Fundamentals of Paramedic Practice
Description
Assuming no prior knowledge of the subject, this user-friendly textbook provides broad and inclusive coverage of topics including professionalism, law and ethics, assessment skills, research methods, pharmacology and more. Contributions from experienced paramedics and clinicians, contemporary case studies, full-colour illustrations and powerful pedagogical tools help students gain a thorough understanding of the essential components of paramedic practice.
* Employs a comprehensive, multidisciplinary approach to the study of paramedic practice, presenting theoretical and clinical topics in a straightforward and student-friendly manner
* New chapters on toxicology, medical terminology and low acuity care in paramedicine, with an increased focus on mental health
* Includes new end-of-chapter learning activities and quizzes, case studies and references, charts and diagrams
Fundamentals of Paramedic Practice: A Systems Approach is an invaluable resource for undergraduate paramedic and emergency care students as well as qualified paramedics, clinicians and educators seeking an authoritative reference on current practice.
More details
Other editions
Additional editions
Persons
Sam Willis is Senior Lecturer in Paramedicine, School of Biomedical Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia.
Roger Dalrymple is Principal Lecturer, Professional Education and Leadership Programmes, Oxford Brookes University, Oxford, UK.
Content
List of contributors xiv
Preface xvi
Acknowledgements xvii
About the companion website xviii
Chapter 1 Professionalism in paramedic practice 1
Netta Lloyd-Jones
Introduction 2
Professionalism in paramedic practice 2
Defining professionalism 3
Professionalism as ethical practice 3
Professional identity, socialisation, and culture 4
How do students learn professionalism? 6
Assessment and standards of professionalism 7
Regulatory areas, fitness to practise processes, and outcomes 8
Conclusion 9
Activities 9
Glossary 10
References 10
Chapter 2 Professional health regulation for paramedicine and ambulance prehospital emergency care 12
Ramon Z. Shaban, Ruth Townsend
Introduction 13
Principles for paramedic professional health regulation 13
Health professional regulation for paramedic professionalism 14
The UK experience 15
Paramedics behaving badly 18
The Australian experience 19
Conclusion 20
Activities 21
Glossary 21
References 22
Chapter 3 Human factors in paramedicine 23
Sam Willis, Helen Pocock
Introduction 24
What are human factors? 24
Human error in paramedicine 25
Tasks 26
Organisation 27
Tools and technology 28
Environment 28
Interactions 29
Human factors in paramedic practice 29
Conclusion 32
Activities 32
Glossary 33
References 33
Chapter 4 Mental capacity and prehospital care 35
Sue Putman
Introduction 36
What is mental capacity? 36
How do we make decisions? 37
Assessing mental capacity 38
The five principles 39
Additional mental capacity safeguards 43
Conclusion 45
Activities 46
Glossary 46
References 47
Chapter 5 Mental health and prehospital care 48
Sue Putman
Introduction 49
What is 'mental health'? 49
What are 'mental disorder' and 'mental illness'? 50
Emotions (mood) and behaviour 52
ABC model of emotion 52
Brief outline of common mental illnesses 52
General strategies to help with all mental health conditions in the prehospital environment 56
Mental health act 57
Conclusion 57
Activities 58
Glossary 58
References 58
Chapter 6 Communication skills for the prehospital professional 60
Sam Willis, Gary Mellor
Introduction 61
Background 61
The importance of effective communication 62
A model of communication 62 vii
Nonverbal communication 63
Verbal communication 68
Effective listening 69
Empathy 70
Barriers to effective communication in the prehospital setting 70
Conclusion 71
Activities 71
Glossary 72
References 73
Chapter 7 Sociological aspects of paramedic practice 74
Kellie Tune
Introduction 75
The sociological imagination 75
Three sociological paradigms 76
The sociocultural context of health 78
Medicalisation and demedicalisation 80
Conclusion 80
Activities 80
Glossary 82
References 82
Chapter 8 Legal and ethical aspects of paramedic practice 84
Ruth Townsend, Sam Willis, Nevin Mehmet
Introduction 85
Legal aspects of paramedic practice 85
Ethical aspects of paramedic practice 90
Ethical principles: An ethical framework 92
Conclusion 93
Activities 93
Glossary 94
References 94
Chapter 9 Leadership and mentorship in paramedic practice 95
Roger Dalrymple
Introduction 96
Theories of leadership: a brief overview 97
