All previous HCPC reflective prompt posts were published on our social media pages – X, Facebook, Instagram.
Category: CPD
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CPD V1.7 (Nov 2023) Portfolio Access
Access All Links Below
View an example of a completed portfolio export – check out Article 999’s portfolio sample here.DownloadParamedics:
- If you are an HCPC-Registered Paramedic post-NQP, click here
- If you are an HCPC-Registered Newly Qualified Paramedic, click here – don’t worry, you can stick to the same portfolio when you complete your NQP period, you may just then choose not to print your NQP learning outcomes section.
These are the same with the exception of an additional section for NQPs to tick off their learning outcomes, and additional guidance when completing reflections. The learning outcomes are based on EEAST’s portfolio and are agreed nationally, so they should be the same for every Trust. However, please check your own Trust’s portfolio for certainty. If you don’t think the portfolio meets your Trust’s requirements, please get in touch for adaptations.
Non-HCPC Staff
- If you are a non-HCPC registered health-care practitioner (EMT/AAP/ECA/FREC etc), click here.
For Paramedics and NQPs, this contains all elements mentioned in the posters on the page you just visited – enter all of your CPD here. For non-HCPC staff, the template contains all necessary components: the ability to log reflections, skills, development goals, collect feedback, and log general CPD from a simple form, along with calendar views and more.
Thank you, and let me know what you think!
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HCPC Portfolio Help File
[tabby title=”Intro to the Help Folder”]
This help folder is a guide to help you create a CPD portfolio that is ready to submit to the HCPC. Pair this with Article 999’s CPD templates for everyone from first aiders/FREC-qualified staff/EMTs through to NQPs and post-NQPs. These are available from this link.
You will need to set up your own free Airtable account. Then, click ‘copy base’ to add the entire template to your own account. You can then click on the tables and add or edit it as you desire.
Those of you following Article 999 in recent months will be aware of the developments in the CPD templates, which are now for everyone from first aiders/FREC/EMT-level staff through to NQPs and post-NQPs.
Previously at v1.5, new updates have just been launched to move these templates on to v1.6. Here is a summary of the key changes.
Previously, you were asked to have a look at a OneNote ‘help file’ (originally called the portfolio). The latest updates to the Airtable templates mean the file in its previous format is no longer needed, so I have copied the majority of the information here for ease. Simply use this for reference to ensure you understand the process, and to check you have everything you need before you submit.
In this help folder, each tab contains referenced guidance on what is required.
How do I use the help folder?
There are 4 numbered sections that each contain advice for you to read: 500 word summary of practice, dated list of CPD activities, 1,500 word supporting statement, and supporting evidence.
These sections form a template that you are encouraged to copy to meet the HCPC audits. You could copy the layout into your own (empty) folder and fill in the pages if you’d like to customise it all, or fill out the sections in your Airtable portfolio.
The second-last tab contains links to the above documents. Use them to review your folder and check that you meet the criteria.
When you are ready to submit, print/export directly from Airtable (choose the ‘save to pdf’ printer option if you don’t need a paper copy), then use Adobe’s free online merger tool.
What if I need help?
That’s absolutely fine. Further information, video guides, and an appointment booker is available from the Article 999 website here: https://article999.co.uk/cpd-templates-for-paramedics-and-nqps/
What if I’m using an older version of the templates?
Please get in touch with a screenshot of your CPD template number or the date you first started using it. I’ll personally update your version to the latest one.
References
This help folder has been produced with reference to the following:
https://library.myebook.com/MyeBookEM/college-of-paramedics-1/2984/
[tabby title=”1. 500 Word Summary of Practice History”]
You are expected to write a 500 word summary of your practice history – i.e. what your role is and what you come across within that role. You can use your official job description for ideas, but think along the lines of:
- Patient groups (ages/health conditions) – it’s worth mentioning who your service users are and who they could be if you intend to change roles. Later, you’ll justify whether your CPD has benefitted your service users (standard 4)
- Type of work (clinical/mentoring)
- Type of skills (clinical/leadership/mentoring)
Want the reference? Want more info?
