Fundamentals of Paramedic Practice

ABOUT THE EDITORS Sam Willis is Lecturer in Paramedic Sciences at the University of Tasmania, Sydney, Australia. Roger Dalrymple is Principal Lecturer for the Professional Education and Leadership Programmes at Oxford Brookes University, Oxford, UK.

About the series xvii Contributors xviii Preface xxi Acknowledgements xxiii How to use your textbook xxiv About the companion website xxviii Part One Theory and Background Chapter 1 Professionalism in paramedic practice 3 Netta Lloyd-Jones Introduction 4 Professionalism in paramedic practice 4 Defining professionalism 5 Professionalism as ethical practice 6 Professional identity, socialisation and culture 6 How do students learn professionalism? 7 Assessment and standards of professionalism 9 Regulatory areas, fitness to practise processes and outcomes 9 Conclusion 10 Activities 11 Glossary 11 References 12 Chapter 2 Human factors of paramedic practice 14 Sam Willis Introduction 15 Background 16 Defining human factors 16 Human factors of paramedic practice 16 Hazardous attitudes 21 Crew resource management (CRM) 23 Conclusion 24 Activities 25 Glossary 27 References 28 Chapter 3 Communication skills for the pre-hospital professional 29 Sam Willis Introduction 30 Background 31 The importance of effective communication 31 A model of communication 32 Non-verbal communication 33 Verbal communication 38 Effective listening 39 Empathy 40 Barriers to effective communication in the pre-hospital setting 40 Conclusion 42 Activities 42 Glossary 43 References 44 Chapter 4 Sociological aspects of paramedic practice 46 Kellie Tune Introduction 47 The sociological imagination 47 Three sociological paradigms 48 The sociocultural context of health 51 Medicalisation and demedicalisation 52 Conclusion 53 Activities 53 Glossary 55 References 56 Chapter 5 Legal and ethical aspects of paramedic practice 58 Sam Willis, Nevin Mehmet Introduction 59 Ethical aspects of paramedic practice 63 Conclusion 67 Activities 67 Glossary 67 References 68 Chapter 6 The psychology of paramedic care 70 Heather Knight, Helen Pocock Introduction 71 Llewellyn s core domains of clinical health psychology 71 Psychological concepts of health 75 Influences of a loss of control on health 75 Psychological considerations for the paramedic 77 The system 79 Conclusion 80 ix Activities 80 Glossary 82 References 83 Chapter 7 The role of leadership in paramedic practice 85 Roger Dalrymple Introduction 86 Theories of leadership: a brief overview 88 Defi nitions of leadership 88 From leaders to leadership behaviours 88 Leadership styles and approaches 89 Leadership at the individual level 91 Leadership and the mentoring or supervisory role 92 Leadership and teamwork 93 Conclusion 95 Activities 95 Glossary 96 References 97 Chapter 8 Safeguarding vulnerable people 98 Rozz McDonald Introduction 99 Background 99 Legislation and Policy 100 Types of abuse and neglect 101 Recognising abuse and neglect 103 How do you assess seriousness? 109 Practice principles of safeguarding 109 Paramedic responsibilities 109 Responding to abuse and neglect 111 Conclusion 112 Activities 112 Glossary 113 References 114 Chapter 9 Introduction to medicines in pre-hospital care 116 Edward England Theories and principles 117 Cardiovascular system 121 Parasympathetic nervous system 122 Sympathetic nervous system 122 Antiarrhythmics 124 Angina and hypertension 124 Left ventricular failure (LVF) 125 Respiratory system 125 Endocrine system 126 Pain 128 Nausea and vomiting 131 Conclusion 133 Activities 133 Glossary 133 References 134 Chapter 10 The role of refl ection in paramedic practice 136 Sally Markwell, Andrew Kerry Introduction 137 Reflection : what are we talking about? 138 Models and methods of reflection 139 From models to methods and skills 143 Becoming a reflective practitioner in paramedic practice 145 Conclusion 146 Activities 146 Glossary 148 References 148 Chapter 11 Research methods and paramedic practice 150 Jan Davison-Fischer, Catherine J. Davison-Fischer Introduction 151 Qualitative and quantitative research 151 Ethics 152 Literature reviews 154 Case reports 155 Case control studies 155 Questionnaire studies 155 Interview studies 158 Focus group studies 158 Observational and participatory studies 159 Before-and-after studies and routinely collected data 159 Randomised controlled trials 159 Longitudinal cohort and panel studies 160 Conclusion 160 Activities 160 Glossary 161 References 162 Chapter 12 Using simulation to educate the pre-hospital healthcare professional 163 Clair Merriman Introduction 164 Definition of simulation 164 History of simulation 165 Simulation and paramedic practice 166 The simulated learning environment 166 xi Pedagogic principles of simulation 167 Types of simulation and equipment 170 Getting the most out of simulated sessions 172 Conclusion 175 Activities 175 Glossary 176 References 177 Part Two Assessment and Application Chapter 13 Trauma 181 Charlie McGurk, Sam Willis Introduction 182 Head injuries 182 Facial injuries 185 Neck and back injuries 186 Chest injuries 187 Abdominal injuries 188 Pelvic injuries 190 Limb injuries 190 Upper limb injuries 191 