP contracts initially outlined paramedics working in primary care should be paid at Agenda-for-Change Band 6, 31 yet the study by Turner and Williams 19 found that Band 6 posts were considered training posts with supervision and mentoring within primary and urgent care. The most recent update has outlined that paramedics, included into the reimbursement scheme from April 2021, will be reimbursed up to an indicative Agenda-for-Change Band 7 rate. 41 The update further outlined that, to qualify as an advanced paramedic practitioner, a relevant Master’s degree is the level of education required for this role. This more accurately represents the degree of autonomy paramedics can have, and also outlines the range of patients they can safely manage. However, this document continues to conflate titles, using both terms ‘community paramedic’ and ‘advanced paramedic practitioners’.

Although several studies make the claim that paramedics in primary care may provide cost savings, only one study provided any empirical data to back up this claim and the data were only estimates. 15 Further evidence needs to be gathered to determine whether paramedics in primary care are able to reduce costs, perhaps by directing GP time to more complex patients with chronic conditions, and to managing both lower- and higher-acuity same-day presentations autonomously.

The evidence within this review identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK, but fails to provide sufficient detail regarding the clinical contribution of paramedics in this clinical setting. If primary care employers are to see the full potential of paramedics working in these settings, more research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

• Acknowledgments

Georgette Eaton would like to thank Rachel Gardner, DPhil Student at the University of Oxford, for second-screening extracted articles.

Georgette Eaton acknowledges NHS Health Education England for its support of this research (ref: 190121). Kamal R Mahtani, Geoff Wong, and Nia Roberts are supported by the National Institute for Health Research (NIHR) School of Primary Care Research Evidence Synthesis Working Group (project 390). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, Health Education England, or the host institution.

Ethical approval

Not applicable.

Freely submitted; externally peer reviewed.

Competing interests

Kamal R Mahtani is Chair and Geoff Wong is Joint Deputy Chair of the NIHR Health Technology Assessment Prioritisation Committee: Integrated Community Health and Social Care Panel (A).

Discuss this article

Contribute and read comments about this article: bjgp.org/letters

• Received October 7, 2019.
• Revision requested November 3, 2019.
• Accepted December 5, 2019.
• ©The Authors

This article is Open Access: CC BY-NC 4.0 licence ( http://creativecommons.org/licences/by-nc/4.0/ ).

• McGovern R ,
• Newbury-Birch D
• Mahtani KR ,
• Catterall M ,
• Williams B ,
• Fielder C ,
• NHS England
• Mahtani K ,
• Catterall M
• National Institute for Health and Care Excellence
• Primary Care Workforce Commission
• Aromataris E ,
• Godfrey C ,
• McInerney P ,
• Tricco AC ,
• Mohammed D ,
• Ellison GTH
• Lattimer V ,
• Burgess A ,
• Coleman P ,
• O’Keeffe C ,
• Clompus S ,
• Lockyer L ,
• RSM UK Group
• Chambers D ,
• McMeekin P ,
• Northumberland Local Medical Committee, Northumberland Clinical Commissioning Group
• NHS Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups
• Pinnock H ,
• Epiphaniou E ,
• College of Paramedics

In this issue

• Table of Contents
• Index by author

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Citation Manager Formats

• EndNote (tagged)
• EndNote 8 (xml)
• RefWorks Tagged
• Ref Manager

• Tweet Widget
• Facebook Like
• Google Plus One

Jump to section

More in this toc section.

• What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients’ experiences and expectations
• Risk of Parkinson’s disease in people aged ≥50 years with new-onset anxiety: a retrospective cohort study in UK primary care
• Patients’ perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary care

Related Articles

Cited by....

British Journal of General Practice

• Health & Social Care
• Physiotherapy

Clinical Cases in Paramedicine

ISBN: 978-1-119-61925-3

Wiley-Blackwell

Digital Evaluation Copy

Rod Hill , Ian Peate , Sam Willis

Clinical Cases in Paramedicine provides students, educators, and early career paramedics with a diverse range of detailed case studies that realistically represent the conditions, scenarios, and challenges encountered in practice. Integrating evidence-based cases and expert insights from leading academics and practitioners, this engaging resource helps readers develop appropriate decision-making skills and apply theoretical concepts to practical situations. Organised by medical presentations and body systems, the text provides readers with a systematic framework that mirrors how paramedics assess cases in the real world.