The above is summarised from: https://www.hcpc-uk.org/globalassets/resources/cpd/how-to-complete-your-cpd-profile.pdf?v=637366426050000000
[tabby title=”2. Dated List of CPD Activities”]
Please follow the information on our CPD template page here. You will need to set up your own free Airtable account. Then, click ‘copy base’ to add the entire template to your own account. It is now yours and you can start logging CPD.
This is important:
All of your activities should meet standard 2 – they should be relevant to your current or future practice, and they should be a mix of different types.
No gaps of more than 3 months without an explanation
How much stuff?
- The HCPC do not request a number of hours and do not record CPD points.
- You need to show a continuous record, with unexplained gaps of no more than 3 months, but beyond that there is no requirement for doing a certain amount of CPD.
- As long as you have a combination of CPD activities, some (the ones you specifically mention in your statements) are evidenced, and you meet the HCPC standards, you should have enough content.
If you want clarification/reassurance about what should be in your portfolio, here is some info on how it should look:
How should I display the dated list of CPD activities?
- Use any format you wish for this. This may be a report produced by a CPD app, or your own Excel/Word/Access database.
What content should be in it?
- Date
- Title of activity
- Type of activity
- Tick boxes to show the activity meets standards 3 + 4
- Page number reference for any evidence/attachment
- You may wish to include a comments box or short reflection (what/so what/now what) to explain how each activity meets standards 3 and 4 or what you have gained from doing each activity.
- Reference (optional; if relevant)
- Development goals (optional; you may find it useful to keep a log of how your activities are meeting your own career development goals).
- Time spent on activity (optional; may be useful for you to record)
[tabby title=”3. 1,500 word supporting statement – How I Have Met the Standards”]
How long should the supporting statement be?
Up to 1, 500 words.
What’s it about?
The below is summarised from Clarke, 2020 & HCPC, 2017 (references below).
This is a supporting statement that should explain how you have met standards 3 + 4 by completing your CPD activities. Focus on what you have gained from your CPD activities, and on what the service & patients gain from your learning. Focus on 4-5 CPD activities and ensure these are different types. It’s best to use activities that you also have evidence and/or reflections for, then reference or quote from these. Link in your personal development goals as long as they don’t distract from the bold bits above.
Standards 1 and 2 should be mentioned but are met by completing your CPD portfolio properly, as requested by the HCPC.
The statement should also explain how you have met your development goals. These goals should include your ‘learning needs’ (HCPC, 2017). By discussing how you have met these goals (i.e. how have your CPD activities been relevant to your current and future work), you’ll be adding further evidence to Standard 2.
What are the HCPC Standards?
Standard 1 – Maintain a continuous, up-to-date and accurate record of my CPD activities
Standard 2 – Demonstrate that my CPD activities are a mixture of learning activities relevant to current or future practice
Standard 3 – Seek to ensure that my CPD has contributed to the quality of my practice and service and delivery
Standard 4 – Seek to ensure that my CPD benefits the service user.
Standard 5 – Complete and submit a CPD profile, and evidence of your CPD, when asked
More details, please.
The Article 999 templates are based on advice gained from Vince Clarke’s (2020) guide to a CPD portfolio. Here’s the link: https://library.myebook.com/MyeBookEM/college-of-paramedics-1/2984/.
They are also based on the HCPC’s guidance to creating a CPD profile (2017). Here’s the link: https://www.hcpc-uk.org/globalassets/resources/cpd/how-to-complete-your-cpd-profile.pdf?v=637366426050000000
[tabby title=”4. Supporting Evidence”]
Key Points
- Attach at least 4 pieces of evidence.
- These are activities you have ‘written about in the profile’ (HCPC, 2017) – i.e. not all activities, but you must include the ones you choose to specify in your statement.
