Pain management is a contemporary issue in pre-hospital care. Mark Hodkinson outlines how in recent years, the development of specialist paramedic roles and changes in laws relating to the control of drugs has seen advances in the array of analgesic options available to paramedics.
Background
The risk of COVID-19 transmission to healthcare professionals is likely to continue for the foreseeable future. The wearing of personal protective equipment (PPE) presents a number of potential challenges to responders that may impact upon the management of patients in a multi-casualty incident.
This report describes a multi-agency multi-casualty incident. It identifies learning points specifically related to the challenges of conducting a conventional multi-casualty incident in COVID-19 PPE.
Case
The multi casualty incident in Reading, UK on the 20 June 2020 involved six stab injury victims and was attended by four pre-hospital critical care teams. This was the first conventional multi-casualty incident that pre-hospital critical care teams had attended during the COVID-19 era and it was conducted in COVID-19 PPE (1). The scene was an urban park where three patients were confirmed to be in Traumatic Cardiac Arrest (TCA) from stab wounds and another three patients had also suffered stab injuries. By the time the incident had concluded three patients were pronounced dead at the scene. Two patients were transported to the local trauma unit and one patient was transported to the regional Major Trauma Centre depending on the severity of their injuries.
Conclusions
We conducted a semi structured telephone interview with the critical care clinicians who were involved in the incident. The interviews focused specifically on the challenges of responding whilst wearing COVID-19 PPE, rather than the wider challenges of responding to such an incident. The key learning points identified were:
Improving the identifiability of clinicians in level 3 PPE
wearing identification tabards
using visible labelling on PPE suits
Improving communication by radio
using a belt to carry the radio
using an earpiece and push to talk system.
Training in conducting multi casualty incidents in level 3 PPE.
Meningococcal septicaemia is a potentially life-threatening disease process which requires early recognition and rapid management in both pre-hospital and hospital phases of patient care. It is estimated that there are around 3 500 confirmed cases annually in the United Kingdom and, as such, widespread campaigns and national guidelines have been developed and adopted throughout NHS trusts. Standard treatment protocols have been developed and adopted to manage patients appropriately; however, other emerging treatment options are becoming more widely acknowledged, but require further investigation before recommendations can be made. It is vitally important that clinicians in patient-facing roles who are likely to come into contact with meningococcal-related diseases adopt a high index of suspicion, basing diagnosis on history, physical examination and clinical investigations. Rapid intervention should be undertaken for any patient where the disease process is suspected.
The laryngeal mask airway was first developed in the 1980s by Dr Archie Brain. The market for supraglottic airways has rapidly expanded since the 1980s, incorporating both reusable and single patient use devices, varying in design, application, cost and durability. Here, the author considers theoretical and anecdotal evidence when comparing single patient use and reusable supraglottic airways. Particular attention has been drawn to the I-Gel, pro-seal laryngeal mask airway and conventional laryngeal mask airway.
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