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Should paramedics undertake yet another scope of practice

Introduction

Ambulance services and the medical professionals offering the support to accomplish this provision are playing an increasingly wide role in the NHS, not merely by providing an instant respond to 999 calls and transferring patients to medical center but learning to be a portable health care service for the NHS. The ambulance service goes on to develop and like other scientific specialties within the NHS the professionals used within the ambulance service experienced to developed knowledge, skills and an understanding of modern technology in an attempt to take professional medical to individuals beyond the hospital environment. It is suggested that ambulance services reach an array of patient groups; for example to patients who need an emergency response; to people who do not have a life threatening condition but would like immediate advice or treatment, also to those whose condition or location helps prevent them from venturing easily to access healthcare services (Warner, 2005).

Traditionally ambulance services have been mostly perceived as an emergency service where the response is to meet up with the needs of individuals who may be experiencing life intimidating emergencies, with severe deep breathing difficulties, serious coronary symptoms or struggling major stress (Lendrum et al, . 2000). Training and service development has been organised to indicate this need for emergency acute good care, however a paradigm switch has took place with emphasis now being made after more good care and treatment being provided within community configurations and within patients homes and the traditional perceptions of the ambulance service are steadily being replaced with the view that it's a mobile health learning resource, able to offer an increasing range of assessment, treatment and diagnostic services (Section of Health, 2005).

This assignment will try to explore further these trends in ambulance service provision, emergency care and the growing paramedic professional opportunity of practice utilizing the example of an 8 year old young man who had sustained a head wound. The child in question acquired on initial exam a tiny laceration above the right eyebrow, his GCS report was 14 and he was able to self report on paediatric pain chart that the wound 'only hurts a little'. The harm was reported to obtain been inflicted following a land whilst 'play fighting with each other' with his brother. Historically it might be accepted practice for the ambulance employees to transfer the kid with a proper adult to the severe hospital setting for even more treatment of the wound, however for the purpose of this assignment and in light of the producing role of the paramedic and ambulance service the concentration will be on how the procedure of home treatment and treatment in a safe and appropriate clinical manner might have been delivered to minimise the use of acute medical center resources as well as for the patient to receive wound care of their own house and community.

Ambulance Services and Children

It is advised in the literature that 5 to 10% of calls designed to the ambulance service are for children (Jewkes, 2004a, Jewkes, 2004b and Kumar et al, . 1997) and this as this body is relatively small this may be translated to imply that a paramedics contact with children who are critically sick or injured may likely to be infrequent (Houston and Pearson, 2010). With this in mind it could be suggested that there surely is the potential for ongoing problems with the implementation of clinical skills in the paramedic's practice, particularly if those skills are relevant and also have been obtained in paediatrics and good care of the unwell child, if they're not used or utilized often enough.

Houston and Pearson (2010) indicate that ambulance telephone calls that involve children can often be stressful for health care providers such as paramedics which feeling can often be exacerbated if the average person is not trained to cope with the needs of the sick or damaged child. The result of this would be that the anxiety provoked by the call to a paediatric disaster results in the paramedic becoming hesitant to intervene (Roach, 1994; Spaite, 2000 and Dawson 2003) and this may place the kid in more threat or on the other hand may lead to more transfers to the severe hospital environment for conditions which could in essence be been able within the pre clinic environment.

A research that was conducted in 2003 by Dawson et al. identified that by assessing working out and comfort of basic and paramedic skills providers felt overall perfectly prepared in every areas of emergency care aside from paediatrics and childbirth. This study although highly relevant to the context of the discussion was based on North american ambulance workforces who have different certification and training solutions therefore can be disregarded as a benchmark for the delivery of care and attention by ambulance companies to children.

