The advanced paramedic clinical activity study (APCAS): an insight into the work of advanced paramedics in the mid-west of Ireland

Background The Advanced Paramedic (AP) is a relatively recent role in Ireland and refers to a prehospital practitioner with Advanced Life Support (ALS) skills and training. The Advanced Paramedic Clinical Activity Study (APCAS) was initiated to provide an evaluation of the impact of the AP programme on patient care in Ireland. Aim The aim of this study is to provide an insight into the clinical activity of APs over a six month period in the Mid-West region of Ireland. Methods A prospective study was initiated whereby all ambulance calls dispatched by the regional Ambulance Control Centre were recorded by the attending AP, including calls received via the statutory 999/112 system. Participating APs were asked to complete a separate call log data sheet recording all demographic and clinical information for every call attended during the study period. Results A total of 17 APs participated and 1,969 ambulance calls were recorded in APCAS. The Mid-Western Regional Hospital, Limerick was the busiest receiving facility. Activity peaked at weekends and was lowest on Tuesdays. Crew response, on-scene and transport times agree with previous reports. Most common emergencies include Medical (12%), Cardiovascular (10%) and Altered level of Consciousness & Seizures (10%). Least common calls include Airway & Ventilation and Environmental emergencies (<1%). Conclusions This study provides an insight into the work of APs in the Mid-West region of Ireland. It would appear that despite the relative recency of the Irish AP programme the findings of this study are in line with previous international studies

Consent as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review

Background: Clinical trials in the ambulance setting are essential for providing the basis for evidence based healthcare in the prehospital environment. As the number and complexity of ambulance trials increases the ethical issues involved in such trials. We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods: We conducted a systematic review of ethical issues considered in randomised controlled trials in ambulance settings. A search of eight databases identified ethical issues discussed in published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and then extracted relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis.Results: In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Several consent models were used ranging from informed consent to exception from informed consent (also termed waiver of consent). Type of consent differed depending on the clinical condition or the intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from informed consent appeared to be most commonly used. Many studies cited international guidelines as informing their choice of consent model and diverse and sometimes confused terms were used to describe these models.Conclusions: Consent was the main ethical consideration in published ambulance based research. A wide range of terms was used to describe consent and terms were sometimes confused or used inconsistently. This suggests that standardisation of consent models and the terminology used to describe them may be helpful for researchers, ethics committees and research participants.</p

Possible Pleistocene Pinniped Ichnofossils on South Africa’s Cape South Coast

Exposed surfaces of cemented foreshore deposits and aeolianites on the Cape south coast of South Africa have been demonstrated to contain numerous Pleistocene vertebrate tracksites. Two ichnosites have recently been identified that appear to demonstrate traces made by seals. These would be the first seal trace fossils thus far described in the global fossil record. The sites are situated 560 m apart in the Goukamma Nature Reserve. One site exhibits apparent flipper traces and a furrow, and the other site exhibits impressions consistent with moulds of juvenile seals. In conjunction with new luminescence dating of the associated sediments, these findings suggest a seal presence on Cape south coast beaches ∼75,000 years ago in the mild glacial period of Marine Isotope Stage 5a.</p

Design and evaluation of interprofessional training program for healthcare students from collectivistic culture

Background Healthcare is team-based, and with increased mobility of healthcare workers, most of them will work with team members from all over the globe. Interprofessional education (IPE) research has mostly focused on specially designed programs in academic health institutions to prepare students for multidisciplinary work. Few IPE programs aim to integrate students with mixed disciplines from collectivist cultures. Methods This mixed-methods study was conducted between June and August 2019. Surveys and an e-portfolio were recorded of 33 fnal-year and graduated health professional students’ participation in an 8-week IPE summer program at a medical school in Ireland. Survey results are described, and the content of portfolios was analyzed based on the deductive analysis of qualitative data derived from questions. Results Students reported the greatest improvement in presentation skills (63.6%), followed by communication (54.5%), team working skills (93.9%), and interprofessional learning (42.4%), respectively. Qualitative fndings highlighted challenges for students from a collectivist culture adapting to an IPE: uncomfortable verbally expressing themselves in problem-based learning (PBL) and how to work with other sex. Positive themes about IPE that emerged were enjoyment in sharing ideas and building trust with PBL groups. We learned that the program had to be fexible enough to meet the educational require ments of a target community with mixed English language ability and adaptability to IPE. Conclusion The authors propose that an international PBL-based summer program is efective in improving healthcare students’ attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to increased collaboration between students across various healthcare discipline

Appendix A. A table showing a summary of site characteristics, taxa studied, and methods used in sampling the taxa.

A table showing a summary of site characteristics, taxa studied, and methods used in sampling the taxa