Paramedic stress: ‘We’re micro-managed by people checking response times’

A man who has been a paramedic for 20 years describes the stresses that led to him taking two months’ sick leave in 2015

Peter (not his real name) has been a paramedic with an NHS regional ambulance service in the south of England for almost 20 years. He took two months’ sick leave because of stress in 2015.

I once turned up at a house where a woman and her daughter were crying hysterically because her husband – a man in his 30s – had passed away from a heart attack. And then the couple’s son came home from school to find his dad lying there and his mum and sister in that state. It was awful. I ended up crying with the family while we waited an hour for the police to arrive.

Related: Paramedics taking tens of thousands of days a year off sick with stress

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Paramedics taking tens of thousands of days a year off sick with stress

Staff shortages, pressure to meet response targets, long shifts and emotional toll said to explain rise in stress-related sick days

Paramedics are taking tens of thousands of days a year off sick with stress, as growing numbers of 999 calls add to the pressure on NHS ambulance services.

The number of days being lost to paramedics having time off work because they are struggling with stress, anxiety or other mental health conditions is rising, official figures show.

Related: Paramedic stress: ‘We’re micro-managed by people checking how response times are going’

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Streamlining faster care for EMS triage, transport of stroke patients

A new process, developed by the American Heart Association/ American Stroke Association, will help streamline the initial emergency care of stroke patients.

The new Severity-based Stroke Triage Algorithm for emergency medical services (EMS) equips ambulance crews with information and tools to better identify a stroke, assess a patient’s overall condition and determine the best hospital for the patient’s specific treatment needs.

“The new algorithm is needed as new innovations in stroke treatment emerge, such as catheters used to remove large clots in the brain. Although the intravenous use of tissue plasminogen activator, or IV r-tPA (alteplase), is still the most common standard for treating many strokes, these newer endovascular treatments are appropriate in certain cases. However, they require specific equipment and specially-trained personnel that aren’t available at all hospitals, especially those in rural or suburban areas,” said Peter D. Panagos, M.D., co-chair of the American Heart Association/American Stroke Association Mission Lifeline: Stroke committee that helped oversee and develop the algorithm. “With these available treatment options, the challenge is identifying severe strokes early, before arrival at the hospital, to get patients to the right facility to get the right therapy in the right amount of time.”

The algorithm puts more responsibility on EMS to provide fast, appropriate triage for the most severely impaired stroke patients. It calls for first responders to use a regionally approved stroke severity tool that may help identify a larger ischemic stroke that may require both intravenous and endovascular thrombectomy treatments.

The protocol considers that regions around the U.S. have different assets and resources when it comes to treating stroke — meaning the right stroke care may not always be available at the closest facility. Ideally, providers, responders and other stakeholders in each region understand available resources and work together on a stroke EMS plan. The plan should allow EMS to triage large vessel occlusion stroke patients to centers offering advanced stroke treatments, such as endovascular thrombectomy, as needed, if doesn’t delay treatment too long or impact the use of IV alteplase.

“Sometimes, this could mean bypassing a smaller, closer hospital to get the patient to a larger center providing specialized treatment,” said Panagos, an associate professor of emergency medicine and neurology at Washington University School of Medicine in St. Louis. “Not only does it help to get stroke patients to the optimal hospital, but the algorithm also requires that smaller centers and larger centers work together in a collaborative fashion to streamline the effective care of stroke patients. We like to consider most care is appropriate locally and reserve transport to larger centers in only the most extreme cases.”

A diverse group of healthcare professionals, including EMS and all levels of the hospital-based stroke care teams designed the Severity-based Stroke Triage Algorithm. It is broad enough to be applied across the country and across regions and flexible enough to be tailored to individual communities.

The algorithm is available online for download at www.heart.org/MissionLifelineStroke.

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Materials provided by American Heart Association. Note: Content may be edited for style and length.

Research team develops first-of-a-kind model to research post-malaria epilepsy

A first-of-its-kind mouse model could lead to an understanding of how cerebral malaria infection leads to the development of epilepsy in children, and to the prevention of seizures. The model — a way for researchers to simulate the effects of malaria in children by using mice — was developed in a collaboration between researchers at Penn State’s colleges of medicine, engineering, science and agriculture.

