This study is an investigation into whether briefing information, which was heard prior to seeing a firearms incident in a firearms training simulator, affected British police officers' decisions to shoot, as measured by their shooting behavior. Police authorized firearms officers (AFOs) heard either threat or neutral briefing information and then saw a "shoot" (suspect shot at AFO) or "no-shoot" (suspect surrendered without shooting) scenario. AFOs were tested in one of four conditions: threat briefing with shoot scenario, threat briefing with no-shoot scenario, neutral briefing with shoot scenario, or neutral briefing with no-shoot scenario. A postevent questionnaire and the General Decision Making Style (GDMS) questionnaire were completed by the AFOs. Those who had heard the neutral briefing felt more surprised when they saw the suspects than did those who had heard the threat briefing, regardless of which scenario they had seen. However, the briefing type did not affect the time taken to draw and aim the gun at the screen. No shots were fired in the no-shoot scenario, regardless of which briefing the AFOs had received. Differences in preferred decision style were not related to shooting decisions. The results suggest that the briefing information did not influence the AFOs' decisions to shoot, but they attended to cues in the scenario (not identified) and responded accordingly.
We report the case of a patient who presented to the emergency with the common symptoms of chest pain and dyspnoea and who was subsequently found to have the rare diagnosis of a phaeochromocytoma. We highlight the need to maintain a high index of suspicion of the various differential diagnoses in any case presentation and the importance of trusting clinical intuition. We comment on the benefit of the use of emergency ultrasound.A 62-year-old man presented to the emergency department with central chest pain. Past medical history included a non-ST elevation myocardial infarction (NSTEMI), hypercholesterolaemia, diabetes and hypertension.At presentation, he had an atypical dull chest ache. He was hypertensive, with a systolic blood pressure of 210 mm Hg, and tachypnoeic, but felt well in himself and was insistent on being discharged. An electrocardiogram (ECG) showed sinus tachycardia and partial right bundle branch block. Blood gas analysis showed metabolic acidaemia and relative hypoxia. A working diagnosis of a pulmonary embolus was made.A contrast computed tomography (CT) pulmonary angiogram showed no evidence of pulmonary embolus but immediately afterwards the patient deteriorated catastrophically with flash pulmonary oedema. He became increasingly tachycardic, with unrecordable blood pressure and oxygen saturations. ECG monitoring revealed dynamic changes of an NSTEMI.The patient was intubated and ventilated and an epinephrine (adrenaline) infusion commenced to maintain mean arterial pressure. Hydrocortisone was administered to cover the possibility of a CT contrast reaction. Urgent echocardiography showed only globally impaired left ventricular function. There was a mild neutrophilia but other blood tests including C reactive protein and creatinine kinase were normal.
Stocking of important antidotes should be rationalised and simplified using central locations, preferably close to the ED. Clinically important antidotes may not be available for patients when they need them. Clear guidance should be available for staff detailing the location of antidotes. There is a need for clarification around the treatment of cyanide poisoning to facilitate rational antidote stocking for this potentially lethal condition.
This article focuses on the implementation of evidence‐based parenting programmes (EBPPs) in a small sample of urban local authorities in England. The first part discusses the development of government policy, guidance and implementation issues. The second part presents findings from an exploratory study, which focused on the implementation of EBPPs in terms of programme eligibility, fidelity and intensity in six urban local authorities. Implementation was not necessarily in line with policy or guidance. Issues associated with programme fidelity along with concerns about sustainability as a result of cuts in funding are discussed and implications for policy and future research considered.
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