No abstract

No abstract

Background: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce. Methods: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being. Results: Thirty-nine articles met the eligibility criteria. Several factors present in the day-today work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.

Introduction This study explores the perceptions of paramedics regarding their role, education and training, organisational culture and interaction with allied professionals when attending suspected or known cases of mental illness. The study uses the South Australian Ambulance Service (SAAS) clinical data to establish a quantitative measure of workload in relation to cases that have been classified as psychiatric. It examines how paramedics perceive their use of the resources currently in place to support practice and their role when dealing with patients displaying mental illness. Methods Data were sourced from the SAAS clinical database, a survey and three focus groups. One hundred and fifty surveys were distributed to career paramedic staff in both metropolitan and regional centres of South Australia with a response rate of 49.3% (n=74). The survey was analysed using descriptive statistics to compare paramedics‟ perceptions of workload and time-on-scene with the quantitative data from the SAAS Clinical Database. Thematic analysis was undertaken of the open questions from the survey and focus groups data. Results The analysis of workload and time-on-scene showed significant differences between the SAAS database and paramedic perceptions. The survey and focus groups discussed themes in relation to paramedic practice: the role of paramedics in managing mental illness, education and training, organisational culture and interdisciplinary relationships. Conclusion Mentally ill patients comprise a growing proportion of the workload of paramedics. This descriptive and exploratory study identifies issues in relation to their perception of workload, education and training, organisational culture and their working relationships with other services. Further research is recommended to understand how these perceptions affect paramedic practice in this area.

BackgroundParamedics are called on frequently to provide care to patients with mental health and/or and alcohol and other drug (AOD) problems, but may have mixed views about how this fits within their role.AimsTo explore paramedics’ experience of caring for patients with non-medical emergency-related mental health and/or AOD problems, understand their perceptions of their scope of practice in caring for these patients, and ascertain if their practice should be extended to incorporate education with these patients.MethodA convenience sample of 73 paramedics from most Australian states and territories—recruited through an online survey—participated in individual audio-recorded, qualitative interviews, conducted by telephone. The interviews were part of a mixed method study comprising qualitative interviews and online survey. A Framework Method of analysis to analyse the qualitative data.ResultsThree themes and sub-themes were abstracted from the data about participants’ experiences and, at times, opposing viewpoints about caring for patients with non-medical emergency-related mental health and/or AOD problems: caring for these patients is a routine part of paramedics’ work, contrasting perspectives about scope of practice in caring for this group of patients, competing perspectives about extending scope of practice to incorporate education with this cohort of patients.ConclusionsParamedics need more undergraduate and in-service education about the care of patients with mental health and/or AOD problems, and to address concerns about extending their scope of practice to include education with these patients. Thought should be given to introducing alternative models of paramedic practice, such as community paramedicine, with a focus on supporting people in the community with mental health and/or AOD problems. There is a need for a change in workplace and organisational culture about scope of practice in caring for patients with these problems. Extending paramedics’ role could, potentially, benefit people with these problems by improving the quality of care, reducing the need for transportation to emergency departments, and decreasing clinicians’ workloads in these departments.

The educational experiences and attainment of looked-after children and young people (LACYP) remains an issue of widespread international concern. Within the UK, children and young people in care achieve poorer educational outcomes compared to individuals not in care. Despite proliferation of research documenting the reasons for educational disadvantage amongst this population, there remains limited empirical consideration of the lived experiences of the educational system, as perceived by LACYP themselves. This paper draws upon qualitative research with 67 care-experienced children and young people in Wales. The sample was aged 6-27 years, and comprised 27 females and 40 males. Participants had experienced a range of care placements. Findings focus on how educational policies and practices alienate LACYP from dominant discourses of educational achievement through assignment of the 'supported' subject position, where children and young people are permitted and even encouraged not to succeed academically due to their complex and disrupted home circumstances. However, such diminished expectations are rejected by LACYP, who want to be pushed and challenged in the realisation of their potential. The paper argues that more differentiated understandings of LACYP's aspirations and capabilities need to be embedded into everyday practices, to ensure that effective educational support systems are developed.

1 The endogenous fatty acid anandamide (AEA) is a partial agonist at cannabinoid CB1 receptors and has been reported to be a full agonist at the recombinant vanilloid receptor, VR1. 2 Whole cell voltage clamp techniques were used to examine the e cacy of AEA and related analogues methanandamide and N-(4-hydroxyphenyl)-arachidonylamide (AM404) at native VR1 receptors in acutely isolated mouse trigeminal neurons. 3 Superfusion of the VR1 agonist capsaicin onto small trigeminal neurons voltage clamped at +40 mV produced outward currents in most cells, with a pEC 50 of 6.3+0.1 (maximum currents at 10 ± 30 mM). 4 AEA produced outward currents with a pEC 50 of 5.6+0.1. Maximal AEA currents (30 ± 100 mM) were 38+2% of the capsaicin maximum. AEA currents were blocked by the VR1 antagonist capsazepine (30 mM), but una ected by the CB1 antagonist SR141716A (1 mM). 5 Methanandamide and AM404 were less potent than AEA at activating VR1. Methanandamide (100 mM) produced currents 37+6% of the capsaicin maximum, the highest concentration of AM404 tested (100 mM) produced currents that were 55+9% of the capsaicin maximum. 6 Capsazepine abolished the currents produced by AM404 (100 mM) and strongly attenuated (470%) those produced by methanandamide (100 mM). 7 Co-superfusion of AEA (30 mM, methanandamide (100 mM) or AM404 (100 mM) with capsaicin (3 mM) resulted in a signi®cant reduction of the capsaicin current. Richardson et al., 1998). AEA also activates the vanilloid receptor VR1 (Caterina et al., 1997;Zygmunt et al., 1999), a protein known to be primarily activated by noxious stimuli, including heat, hydrogen ions and capsaicin, the pungent ingredient found in chili peppers. The possible concurrent activation of these two receptors, which may be expressed on the same primary a erent ®bers (Ahluwalia et al., 2000; Tognetto et al., 2001), raises interesting questions regarding the physiological role of AEA in nociceptive function and its e ect on sensory neuronal activity. In order to address these questions, it is important that the interactions of AEA with its cellular e ectors such as CB1 receptors and VR1 be unambiguously characterized. AEA is considered to be a partial agonist at CB1 receptors (Mackie et al., 1993;Burkey et al., 1997;Glass & Northup, 1999), although it can exhibit similar maximal e ectiveness to e cacious synthetic cannabinoids at native CB1 receptors (Shen et al., 1996;Twitchell et al., 1997;Morisset & Urban, 2001). AEA and capsaicin appear to share a similar binding site on VR1 (Jordt & Julius, 2002) but the relative e cacy of AEA at VR1 has been the subject of some controversy. Initial reports suggested that AEA was a partial agonist at recombinant VR1 (Zygmunt et al., 1999;Hwang et al., 2000) while a number of subsequent studies have demonstrated that AEA is apparently a full agonist at recombinant rat and human VR1 De Petrocellis et al., 2000;Ralevic et al., 2001;Ross et al., 2001 resulting from VR1 activation are likely to be signi®cantly ampli®ed in any cell, including heterologous expression sys...

No abstract