Ambulance Care Practice

Description

Brought up-to-date with the latest guidance, research and policy, this second edition of Ambulance Care Practice is an essential guide for paramedic students, trainee associate ambulance practitioners, those studying towards a certificate in first response emergency care and other ambulance clinicians. It provides a complete overview of the key skills, knowledge and understanding required to work at ambulance associate practitioner level or similar within the ambulance service, covering theoretical aspects and practical application, as well as a range of different clinical procedures and patient populations. Key features include: *Clearly illustrated, step-by-step instructions for range of essential clinical skills and procedures including how to handle different types of trauma and cardiac arrest *Detailed anatomical diagrams to provide the reader with the necessary context to carry out the practical elements of their job *Evidence-based throughout and up-to-date with the latest guidance, policy and research *Specific chapters on each area of patient assessment and specific patient populations and how to manage these effectively *Chapters relevant to associate practitioner level including drug administration, mental health and end of life care as well as an in-depth chapter on assisting the paramedic. ∙ In line with the National Education Network for Ambulance Services standards The book covers learning objectives from a range of courses offered by ambulance services. It is an essential resource for anyone wanting to prepare themselves for a role within the ambulance service as well as those hoping to become a more effective member of an emergency ambulance crew. AMBULANCE CARE Practice Half Title Page Copyright Title Page Contents List of Abbreviations Acknowledgements Foreword Chapter 1: Introduction 1 Textbook guide 1.1 Introduction 1.2 Textbook 1.3 Getting started 2 Anatomy of an emergency call 2.1 Introduction 2.2 The emergency operations centre 2.3 Arriving on scene 2.4 Principles of communication 2.5 Patient assessment 2.6 Patient history 2.7 The 12-lead ECG 2.8 Manual handling 2.9 Assist the paramedic 2.10 Hospital arrival 2.11 Clean up and prepare for the next call Chapter 2: The Ambulance Service 1 Organisational structure 1.1 Learning objectives 1.2 Introduction 2 Response to a 999 call 2.1 Learning objectives 2.2 Introduction 2.3 Call for help and triage 2.4 Ambulance service response 2.5 Onward care 3 Roles within the ambulance service 3.1 Learning objectives 3.2 Introduction 3.3 Clinical roles 3.4 Clinical leadership roles 3.5 Command and control roles 4 Working relationships Chapter 3: Communication 1 Principles of communication 1.1 Learning objectives 1.2 Introduction 1.3 Who will you be communicating with? 1.4 Basics of communication 1.5 Social context 1.6 Barriers to communication 1.7 Summary 2 Practical communication 2.1 Learning objectives 2.2 Record keeping 2.3 Handover 2.4 Pre-alert 2.5 Breaking bad news 3 Electronic communication devices 3.1 Learning objectives 3.2 Introduction 3.3 Radios 3.4 Mobile data terminals 3.5 Electronic patient records Chapter 4: Legal, Ethical and Professional Issues 1 Being a healthcare professional 1.1 Learning objectives 1.2 Introduction 1.3 Values-based healthcare 1.4 Duty of care 1.5 Scope of practice and standards 1.6 When things go wrong 1.7 Reflection 2 Provision of healthcare 2.1 Learning objectives 2.2 Introduction 2.3 Health inequalities 2.4 Person-centred care 2.5 Health promotion 3 Consent and capacity 