In the UK there's been little research to recognize the effectiveness and skill of ambulance providers in the delivery of good care to children until the publication of Houston and Pearson's (2010) exploratory work on ambulance provision for children. The findings of this study identified that but the NHS did not have a particular budget to aid ambulance crews and paramedics in training and education in paediatric care and attention in 85% of ambulance service trusts it was reported that there is the ability for 'in house' medical trained in paediatrics. The analysis was also able to see that if working out was not necessary then double technician ambulance crews would be dispatched to telephone calls involving children and that overall variation used is lowering with a far more cohesive shift within NHS trusts towards making sure ambulance service personnel are appropriately trained to provide effective pre clinic care to children.

Wound Care

In the circumstance identified in the intro the author referred to the clinical case of your 8 calendar year old boy with a brain laceration, the ambulance service had been called to react and the paramedic in attendance became the business lead physician in handling the pre hospital care of the child in question.

Prior to the introduction of the ambulance services and before the shift towards learning to be a portable healthcare service for the NHS, ambulance crews would triage the patient on arena, ensure these were physically stable for transfer and the facilitate the patients transition between your community and the serious hospital setting for further examination and treatment. With the paradigm move towards ambulance services providing advanced and expansive pre clinic care being acknowledged this assignment will now continue by checking out the ideas of good practice in wound care which the paramedic on world could deliver to the 8 year old youngster with the top laceration to assist in care delivery within the home environment and reduce the need for severe hospital health care which places a bulkier demand on enough time of all functions involved in this scenario and on the NHS.

Wound care can be an integral area of the role of the paramedic or the crisis care practitioner and is also a scientific skill with an facts structured knowledge that is purchased during the training process. The entire aim of managing wounds is to market the healing up process and for most patients and health professionals, for different reasons, they might want wound closure that occurs as fast as possible (Flanagan, 2005). It is well noted that wound treatment has advanced significantly within modern times and with the development of wound attention specialists that are research literate, knowledgeable about insurance policy and practice and have the ability to effectively bridge the gap across theory and practice (Flanagan, 2005) other health professionals, such as paramedics, hold the chance to learn skills and techniques in wound management by showing good practice and having the ability to access training programs that are specifically tailored to develop specialized medical skills in wound care.

In relation to the circumstance presented of the 8 12 months old child with the small head laceration, he was assisted to the neighborhood clinic by the ambulance service so that his mind laceration could be glued, however utilising the paradigm that the ambulance service is a mobile health learning resource, able to offer an increasing range of diagnosis, treatment and diagnostic services (Department of Health, 2005) the target will now move on to the alternative approach to attending the neighborhood acute hospital and will present the argument that pre hospital treatment and wound care would have been appropriate in this instance.

Pre Hospital Triage

A lot of people maintain head traumas and mind wounds each year many of that are sufficiently minor never to require medical attention (Country wide Collaborating Centre for Acute Health care, 2007) ; as an alternative to transporting an individual (child or adult) to hospital for the analysis and treatment of a head wound, the health professional from the ambulance service might have been able to deliver treatment to the individual within their own home, thus aiding the ideology of ambulance services being truly a mobile health reference.

The paramedic would have to make an analysis of the child to ascertain the way the wound was inflicted, examine the child's neurological position utilizing the paediatric version of the Glasgow Coma Scale (Jennett and Teasdale, 1974) and make an archive of the child's baseline observations for future research if there was an serious change to the patient which required further involvement. The assessment and triage of the patient would also provide an opportunity for medical professional to recognize any factors that if present would suggest the immediate transfer of the child to a healthcare facility setting. These factors are the presence and reporting of; vomiting, throbbing headache, loss of consciousness, amnesia, seizure and neurological change, proof skull fracture or mind damage, injury that was caused by high impact, medication or liquor intoxication, irritability or changed behaviour or if the individual has had previous cranial neurosurgery or head incidents (NCCAC, 2007; NICE, 2007).

In the situation of the 8 time old child, the only report which may fast the paramedic to move the kid to hospital would be the GCS (Jennett and Teasdale, 1974) that was noted as 14/15 and the record of the laceration hurting just a little, however with the triage figuring out that the child (corroborated by a proper adult) had not experienced or reported the factors that would indicate proof a head harm requiring disaster or even immediate treatment in the serious hospital setting up, the triage may indicate that the treatment options may be reduced to being supplied within the house environment.