Throughout the text, cases of varying levels of complexity are designed to meet the needs of Case-Based Learning (CBL) and Problem-Based Learning (PBL) curricula used in paramedic training programmes worldwide. Each chapter contains six case studies—introductory, intermediate, and advanced—and features interactive learning activities, discussion questions, practical tips, and authoritative guidance aligned to national and international best-practice standards. Case studies illustrate scenarios related to trauma, medical emergencies, obstetrics, respiratory and cardiac events, minor injuries, drug overdoses, and many others. This comprehensive resource:

• Features case studies of varying lengths and degrees of complexity to suit different readers, from student to professional
• Suitable for use in many international programmes
• Offers chapter introductions and summaries, practice questions, and additional online resources
• Contains clinical, legal, ethical, cultural, remote and rural case studies
• Includes a cumulative and comprehensive "Test Your Knowledge" concluding chapter

Those studying or working in paramedicine must keep pace with changes in the field using the latest evidence and expert opinion. Clinical Cases in Paramedicine is an essential volume for paramedic students and early-career professionals, as well as educators, lecturers, and trainers.

SAM WILLIS is a Lecturer in Paramedicine at Curtin University and makes contributions to the profession through his innovative teaching practices and publications. He holds a number of professional registrations including as a paramedic and a Teaching Fellow with the UK Higher Education Academy. He is currently undertaking a PhD in the field of Paramedic Education.

IAN PEATE, OBE FRCN , is Head of School, School of Health Studies, Gibraltar, Visiting Professor of Nursing, Northumbria University and St George’s University of London, Visiting Senior Clinical Fellow, University of Hertfordshire, Editor-in-Chief of the British Journal of Nursing and Consultant Editor of the Journal of Paramedic Practice.

ROD HILL is Professor of Physiology and Head of the School of Biomedical Sciences at Charles Sturt University. Rod has brought broad impact as a Fellow of the American Association for the Advancement of Science. Rod leads the Charles Sturt paramedicine team which offered the first university programme for paramedicine in Australia in 1995, and is the leading Australian programme in both graduate and undergraduate level paramedicine.

Paramedic case study

• Published: December 16, 2021
• Updated: December 16, 2021
• University / College: The University of Edinburgh
• Language: English
• Downloads: 38

April The major traumatic Injuries that this patient may experience would be possible pelvic fractures, a lateral compression fracture, anterior posterior fracture (open book), or vertical shear fracture. Also combine would be hypothalamic shock and a pneumonia which could possibly develop into a possible tension pneumonia. The bony pelvis consists of the Ilium (iliac wings), schism, and pubis, which form an anatomic ring with the sacrum. Disruption of this ring requires significant energy.

Because of the forces involved, pelvic fractures frequently involve injury to organs contained within the bony pelvis.

In addition, trauma to extra-pelvic organs is common. Pelvic fractures are often associated with severe hemorrhage due to the extensive blood supply to the region (Cooperates & Bandits, 2009). Pelvic fractures are most commonly described using one of two classification systems. The Tile classification system Is based on the Integrity of the posterior sacroiliac complex (Sutton & Hall, 2011). In type A Injuries, the sacroiliac complex Is Intact. The Elvin ring has a stable fracture that can be managed non operatively.

* Type B injuries are caused by either external or internal rotational forces resulting in partial disruption of the posterior sacroiliac complex. These are often unstable. * Type C injuries are characterized by complete disruption of the posterior sacroiliac complex and are both rotationally and vertically unstable. These injuries are the result of great force, usually from a motor vehicle crash, fall from a height, or severe compression.

The Young classification system is based on mechanism of injury: eternal compression, anterior posterior compression, vertical shear, or a combination of forces.