Definitions of leadership 98
From leaders to leadership behaviours 98
Leadership styles and approaches 99
Leadership at the individual level 100
Leadership and the mentoring or supervisory role 101
Leadership and team work 103
Ongoing leadership development 104
Conclusion 104
Activities 104
Glossary 105
References 106
Chapter 10 Safeguarding adults at risk of abuse and neglect 107
Rozz McDonald
Introduction 108
Legislation and policy 108
Types of abuse and neglect 110
Recognising abuse and neglect 110
Radicalisation and extremism 115
Practice principles of safeguarding 116
Paramedic responsibilities 116
Conclusion 119
Activities 119
Glossary 119
References 120
Chapter 11 Essential toxicology for prehospital clinicians 122
Jack Matulich
Introduction 123
Pharmacokinetics in toxicology 124
The importance of clinical context and vulnerability 125
The initial resuscitative approach in toxicology 126
Toxidromes 130
Activities 139
Glossary 140
References 141
Chapter 12 Medical terminology 142
Steve Whitfield, Michael Porter
Introduction 143
A brief history (Hx) of medical terminology 144
Medical terminology and word structure 145
Prefixes and suffixes 145
The building blocks of medical terms 148
Pronunciation of medical terms 149
Forming plurals 150
Eponyms 150
Anatomical positions 151
Movement terminology 154
Medical abbreviations and acronyms 154
Common similarities in terminology 160
Spelling - British versus American English 161
Conclusion 161
Activities 162
Glossary 162
References 163
Chapter 13 Research methods and paramedic practice 164
Jan Davison-Fischer, Catherine J. Davison-Fischer, Roger Dalrymple
Introduction 165
Qualitative and quantitative research 165
Ethics 167
Case reports 167
Case control studies 167
Questionnaire studies 168
Interview studies 170
Focus group studies 170
Observational and participatory studies 170
Before-and-after studies and routinely collected data 171
Randomised controlled trials 171
Longitudinal cohort and panel studies 172
Critical literature reviews 172
Conclusion 175
Activities 175
Glossary 176
References 176
Chapter 14 Trauma 178
Charlie McGurk, Sam Willis, Alice Acutt
Introduction 179
Head injuries 179
Facial injuries 182
Neck and back injuries 183
Chest injuries 185
Abdominal injuries 188
Pelvic injuries 189
Limb injuries 190
Upper limb injuries 191
Shock 192
Conclusion 192
Activities 192
Glossary 193
References 194
Chapter 15 Prehospital electrocardiography 195
Nathan Puckeridge
Introduction 196
What is an ECG? 196
P, Q, R, S, and T waves 197
Evaluating the ECG 198
Atrioventricular heart blocks 201
Performing and reviewing a 12-lead ECG 202
Acute coronary syndromes and the ECG 203
Idioventricular rhythm 204
Bundle branch blocks 205
Conclusion 205
Activities 206
Glossary 206
References 207
Chapter 16 Assessing the cardiac system 208
Mark Ives, Sam Willis, Sonja Maria, Clare Sutton
Introduction 209
Cardiac anatomy and physiology 209
Common cardiac conditions 211
Patient assessment 215
Conclusion 224
Activities 224
Glossary 225
References 225
Chapter 17 Assessing the nervous system 227
Clair Merriman
Introduction 228
Nervous system: structure and function 228
Central nervous system 229
Peripheral nervous system 232
Upper and lower motor neurones 233
History and physical examination 233
Conclusion 241
Activities 241
Glossary 242
References 242
Chapter 18 Assessing the abdomen 243
Matthew Faulkner, Clare Sutton, Georgina Pickering
Introduction 244
Abdominal anatomy and physiology 244
Patient assessment 254
Conclusion 261
Activities 261
Glossary 262
References 263
Chapter 19 Respiratory assessment 264
Dan Staines, Samantha Sheridan, Georgina Pickering
Introduction 265
Respiratory anatomy and physiology 266
Pathophysiology of respiratory conditions 268
Patient assessment 268
Conclusion 278
Activities 278
Glossary 279
References 279
Chapter 20 Paramedic assessment skills 280
Duncan McConnell
Introduction 281
Part 1: The conscious patient 281
Case study 1: Using the primary survey 283
Case study 2: Implementing the secondary survey 287
Case study 3: Completing the systematic approach 290
Part 2: The unconscious patient 292
Case study 4: The unconscious patient systematic approach 296
Conclusion 299
Activities 304
Glossary 304
References 305
Chapter 21 Birth and the paramedic 307
Robb Kightley
Introduction 308
Physiological birth 308
Birth phases 309
Preparing for the birth 311
Paramedic intervention following normal childbirth 312
Birth complications 313
Conclusion 317
Activities 317
Glossary 318
References 318
