Within the civilian pre-hospital environment, penetrating projectile injury may be caused by an extremely broad range of firearms and explosive propellants. Despite a great variance in the potential for injury however, a basic knowledge of how penetrating projectiles behave and interact with living tissues is likely to assist emergency healthcare professionals with making informed decisions, as well as establishing priorities for treatment and transportation. Amoung such important considerations is the transference of kinetic energy from a projectile to the tissues, itself influenced by factors such as the area of presentation, deformation, fragmentation, mass and velocity. Projectile retardation, along with correlating levels of energy transference, will also be influenced by the density of the affected tissues, and the permanent disruption caused by the stretching and shearing forces of temporary cavitation will be largely dictated by the elastic tolerance of the tissues and their capacity to expand. The presence and location of entrance and exit wounds, if they exist, can offer some clue to the nature of the projectile/tissue interaction, though caution is required when interpreting such signs. Focussing upon the civilian pre-hospital environment, this article will seek to highlight some of the key features of wound ballistics, and explore some of the misconceptions that can exist concerning the impoprtance of projectile velocity, as well as the dangers of drawing potentially erroneous clinical conclusions based solely upon the nature of the firearm involved, or visible signs of injury.
Background: In an effort to shield them from distress, pre-hospital ambulance staff may avoid discussing traumatic workplace experiences with friends and family. As a source of informal support, however, workplace camaraderie is considered important for managing occupational stress. For supernumerary university paramedic students there is limited research concerning how such experiences are managed, and whether they may benefit from similar informal support. This is a concerning deficit when contextualised by reports of higher stress levels among students undertaking work-based learning, and among paramedics / paramedic students in general. These original findings allude to how university paramedic students who are supernumerary within the pre-hospital workplace utilise informal support mechanisms.Methods: A qualitative, interpretive approach was adopted. University paramedic students were recruited via purposive sampling. Audio-recorded face-to-face semi-structured interviews were performed and transcribed verbatim. Analysis involved initial descriptive coding and then inferential pattern coding. The identification of themes and discussion topics was facilitated by a review of the literature.Results: Twelve participants were recruited aged from 19 to 27 years, and 58% (n = 7) were female. While most participants cited that they were able to enjoy the informal stress-relieving camaraderie of ambulance staff, there were perceptions that supernumerary status may leave them potentially isolated within the workplace. Participants may also compartmentalise their experiences away from friends and family in a manner similar to that found among ambulance staff. Informal student peer support networks were praised as a source of information and for emotional support. Self-organised online chat groups were ubiquitous as a means of keeping in touch with student peers.Conclusions: While undertaking pre-hospital practice placements, supernumerary university paramedic students may not have complete access to the informal support of ambulance staff, and they may feel unable to discuss stressful feelings with friends or loved ones. However, within this study, self-moderated online chat groups were used almost universally as a readily accessible means of peer support. Paramedic educators ideally need an awareness of how such groups are used to ensure that they represent a supportive and inclusive space for students. Further research into how university paramedic students utilise online chat groups for peer support may further reveal a potentially valuable informal support structure.
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