Treatment

The laceration to the kid was originally cured in the disaster section with Dermabond which really is a cyanoacrylate muscle adhesive that sorts a strong bond across apposed wound corners, allowing normal healing that occurs below (Bruns and Worthington, 2000). This treatment could have been delivered proficiently within the patient's own house by the paramedic and in so doing may have retained health care professionals and resources from the acute medical center and NHS focused on delivering care to other individuals whose needs have been assessed to be increased.

Legal and Moral Considerations

The paramedic scope of practice is the recorded area or regions of the profession in which the knowledge, skills and experience to practise lawfully, securely and effectively, is set up in a manner that meets agreed specifications and does not pose any risk to the general public or to the paramedic. As long as the paramedic exercises self governance in guaranteeing they are really practising safely and securely and effectively within the given range of practice and don't practise in the areas where they aren't proficient to do so, this isn't advocated to be problem with regards to doing within the professional scope of practice (Health Occupations Council, 2007).

Legal frameworks are in place for the paramedic to adhere to and understand to ensure their medical practice is reputable as patients possess the legal right to make their own health care decisions even if the paramedic is convinced they have the clinical skills and talents to improve the health of the average person. However, poor health can jeopardize people's potential to guard their rights and this is the reason why legal frameworks, like the Mental Capacity Function (2005) or the Children's Function (2004), support individuals to keep up their legal rights and gives route and a construction for healthcare specialists to ensure appropriate action is taken up to protect both the provider and the suggested receiver of the service.

Ethics aren't part of the legal or legislative construction but are more centered on how, for the intended purpose of this task, the healthcare professional makes scientific decisions and judgements when involved in the procedure for patient good care. Ethics are important for several reasons. First of all, ethics are important because they give us set up a baseline for understanding the concepts of right and incorrect. Ethics help us to truly have a ready understanding of how to respond to a certain situation long before that situation happens and to be able to provide honest reasoning in situations which are not self-explanatory or present as challenging to decision making functions.

Legally, in the situation we have focused on during the course of this essay, it might be unlawful for the paramedic to start treatment on the child's head wound without consent. As a child below the age of 16 is legitimately classed as a minor then consent to treatment should be extracted from the child's comparative or appropriate adult representing the child's interests. It also would be ethically wrong to use, as an example, a new treatment for the closure of brain wounds that was part of an professional medical trial without advising the patient and their adult agent of the research process and describe the risk/ benefit issues. If the paramedic joining to the kid had not held current with compulsory training on wound health care or had not received any training on child and paediatric pre hospital care it would be un-ethical for the paramedic to continue to treat the kid, the paramedic would maintain breach of the professional range of practice and there may be legal outcomes if any action considered by the paramedic results in further personal injury or harm to the patients health insurance and welfare.

Conclusion

In order for ambulance services and paramedics to provide the portable healthcare service for the NHS with service advancements including mobile health resources, in a position to offer an increasing selection of assessment, treatment and diagnostic services (Team of Health, 2005), it has become clear that paramedics have to develop and increase their knowledge and range of practice to ensure that these changes can be shipped. Changing service provision must solve the training needs of the care providers to ensure that patients continue steadily to obtain high quality proof based health care that is provided in a number of adjustments, from the serious hospital with their own homes.

Wound treatment is one factor of service provision that paramedics and ambulance service workers are trained in responding to and in the scenario for this project the wound care and attention intervention was evaluated to be relatively self-explanatory therefore professional medical decision making predicated on the professionals scope of practice and moral reasoning supported the decision for the paramedic to take care of within the patients home environment.

In more technical situations, where the wound treatment requires more complex intervention it is essential for the paramedic to have achieved a level of competence in the management of wounds and injury for his or her professional opportunity of practice to stay relevant. The importance of training and skill development ensures degrees of anxiety remain low and medical competence and decision making remains of the best quality.

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