Chapter 22 Paediatrics 319
Sam Whitby, Steve Whitfield, Kerryn Wratt
Introduction 320
Paediatric anatomy and physiology 320
Paediatric examination 322
Patient assessment triangle 322
Paediatric emergencies 324
Conclusion 334
Activities 334
Glossary 335
References 335
Chapter 23 Medical emergencies 337
Tianna Camilleri
Introduction 338
Neurological emergencies 338
Metabolic emergencies 341
End-of-life care 344
Infection 345
Immunological emergencies 349
Conclusion 350
Activities 350
Glossary 351
References 351
Chapter 24 Caring for older adults 353
Helen Pocock
Introduction 354
The elderly population 354
Assessing older adults 355
Physiology of ageing 355
Frailty 358
Trauma 360
Falls 360
Additional assessments in the elderly 362
Pain assessment 362
End-of-life care 363
Conclusion 364
Activities 364
Glossary 365
References 365
Chapter 25 Managing minor injuries in the prehospital setting 367
Craig Barlow
Introduction 368
Background 369
The importance of history taking 369
Consent to treatment 370
Clinical examination 371
Minor head injuries 373
Nasal injuries 374
Wound assessment and care 374
Ankle injuries 376
Minor burns 377
Transporting minor injury patients 378
Conclusion 379
Activities 379
Glossary 380
References 382
Chapter 26 Major incident management 383
Kallai Sugden, Bede Wilson
Introduction 384
Managing the incident site: first ambulance on scene 385
Declaring a major incident: METHANE and SAM 385
Casualty management 387
Incident management system 390
Emergency management 393
Conclusion 393
Activities 394
Glossary 394
References 395
Chapter 27 Low acuity 396
Duncan McConnell
Introduction 397
What is low acuity care? 398
How to approach low acuity care patient assessment 400
Performing a systems review 402
Other physical assessment clues to assist the diagnosis 405
Gathering further clinical information from patients 407
Conclusion 409
Activities 409
Glossary 410
References 411
Answers to activities 412
Index 428
1
Professionalism in paramedic practice
Netta Lloyd-Jones
Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
Contents
- Introduction
- Professionalism in paramedic practice
- Defining professionalism
- Professionalism as ethical practice
- Professional identity, socialisation, and culture
- How do students learn professionalism?
- Assessment and standards of professionalism
- Regulatory areas, fitness to practise processes, and outcomes
- Conclusion
- Activities
- Glossary
- References
Learning outcomes
On completion of this chapter the reader will be able to:
- Discuss the importance of professionalism in relation to paramedic practice.
- Identify three key themes of professionalism.
- Describe three concepts which influence professionalism.
- Describe how you may learn professionalism.
- Describe the potential outcomes of behaving unprofessionally.
Case study
A paramedic student is on a hospital placement and has been allocated to work in the operating theatre suite. This is her second of four days in this placement and she is anxious about learning airway management. She enters an operating department anaesthetic room where an anaesthetist and an operating department practitioner (ODP) are with a conscious patient, preparing him for imminent anaesthetic for surgery. The paramedic student does not introduce herself to anyone and asks loudly: 'Can I practise intubation on this patient?'
Introduction
Today's paramedic must not only demonstrate extensive clinical knowledge and skills for paramedic practice, but must also demonstrate professionalism throughout their daily lives, both on and off duty. This chapter identifies and discusses key aspects of professionalism required by paramedic practice.
Professionalism in paramedic practice
For the paramedic to demonstrate professionalism, they must know what is required of them by their professional statutory regulatory body. In the UK this is the Health and Care Professions Council (HCPC). The HCPC provides a professional code of conduct that applies to all registered paramedics. Part of this code relates directly to professional knowledge, skills, behaviour, and attitude, as well as professional clinical performance by being the 'knowledgeable doer' (the term adopted by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1986) as a rationale for the Project 2000 curricula) and practising safely within the scope of training and practice. The HCPC (2008) Standard 13 states:
You must behave with honesty and integrity and make sure that your behaviour does not damage the public's confidence in you or your profession.