3.1 Learning objectives 3.2 Introduction 3.3 Consent 3.4 Mental capacity 3.5 Summary 4 Confidentiality and information governance 4.1 Learning objectives 4.2 Introduction 4.3 Maintaining confidentiality 4.4 Key points 5 Equality and diversity 5.1 Learning objectives 5.2 Introduction 5.3 Equality in healthcare 5.4 Discrimination 5.5 Identity, self-image and self-esteem 6 Clinical governance 6.1 Learning objectives 6.2 Introduction to clinical governance 6.3 Purpose of clinical governance 6.4 How to contribute to clinical governance Chapter 5: Safeguarding 1 Safeguarding adults and children 1.1 Learning objectives 1.2 Introduction 1.3 Learning from previous cases 1.4 Vulnerability 1.5 Forms of abuse 1.6 Domestic violence and abuse 1.7 Managing abuse or disclosures of abuse 1.8 Safeguarding referrals 1.9 Summary 2 Counter-terrorism and anti-radicalisation 2.1 Learning objectives 2.2 Introduction 2.3 PREVENT 2.4 Your role Chapter 6: Health and Safety 1 Health and safety policies and legislation 1.1 Learning objectives 1.2 Introduction 1.3 Health and Safety at Work, etc. Act 1.4 Management of Health and Safety at Work Regulations 1.5 Manual Handling Operations Regulations 1.6 Provision and Use of Work Equipment Regulations 1.7 Lifting Operations and Lifting Equipment Regulations 1.8 Personal Protective Equipment at Work Regulations 1.9 Control of Substances Hazardous to Health Regulations 1.10 Regulatory bodies 1.11 Why health and safety matters 1.12 Communicating health and safety 2 Risk assessment 2.1 Learning objectives 2.2 Introduction 2.3 Risk assessment 3 Infection prevention and control 3.1 Learning objectives 3.2 Introduction 3.3 Regulations and legislation 3.4 Microorganisms 3.5 Infection and precautions 3.6 Personal hygiene 3.7 Hand hygiene 3.8 Personal protective equipment 3.9 Managing healthcare waste 3.10 Decontamination process 3.11 Handling linen and laundry 3.12 Sharps injury 3.13 Splash contamination 3.14 Legionella awareness 3.15 Occupational health 3.16 Reporting incidents 4 Fire safety 4.1 Learning objectives 4.2 Introduction 4.3 Fire prevention 4.4 What to do in case of fire 5 Stress 5.1 Learning objectives 5.2 Introduction 5.3 Signs of stress 5.4 Managing stress Chapter 7: Manual Handling 1 Principles of manual handling 1.1 Learning objectives 1.2 Introduction 1.3 Consequences of poor manual handling 1.4 Risk assessment 1.5 Biomechanics 1.6 General principles 1.7 Handling aids 1.8 Procedure 1.9 Team handling 1.10 Bariatric patients 1.11 Further help and support 2 Moving and handling equipment and techniques 2.1 Learning objectives 2.2 Introduction 2.3 Patients on the floor 2.4 Seated patients 2.5 Patients in bed 2.6 Carry chair 2.7 Ambulance trolley Chapter 8: Drug Administration 1 Drug legislation and guidelines 1.1 Learning objectives 1.2 Introduction 1.3 Legislation and guidelines 1.4 Routes of administration 1.5 Drug administration 2 Administering medication to patients 2.1 Learning objectives 2.2 Drawing medication from an ampoule 2.3 Administering oral medication 2.4 Administering nebulised drugs 2.5 Administering intramuscular drugs 2.6 Administering intranasal drugs Chapter 9: Scene Assessment 1 Scene assessment and safety 1.1 Learning objectives 1.2 Introduction 1.3 Safety 1.4 Cause 1.5 Environment 1.6 Number of patients 1.7 Extra resources 2 Major incidents 2.1 Learning objectives 2.2 Introduction 2.3 Interoperability and JESIP 2.4 Classification of incidents 2.5 Role of the ambulance service 2.6 Incident command and control 2.7 First crew on scene 2.8 Subsequent crews on scene 