Injuries account for 9.2% of all deaths and 9.9% of the total disability-adjusted life years in Nepal. To date, there has not been a systematic assessment of the status of first response systems in Nepal. An online survey was cascaded through government, non-governmental organisations and academic networks to identify first response providers across Nepal. Identified organisations were invited to complete a questionnaire to explore the services, personnel, equipment, and resources in these organisations, their first aid training activities and whether the organisation evaluated their first response services and training. Of 28 organisations identified, 17 (61%) completed the questionnaire. The range of services offered varied considerably; 15 (88.2%) provided first aid training, 9 (52.9%) provided treatment at the scene and 5 (29.4%) provided full emergency medical services with assessment, treatment and transport to a health facility. Only 8 (47.1%) of providers had an ambulance, with 6 (35.3%) offering transportation without an ambulance. Of 13 first aid training providers, 7 (53.8%) evaluated skill retention and 6 (46.2%) assessed health outcomes of patients. The length of a training course varied from 1 to 16 days and costs from US$4.0 to 430.0 per participant. There was a variation among training providers in who they train, how they train, and whether they evaluate that training. No standardisation existed for either first aid training or provision of care at the scene of an injury. This survey suggests that coordination and leadership will be required to develop an effective first response system across the country.

‘The role of the paramedic in health education’, is a subject area identified in the College of Paramedics Paramedic Curriculum Guidance and Competence Framework (College of Paramedics, 2007). There is no specific guidance on the content or context of this particular subject; therefore student paramedics and paramedic lecturers have interpreted this and linked it to health topics seen as relevant to young people. It is known that people can die for want of first-aid and that many people do not know how to perform first-aid. Two innovative 1-hour workshops have been designed for delivery to secondary school children in which the topic of emergency first-aid is linked with knife crime and drug and alcohol abuse. This article describes the rationale and design of the programme and reports on its initial feedback. It is a programme that shows great promise, but will require further evaluation before it can be rolled-out further.

Paramedics are required by the Health Professions Council, as a condition for maintaining their registration, to maintain high clinical standards and continuously engage in their own professional development. Similarly, student paramedics are required to provide a portfolio of evidence that demonstrates their development and eventual competency. One means of engaging with this process is to apply a formal reflection process to emergency calls attended. Reflection is a hot-topic in paramedic education. However, it is known that for some, reflection can be daunting. Concerns about the academic process, writing and knowing where to begin are often articulated by students attending higher education programmes. This article outlines a suggested reflective framework adapted from Gibbs (1985) reflective cycle. It outlines a series of applicable, sequential questions. Reflection is about using questions to retell a story; it’s about answering these questions critically and, in so doing, often results in a well structured, reflective case-study; as well as improving one’s own clinical understanding and practice. In practice, we have found that both experienced practitioners and student paramedics have been able to use these steps to shape their writing. For those new to writing reflective case studies, the questions help to provide the muse for overcoming the ‘blank-sheet-of-paper’ inertia that can accompany portfolio building.

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