Strike action in healthcare has been common over the last several decades. The overarching aim of this systematic review was to synthesise and analyse the empirical literature that examines the impact of strike action on patient morbidity, that is, all patient outcomes except mortality. After conducting a search and apply eligibility criteria, 15 studies were included in this review. These articles included a variety of outcomes from hypertension control to rates of chlamydia. Strikes ranged from 13 to 118 days, with a mean strike length of 56 days. A textual narrative synthesis was employed to arrange studies by whether they had a positive, mixed or neutral or negative impact on patient morbidity.Results suggest that strike action has little impact on patient morbidity. The majority of studies reported that strike action had a neutral or mixed impact of strike action on patient morbidity. One study reported positive outcomes and three studies reported negative outcomes, however in both cases, the impact that the strike had was marginal.

Coronary heart disease is a leading cause of death worldwide. Paramedics are instrumental in the treatment, triage and transport of patients experiencing acute coronary syndromes and acute myocardial infarction (AMI). Paramedics currently rely on prehospital electrocardiography and patient symptomology to diagnose AMI, which may result in missed diagnoses. Point-of-care biomarkers such as cardiac troponin (cTnT) and copeptin may have the potential to increase the diagnostic capabilities of prehospital providers. Multiple electronic databases (MAG Online Library, Cochrane Library, PubMed and Embase) were searched to evaluate the feasibility and potential application of cardiac biomarkers cTnT and copeptin in the prehospital setting. Because of the paucity of evidence, this article explores the evidence on the dual-marker strategy of cTnT and copeptin to increase diagnostic capabilities of prehospital providers, and as an adjunct for decision-making and risk stratification for AMI. The evidence suggests that using the combined dual-marker strategy of cTnT and copeptin may counteract limitations of the ‘troponin-blind’ period of cTnT and the low cardiac specificity of copeptin. However, the research for this method is still in its infancy and requires investigation into its feasibility and affordability as well as into the training required to implement it in paramedic practice.

Background: Isolated traumatic brain injury (TBI) accounts for 30% of injury-related deaths globally, with significant cost to individual health, lifestyle and the economy. Despite advances in prehospital trauma care, frontline paramedics have limited options to manage cerebral oedema and herniation. Prehospital osmotherapy could limit cerebral oedema and subsequent secondary brain injury, but uncertainties remain of its benefit to patient outcomes. Aim: This study aimed to explore whether prehospital osmotherapy such as hypertonic saline (HTS) could improve mortality and neurological outcomes in adults with severe isolated TBI compared with other products. Methods: Multiple electronic databases (PubMed, MAG Online Library, EMBase and Cochrane Library) were searched to investigate the impact of prehospital osmotherapy on mortality and neurological outcome. Findings: 9005 articles were identified, with six articles fully meeting the research aim. The majority of literature was high quality with an overriding consensus that administration of prehospital HTS or other hyperosmolar products had limited benefit to patient mortality and neurological outcome in isolated TBI. Conclusion: High-quality literature demonstrated that there is no current strong argument to adopt prehospital osmotherapy for isolated TBI. Paramedics should prioritise managing hypoxia and hypotension, which have proven impacts on long-term mortality and neurological outcomes. Future research should focus on the benefits of the expansion of rapid sequence intubation to advanced paramedics and appropriate analgesia (ketamine) for paramedics to enhance isolated TBI management in UK paramedic practice. However, paramedics should not disregard the importance of fundamental basic resuscitation skills in isolated TBI.