2.9 Triage 3 Hazardous materials 3.1 Learning objectives 3.2 Introduction 3.3 Labelling hazardous substances 3.4 Transporting hazardous substances 3.5 Danger labels 3.6 Ambulance crew actions at scene Chapter 10: Patient Assessment 1 Patient assessment process 1.1 Learning objectives 1.2 Introduction 1.3 Primary survey 1.4 History-taking 1.5 Secondary survey 1.6 Reassessment Chapter 11: Airway 1 Airway anatomy 1.1 Learning objective 1.2 Introduction 1.3 Nose 1.4 Mouth 1.5 Pharynx 1.6 Lower airway 1.7 Trachea 1.8 Bronchi 1.9 Lungs 2 Assessing and managing the airway 2.1 Learning objectives 2.2 Introduction 2.3 Assessing the airway 2.4 Step-wise approach to the airway 2.5 Manual airway manoeuvres 2.6 Suction 2.7 Airway adjuncts 2.8 Supraglottic airway device (SAD) 2.9 Removal of foreign bodies with laryngoscopy in adults 3 Tracheostomies 3.1 Learning objectives 3.2 Introduction 3.3 Tracheostomy tubes 3.4 Management of the tracheostomy patient 3.5 Management of the laryngectomy patient 4 Choking in adults 4.1 Learning objectives 4.2 Introduction 4.3 Recognition 4.4 Management 5 Choking in the paediatric patient 5.1 Learning objective 5.2 Introduction 5.3 The paediatric airway 5.4 Recognition 5.5 Management Chapter 12: Breathing 1 Respiratory system physiology 1.1 Learning objective 1.2 Introduction 1.3 Respiration 1.4 The lungs 1.5 Mechanics of breathing 1.6 Gas exchange 1.7 Control of breathing 1.8 Oxygen physiology 2 Using medical gases safely 2.1 Learning objectives 2.2 Introduction 2.3 Medical gas cylinder storage 2.4 Anatomy of a medical gas cylinder 2.5 Safety first 2.6 Preparing a new cylinder for use 2.7 Oxygen delivery devices 2.8 Assisted ventilation 2.9 Mechanical ventilation 2.10 Oxygen administration 2.11 After use 2.12 Entonox 3 Assessment of breathing 3.1 Learning objectives 3.2 Respiratory rate 3.3 Oxygen saturations 3.4 Peak flow 3.5 Capnography 3.6 Auscultation 4 Common respiratory conditions 4.1 Learning objectives 4.2 Asthma 4.3 Chronic obstructive pulmonary disease 4.4 Pneumonia 4.5 Pulmonary embolism Chapter 13: Circulation 1 Cardiovascular system anatomy and physiology 1.1 Learning objectives 1.2 Introduction 1.3 Heart 1.4 Blood 1.5 Blood vessels 1.6 Cardiac cycle 1.7 Electrocardiograms 2 Lymphatic system and immunity 2.1 Learning objectives 2.2 Introduction 2.3 Anatomy and physiology 2.4 Immunity 2.5 Autoimmune disease 3 Assessment of circulation 3.1 Learning objectives 3.2 Introduction 3.3 Pulse 3.4 Capillary refill time 3.5 Blood pressure 3.6 Recording an ECG 4 Cardiovascular system disorders 4.1 Learning objectives 4.2 Introduction 4.3 Coronary artery disease 4.4 Stable angina 4.5 Acute coronary syndromes 4.6 Heart failure 4.7 Aortic dissection 4.8 Shock 4.9 Sickle cell disease Chapter 14: Disability 1 Nervous system anatomy and physiology 1.1 Learning objectives 1.2 Introduction 1.3 Anatomy and physiology 1.4 Brain 1.5 Spinal cord 1.6 Somatic nervous system 1.7 Autonomic nervous system 1.8 The eye 2 Assessment of disability 2.1 Learning objectives 2.2 Introduction 2.3 Glasgow Coma Scale 2.4 Pupillary response 2.5 Face, arm, speech test 3 Disorders of the nervous system 3.1 Learning objectives 3.2 Introduction 3.3 Convulsions 3.4 Stroke 3.5 Meningococcal disease 3.6 Cauda equina syndrome 3.7 Paralysis 3.8 Coma Chapter 15: Exposure 1 Extremes of temperature 1.1 Learning objectives 1.2 Introduction 1.3 Hypothermia 1.4 Heat-related illness 1.5 Assessment of temperature 2 Drowning 2.1 Learning objective 2.2 Introduction 2.3 Pathophysiology 2.4 Management Chapter 16: Medical and Surgical