- Evidence types that are suggested include:
- development plans
- certificates
- reflections
- meeting notes
- feedback from peers or patients (including compliments, where these are confidential)
- Note that development goals are printed separately from Airtable but do count as part of your evidence.
- You can use the Airtable template to print a contents page of your evidence (all CPD entries that you have attached evidence to).
- To attach your chosen 4 pieces of supporting evidence (I like to call them ‘featured’ evidence), simply print them directly from Airtable:
Click on the thumbnail, and print/export. Details, please
The notes here are summarised from:
More details can be found there, including an appendix of a variety of evidence types if you are looking for ideas.
[tabby title=”Detailed Reflections”]
Detailed reflections may be used as evidence – Within the Airtable database, Rolfe et al’s (2001) reflective model is used. But the HCPC don’t prescribe any specific model. You could use any you prefer, including Gibbs or John’s (below).
John’s model:
- Description of the experience
- Reflection
- Influencing factors
- Could I have dealt with it better?
- Learning
- Appendix
- References
Here’s a good pocket book for finding reflective models that might be lesser known but more useful to you:
[tabby title=”Review CPD Prior to Submission”]
Those familiar with the OneNote version of this help file will know that file printouts of 2/3 of the below are available there. In this version, I have added the three references as links. I’ll always recommend reading these before submitting your portfolio as evidence to ensure you understand the process and have been thorough in your preparation.
https://library.myebook.com/MyeBookEM/college-of-paramedics-1/2984/
[tabby title=”Using the templates”]
Here is the full video on how to use v1.6 of the CPD templates:
Don’t forget, there is a calendar in the templates as well, which are available for you to check you haven’t left gaps of 3 or more consecutive months without an explanation. The skills calendar is available so that you can check how often you are completing skills.
For more information about the templates, and to book a 1:1 Teams appointment for additional support, please see this page.
If you are just looking for a printing/exporting guide, please click on the next tab.
[tabby title=”Printing/exporting guide”]
Printing/Exporting
Here’s a basic list of the order to print and export your CPD portfolio in:
- The Cover Page
- Print this using the ‘extensions’ tab on the right-hand-side of the page. Ensure the correct table is selected by clicking the settings button and selecting the chosen table:
Settings button within the extension tab. 
Settings option Click done, then print, then print again. Set your destination as your chosen printer, or print to pdf. Click save, and save this file in a folder on your computer.
2. The Summary of Practice History
This should be printed using the same tool, above. Select from the settings the correct table (1. Summary of Practice History). Repeat the instructions above.
3. The Dated List of CPD Activities
- There are a few things to print here:
- The CPD log
- Evidence List
- Reflections
- Skills
- To print the CPD log, select the table, then select the title, and choose print view from the list:
Check the settings show: landscape, actual size, small, and that all other options are turned on. Select print. Choose your printer option – or save to pdf – and print/save. Ensure the ‘headers and footers’ option is turned off in your browser printing settings.
- The evidence list and skills tables prints the same as the above – repeat the instructions
- The reflections table prints using the extension on the right-hand side. Select the settings icon as shown above, then the following:
4. Development Goals, NQP Learning Outcomes, and HCPC Standards of Proficiency print the same way the CPD log, evidence list, and skills do. Repeat those instructions above to print these.
5. The Statement of How I Have Met the Standards prints the same way the reflections, cover page, and Summary of Practice History does. Repeat those instructions to print this, ensuring the correct table is selected in the extensions tab.
To summarise, you should end up with 10 PDFs or printed documents if you are printing/exporting every option available. These should consist of:
- 6 that have been printed using the ‘print view’ option, in which you simply print the same table that you see.
- 4 that have been printed using the ‘extensions’ tab on the right-hand side, in which you print 1 page per entry (1 page per reflection, 1 cover page, 1 page for each statement).
