Clinical Practice

Pre-hospital medicine: South Africa vs. the United Kingdom

In an introductory overview, the differences and similarities between emergency medicine in South Africa (SA) and the United Kingdom (UK), predominantly in the paramedical area of practice, are explored. The author discussed areas of interest, as well as a potential future direction. The current article focuses on the more prevalent similarities and differences identified. However, it is worth noting that not all trusts and/or organisations work identically regardless of country-specific...

Successful use of percussion pacing in a pre-hospital p-wave asystole and ventricular standstill

Background: The use of percussion pacing (PP) using a clenched fist as an external cardiac pacemaker is not scientifically supported. However, European Guidelines for resuscitation 2015 recommend PP as an initial intervention for haemodynamically unstable patients with bradyarrhythmias or p-wave asystole. We describe a case where paramedics witnessed a patient developing p-wave asystole with ventricular standstill, and treated the patient successfully with PP until transcutaneous pacing was...

Experiences of two paramedics deployed to the Phillipines in response to Typhoon Haiyan

This article describes the experiences of two paramedics from the UK International Emergency Trauma Register (UKIETR) who deployed as part of the UK-Med response to Typhoon Haiyan in 2013. Each had a key role in the deployed teams, both targeting distinct but differing health needs following the Typhoon. Tim Byrom was a member of the first team activated on 13 November 2013. He formed part of a surgical, anaesthetic and rehabilitation team that assisted the Australian Medical Assistance Team...

Prevention, assessment and management of altitude sickness

With the growing prevalence of adventure holidays and international travel, exposure to the extremes of altitude is becoming more and more common. With this increase in adventure travel the need for expedition medics is expanding, although education in this area is understandably lacking from most medical and allied health professional core training. This article provides a brief overview of the pathophysiology, assessment and management of high-altitude disorders. It does not discuss the...

Providing medical aid to Brazzaville, the Republic of Congo

Following five explosions in Brazzaville, the Republic of Congo on 4 March 2012, a field hospital was flown in from South Africa to help deal with the aftermath. Donated by the Ichikowitz Family Foundation, it aimed to treat the injured patients who were in excess of 2 300.On arrival, a singular old-style army tent, sponsored by the French petroleum company Total, was the only medical service on the site. The tent was manned by staff from the French charity Médecins d'Afrique.Building the...

Which paediatric weight formula is best suited for the out-of-hospital field?

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula.

Rural acute myocardial infarction survey (RAMIS)

Objectives: The purpose of this study was to evaluate why current treatment goals for patients with Acute Myocardial Infarction are not being achieved despite a large body of evidence supporting regionalised ST Elevation Myocardial Infarction (STEMI) systems.

The paramedics' role in safeguarding and protecting children and young people

In the aftermath of well–publicised child abuse cases such as the United Kingdom examples of Baby P and Victoria Climbie governments, communities and professions have begun to question their role in the protection and safeguarding of children and young people. Safeguarding, protection, abuse, neglect and need are all distinctly separate terms within their own right and yet jointly play a part in the safety assurance of children and young people. This article reviews the current literature and...

Atlanto-occipital dislocation in children: saving a life in the trauma field

Traumatic atlanto-occipital dislocation is (AOD) a serious injury of the cervical spine that occurs in children. It is more common than previously thought and is estimated to account for 6–8 % of all fatal traffic injuries. The cause is usually a high energy trauma, resulting in a disruption of the ligaments and membranes that give support to the craniocervical junction between the occiput and the proximal cervical vertebrae. These supporting structures are incompletely developed in children,...

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