Search results

Most UK ambulance services undertake remote assessments of 999 calls with nurses and paramedics to manage demand and reduce inappropriate hospital admissions. However, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they offer.

The retrospective descriptive study analysed data collected at Welsh Ambulance Services University NHS Trust (WAST) from prioritisation, triage, and audit tools between the 17th May 2022 to 8th November 2022. A total of 21,076 cases and 728 audits were included for review.

There was little difference in the type and frequency of the presenting complaints assessed, and clinical outcomes reached in percentage terms. Whilst paramedics had more highly compliant call audits and fewer non-compliant call audits, there was, again, little difference in percentage terms between the two, indicating positive levels of safety across the two professional groups.

There continues to be a substantial difference between UK paramedics to those in the Middle East, the United States, and some African nations, which may limit the applicability of findings. This study also looked at a six-month window from only one UK service using one type of prioritisation and triage tool. Future research could explore longer periods from multiple services using various tools. It is important to note that this study did not link outcome data with primary, secondary or tertiary care settings. Thus, it is impossible to determine if the level of care aligned closely with the final diagnosis.

The practical implications of this work include better workforce planning for agencies who have perhaps only employed one type of clinician or a reaffirmation to those who have employed both. The authors suggest that the training and education of both sets of clinicians could remain general in nature, with no overt requirement for specificity based on professional registration alone. Commissioners and stakeholders in the wider health economy should consider ensuring equitable access to alternative pathways for patients assessed by both nurses and paramedics.

It has been posited that UK nurses and paramedics are, by virtue of their consistency in education, skill set, licensure, and general experience, both able to achieve safe and effective remote outcomes in 999 settings. This study provides evidence to support that hypothesis. These results say more about the two professions' ability to work together rather than just the professions themselves. The multidisciplinary team approach is well-established in acute care settings, and is broadly considered to improve communication, coordination decision making, adherence to up-to-date treatment recommendations, and be positive for shared learning and development for younger colleagues.

Most UK services use a mix of nurses and paramedics; however, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they each offer. The most recent studies of this nature were published in 2003 and 2004 and looked only at low-acuity 999 calls when remote assessment was not even an established role for UK paramedics. This study updates the literature, identifies areas for future research, and applies to the international setting for the most part.

The institution of food and cookery exhibitions and the dissemination of practical knowledge with respect to cookery by means of lectures and demonstrations are excellent things in their way. But while it is important that better and more scientific attention should be generally given to the preparation of food for the table, it must be admitted to be at least equally important to insure that the food before it comes into the hands of the expert cook shall be free from adulteration, and as far as possible from impurity,—that it should be, in fact, of the quality expected. Protection up to a certain point and in certain directions is afforded to the consumer by penal enactments, and hitherto the general public have been disposed to believe that those enactments are in their nature and in their application such as to guarantee a fairly general supply of articles of tolerable quality. The adulteration laws, however, while absolutely necessary for the purpose of holding many forms of fraud in check, and particularly for keeping them within certain bounds, cannot afford any guarantees of superior, or even of good, quality. Except in rare instances, even those who control the supply of articles of food to large public and private establishments fail to take steps to assure themselves that the nature and quality of the goods supplied to them are what they are represented to be. The sophisticator and adulterator are always with us. The temptations to undersell and to misrepresent seem to be so strong that firms and individuals from whom far better things might reasonably be expected fall away from the right path with deplorable facility, and seek to save themselves, should they by chance be brought to book, by forms of quibbling and wriggling which are in themselves sufficient to show the moral rottenness which can be brought about by an insatiable lust for gain. There is, unfortunately, cheating to be met with at every turn, and it behoves at least those who control the purchase and the cooking of food on the large scale to do what they can to insure the supply to them of articles which have not been tampered with, and which are in all respects of proper quality, both by insisting on being furnished with sufficiently authoritative guarantees by the vendors, and by themselves causing the application of reasonably frequent scientific checks upon the quality of the goods.