Merging the PDFs
To merge your files, please use your favourite merger tool or https://smallpdf.com/, which is a free website/app for Windows and Mac users. Ignore anything on this site that says you need to sign up for this trial. Press the x to get out of any pop-up that insists on this. Please do the following:
- Upload the files to the merge PDF section, and order them accordingly.
- Download this file
- If you would like page numbers in your file, please use the number pages option in the tool menu. To use this, click on it, upload the merged document, allow it to number pages, then download the new document if you are happy with this.
- If you are not happy with the finished version, click on the edit pdf option to delete any blank pages or re-order accordingly.
- When you are happy, download the final version. Try not to experiment with multiple downloads as smallpdf has a daily download limit.
Electronic Signatures?
- If you are an NQP and you would like electronic signatures for your learning outcomes (and your Trust is happy with this), send the completed document to the person marking your portfolio and ask them to sign in the signature column, in the NQP learning outcomes section, using Adobe Acrobat (free). They can then send this completed version back to you. And voila, we have electronic portfolios!
Prefer to Watch This? Here’s a Video:
[tabby title=”Preview the final portfolio”]
The cover page will print on one A4 page 
The summary of practice history will print one one A4 page using the extension tab on the right-hand side. Click on the settings icon to navigate between the cover page, summary of practice history, statement of how you have met the standards, and reflections (within the dated list of CPD activities).
Settings button within the extension tab. 
When printed in landscape, this is how the CPD log will look. You can set your destination to ‘save as PDF’ if you would like to export it. The yes/no to evidence column acts as a reference to your evidence list. 
The statement of how you have met the standards will print on one A4 page using the extension tab on the right-hand side. 
The evidence list can be found within the dated list of CPD activities section and printed in landscape or portrait mode (some adjustments to the size of the columns may be needed when printed in portrait mode). This list will contain a title, date, the CPD categories/type, and a thumbnail of any evidence attached. The page number column is optional and may be used if you choose to print your evidence separately in larger images. Remember, you only need 4-6 pieces of evidence, so it may be useful to feature your evidence in a larger format. Clicking on the image will expand it in a PDF format, which can then be saved/printed. 
Finally, reflections can be printed using the extensions tab and ensuring your dated list of CPD activities is selected, and the ‘view’ is highlighted to be reflections. These print on one A4 page as shown above. Try to write more than a few lines so it presents nicely – but less than the word count shown in your portfolios. More on this in the video guides (v1.6 guide coming soon). If you are exporting your portfolio to PDF, choose to print, then ‘save as PDF’ as your printer type. You will end up with several PDFs that will need to be merged using your preferred tool. I am now recommending the smallpdf website/app. This app also allows you to number PDF pages and edit the final version (delete pages you don’t want, etc) for free. Downloads have a daily limit, so be sure to only download when you’re happy it’s ready.
If you are a NQP who would like electronic signatures on your portfolio, you can then send your portfolio to your mentor/manager and ask them to fill in the signature column using Adobe Acrobat (free). They can then save and email this final version back to you.
Need help or more info, or want to go ahead and get started? Great, head here for the details.
[tabbyending]
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Seeking Clinical Mentors
As HCPs we are used to having mentors. We are assigned them in training programmes, trained to become them as part of our progression, and some workplaces offer ‘team leader’ style roles for continued mentorship post-training. But what about when we want advice on accessing career pathways that aren’t immediately available?
What about when we are thinking of reducing hours, changing contracts, trying different Trusts and don’t know anyone currently doing the same?
LinkedIn is a great tool – if people respond, and I have said for some time that if you look for someone doing what you would like to do, you will likely find them. The problem is, that doesn’t mean you can ask them how they got there, what courses were worthwhile (or are now worthwhile amidst constantly moving barriers like Trusts previously wanting level 3 certificates now wanting level 4, and evolving career maps), or how to get anyone in your chosen line of work to answer your enquiries.
