Australian Ambulance Services (Essay Sample)

Australian ambulance services adult cardiac arrest clinical practice guidelines are created according to best practice using credible evidence
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Introduction
Ambulance Victoria has been providing ambulance services in Victoria since 2008 serving a population of more than 5.5 million peopleADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Report", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "2012-2013 Annual report", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "title" : "Ambulance Victoria 2012-2013 annual report", "type" : "article-journal" }, "uris" : [ "/documents/?uuid=fe67ccd2-79ee-4299-a82b-e9f88ab556ab" ] } ], "mendeley" : { "formattedCitation" : "(Report 2012)", "plainTextFormattedCitation" : "(Report 2012)", "previouslyFormattedCitation" : "(Report 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Report 2012). Because of the large size it reaches on, and the critical nature of the services ambulance and first aiders offer, it is important that they operate under universally accepted and verified guidelines. This would ensure that there is standardisation in service delivery among medical personnel, to avoid adverse effects that could result in a confused system. Ambulance Victoria is one among the Australian ambulance services that operates under stipulated guidelines. The working paper sets to analyze whether guidelines used by Australian ambulance services are based on best practice. With reference to Chapter 2 of the Clinical Practice Guidelines for Ambulance and MICA Paramedics, the working paper will analyze ROSC management under cardiac arrest as a clinical practice guideline. The paper will begin with a review of the stipulated protocol for ROSC management as outlined in the Clinical Practice Guidelines for Ambulance and MICA Paramedics before selecting one element in the and assessing its relevance to other literary material, The working paper will the conclude with a recap of the findings from the correlation of the guidelines with literature review.
Analysis of ROSC guidelines in the handbook
Return of spontaneous circulation (ROSC) management is carried out after one has just had a cardiac arrest and involves resuming of cardiac activity with an aim of having a respiratory effect. According to the guidelines, it is recommended that the paramedic initiates ROSC management through in a sequence of four steps: unintubated, perfusion mix, therapeutic cooling and finally transport ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Victoria", "given" : "Ambulance", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "Cardiac Ar", "container-title" : "Clinical Practice Guidelines for Ambulance and MICA Paramedics", "edition" : "Revised", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "19-25", "publisher" : "Ambulance Victoria", "publisher-place" : "Doncaster, Victoria", "title" : "Clinical Practice Guidelines for Ambulance and MICA Paramedics", "type" : "chapter" }, "uris" : [ "/documents/?uuid=2e3c4447-f39d-452c-b8b6-4aada789f4ee" ] } ], "mendeley" : { "formattedCitation" : "(Victoria 2014)", "plainTextFormattedCitation" : "(Victoria 2014)", "previouslyFormattedCitation" : "(Victoria 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(Victoria 2014). The following section discusses the four steps as outlined in the guideline:
* Unintubated
The unitubated step is initiated when the GCS (Glasgow Coma Score) Collapses. It may fall or rise. In case it rises to 10/60 the paramedic is required to initiate endotracheal intubation notably if the coma persists despite initial oxygenation efforts. In case it falls below 10/60, it is required that 10/60it is usually no therapeutic cooling. It is recommended that the paramedic follows Rapid Sequence Intubation in the event that coma persists despite the oxygenation attempts. This would ensure safety in delivery of services.
* Perfusion management
In the second step, the perfusion management is done to maintain blood pressure, usually at above 120mmHg or the default patient’s blood pressure if it can be determined. The action recommended for paramedics is to use normal saline and adrenaline infusions. The recommended general care for adrenaline infusion is 50mcg per minute to manage the patients. It is stressed that the paramedic should ensure that the delivery system if fully operational. Alternatively, the infusion could be in the form of adrenaline infusion in which case 3 milligram of adrenaline is added to make 50 milliliters with 5 percent dextrose or normal saline. Then it is stipulated that the patient’s heart rate be monitored. The precaution at thus step is that the paramedic should not administer amiodarone unless in the occurrence of a breakthrough in ventricular fibrillation or ventricular tachycardia.
* Therapeutic cooling
It is initiated by occurrence of any of these conditions: the patient is intubated, the patient’s ROSC has collapsed to more than 10/60, the temperature of the patient has risen to above 34.5 degrees Celsius, there is no pulmonary oedema and when the cardiac arrest in due to other causes other than bleeding. The recommended protocol for paramedics at this stage is to assess the patient temperature and perform sedation or paralysis using either midazolam or pancuronium both intravenously. The recommended dose of midazolam is 1-5 milligram while the recommended dose of pancuronium is 8 milligram. The subject should then be placed on a rapid infusion of up to 2000 milliliters of normal saline intravenously. The process should, however, be ceased on the occurrence of acute pulmonary oedema and the patient treated for oedema. The patient’s temperature should, in all cases, be maintained at 32-34 degrees Celsius at all times in this step.
* Transport
This is the fourth step in the ROSC management protocol. The paramedic is recommended to make an early notification to the appropriate receiving hospital about the state of the patient. If available, it is recommended that the patient be placed on a 12-lead electrocardiogram.
Discussion
Guidelines used by resuscitation ambulances are based on best practice. This section will analyse the relevance of the stated argument by examining therapeutic cooling, the third step in ROSC management. The analysis will draw on the medical literature and current research as the basis to support the guidelines. The discussion will be based on factors used in forming the guideline that will be listed and given an insight.
1 Technique for initiating hypothermia
In the guideline, it is recommended that the patient’s temperature be maintained at 32-34 degrees Celsius. This was to be done using infusions, particularly normal saline. In a different study, it was found out that cold-fluid infusion was the most commonly used technique accounting for 80 percent of all the techniques used for initiation of therapeutic hypothermia after out-of-hospital cardiac arrest ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1399-6576.2009.02021.x", "ISSN" : "1399-6576", "PMID" : "19549271", "abstract" : "BACKGROUND: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH.\n\nMETHODS: Data on out-of-hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long-term outcome (6-12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1-2 representing a good outcome and 3-5 a bad outcome.\n\nRESULTS: From October 2004 to October 2008, 986 TH-treated OHCA patients of all causes were included in the registry. Long-term outcome was reported in 975 patients. The median time from arrest to initiation of TH was 90 min (interquartile range, 60-165 min) and time to achieving the target temperature (< or =34 degrees C) was 260 min (178-400 min). Half of the patients underwent coronary angiography and one-third underwent percutaneous coronary intervention (PCI). Higher age, longer time to return of spontaneous circulation, lower Glasgow Coma Scale at admission, unwitnessed arrest and initial rhythm asystole were all predictors of bad outcome, whereas time to initiation of TH and time to reach the goal temperature had no significant association. Bleeding requiring transfusion occurred in 4% of patients, with a significantly higher risk if angiography/PCI was performed (2.8% vs. 6.2%P=0.02).\n\nCONCLUSIONS: Half of the patients survived, with >90% having a good neurological function at long-term follow-up. Factors related to the timing of TH had no apparent association to outcome. The incidence of adverse events was acceptable but the risk of bleeding was increased if angiography/PCI was performed.", "author" : [ { "dropping-particle" : "", "family" : "Nielsen", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hovdenes", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nilsson", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rubertsson", "given" : "S",...