Dead space is the portion of each breath that does not participate in gas exchange and is a fundamental but frequently misunderstood concept in paediatric airway management. While anatomical and alveolar dead space are fixed physiological factors, apparatus dead space added by airway equipment is modifiable, yet often overlooked in emergency settings where adult-sized components may default into use. Because paediatric tidal volumes are small, even modest additional apparatus dead space can disproportionately reduce effective alveolar ventilation, risking hypercapnia despite visible chest rise or a reassuring capnography trace. Using simplified worked calculations, this article offers clinicians and educators a straightforward way to understand dead space and effective alveolar ventilation, and to examine their own equipment, training systems and default airway-management practices.
Elizabeth Leddy shares her Elizabeth Leddy shares her experience of a palliative care job after her own personal loss
Emotional intelligence (EI) is vital for effective leadership and clinical decision-making in healthcare, especially for paramedics in high-stress environments. This article examines the relationship between EI, leadership, intuition and clinical decision-making, emphasising the significance of EI in enhancing these processes. Various EI models, including trait, ability and mixed, are reviewed for their relevance to healthcare. The role of EI in fostering self-awareness, self-regulation, motivation, empathy and social skills is emphasised. The article examines the neurological basis of decision-making and different decision-making models, illustrating how EI influences clinical judgements and leadership. The Goldfish Postulate metaphorically represents the balance between rational decision-making and EI in leadership. Despite challenges in measuring EI, its integration in leadership and clinical decision-making improves patient care and team dynamics. Developing EI among paramedics enhances their leadership and decision-making skills, leading to better patient outcomes and healthcare delivery.
Introduction: Mental health crises have significantly increased in recent years. However, paramedics report deficiencies in their knowledge of their management and communication with these patients. Aims: This review aims to understand if a compassionate approach towards patients experiencing mental health crisis improves their care in the prehospital environment. Methods: For this review, EBSCOhost, Scopus and Web of Science were searched. Limiters were primary research, published in 2015 or later, peer-reviewed, written in English and based in certain geographical areas so results would be relevant to the UK. Results: Five articles were included. Four key themes were identified: need for a place of safety; compassionate approach resulting in greater satisfaction; judgement from staff; and negative attitudes negatively impacting care. Conclusion: A compassionate approach to patients experiencing mental health crisis aided in their care and this included key elements such as a safe space and strong communication.
Background: Autism spectrum disorder is increasingly prevalent in Australia. Its complexity can make assessment and management challenging, so paramedics need to be well prepared to deliver appropriate care. Aim: The aim of this review is to understand what information exists that contributes to paramedics assessing and managing this population group in out-of-hospital settings. Methods: Six databases were searched. Articles were screened by title and abstract, duplicates were removed and full-text screening to determine eligible articles was undertaken. An iterative thematic analysis informed by Braun and Clarke was undertaken to identify key themes. Findings: Nine articles were included in the study. Three themes emerged: lack of knowledge, awareness and skill; communication challenges; education and improving patient care. Conclusion: Limited education and training resources are available to paramedics regarding patients with autism spectrum disorder, indicating that there is a gap in the literature.
Background: Refractory shockable rhythms are associated with mortality as high as 97%. Dual sequential defibrillation has been proposed as a potential solution; debate has heightened following completion of the DOSE VF trial. Aims: This study aimed to identify themes to guide meaningful discussion for future protocol refinement. Methods: Three databases were searched for peer-reviewed research examining dual sequential defibrillation versus standard defibrillation in prehospital settings within the past 10 years. Traumatic and paediatric cardiac arrests were excluded. Findings: The five studies reviewed provided low-certainty evidence with a high risk of bias. Two main themes were identified to guide discussion: defibrillation strategies; and unbalanced gender recruitment. Conclusion: Dual sequential defibrillation was not associated with improved survival to hospital discharge. Further research is warranted, ideally incorporating shock intervals of between 150 ms and 5 seconds provided after 4–8 failed standard defibrillations, and assessment of anatomical pad positioning.