Image: Little help with those steps, please. Image shows a hand holding a wooden block in place as a stair while a wooden man steps up to it. Paramedics are now working across a variety of fields, and as I have written recently, I believe that we may soon reach a point like other professions of working a generic few years before choosing specialist paths. However, I am aware that many are trying to work out which path is most suited to them, which one isn’t a dead-end and involves a good mix of a healthy shift pattern, interesting work, and career progression. It isn’t easy to choose when many pathways are new or still being developed. Some appear in one part of the country several months before they pop up in another and as most of us have experienced, the same pathway doesn’t necessarily look or feel the same in every Trust.
I believe that it should be easier for us to find mentors and support each other to answer simple questions like those written above. I hope to soon provide Article 999 mentors who will available to answer questions and offer guidance. These mentors will be working in a variety of specialised roles. They may have specialist interests that have become part of their career. Going forward, they may be able to provide more in-depth career discussions and advice, and some of them may be interested in collaborating on projects and ideas.
What does mentoring mean to you? Image shows people trying to climb up a series of blocks, receiving help from each other in the form of hands up and ladders. We as Paramedics do have the benefit of information and support available from unions and the College of Paramedics, but we don’t have an easy to access resource of helpful, responsive, qualified mentors who are there to help you:
- Progress
- Network
- Make informed career choices
- Make informed course choices to spend your money and time effectively and efficiently
- Find guidance (and perhaps inspiration) when you are unsure where to take your career or what is next for you.
Learning and leadership – two interconnected terms relating to mentoring If you are interested in becoming a mentor for Article 999 please email me at article999uk[at]gmail.com with your name, role (and registration number if you are registered), clinical background and experience, area of specialist interest(s), and mentoring experience and qualifications. Please note this is currently voluntary, but committed mentors will be contacted in the future as this project develops and grows. Mentors will also receive a certificate that could be used for CPD portfolios.
If you are interested in being mentored then please let us know by liking this post, commenting and/or sharing it.
Motivational quote “Leadership is unlocking people’s potential to become better” appearing behind torn blue paper. “Mentoring is a brain to pick, an ear to listen, and a push in the right direction.”
John C. Crosby
(one of many quotes that describe effective mentoring) -
To Specialise or Remain General? An Opinion Post.
This is a discussion I have had with several people recently. I’ve observed the same discussion on social media: Is it better to specialise by taking specific job roles or courses, or to keep up with the ‘jack of all trades’ role of a Paramedic?
Our profession is at a point of developing specialisms that seem to be staying put. We can now work in primary and urgent care, in research, in palliative care, resuscitation and education roles, or in other community roles such as rapid response. There are ACCP routes popping up around the country. There are resuscitation roles in specialist hospitals, and community roles that focus expertise on specific conditions. I can see a potential future for new staff being one of a few years of general practice, followed by a series of options containing different specialities and of course, different rotas. This is the way other professions have gone and of course, Paramedicine is young compared to the role of a Doctor or Nurse. Perhaps it is only natural for career paths like these to develop over time. It certainly makes for a more interesting, unique career, and it allows us to develop expertise. Specialising also contributes to a clear CV that should help lead to further roles in the area. It could be argued that without emphasising those areas of expertise on our CV, we might stand out less to a potential employer.
Some argue that remaining general means we never develop expertise in any given area, hence the ‘jack of all trades’ expression that I have heard previously expressed about our profession – we all know how that expression ends. Can anyone be a master of all?
Many of the roles currently available offer part-time work. I am working in one of these, four days a week. It means the majority of my time is spent with adults, but as I maintain frontline shifts I could still come across paediatrics and maternity jobs. I may specialise in one or two areas, but if this means I do not develop in other areas then I am not being honest with myself: I need more CPD related to those areas I now come across less because I am at risk of deskilling. If I want to develop as a Paramedic then surely I need to develop in all areas of practice.
