Objectives: This project aims to use information about the desirable attributes of the ambulance technician, paramedic, and clinical supervisor to inform future curriculum development. Methods: Data generated by a Delphi study investigating the desirable attributes of ambulance technician, paramedic, and clinical supervisor were subject to factor analysis to explore inter-relations between the variables or desirable attributes. Variables that loaded onto any factor at a correlation level of .0.3 were included in the analysis. Results: Three factors emerged in each of the occupational groups. In respect of the ambulance technician these factors may be described as; core professional skills, individual and collaborative approaches to health and safety, and the management of self and clinical situations. For the paramedic the themes are; core professional skills, management of self and clinical situations, and approaches to health and safety. For the clinical supervisor there is again a theme described as core professional skills, with a further two themes described as role model and lifelong learning. Conclusions: The profile of desirable attributes emerging from this study are remarkably similar to the generic benchmark statements for health care programmes outlined by the Quality Assurance Agency for Higher Education. It seems that a case is emerging for a revision of the curriculum currently used for the education and training of ambulance staff, which is more suited to a consumer led health service and which reflects the broader professional base seen in programmes associated with other healthcare professions. This study has suggested outline content, and module structure for the education of the technician, paramedic, and clinical supervisor, based on empirical evidence.

Introduction:British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.Methods:Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.Results:The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.Conclusion:It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.

Objectives: To identify those attributes experts regard as desirable qualities in the ambulance technician, paramedic, and clinical supervisor. Methods: The Delphi technique was used to gain a consensus view from a panel of experts. The first round of the study asked the experts to list the attributes they believed were desirable for the ambulance technician, the ambulance paramedic, and the clinical supervisor. The first round of the study generated 3403 individual statements that were collapsed into 25 broad categories, which were returned to the experts, who were required to rate each of the attributes along a visual analogue scale in respect of each of the identified occupational groups. Results: On completion of the second round the data were analysed to demonstrate rank ordering of desirable attributes by occupational group. The level of agreement within each group was determined by analysis using the Kendall coefficient of concordance. This showed high levels of agreement within the technician group but less agreement within the paramedic and clinical supervisor group. All were highly significant p,0.0001. Conclusions: There was significant agreement among the experts as to the desirable attributes of ambulance staff, many of which do not feature in existing ambulance training curriculums. The findings of this study may therefore be of value in informing future curriculum development and in providing guidance for the selection of staff for each of the occupational groups.

Objective: To examine the accuracy of theoretical triage decision making among emergency prehospital health care professionals, using a multiple casualty paper exercise. Methods: A standardised 20 casualty paper exercise requiring each casualty to be prioritised for treatment was given to 100 doctors, 59 nurses, and 74 ambulance paramedics who could potentially be involved at the scene of a multiple casualty incident. Each paper was scored using the triage sieve algorithm. The paper contained descriptions of two casualties regarded as dead, six priority 1 casualties, six priority 2 casualties, and six priority 3 casualties. Results: There was no significant difference in the scores received by both doctors and nurses, but paramedics did significantly less well than both nurses and doctors (p<0.05) However, the actual difference in mean scores is only just over 1; both doctors and nurses had a mean score of 13.03 and paramedics a mean score of 11.83. All professional groups tended to over triage patients. While there was no significant difference between doctors and nurses there was a significant difference (p<0.001) between paramedics and both doctors and nurses. Conclusions: There is little difference in the accuracy of triage decision making between the professional groups, with doctors and nurses scoring marginally better than paramedics. The rates of over triage are high posing the risk of overwhelming available resources further. Under triage rates are also high, with potentially life threatening conditions going unrecognised. However, some margin of error may be accounted for by the untested validity of the triage sieve methodology.

This study aims to determine whether the British Heart Foundation PocketCPR training application can improve the depth and rate of chest compression and therefore be confidently recommended for bystander use. A total of 118 candidates were recruited into a randomised crossover manikin trial. Each candidate performed cardiopulmonary resuscitation for 2 min without instruction or performed chest compressions using the PocketCPR application. Candidates then performed a further 2 min of cardiopulmonary resuscitation within the opposite arm. The number of chest compressions performed improved when PocketCPR was used compared to chest compressions when it was not (44.28% vs 40.57%, p < 0.001). The number of chest compressions performed to the required depth was higher in the PocketCPR group (90.86 vs 66.26). The British Heart Foundation PocketCPR application improved the percentage of chest compressions that were performed to the required depth. Despite this, more work is required in order to develop a feedback device that can improve bystander cardiopulmonary resuscitation without creating delay.