Cerebral malaria is prevalent in children under 5 in developing countries with high malaria incidence. This form of malaria has a high mortality rate and also leads to epilepsy in survivors, with the rate of epilepsy in countries with malaria infections being up to six times higher than those in industrialized countries. There are no treatments during the infection that have been shown to reduce the development of epilepsy and it is not yet understood how malaria leads to epilepsy.

“I work in Africa and people tell me about the shockingly high incidence of epilepsy in children and adults,” said lead investigator Steven Schiff, professor of neurosurgery, Brush Chair Professor of Engineering Science and Mechanics and Mechanical Engineering and director of the Penn State Center for Neural Engineering.

Children with cerebral malaria often enter a coma and die from complications, and up to 17 percent of survivors develop epilepsy. As Schiff looked into how to approach the problem, he realized that not much science is available on post-malaria epilepsy, one of the leading causes of epilepsy on the planet.

“A group of us at Penn State decided to put together our expertise and develop an animal model to test what would be the best therapies for children, so they don’t get epilepsy after malaria,” he said.

To effectively study post-malarial epilepsy, the animal model must be as close to the human version of the disease as possible. The model must contract malaria, be cured and then have the potential to develop epilepsy in the same way that a child does. To mirror the natural environment, the model needs to be generalizable to a variety of situations and not be restricted to a particular type of parasite or infected host.

Having a model will allow researchers to perform pre-clinical testing to design therapies to prevent epilepsy if given during treatment of malaria infection. The model can also be used to study how malaria and similar infectious diseases cause epilepsy — a mystery at present.

The researchers developed four different variations, giving scientists a suite of tools to study malaria. They reported their results in Scientific Reports.

“It’s a suite of models, not just one strain of malaria,” Schiff said. “This helps protect against a model having a version of the disease that is irrelevant to humans. It’s our best shot at developing treatments because there are four different parasite-mouse models to use.”

The model can also be used to study sudden unexplained death from epilepsy (SUDEP). In certain cases, epileptic seizures can lead to a person not breathing and their heart stopping. Until now, researchers did not have a way to study SUDEP. The model they developed also shows instances of SUDEP, giving scientists an important tool to learn what causes the sudden death. By understanding how epilepsy causes SUDEP, researchers can better develop preventative treatments.

This research was a collaboration between Penn State colleges and departments, bringing together experts in malaria and infectious disease, neurosciences, mechanical engineering, electrical engineering, experimental physics, biology, public health sciences and more. The first author on the paper, Paddy Ssentongo, is an African physician with deep knowledge of the complexities of malaria in Africa. The College of Engineering faculty helped develop the technologies needed to conduct the research. Schiff said that the research could not have happened without the team effort.

“This was indeed a collaborative project between requiring a range of very different and critical expertise — from the identification of a critical clinical and human high-impact health problem, to the biology and physiology of malaria parasites, to experimental and instrumentation design,” said Bruce Gluckman, associate professor of engineering science and mechanics and biomedical engineering. “Equally important was the extensive effort — the long hours — put in by the assembled team to pursue this project to its end.”

Research that crosses the borders of engineering, biology and medicine is often complex and complicated.

“This research is a testament to the interdisciplinary collaboration that flourishes at the Penn State Center for Neural Engineering, the Penn State Neuroscience Institute and Penn State University,” said Robert Harbaugh, director of Penn State Neuroscience Institute and chair, Department of Neurosurgery.

Judith Todd, chair, engineering science and mechanics said, “Led by Dr. Steven Schiff, Penn State’s Center for Neural Engineering is truly a model for interdisciplinary collaboration. The common goals of identifying the mechanisms and prevention of post-malarial epilepsy and SUDEP have unified faculty, physicians and students from the engineering sciences, medicine, biomedical engineering, the sciences, and public health, with our global colleagues in Uganda, to achieve results far beyond those of any one group alone. Inspired by a vision of preventing post-malarial epilepsy in millions of sufferers per year, Dr. Schiff is showing how breakthrough research is found when multiple disciplines intersect.”