Strong Response to EMS Field Guide

Irish EMS practitioners take the lead in directing and guiding their profession.

The consultation process for an Irish EMS Field Guide has recently concluded. PHECC-registered practitioners have for some time called for a quick reference tool to assist them, particularly with medication calculations, infrequent clinical encounters and values for clinical measurements. CPG manuals are too large to use as a reference manual during actual patient care, however a field guide is suitable as an aid as it can be carried in the uniform pocket of Practitioners. Low call volume and in particular low volume of specific pre-hospital emergency care clinical conditions has the potential to reduce Practitioner confidence and competence. There are many field guides available commercially, however most are published in the USA and do not comply with PHECC CPGs and medication formulary. Strong demand from practitioners for an Irish EMS Field Guide wasthe driving force behind a PHECC consultation process which started in late 2010. A draft Field Guide was published and circulated to all registrants for evaluation and feedback. The spring edition of the PHECC Voice gave details of an electronic survey where practitioners could participate and contribute with their opinions and suggestions.		Participation in the electronic survey has been comprehensive and detailed. The responses have been very constructive and will contribute to the publication of a Field Guide which reflects what frontline practitioners want. The responses and comments covered not just the clinical content but also the design and quality of the field guide, a sample of which is shown here. The next step will see a process of distillation and evaluation of all the feedback. Every effort will be made to incorporate the input from practitioners. Recommendations relating to content and style will be integrated and balanced to produce a truly reflective field guide. This publication will incorporate the PHECC CPGs and medication formulary but will be driven by the requirements and suggestions. The practitioners next edition will be circulated in September this year, making the edition currently in use obsolete. This publication is a valuable tool which will help protect the public and assist with confidence of frontline practitioners to help reduce clinical and medication errors. The need or requirement for this Guide was identified by the emerging Irish EMS profession and now the content and style has also come from this same group. PHECC would like to thank everyone for their contribution to this process.

You can only please some of the people some of the time . . .
Too much irrelevant detail.		Good size and not filled with unnecessary content. •For a first version the field guide is quite good but is not detailed enough.

•Remove hospital contact numbers – not needed.		•I carry contact numbers for A/E hospitals on area I am working at the time. I notice the field guide list is not exhaustive.

•Size should be made smallenough to fit into the uniform shirt pocket for handy reference; we carry enough gear in our coat & trouser pockets as it is.		•Good size fits well into HSEcombats. •Perfect size to fit in combats or jacket pocket.

•Some content is not required such as Primary Survey, FAST assessment and Lead placement should be like breathing to a professional.		•EMTs do a four-lead placementand may not do this very often so a diagram for EMTs wouldbe welcome.

Feedback always welcome . . . but . . . specifics needed also . . .

It won’t survive.
No suggestions.
No particular comments save to say that improvements need to happen in all walks of life!
You are taken [sic] away my work by all the AP’s if you want AP to do everything you have to get a lot more on the road and you never listen to us before why do you think I believe you will NOW.
I did not receive a field guide so i am unable to rate the quality of the content.
A drug dose is incorrect.
Some of the items I found confusing.

Practitioner Field Guide

What is your practitioner level on the PHECC register?

Answer Options	Response Percent	Response Count
EMT	46.7%	303
Paramedic	36.1%	234
Advanced Paramedic	7.3%	112

Answered question

Skipped question

649

FORMAT

Better quality ring binder.
More durable, particularly the outer covers.
Material of pages should be more durable and waterproofed
Include additional blank pages at rear for individual notes/numbers
Better colour code tabs.Page tabs could be one letter per tab or show all the letters on each tab i.e. A-B-C.

Tabs are a good idea but should include index of the topic they cover.

Use other colours besides blue, could be more like the CPGs.
If the layout of the handbook had a clip where additional sheets could be added.
Should be constructed to open from right to left like a conventional book.
Tabs just folded after one shift.
Can’t find info easily in contents and tabs very poor.
Size should be made small enough to fit into the uniform shirt pocket.

CLINICAL / CONTENT

Quick-guide content list on the cover.
I think that having a field guide with only the relevant info for the level each person practises at would be better, as searching through info that is not applicable is time consuming, e.g. all the drug are listed but only a few are relevant to my level.
I would like the full medication calculations listed.
Would suggest inclusion of a section on common medical abbreviations, to include common prescription terms and a spell checker list. Should also include the new Medical Oversight contact numbers.

Insert a ruler on the edge of the outer cover giving coloured scale bands min and max widths of pr interval, qrs width and qt duration etc. a rate ruler for measuring rr intervals and for assessing regularity of rhythms also.
I think there should be more content surrounding the most common medical and traumatic situations faced from day-to-day including childbirth as it is not a common call so info ready to hand would be a good resource.

Consider putting in an anatomical diagram indicating different regions of the body. A dermatone map would also be useful.
An age per page section might be useful.
Like to see paedi weight calculations etc.
Maybe put in ambulance control centre call numbers with hospital numbers.
I think the Wong Baker faces need to be in a line of order left to right as on the pain scale.
Could the blank pages have the actual CPG printed to coincide with the medication as a reminder?
An ASHICE report with a brief explanation of each letter is very necessary, the standard of verbal handovers in the NAS aren’t very standard at present.
From the EMT point of view, it would be helpful if the medications section had a reference to EMT usage, especially where they differ from P/AP, e.g. salbutamol.
Separate the guide into named relevant sections; Neuro; Cardiac; etc
There should be a little more on ECG interpretation maybe a reminder of what the basic rhythms look like.
Is there any chance that they could lay out ONE page that just reminds us of the med doses for adult and paediatric (for paramedics) i.e. for the most common medications given e.g. Aspirin, Epinephrine, Glucagon, Glucose Gel, GTN, and the new meds coming on stream.

GENERAL

Very well laid out.
Great tool for all responders.
Very good aid, looking forward to next version.
Great to have pocket size reference.
A good field guide...well done .... would be willing to pay up to €10 with improvements.
This booklet is very useful in the field for rapid decision making without time delay. An excellent aid for pre-hospital care for practitioners. Well done PHECC.
Absolutely excellent field guide, small and easy to become part of your daily kit but very comprehensive and informative particularly with all the drug dosages laid out so well and is fantastic for paeds dosages.
Mostly practical and well put together; have used it on several occasions now.
Perhaps copies could be put into vehicle drugs bag and included in vehicle daily check sheet. As this field guide is very important in facilitating safe practise.
Well done gang. Another step in the right direction. Cheers.
This is a great advancement in our field. The book is easy to use, compact and well written. A fantastic attachment for an AP, credit to all the team at PHECC. Great progress as ever from PHECC.
Fantastic booklet, almost all the essential information from the cpg’s that you need on the road. Medication doses an excellent benefit. Well done.
Probably one of the best ideas to come out of PHECC, something tangible, a real improvement that we can see and use for our benefit.
As one of the APs said its now part of your uniform! The book itself is a great resource and always readily available on the person, well laid out and brilliant design.