Emergencies 1 Anaphylaxis 1.1 Learning objectives 1.2 Introduction 1.3 Signs and symptoms 1.4 Management 2 Sepsis 2.1 Learning objectives 2.2 Introduction 2.3 Risk factors for sepsis 2.4 Recognition 2.5 Management 3 Endocrine system disorders 3.1 Learning objectives 3.2 Introduction 3.3 Anatomy and physiology of the pancreas 3.4 Anatomy and physiology of the adrenal glands 3.5 Diabetes 3.6 Diabetic emergencies 3.7 Hypoglycaemia 3.8 Severe hyperglycaemia 3.9 Blood sugar measurement 3.10 Addison’s disease 4 Poisoning 4.1 Toxidromes 4.2 Assessment and management 5 The acute abdomen 5.1 Learning objectives 5.2 Introduction 5.3 The abdominal cavity 5.4 Locating abdominal organs 5.5 The digestive system 5.6 Abdominal pain 5.7 Management of abdominal pain 6 Urinary system disorders 6.1 Learning objectives 6.2 Introduction 6.3 Anatomy and physiology 6.4 Urinary tract infections 6.5 Renal dialysis Chapter 17: Trauma 1 Major trauma services 1.1 Learning objectives 1.2 Introduction 1.3 Inclusive trauma systems 1.4 Major trauma triage tool 2 Mechanism of injury 2.1 Learning objectives 2.2 Introduction 2.3 Kinetics 2.4 Energy 2.5 Mechanisms that cause injury 3 Integumentary system anatomy and physiology 3.1 Learning objective 3.2 Introduction 3.3 Epidermis 3.4 Dermis 3.5 Hypodermis 3.6 Physiology 4 Wounds and bleeding 4.1 Learning objectives 4.2 Introduction 4.3 Bleeding 4.4 Wounds 5 Assessment and management of the trauma patient 5.1 Learning objectives 5.2 Introduction 5.3 Scene assessment 5.4 Primary survey 5.5 Secondary survey 5.6 Head injuries 5.7 Maxillofacial injuries 5.8 Spinal injuries 5.9 Thoracic injuries 5.10 Abdominal injuries 5.11 Pelvic injuries 5.12 Suspension trauma 5.13 Musculoskeletal injuries 6 Skeletal immobilisation 6.1 Learning objective 6.2 Introduction 6.3 First-aid techniques 6.4 Spinal immobilisation 6.5 Splints 7 Burns 7.1 Learning objectives 7.2 Introduction 7.3 Assessment of burns 7.4 Thermal burns 7.5 Chemical burns including acid attacks 7.6 Radiation burns 7.7 Electrical injuries 7.8 The impact of burns Chapter 18: Assisting the Paramedic 1 Tracheal intubation 1.1 Learning objectives 1.2 Introduction 1.3 Tracheal intubation 1.4 DOPES 2 Intravenous drug administration 2.1 Learning objectives 2.2 Introduction 2.3 Intravenous cannulation 2.4 Preparing an intravenous infusion 2.5 Intraosseous cannulation Chapter 19: Obstetrics and Gynaecology 1 Reproduction 1.1 Learning objectives 1.2 Introduction 1.3 Anatomy and physiology 1.4 Normal pregnancy 1.5 Terminology and abbreviations 1.6 Assessing the pregnant woman 2 Complications in pregnancy 2.1 Learning objectives 2.2 Ectopic pregnancy 2.3 Antepartum haemorrhage 2.4 Miscarriage 2.5 Pre-eclampsia 2.6 Trauma in pregnancy 3 Normal childbirth 3.1 Learning objectives 3.2 Stages of labour 3.3 Equipment for childbirth 3.4 Management of the first stage of labour 3.5 Management of the second stage of labour 3.6 Management of the third stage of labour 4 Childbirth complications 4.1 Learning objectives 4.2 Cord prolapse 4.3 Shoulder dystocia 4.4 Breech presentation 4.5 Post-partum haemorrhage 4.6 Multiple births 4.7 Preterm labour 5 Newborn life support 5.1 Learning objectives 5.2 Introduction 5.3 Management 5.4 The preterm infant 6 Gynaecological emergencies 6.1 Learning objectives 6.2 Introduction 6.3 Vaginal tissue damage 6.4 Heavy menstrual bleeding (menorrhagia) 6.5 Termination of pregnancy 6.6 Uterine prolapse 6.7 Gynaecological cancers Chapter 20: Children and Infants 1 Why paediatric patients are different 1.1 Learning objective 1.2 