A quantitative study of confidence among paramedics in assessment of the cardiovascular system

Background

Patients presenting to the ambulance services with cardiovascular complaints are common, and as such, represent a notable proportion of paramedic clinical practice. Numerous texts refer to a system-based approach to cardiovascular assessment, however the application by paramedics is scarcely researched. As such, this article aims to quantify paramedic confidence levels regarding an examination of a patient with a cardiovascular complaint.

Methods

An online cross-sectional survey was conducted, recruiting paramedics from one ambulance trust within the United Kingdom and analysing their confidence levels of assessing a patient with a cardiovascular complaint. Paramedics were recruited using purposive sampling and asked to complete an online questionnaire exploring their confidence levels among cardiovascular assessments, which were subsequently quantified to summarise confidence levels expressed by these respondents.

Results

A total of 331 responses across one ambulance service were received in April 2021. Of these, 90.3% (299/331) reported a high level of confidence with the general cardiovascular assessment. Throughout all individual elements of assessment, over 50% of respondents indicated they feel confident with the examination, except when assessing heaves and thrills where 56.2% (185/329) and 55.1% (182/330) of respondents disagreed with feeling confident, respectively. A strong correlation was seen throughout the results between confidence levels and the reported occurrence of each type of assessment, which was demonstrated using Spearman's rank-order correlation.

Conclusions

High confidence levels for a cardiovascular examination were reported among the respondents of this survey. Paramedics have shown good confidence among all areas of a cardiovascular assessment, except with palpating the chest for heaves and thrills. There is an evident link between reported confidence levels and how often these assessments are completed, however there is still room for additional training and research within this area.

Pre-hospital Assessment of Large Vessel Occlusion Strokes: Implications for Modeling and Planning Stroke Systems of Care

The social and financial burden of stroke is remarkable. Stroke is a leading cause of death and long-term disability worldwide. For several years, intravenous recombinant tissue plasminogen activator (IV rt-PA) remained as the only proven therapy for acute ischemic stroke. However, its benefit is hampered by a narrow therapeutic window and limited efficacy for large vessel occlusion (LVO) strokes. Recent trials of endovascular therapy (EVT) for LVO strokes have demonstrated improved patient outcomes when compared to treatment with medical treatment alone (with or without IV rt-PA). Thus, EVT has become a critical component of stroke care. As in IV rt-PA, time to treatment is a crucial factor with high impact on outcomes. Unlike IV rt-PA, EVT is only available at a limited number of centers. Considering the time sensitive benefit of reperfusion therapies of acute ischemic stroke, costs and logistics associated, it is recommended that regional systems of acute stroke care should be developed. These should include rapid identification of suspected stroke, centers that provide initial emergency care, including administration of IV rt-PA, and centers capable of performing endovascular stroke treatment with comprehensive periprocedural care to which rapid transport can be arranged when appropriate. In the pre-hospital setting, the development of scales easier and quicker to perform than the NIHSS yet with a maintained accuracy for detecting LVO strokes is of paramount importance. Several scales have been developed. On the other hand, the decision whether to transport to a primary stroke center (PSC) or to a comprehensive stroke center (CSC) is complex and far beyond the simple diagnosis of a LVO. Ongoing studies will provide important answers to the best transfer strategy for acute stroke patients. At the same time, the development of new technologies to aid in real time the decision-making process will simplify the logistics of regional systems for acute stroke care and, likely improve patients' outcomes through tailored selection of the most appropriate recanalization strategy and destination center.

A cool response-The influence of ambient temperature on capillary refill time

OBJECTIVE

To describe the effect of low ambient temperature on skin temperature and capillary refill (CR) time in forehead, sternum and finger pulp.

METHODS

An observational, nonrandomized experimental study on 15 healthy subjects (6 females) in a cold room (8°C). Outcome measures were skin temperature and quantified CR test after application of a standardized blanching pressure (9 N/cm² ) using digital photographic polarization spectroscopy to generate CR times.

RESULTS

The finger pulp showed marked temperature fall and prolonged CR times (>10 seconds). The CR registrations of the forehead and sternum were more comparable to curves observed in a control material at room temperature, and skin temperature falls were less marked. CR times were not prolonged in forehead measurements. At the sternum, some individuals showed CR times beyond guideline recommendations despite only a marginal reduction in skin temperature.

CONCLUSIONS

Low ambient temperature is a strong independent factor for CR time at peripheral sites. Reservation about sternum as a site of measurement is warranted since cold provocation produced prolonged CR times in some individuals. We found that the forehead is the most thermostable of the 3 sites and thus the preferred site to avoid ambient temperature artifact in measuring CR time.