Conclusion 192 Activities 192 Glossary 193 References 194 Chapter 14 Pre-hospital electrocardiography 195 Nathan Puckeridge Introduction 196 What is an ECG? 196 The P, Q, R, S and T waves 197 Evaluating the ECG 198 Heart rate 198 Heart rhythm 198 The P -wave 198 The QRS complex 199 The T -wave 200 The PR interval 200 Atrioventricular (AV) heart blocks 200 Performing and reviewing a 12-lead ECG 201 Acute coronary syndromes and the ECG 203 Idioventricular rhythm 204 Bundle branch blocks 204 Conclusion 205 Activities 205 Glossary 206 References 207 Chapter 15 Assessing the cardiac system 208 Mark Ives, Sam Willis Introduction 209 The heart 209 Common cardiac conditions 211 Patient assessment 215 Conclusion 220 Activities 221 Glossary 221 References 222 Chapter 16 Assessing the nervous system 223 Clair Merriman Introduction 224 The nervous system: structure and function 224 Central nervous system 225 Peripheral nervous system 228 Upper and lower motor neurones 230 The history and physical examination 231 Detecting increased in intracranial pressure (ICP) 239 Conclusion 240 Activities 240 Glossary 240 References 241 Chapter 17 Assessing the abdomen 242 Matthew Faulkner Introduction 243 Abdominal anatomy and physiology 243 History-taking 247 Abdominal physical assessment 251 The nature of abdominal pain 253 The acute abdomen 256 Important abdominal pathologies 256 Conclusion 258 Activities 259 Glossary 260 References 261 Chapter 18 Respiratory assessment 262 Dan Staines Introduction 263 Anatomy of the respiratory system 263 Lungs and pleural membranes 265 xiii Mechanism of breathing 265 Pathophysiology of respiratory conditions 266 Respiratory system assessment 266 Eyeballing the scene (also known as a global overview) 267 Eyeballing the patient (patient assessment triangle) 267 Primary survey 269 Subjective history 269 Secondary survey 270 Chest examination 273 Conclusion 279 Activities 279 Glossary 280 References 280 Chapter 19 Paramedic skills 281 Roshan Raja Introduction 282 Airway 282 Ventilation 291 Circulation 292 Conclusion 296 Activities 296 Glossary 298 References 298 Chapter 20 Pre-hospital obstetrics 300 Robb Kightley Introduction 301 Normal (physiological) birth 301 Birth phases 302 Preparing for the birth 304 Paramedic intervention following normal childbirth 306 Birth complications 307 Conclusion 311 Activities 311 Glossary 312 References 313 Chapter 21 Paediatrics 314 Sam Whitby Introduction 315 Paediatric anatomy and physiology 315 Pediatric examination 317 Paediatric assessment triangle (PAT) 318 Paediatric emergencies 320 Conclusion 327 Activities 327 Glossary 327 References 328 Chapter 22 Managing medical emergencies 329 Bonita Baber, Sam Willis Introduction 330 Respiratory emergencies 330 Cardiac emergencies 338 Neurological emergencies 341 Metabolic disorders 344 Immunological emergencies 348 Conclusion 349 Activities 349 Glossary 349 References 350 Chapter 23 Managing the older adult 352 Helen Pocock, Heather Knight Introduction 353 Physiology of ageing 353 Ageing and health psychology 355 Long-term conditions in the ageing population 357 Poly-pharmacy and pharmacology in ageing 359 Conclusion 361 Activities 361 Glossary 361 References 362 Chapter 24 Managing minor injuries in the pre-hospital setting 364 Craig Barlow Introduction 365 Background 366 The importance of history-taking 366 Examination 367 Minor head injury 370 Nose injury 371 Wound care and assessment 372 Ankle injury 374 Minor burn 375 Conclusion 376 Activities 376 Glossary 377 References 379 Chapter 25 Mental capacity and pre-hospital care 380 Sue Putman Introduction 381 What is mental capacity? 381 How do we make decisions? 382 The five principles 383 Additional mental capacity safeguards 387 Legal aspects of mental capacity 388 Conclusion 390 Activities 391 Glossary 391 References 392 Chapter 26 Mental health and pre-hospital care 393 Sue Putman Introduction 394 What is mental health ? 394 What are mental disorder and mental illness ? 395 Emotions (mood) and behaviour 397 ABC model of emotion 397 Brief outline of common mental illnesses 398 General strategies to help all mental health conditions in the pre-hospital environment 403 Mental Health Act 1983 (amended 2007) England and Wales (MHA) 403 Conclusion 404 Activities 404 Glossary 404 References 405 Chapter 27 Supporting people with learning disability as a pre-hospital professional 407 Jenny Begley, Mark Begley, Sam Willis Introduction 408 Background 408 Conditions and syndromes associated with learning disability 409 Dispelling common assumptions relating to LD patients 411 Pre-hospital management considerations for the patient with an LD 413 Conclusion 414 Activities 414 Glossary 415 References 416 Chapter 28 Attending major incidents in paramedic practice 417 Gail Rowntree Introduction 418 Civil Contingency Act 2004 419 Reality vs. theory: interview with A 420 How to manage a site 421 First attendant crew 422 What a major incident scene looks like 422 Reality of attending a major incident: interview with B 423 Triage 424 Media 425 Self-care 425 Building resilience 426 Conclusion 427 Activities 427 Glossary 428 References 429 Answers to activities 430 Index 451