Lateral compression (LLC) fractures Involve transverse fractures of the pubic ramie, either Epistolary or controllable to a posterior Injury (Sutton & Hall, 2011). * Grade I – Associated sacral compression on side of Impact Grade II – Associated posterior iliac (“ crescent”) fracture on side of impact * Grade Ill Associated controllable sacroiliac joint injury Anterior-posterior compression (APPC) fractures, involve sympathy’s diastase or longitudinal ramie fractures. Grade I – Associated deeding (slight) of pubic symposia or of the anterior sacroiliac (SSL) Joint, while carburetors, acrimonious, and posterior SSL ligaments remain intact * Grade II – Associated widening of the anterior SSL Joint caused by disruption of the anterior SSL, carburetors, and acrimonious ligaments; posterior SSL ligaments remain intact * Grade Ill (open book) – Complete SSL Joint disruption with lateral displacement and disrupted anterior SSL, carburetors, acrimonious, and posterior SSL ligaments.

Vertical shear (VS.) Involves sympathy’s diastase or vertical displacement interiorly ND posterior, which Is usually through the SSL Joint, though occasionally through the Iliac wing or sacrum.

Executable fractures most commonly Involve disruption of the executable socket when the hip is driven backward in a motor vehicle accident. Occasionally, teen occur In a Pasternak struck Day a ventricle moving at a gallants rate of speed. Falls in elderly persons may involve fractures (usually of the pubic ramie) without disruption of the ring (Sanders, 2010).

Implications that can lead from abdominal and pelvic injuries are things like Hypoglycemic shock. Hypoglycemic shock offers to a medical or surgical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion.

Most often, hypoglycemic shock is secondary to rapid blood loss (hemorrhagic shock). ( Menace & Whether, 2009). Acute external blood loss secondary to penetrating trauma and severe GIG bleeding disorders are 2 common causes of hemorrhagic shock.

Hemorrhagic shock can also result from significant acute internal blood loss into the thoracic and abdominal cavities (Curtis & Ramadan, 2011). Pneumonia is defined as the presence of air or gas in the pleural avidity (e, the potential space between the visceral and parietal pleura of the lung). The clinical results are dependent on the degree of collapse of the lung on the affected side.

Pneumonia can impair oxygenation and/or ventilation.

If the pneumonia is significant, it can cause a shift of the medications and compromise hemorrhagic stability (Maries & Hone, 2010). Traumatic pneumonia results from blunt trauma or penetrating trauma that disrupts the parietal or visceral pleura Management steps for traumatic pneumatics’s are similar to those for other, maturation causes. If hemorrhagic or respiratory status is compromised or an open (communicating to the atmosphere) and/or hemorrhoid are also present, tube tracheotomy is performed to evacuate air and allow re-expansion of the lung.

A tension pneumonia is a life-threatening condition characterized by an accumulation of air under pressure in the plural space but prohibiting any outflow, collapsing the lung and causing hypoxia’s as well as obstructive shock (Sanders, 2012).

Prompt recognition of this condition is lifesaving, both outside the hospital and in a modern CICS. Because tension pneumonia occurs infrequently and has a tangentially devastating outcome, a high index of suspicion and knowledge of basic emergency thoracic decompression procedures are important for all healthcare personnel.

Immediate decompression of the thorax is mandatory when tension pneumonia is suspected (Sanders, 2012). From the case study provided for this assignment and the patient vital signs, symptoms and mechanism of injury. I have drawn my conclusion that the patient is suffering from a lateral compression fracture with evidence of hemorrhagic compromise from the fall that was greater than 3 meters.

The appearance of the patient being described as pale and diaphragmatic, with n increasing pulse rate, and a decreasing blood pressure, tells me that this patient is losing blood volume internally and is in hypothalamic shock.

Also signs from a CACM contusion to the left axial and anterior chest wall with increasing respirations from 20 to 30 rasps after 10 minutes on scene lead me to believe that this patient is also suffering from a pneumonia (Queensland Ambulance Service, 2010). I got all these details from doing the primary survey which consists of Danger, Response, Circulation, Airway, Breathing and assessment of the scene. How I would manage his patient would be to call for backup or as an CAP crew, consultation and approval from the AS on call medical officer required in all situations.

Because the seriousness of this condition and how fast an asymptomatic person can deteriorate alter Tats transport to a national or a scent decompression snouts De performer The pre hospital assessment would to be to count the respiratory rate and pattern.

