For paramedics caring for patients for extended periods, the direction of change may be as important as whether an individual value remains within a conventional reference range. Serial observations can reveal early deterioration, demonstrate response to treatment, and support decisions about escalation, evacuation and resource use. This article reviews the rationale for trending vital signs in prehospital and prolonged casualty care, with particular reference to the Joint Trauma System Prolonged Casualty Care Clinical Practice Guideline.
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.
