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The UK has one of the highest rates of self harm (SH) in Europe, and almost four times more people die by suicide than in road traffic collisions. Emergency ambulance paramedics are often the first health professionals involved in the care of people who have self-harmed, yet little is known about the care provided or issues raised in these encounters. The aim of this study is to explore paramedics' perceptions and experiences of caring for people who SH, to inform education and policy. Semi structured interviews were conducted with paramedics, and themes generated by constant comparison coding. This paper reports two emerging themes: Firstly, professional, legal, clinical and ethical tensions, linked to limited decision support, referral options and education. The second theme of relationships with police, revealed practices and surreptitious strategies related to care and detention, aimed at overcoming complexities of care. In the absence of tailored education, guidance or support for self-harm care, 'ways and means' have evolved which may negatively influence care and challenge ethical and legal frameworks. There is an urgent need to include evidence from this study in revised guidance and educational materials for paramedics working with people who self-harm in the prehospital emergency setting. [ABSTRACT FROM AUTHOR]

The article discusses several developments involving New York administrative laws and practice in 2013, focusing on issues such as search and seizure, various rulings by the New York Court of Appeals, and interpretations of rules and regulations by state agencies. Other topics such as government liability, negligence by emergency medical technicians, and a family member's succession rights. New York's Penal Law, firearm licensee laws, and the NY Safe Act statute are also examined.

Critical care providers are often privy to confidential information in the course of clinical practice. A dilemma can arise when confidential information is requested by family members or friends of the patient. Critical care nurses must be aware of the regulations regarding confidentiality, as well as situations where the use and disclosure of protected health information are permitted. [ABSTRACT FROM AUTHOR]

The article legal and ethical issues concerning mental health screening policies, licensure portability, and compensation programs, which are significant to first responders' access on mental health services. It mentions that mental health screening for first responders including public safety, human services, and health workers should be provided before, during, and after emergencies. Moreover, permanent legal solutions are needed to ensure access of first responders to mental health services.

Passage of the Patient Protection and Affordable Care Act ( ACA) has served to refocus attention on the complexity of health care delivery in the United States, with particular attention to concepts of quality, access, and outcomes. This article argues that our understanding of the ACA must be informed by an examination of policy implementation in health care, including the core public function of emergency medical services ( EMS). Key concepts of implementation in frontline service-notably, rule abidance and deviation-are examined from the perspective of street-level EMS workers. Results indicate that the intersection of rules, patient needs, and professional culture creates instances of both rule abidance and deviation, both of which contribute substantively to concepts of quality in a health care setting. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Paramedics Experiences and Expectations Concerning Advance Directives: A Prospective, Questionnaire-Based, Bi-Centre Study" by Taghavi and colleagues in the September 2012 issue.

A response from the author of the article "Paramedics Experiences and Expectations Concerning Advance Directives: A Prospective, Questionnaire-Based, Bi-Centre Study'" in the September 2012 issue is presented.

Reports on a court decision restraining the Alabama State Committee of Public of Health in requiring emergency department paramedics were to provide nursing services. Lobbying efforts by the Emergency Nurses Association to oppose the Alabama's Public Health Department's regulation.