The information which has hitherto appeared in the daily press as to the evidence laid before the Departmental Committee which is inquiring into the use of preservatives and colouring matters can hardly have afforded pleasant reading to the apologists for the drugging of foods. It is plainly the intention of the Committee to make a thorough investigation of the whole subject, and the main conclusions which, in the result, must bo forced upon unbiassed persons by an investigation of this character will be tolerably obvious to those who have given serious attention to the subject. At a later stage of the inquiry we shall publish a full account of the evidence submitted and of the Committee's proceedings. At present we may observe that the facts which have been brought forward fully confirm the statements made from time to time upon these matters in the BRITISH FOOD JOURNAL, and amply justify the attitude which we have adopted on the whole question. Representatives of various trade interests have given evidence which has served to show the extent to which the practices now being inquired into are followed. Strong medical evidence, as to the dangers which must attach to the promiscuous and unacknowledged drugging of the public by more or less ignorant persons, has been given; and some medical evidence of that apologetic order to which the public have of late become accustomed, and which we, at any rate, regard as particularly feeble, has also been put forward. Much more will no doubt be said, but those who have borne the heat and burden of the day in forcing these matters upon the attention of the Legislature and of the public can view with satisfaction the result already attained. Full and free investigation must produce its educational effect ; and whatever legal machinery may be devised to put some kind of check upon these most dangerous forms of adulteration, the demand of the public will be for undrugged food, and for a guarantee of sufficient authority to ensure that the demand is met.

What proof have the public, independent of the assertions of the makers, that all the firms whose products are sold indifferently by the shopkeepers use only the best materials; or, indeed, that a large number of the articles sold are not mixtures more or less objectionable or fraudulent ? This, in effect, is the question put by a writer in a West of England newspaper, and it might be used as a text upon which to write a lengthy homily on the adulteration question and on the astonishing gullibility of the public. As a matter of fact the only evidence of the character and quality of food and other products, in regard to which there is no independent guarantee, is that which is afforded by the standing of the makers, and to some extent of the firms which offer them for sale. And this evidence cannot, under any circumstances, be looked upon as constituting proof. The startling allegations so commonly put forward by advertisers with respect to their wares, while they may be ineffective in so far as thinking people are concerned, must nevertheless be found pecuniarily advantageous since the expense involved in placing them under the eyes of the public would otherwise hardly be incurred. Many of these advertised allegations are, of course, entirely unjustifiable, or are incapable of proof. It may be hoped that the lavish manner in which they are set out, and their very extravagance, may, in time, result in producing a general effect not contemplated by the advertisers. In the meantime it cannot be too often pointed out that proof, such as that which is required for the satisfaction of the retailer and for the protection of the public, can only be obtained by the exercise of an independent control, and, in certain cases, by the maintenance of efficient independent inspection in addition, so that a guarantee of a character entirely different to that which may be offered, even by a firm of the highest eminence, may be supplied.

Month after month we bring forward additional evidence of the injury resulting from the use of chemical “preservatives” in food, while the Authorities feebly hesitate to give specific legal effect to the recommendations of the Departmental Committee which made such a complete inquiry into this question. The evidence upon which those recommendations were based has been fully corroborated by a number of different observers. FERE and others have shown that, as regards boric acid and borax, even when administered in the smallest medicinal doses, there is always the risk that these drugs may aggravate, or even produce, renal diseases. These observations have been confirmed by the work of Dr. CHARLES HARRINGTON, an account of which has been recently published. Twelve cats were fed on the same food; six were treated with borax, one had no preservative, and five were given a preservative which had no apparent effect. The experiment extended over a period of 133 days, the quantity of borax given averaging about 0.5 grms, per diem. Three of the borated cats soon became ill, and one died at the end of six weeks. On the termination of the experiment the cats were all killed, and upon examination it was found that the organs of the six cats which had not taken borax were in perfectly sound and healthy condition, while the others, with one exception, were all suffering from nephritis. Of course, instances are recorded in which patients have been treated with borax and boracic acid with apparently no injurious result, but as a general rule these experiments have been of too short duration to allow of the desired information being arrived at, and the results must therefore be regarded as inconclusive and unreliable. It is perfectly evident that the kidneys may be for a short time quite capable of eliminating many objectionable substances, but the long‐continued use of such bodies, as Dr. HARRINGTON'S researches clearly indicate, sets up an inflammatory condition of the kidneys which, of course, interferes with the effective performance of their proper functions, and lays the foundations for complications of the most serious nature.