Introduction 1.3 Anatomy and physiology 1.4 Cognitive development 2 Initial assessment and management of the paediatric patient 2.1 Learning objectives 2.2 Introduction 2.3 Developmental approach to the paediatric patient 2.4 Recognising the sick infant and child 2.5 Primary survey Chapter 21: Mental Health 1 Mental health legislation and codes of practice 1.1 Learning objectives 1.2 Introduction 1.3 The Mental Health Act 1983 (as amended 2007, MHA) 1.4 Transporting patients 2 Mental disorders 2.1 Learning objectives 2.2 Introduction 2.3 Organic disorders 2.4 Schizophrenia and delusional disorders 2.5 Mood (affective) disorders 2.6 Neurotic, stress-related and somatoform disorders 2.7 Personality disorders 2.8 Suicide and deliberate self-harm (DSH) 2.9 Assessment of patient with mental health problems 2.10 Management of patients with mental disorders 3 Caring for yourself and colleagues 3.1 Learning objectives 3.2 Introduction 3.3 Mental well-being 3.4 Building resilience 3.5 Seeking help 3.6 Supporting a colleague Chapter 22: Learning Disabilities 1 Supporting the care of people with learning disabilities 1.1 Learning objectives 1.2 Introduction 1.3 Learning disabilities legislation and rights 1.4 Causes of learning disabilities 1.5 Categories of learning disabilities 2 Disabilities, healthcare and discrimination 2.1 Learning objectives 2.2 Inequality in healthcare 2.3 Tackling inequality 2.4 Communication 2.5 Learning difficulties and vulnerability 2.6 Further support Chapter 23: Older People 1 Ageing 1.1 Learning objective 1.2 Introduction 1.3 Anatomy and physiology of ageing 2 Caring for older patients 2.1 Learning objectives 2.2 Age-related conditions 2.3 Patients with co-morbidities 2.4 Attitudes to ageing 3 Dementia 3.1 Learning objectives 3.2 Introduction 3.3 Dementia 3.4 Communication 3.5 Challenging behaviour 4 Frailty 4.1 Learning objectives 4.2 Introduction 4.3 Recognising frailty 4.4 Living with frailty 4.5 Supporting patients with frailty 5 Falls 5.1 Learning objectives 5.2 Introduction 5.3 Assessing people who fall Chapter 24: Cardiac Arrest 1 Adult basic life support 1.1 Learning objectives 1.2 Introduction 1.3 Chain of survival 2 Paediatric basic life support 2.1 Learning objectives 2.2 Introduction 2.3 Infant BLS 2.4 Child BLS 3 Defibrillation 3.1 Learning objectives 3.2 Introduction 3.3 Shockable rhythms 3.4 Non-shockable rhythms 3.5 Defibrillators 4 Cardiac arrest in special circumstances 4.1 Learning objectives 4.2 Introduction 4.3 Cardiac arrest in pregnancy 4.4 Cardiac arrest in hypothermic patients 4.5 Cardiac arrest in drowned patients 4.6 Traumatic cardiac arrest 5 Post-resuscitation care 5.1 Learning objectives 5.2 Introduction 5.3 Management 6 Cardiac arrest decisions 6.1 Learning objectives 6.2 When to start and stop resuscitation 6.3 End of life decisions 6.4 Recognition of life extinct (ROLE) 6.5 Sudden unexpected death in infants, children and adolescents Chapter 25: End of Life Care 1 End of life care 1.1 Learning objectives 1.2 Introduction 1.3 Palliative care and end of life care 1.4 Care of dying adults in the last days of life 1.5 Religious and spiritual influences on end of life care 1.6 Advance care planning 1.7 Disclosures of patient wishes 1.8 Hospices 1.9 End of life care in the community 1.10 Resuscitation in end of life care 1.11 Supporting carers and relatives 2 Bereavement 2.1 Learning objectives 2.2 Introduction 2.3 Bereavement and grieving process 2.4 Referring for additional help 2.5 Sources of help 2.6 Support for health professionals References Glossary Index