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INTRODUCTION: Over 70,000 cases of Proximal Femoral Fracture (PFF) occur annually in the United Kingdom (UK), primarily affecting the elderly. These injuries are associated with high morbidity and mortality, and often see inadequate pain management in the prehospital setting. The Fascia Iliaca Compartment Block (FICB), a regional anaesthesia technique, is the gold standard of care in Emergency Departments (ED). This review aims to assess the literature on paramedic-performed FICB for suspected PFF in the prehospital setting, highlighting benefits and challenges to guide future practice and policy in the ambulance sector. MATERIALS AND METHODS: A rapid scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with modifications for this project’s limitations. A systematic search of the databases CINHAL, PubMed, EMBASE, and Medline was performed. A synthesis matrix was created to extrapolate data from the included studies and allow for a coherent interpretation of results. Each included study was subject to a critical appraisal conducted using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Data was extracted from three studies and two reports which identified four key themes emerged: paramedic competency in performing FICB, patient perspectives, adverse events, and training and governance. Studies showed paramedics can competently perform FICBs in prehospital settings. Verbal pain scores were lower following an FICB compared to standard care with IV morphine, which required more supplementary morphine for break-out pain. Concern for causing harm was a consistent theme among the paramedics performing FICB, particularly in precipitating an adverse event sequela. Adverse events were more common in non-FICB groups, with only one case of local anaesthetic toxicity in the FICB group, which was correctly managed by the paramedic. CONCLUSIONS: Paramedics can competently perform FICB in the prehospital setting, showing promising results in pain relief compared to intravenous morphine. However, higher-level research is needed for confirmation. Patients generally tolerated paramedic-led FICB well, with minimal concerns. Training and governance remain significant barriers to implementing FICB in local ambulance services.

INTRODUCTION: Gen AI, exemplified by tools like ChatGPT, has transformed various sectors, including healthcare education. Despite its rapid adoption across fields, the utilisation of Gen AI in healthcare education in the UK remains inconsistent, with research predominantly focused on academic integrity and examination performance, rather than exploring its potential benefits in educational practices. Notably, there is a paucity of literature within emergency healthcare education and paramedic courses. Objective - to investigate the integration and impact of Generative AI (Gen AI) within emergency healthcare education, focusing on undergraduate and postgraduate pre-registration courses in the UK. MATERIALS AND METHODS: Using the JBI methodology and PRISMA-ScR guidelines, the databases MEDLINE, CINAHL, PubMed, and Cochrane were searched. The selection process involved screening by title and abstract, followed by full text review. Thematic analysis identified prevalent Gen AI applications within healthcare education. Inclusion criteria - the review targeted peer-reviewed studies that discuss the use of Gen AI in healthcare education, without publication date or geographical restrictions. RESULTS: A total of 13 studies were included in the review. These studies demonstrated Gen AI’s application in curriculum development, assessment design, student implementation, academic support, and clinical application. Gen AI aids educators in curriculum design and assessment creation, supports students through digital literacy enhancement, and facilitates academic writing and research practices. Additionally, its role extends to practical skill enhancement in clinical scenarios. CONCLUSIONS: Gen AI offers transformative potential for all healthcare education and applications to the emergency education setting, providing innovative solutions for curriculum design, learning tools, and clinical simulations. While the identified themes are generalisable to healthcare education, they hold particular relevance for individuals seeking to advance the utilisation of Gen AI technologies within the specialised domain of emergency and prehospital care. However, its integration requires careful consideration of legal, ethical, and pedagogical implications.

Background Each year in England, 450,000 children and young people (CYP) under 18 years of age are transported by ambulance to emergency departments. Approximately 20% of these suffer acute pain caused by illness or injury. Pain is a highly complex sensory and emotional experience. The intersection between acute pain, unwell CYP and the unpredictable pre-hospital environment is convoluted. Studies have shown that prehospital pain management in CYP is poor, with 61% of those suffering acute pain not achieving effective pain relief (abolition or reduction of pain score by 2 or more out of 10) when attended by ambulance. Consequences of poor acute pain management include altered pain perception, post-traumatic stress disorder and the development of chronic pain. This realist review will aim to understand how ambulance clinicians can provide improved prehospital acute pain management for CYP. Methods A realist review will be conducted in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidance. A five-stage approach will be adopted; 1) Developing an Initial Programme Theory (IPT): develop an IPT with key stakeholder input and evidence from informal searching; 2) Searching and screening: conduct a thorough search of relevant research databases and other literature sources and perform screening in duplicate; 3) Relevance and rigour assessment: assess documents for relevance and rigour in duplicate; 4) Extracting and organising data: code relevant data into conceptual “buckets” using qualitative data analysis software; and 5) Synthesis and Programme Theory (PT) refinement: utilise a realist logic of analysis to generate context-mechanism-outcome configurations (CMOCs) within and across conceptual “buckets”, test and refine the IPT into a realist PT. Conclusion The realist PT will enhance our understanding of what works best to improve acute prehospital pain management in CYP, which will then be tested and refined within a realist evaluation. Registration PROSPERO Registration: CRD42024505978

