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Sam Willis, Simon Menz and Paul Grant discuss the development of the community paramedic role and explore how it has evolved to meet contextual and community demands across Australia

Managing a complex scene and a critically unwell patient at the same time is a challenge for any paramedic, in terms of both personal preparation and crew resource management. While modern paramedicine requires new solutions to situated challenges, a good starting point is to review existing frameworks to seek ways of maximising the safety of the care delivered by paramedics. This paper provides a synthesis of the theoretical egg-timer model of disparity combined with a practical framework called the zero point survey as cohesive tools for operational paramedics to optimise their performance while experiencing high-stress situations. This synthesis provides a valuable aide mémoire for strategies to improve personal performance, leadership and teamworking in relation to the care of a critically unwell patient. Such models fit within current practice, and have the potential to lead to safer paramedic care through the practical application of human factors theory, with team management skills and psychological interventions to improve patient outcomes.

Background: The ‘Sepsis Six’ bundle was promoted as a more deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Methods: Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-hour point prevalence studies, carried out in fourteen hospitals across Wales from 2016-2019. Results: Out of the 26,947 patients screened 1,651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; pConclusions: Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.Trial registration: Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016

We present a new method for deriving functions that model the relationship between multiple signals in a physical system. The method, which we call dimensional function synthesis , applies to data streams where the dimensions of the signals (e.g., length, mass, etc.) are known. The method comprises two phases: a compile-time synthesis phase and a subsequent calibration using sensor data. We implement dimensional function synthesis and use the implementation to demonstrate efficiently summarizing multimodal sensor data for two physical systems using 90 laboratory experiments and 10,000 synthetic idealized measurements. The results show that our technique can generate models in less than 300 ms on average across all the physical systems we evaluated. This is a marked improvement when compared to an average of 16 s for training neural networks of comparable accuracy on the same computing platform. When calibrated with sensor data, our models outperform traditional regression and neural network models in inference accuracy in all the cases we evaluated. In addition, our models perform better in training latency (up to 1096X improvement) and required arithmetic operations in inference (up to 34X improvement). These significant gains are largely the result of exploiting information on the physics of signals that has hitherto been ignored.

Paramedics are autonomous health professionals who must graduate into the workforce with complex problem-solving skills, an ability to exercise critical thinking, and clinical reasoning skills to challenging situations, if they are to practise safely. Face-to-face action learning (AL) has long been acknowledged for contributing to the development of such skills, by providing a platform for structured thinking, group working, and a tool for developing participant's ability to ask insightful questions ( Pedler et al, 2005 ) and more recently, action learning in the virtual space is becoming increasingly popular. Virtual action learning has emerged for reasons including globalisation, where the emergence of multi-national and dispersed students has become commonplace ( Dickenson et al, 2010 ) and advances in technology that have allowed more collaborative communication.This discussion paper provides an introduction and background to action learning (AL), virtual action learning (VAL) and explores the appropriateness of these paradigms as a tool for embedding reflective practice and problem-solving skills among undergraduate student paramedics.

We present a new method for deriving functions that model the relationship between multiple signals in a physical system. The method, which we call dimensional function synthesis, applies to data streams where the dimensions of the signals are known. The method comprises two phases: a compile-time synthesis phase and a subsequent calibration using sensor data. We implement dimensional function synthesis and use the implementation to demonstrate efficiently summarizing multi-modal sensor data for two physical systems using 90 laboratory experiments and 10 000 synthetic idealized measurements. We evaluate the performance of the compile-time phase of dimensional function synthesis as well as the calibration phase overhead, inference latency, and accuracy of the models our method generates. The results show that our technique can generate models in less than 300 ms on average across all the physical systems we evaluated. When calibrated with sensor data, our models outperform traditional regression and neural network models in inference accuracy in all the cases we evaluated. In addition, our models perform better in training latency (over 8660× improvement) and required arithmetic operations in inference (over 34× improvement). These significant gains are largely the result of exploiting information on the physics of signals that has hitherto been ignored., This research is supported by an Alan Turing Institute award TU/B/000096 under EPSRC grant EP/N510129/1, by Royal Society grant RG170136, and by EPSRC grants EP/P001246/1 and EP/R022534/1.

Paramedic education programmes must draw upon a wide range of teaching, learning and assessment techniques in order to ensure that graduating students possess the necessary skills and qualities for their profession ( Quality Assurance Agency (QAA), 2013 ). Theory and practice must come together as part of a reflective learning process at a number of points within the education cycle, in order to identify crucial learning points, and areas for self-improvement from the practice setting. One way of achieving this is via action learning (AL). This small-scale study uses a mixed methods approach to investigate whether or not student paramedics from a UK university, as participants within action learning sets (ALS), felt that that they were a useful educational tool to use within a Foundation Degree in Paramedic Science. Students reported many benefits to their educational experience having participated in ALS, including developments in personal, academic and professional areas. The research also showed how the AL process could be improved in areas such as AL induction, providing AL members with team working skills as well as supporting students with communication and leadership challenges during ALS.

Ambulance practitioners are regularly faced with those who present with a form of drug overdose. The subject of substance misuse can be controversial, delicate and are not always straightforward to manage. Not only can substance misuse be a sensitive topic to approach, but patients can be adept at hiding the signs and symptoms from friends, family and ambulance practitioners (Caroline 2008). In addition, it may be difficult to establish what exactly has been taken, when, and how much. Gaining consent to treat the patient can also be fraught with difficulties. This reflective account uses a case from practice which highlights several of the difficulties that ambulance practitioners face when dealing with this type of patient.

It would seem hard to imagine how you could draw a comparison between a commercial airline pilot struggling to land a stricken plane in a storm and a paramedic fighting to save the life of a patient in cardiac arrest. Although very different circumstances, they both have one thing in common: that is, they are both vulnerable to a condition known as ‘the human factor’. Examples of where Human Factors (HFs) exist within the prehospital profession can be various, common examples are environmental distractions e.g. noise from bystanders, mobile phones, machines, or more simply caused by lack of sleep and inadequate nourishment. This article discusses human factors within the prehospital environment and will highlight the benefits of being able to recognize and act upon them, with a specific focus upon the impact they can have on the ambulance practitioner operating in the field. It discusses human factors training and recognizes the role of crew resource management (CRM) and its importance within the prehospital profession.

This is a polemical book that maintains an age-old argument frequently cited in the debates concerning ownership of the past. As a museum professional with a wealth of experience, James Cuno confidently asserts his belief in the 'encyclopaedic museum' concept, where museums are seen as institutions that display collections of antiquities as representative examples of the world's artistic legacy. Threats to the encyclopaedic museum, in the form of laws concerning the return of cultural property, deeply concern Cuno, and his fervent belief in the idea that antiquities are the common inheritance of all peoples leads him to challenge the nationalist claims on heritage by modern nation-states.

In August 1759 France needed to unite its Mediterranean and Atlantic fleets before invading England. A small British squadron at Gibraltar under Vice-Admiral Edward Boscawen was tasked with blockading the French at Toulon. When the French ran through the Straits of Gibraltar, Boscawen's fleet rapidly got to sea and chased. Confusion among Boscawen's captains and the French unwillingness to stand and fight ensured that the Battle of Lagos was not decisive, but three French ships were taken, two were driven ashore and burned, and the battle became an important precursor to the more famous Battle of Quiberon Bay of November 1759.