In recent years, ambulance services have shifted their focus from default emergency department (ED) conveyance towards care closer to home; however, variation in non-conveyance rates persists. This mixed-methods service evaluation surveyed 210 and interviewed 25 operational ambulance clinicians to explore factors influencing non-conveyance. Thematic analysis identified four themes: organisational support and culture; decision support tools; the evolving scope of practice and education; and access to care pathways. While 67% of respondents reported consistently using clinical decision support tools, a perceived lack of organisational backing, fear of litigation, inconsistent pathway availability and limited feedback often drove defensive conveyance. The findings highlight the need for improved feedback, strengthened supervision and clearer referral guidance. The study also emphasises the importance of cultural change, targeted workforce development and increased investment in integrated care. Nine priority areas were identified to support the authors' ambulance trust in reducing unnecessary conveyance and enhance consistency in patient care.
Background: Pressure ulcers (PUs) are among the most costly and persistent global health burdens, with UK treatment exceeding £3.4 million daily. Despite this, PU education remains inconsistent, with paramedics notably excluded from national PU training frameworks. Aims: Critically analysing existing primary research, this review explores paramedic involvement in PU care, its impact on outcomes and future implications for practice and research. Methods: Systematically searching major databases identified pertinent studies, which were critically appraised. Key thematic findings were extracted, analysed and synthesised to inform the review. Findings: Paramedics frequently attend patients at risk of or with PUs. Early detection skills are essential in all health professions. Future research should investigate the impact of paramedic-led interventions. Conclusion: PUs present major clinical and economic challenges. Paramedics' unique roles could aid care, but research must validate approaches.
Paramedics frequently encounter death, trauma and acute emotional distress, yet the relational and ethical dimensions of these experiences are often shaped more by informal learning than formal education. This article explores how the hidden curriculum within emergency medical services influences professional identity, emotional regulation and approaches to death notification. It examines the tension between operational efficiency and compassionate care, highlighting the role of emotional labour, moral distress and compassion fatigue. Through reflection and evidence-informed discussion, this article emphasises the importance of conscious communication, presence and ethical awareness in supporting patients and families during moments of profound loss.
As she works through her second year as a student paramedic, Katherine Hennigan reflects on how people seem to perceive the role of a paramedic versus the realities of the day-to-day job, and what aspects actually make being a paramedic meaningful in the quiet moments
Recreational escape rooms are gaining popularity in education, offering gamified, immersive learning across disciplines. A resuscitation-themed escape room was developed to teach basic and advanced life support (ALS) skills, aligning with the abilities expected of Australian paramedics. A pilot was carried out with final-year paramedic students, and the study was evaluated using post-event questionnaires relating to recall of standard ALS features and participant experiences. Of 92 participants, 85 completed the survey, with 100% of responders both recalling all of the imbedded ALS themes and agreeing that the escape room was a highly effective way to teach resuscitation. Qualitative responses highlighted the value of supplementing the normal high-stakes, life-and-death pressure on learning resuscitation. Students described the experience as memorable, enjoyable and novel. The findings suggest escape rooms can offer an effective education experience to complement traditional resuscitation training modalities.
Paramedics have traditionally delivered care within the prehospital setting. However, owing to increased demands on healthcare services, there has been a requirement to develop the role into a sustainable resource to deliver safe patient-centred care across a range of settings. The advanced paramedic role can increase capacity within multidisciplinary teams and help to facilitate the redesign of services. Recent legislative changes have enabled advanced paramedics to independently prescribe controlled drugs. Advantages include enhanced patient experience and improved continuity of care. However, challenges remain such as access to patient records.
The medical response to major incidents has recently seen encouraging developments within the UK. However, the role of independent ambulance services and event medical services appears to have been largely ignored. Part 1 of this two-part article lays the foundations of a critical narrative review that aims to identify, collect and synthesise literature surrounding the role and significance of event medical services at major incidents. This is achieved by using an open hybrid methodology in which both SANRA and PRISMA are employed. The results of this methodological approach will be recorded, analysed and discussed in part 2, which will highlight the overlooked significance of event medical services.