INTRODUCTION: Workplace violence (WPV) against healthcare professionals (HCPs), including student paramedics, is a global concern, with reported incidents ranging from physical to psychological abuse. The prehospital environment, characterised by its high-risk nature, presents unique challenges for student paramedics during clinical placements. To explore the extent and nature of WPV experienced by student paramedics during clinical placements, assess the impact of WPV on their training and psychological well-being, and identify existing support mechanisms and training provisions. MATERIALS AND METHODS: Included were research or review articles specifically exploring WPV experienced by student paramedics during clinical placements. Exclusions were applied to articles not focusing on student paramedics, those not in English, and publications outside the specified time frame. A comprehensive search strategy was used across the databases CINAHL, Medline, EMBASE, EMCARE, and PubMed, supplemented by grey literature searches via Google Scholar and citation searching. Data extraction was facilitated through a synthesis matrix and themes were identified and analysed. RESULTS: From 417 records identified, six articles were included, all conducted in Australia, revealing themes such as the risk and effects of WPV, lack of reporting, the role of the practice educator (PEds), and preparedness for WPV. Freedom of Information (FoI) requests to English Ambulance Services highlighted inconsistencies in recording WPV incidents and variability in support provided to student paramedics. CONCLUSIONS: WPV significantly impacts student paramedics' educational experience and psychological health. There is a crucial need for improved education on WPV, standardised reporting mechanisms, and enhanced support systems. Collaborative efforts between ambulance services and higher educational institutions (HEIs) are essential to address these challenges and ensure a safer learning environment for student paramedics.

Background: An out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. Methods: This multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. Results: In total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57–70.98) and the second attempt (48.68, 95% CI 31.31–66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54–227.37) compared with the second attempt (136.95, 95% CI 87.03–186.88, p = 0.1). Conclusion: A dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.

Background: With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was conducted to answer the question: What are the current approaches to the evaluation of the quality of health-care simulation-based education provision? Methods: Databases PubMed, Cochrane, ERIC, CINAHL and Medline were searched in March 2023 to retrieve peer-reviewed healthcare research and review articles written in the English language within the last 20 years. All data were extracted from six studies, themed and presented in the main text and in tabular form. Results: Two scoping reviews, one systematic review and three research articles were included. Three main themes were found: adherence to existing design frameworks, lack of validation of these frameworks and lack of evaluation frameworks, and a proposed evaluation framework. Many of the excluded articles focussed on gaining participant feedback to evaluate simulation activities, rather than evaluating the quality of the design and implementation of the simulation. Conclusions: Benchmarking of current United Kingdom (UK) healthcare simulation against UK and international simulation standards is required to increase its quality, therefore, an agreed UK template framework to evaluate simulation packages is recommended.

Abstract Background Clinically meaningful pain reduction with respect to severity and the adverse events of drugs used in prehospital pain management for children are areas that have not received sufficient attention. The present systematic review therefore aims to perform a comprehensive search of databases to examine the preferable drugs for prehospital pain relief in paediatric patients with acute pain, irrespective of aetiology. Methods The systematic review includes studies from 2000 and up to 2020 that focus on children’s prehospital pain management. The study protocol is registered in PROSPERO with registration no. CRD42019126699. Pharmacological pain management using any type of analgesic drug and in all routes of administration was included. The main outcomes were (1) measurable pain reduction (effectiveness) and (2) no occurrence of any serious adverse events. Searches were conducted in PubMed, Medline, Embase, CINAHL, Epistemonikos and Cochrane library. Finally, the risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist and a textual narrative analysis was performed due to the heterogeneity of the results. Results The present systematic review on the effectiveness and safety of analgesic drugs in prehospital pain relief in children identified a total of eight articles. Most of the articles reviewed identified analgesic drugs such as fentanyl (intranasal/IV), morphine (IV), methoxyflurane (inhalational) and ketamine (IV/IM). The effects of fentanyl, morphine and methoxyflurane were examined and all of the included analgesic drugs were evaluated as effective. Adverse events of fentanyl, methoxyflurane and ketamine were also reported, although none of these were considered serious. Conclusion The systematic review revealed that fentanyl, morphine, methoxyflurane and combination drugs are effective analgesic drugs for children in prehospital settings. No serious adverse events were reported following the administration of fentanyl, methoxyflurane and ketamine. Intranasal fentanyl and inhalational methoxyflurane seem to be the preferred drugs for children in pre-hospital settings due to their ease of administration, similar effect and safety profile when compared to other analgesic drugs. However, the level of evidence (LOE) in the included studies was only three or four, and further studies are therefore necessary.