Count for 1 minute and reassess at regular intervals as this will be the first indicator of deterioration of the patient. Movement of the chest wall. Are there any asymmetrical features of chest wall movement? Be vigilant for flail segments with paradoxical or abnormal movements of a section of chest wall.

Is there subtle reduced movement of one side of the chest wall with hyper expansion suggesting a tension pneumonia? Reduced movement may also be due to pain, pneumonia or hemorrhage. The patient should be assessed every 10 minutes or whenever there appears to be a change in the patients clinical status.

The interventions that I would take with this patient would be to follow the clinical practice guideline for treatment of hypothalamic shock. Acute hemorrhage, secondary to trauma, is the major cause of hypothalamic shock (Sanders, 2012).

Blood loss can be ‘ hidden’ and not immediately apparent I. E. Pelvic injury. Awareness of clinical features of shock is of paramount importance, as early recognition of hypoglycemia can be life-saving.

Assessment of volume status extends beyond the vital signs and requires a comprehensive review of the patient. I would put the patient on high flow oxygen at 15 liters per minute on a non re breather mask (CAP, 2010). Cover the open wounds of the chest by using a 3 sided dressing. Stop any external hemorrhage by applying direct pressure.

I would then gain IV access and administer IV fluids, and IV analgesic whilst maintaining rhombohedra. If the pneumonia turned into a tension pneumonia, I would then re-evaluate the situation and the patient’s clinical presentations, and if necessary follow the CPM guidelines to performing a decompression.

The management of my patient would also include pain management. Pain is individual and subjective and is influences by factors such as culture, previous experiences, belief, mood, and ability to cope. There are therefore no clinical signs of pain.

There 2 main types of pain management, Non pharmacological techniques such as reassurance, distraction, posturing, positioning, heat or cold therapy and splinting ND pharmacological pain management such as GET, metaphorically, morphine, fontanel, and astatine (Queensland Ambulance Service (DTV). For my patient, if I had ICP backup I would administer astatine.

Astatine is an anesthetic agent that acts as an AMANDA receptor antagonist. At lower doses this drug produces significant analgesia, whilst the airway reflexes and respiratory drive are preserved.

Unlike other general anesthetics, there is minimal hemorrhagic compromise as astatine acts as a psychosomatic agent. The indications for this drug would be severe traumatic pain associated with fracture reduction and or splinting. After the patient is in as little pain as possible I would then move to the placement of a SAM pelvic splint. For the management of the pelvic injury I would place the patient in a SAM pelvic splint.

Pelvic binders reduce and stabilize pelvic ring fractures with diastase and thereby control hemorrhage from the pelvic vascular.

This work, titled "Paramedic case study" was written and willingly shared by a fellow student. This sample can be utilized as a research and reference resource to aid in the writing of your own work. Any use of the work that does not include an appropriate citation is banned.

If you are the owner of this work and don’t want it to be published on AssignBuster, request its removal.

• Chicago (A-D)
• Chicago (N-B)

AssignBuster . (2021) 'Paramedic case study'. 16 December.

AssignBuster. (2021, December 16). Paramedic case study. Retrieved from https://assignbuster.com/paramedic-case-study/

AssignBuster . 2021. "Paramedic case study." December 16, 2021. https://assignbuster.com/paramedic-case-study/.

1. AssignBuster . "Paramedic case study." December 16, 2021. https://assignbuster.com/paramedic-case-study/.

Bibliography

AssignBuster . "Paramedic case study." December 16, 2021. https://assignbuster.com/paramedic-case-study/.

"Paramedic case study." AssignBuster , 16 Dec. 2021, assignbuster.com/paramedic-case-study/.

• People with mental disorders
• Crimean-congo hemorrhagic fever virus (cchfv) treatment
• Pathology report assignment
• Assessment strategies: paramedic education
• The japan airlines 123 flights
• Marburg virus hemorrhagic fever research papers examples
• Commentary: acute hemorrhagic leukoencephalitis (weston–hurst syndrome) in a patient with relapse-remitting multiple sclerosis

Please, let us know if you have any ideas on improving Paramedic case study, or our service. We will be happy to hear what you think: [email protected]