Behaving professionally is a standard expected not only by the HCPC and new regulatory bodies of other countries such as Australia, where recent legislation allows paramedics to be a regulated profession (Townsend 2017), but also by patients, co-workers, other healthcare professionals, and the general public. Healthcare professionalism is currently under a great deal of scrutiny, with increasing numbers of fitness to practise cases being heard by all healthcare professional statutory regulatory bodies, where issues of inappropriate or unprofessional behaviour are cited. In the UK, paramedic fitness to practise cases heard by the HCPC comprise 33% of the total of 16 professions governed (HCPC 2017). This appears to be a higher rate than for other, more established professions, which may be due to the highly challenging practice environments in which paramedic practice is provided. It is therefore important that all paramedics consider professionalism as a lifelong competence that will require continual demonstration (and development) throughout their careers. To support this, the role that professional associations (such as the British College of Paramedics) provide in supporting and promoting professionalism and ethics is developing (van der Gaag et al. 2017).
In 2011, research was commissioned by the HCPC which explored healthcare professionals' understanding of professionalism. It concluded that the key to professional behaviour is 'the interaction of person and context, and the importance of situational judgement' (HCPC 2014, p. 3). This is particularly relevant to paramedics, where responses to crisis, trauma, and emergency situations involving family and significant others, and the heightened emotion at such times, can result in misperceptions and miscommunication (van der Gaag et al. 2017).
Defining professionalism
So what is professionalism? Defining professionalism is not easy, as it is diverse, multifaceted, and open to individual interpretation. In recent years, there has been an increasing focus in the literature on what constitutes professionalism in healthcare, and the concept is evolving according to societal changes. Sociologists may define 'a profession' in terms of being a vocation with a specific body of knowledge, a defined range of skills, which is inherently trustworthy and ethical, and which provides a service to society (e.g. as usefully summarised in Hugman 1991, pp. 2-9; Johnston and Acker 2016). Other healthcare literature focuses upon values of care and compassion held by the profession itself, and roles undertaken by its registered practitioners, for example developing honest relationships with patients (e.g. Burges Watson et al. 2012), patient advocacy (e.g. Batt et al. 2017), and clinical excellence.
There is an increasing body of knowledge that provides more helpful detail. For example, Bossers et al. (1999) devised useful schemata of professionalism, dividing the concept into three main themes:
- Professional parameters (e.g. legal and ethical aspects)
- Professional behaviours (e.g. discipline-related knowledge and skills)
- Professional responsibilities (e.g. responsibility to patients, oneself, employers, and the public)
Professionalism is now more regarded as a meta-skill, comprising situational awareness and contextual judgement, which allows individuals to draw on the communication, technical, and practical skills appropriate for a given professional scenario (HCPC 2014), rather than it comprising a set of discrete skills. Such professional judgement will be dependent upon the knowledge developed through logic; sensed intuitively; gained through experience, particularly prior experience of similar events; and influenced by education, socialisation, and the human resources of employing organisations (Johns 1992; Gallagher et al. 2016; Brown et al. 2005). In addition to this, the current focus is upon consistently demonstrating of a set of identifiable, positive professional attributes, values, and behaviours. It is this challenge of embedding a discrete body of knowledge into the philosophy and values of a profession which the paramedic profession is still exploring (Donaghy 2013; Johnston and Acker 2016; Givati et al. 2017).
Professionalism as ethical practice
Whatever aspect of healthcare we are in, regardless of the specific engagements within the paramedic role, the nature and practice of healthcare demand that paramedics are concerned with morals and ethics (see Chapter 8, Legal and Ethical Aspects of Paramedic Practice). As this chapter details, what paramedics view ethics to be is important within a professional context. Meta-ethics (what is meant by 'right' and 'wrong'), normative ethics (placing the concepts of 'right' and 'wrong' into professional practice situations), and applying ethics in specialised areas, such as healthcare or public health ethics, are all part of demonstrating professionalism. In a scoping review to outline scales for measuring professional behaviour amongst paramedics, Bowen et al. (2017) identified the key characteristics of professionalism. These include practising within a professional code of ethics. Key principles which underpin professionalism as ethical practice include integrity, honesty, trustworthiness, probity, objectivity, and fairness. These key professional characteristics are also applied as legal principles when determining cases of professional misconduct. Professionalism can thus be regarded as ethical competence in all aspects of professional activity.
Professional identity, socialisation, and culture
Professional identity, professional socialisation, and professional culture will all influence understanding of what professionalism is within particular professions.
Identity
Identification encompasses basic cognitive and social processes through which we make sense of and organise our human world (Monrouxe 2010). Our thoughts, experiences, and reflections create a complex catalogue of who we are as individuals and members of groups (Ashmore et al. 2004)....
