The Advanced Paramedic Clinical Activity Study (APCAS): an insight into the work of advanced paramedics in the mid-west of Ireland.

BACKGROUND: The Advanced Paramedic (AP) is a relatively recent role in Ireland and refers to a prehospital practitioner with Advanced Life Support (ALS) skills and training. The Advanced Paramedic Clinical Activity Study (APCAS) was initiated to provide an evaluation of the impact of the AP programme on patient care in Ireland. AIM: The aim of this study is to provide an insight into the clinical activity of APs over a 6-month period in the mid-west region of Ireland. METHODS: A prospective study was initiated whereby all ambulance calls dispatched by the regional Ambulance Control Centre were recorded by the attending AP, including calls received via the statutory 999/112 system. Participating APs were asked to complete a separate call log data sheet recording all demographic and clinical information for every call attended during the study period. RESULTS: A total of 17 APs participated and 1,969 ambulance calls were recorded in APCAS. The Mid-Western Regional Hospital, Limerick was the busiest receiving facility. Activity peaked at weekends and was lowest on Tuesdays. Crew response, on-scene times and transport times agree with previous reports. Most common emergencies include medical (12 %), cardiovascular (10%) and altered level of consciousness and seizures (10%). Least common calls include airway and ventilation and environmental emergencies (<1%). CONCLUSIONS: This study provides an insight into the work of APs in the mid-west region of Ireland. It would appear that despite the relative recency of the Irish AP programme, the findings of this study are in line with previous international studies.

Dead cattle, lead and child health.

This study was carried out as part of a larger interagency investigation in response to concerns about human health following the death of three cattle from lead poisoning in an old lead mining area in Silvermines, Tipperary. Its aim was to screen for lead toxicity in the local child population. Screening consisted of measurement of blood lead concentrations and the completion of questionnaires regarding exposure to lead and general health. Pre-school and primary school children resident in four surrounding district electoral divisions (DEDs) were specifically targeted. One out of 334 (0.3%) children screened had an elevated blood lead concentration. The geometric mean lead concentration was 2.6 microg/dl which is below the intervention lead concentration of 10 microg/dl recommended by the CDC. The mean lead concentration in those aged under three years was statistically significantly higher than in those aged three years and over (3.4 microg/dl vs 2.5 microg/dl; p=0.000581). No specific health problems were identified by the questionnaires. This study concluded that the elevated environmental lead levels which were demonstrated by other agencies involved in this investigation are not currently being transferred to children. It recommends further blood screening of children in the area and ongoing education to minimise the risk of lead toxicity in the area in the future.