My answer to this conundrum is simple: If you do not intend to maintain any frontline work, you do not need to remain general. But if you intend to keep up any of that work, even if this will only be occasional, you must develop in all areas within your remit. You may still specialise and opt for higher level courses in the areas that take up the majority of your time, but it seems sensible to ensure you develop in all the areas you work in. It’s those areas we see the least that will make us the most hesitant. I cannot safely leave my paediatric knowledge behind with what I learned several years ago when I could still see young patients. I cannot stop learning about maternity when those jobs have the potential to be so time-critical. I don’t want to stop focusing on trauma.
I believe to be the best for our patients, we must juggle all areas. Our expertise is then not necessarily about the courses we have done but the experience we have gained. As I spend the majority of my time working in one or two areas, I could argue those are my specialisms – but I am also still remaining general.
Share your opinion in the comments below.
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Should Patients Take Caffeine-Containing Analgesics?
Many of our patients have high temperatures, especially during COVID outbreaks. Some of them are taking over the counter pain relief as required. This is of course recommended, however many of our patients are also tachycardic due at least in part to their high temperatures. When they complain of palpitations, do they need to be aware of the effects of caffeine-paracetamol combinations? Should they be taking this combination at all, or should they simply ease off dietary sources of caffeine while taking analgesics? Here are a few quotes on the subject for discussion. Full references are below. For a fast fact summary, have a look at the featured image below:
A dose of caffeine equivalent to a mug of coffee added to a standard dose of common analgesics such as paracetamol or ibuprofen provided better pain relief. Analgesic plus caffeine increased the number of people who had a good level of pain relief by 5% to 10% compared with analgesic alone
Derry et al, 2014.But…
When the recommended paracetamol-caffeine dosing regimen is combined with dietary caffeine intake, the resulting higher dose of caffeine may increase the potential for caffeine-related adverse effects such as insomnia, restlessness, anxiety, irritability, headaches, gastrointestinal disturbances and palpitations.
EMC, 2017Even a small dose of 50 mg caffeine can cause tachycardia, anxiety and ectopic beats. Toxicity is normally seen at doses > 500 mg, but this depends on tolerance.
Take into account dietary and other medicinal sources of caffeine: people may not be aware from the brand name that a particular preparation contains caffeine. Consider whether paracetamol with caffeine is necessary: it cannot be assumed that it will be tolerated in the same way as paracetamol alone.
NPS MedicineWise, 2010References
Derry, C.J. et al, 2014. Caffeine as an analgesic adjuvant for acute pain in adults. [online] Available at: https://www.cochrane.org/CD009281/SYMPT_caffeine-analgesic-adjuvant-acute-pain-adults (Accessed 21/01/21)
EMC, 2017. Paracetamol & Caffeine 500/65 mg Effervescent Tablets. [online] Available at: https://www.medicines.org.uk/emc/product/7416/smpc#gref (Accessed 21/01/21)
NPS MedicineWise, 2010. Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies. [online] Available at: https://www.nps.org.au/radar/articles/paracetamol-with-caffeine-panadol-extra-available-over-the-counter-from-pharmacies (Accessed 21/01/21)
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What is the structure of the digestive system?
A Biology (basics) post.
‘The human digestive system consists of the alimentary canal [the gut] and its associated glands, the salivary glands, the liver and the pancreas. The alimentary canal begins at the mouth and ends at the anus. Between the two openings is a long convoluted tube organised into several distinct regions.’
(Boyle and Senior, 2008: 131).
The Short Answer
The digestive system is:
the ‘alimentary canal and its associated glands, the salivary glands, the liver and the pancreas.’ (Boyle and Senior, 2008: 131)
The Extended Answer
Within the alimentary canal are:
- The mouth, including the tongue and teeth.
- The oesophagus, which ‘carries food from the mouth to the stomach’
- The stomach, ‘a muscular bag or sac that stores food’
- The small intestine, which is where most digestion and absorption occurs. It includes the:
- duodenum
- ileum
- The large intestine, including the:
- appendix
- colon, ‘whose main function is to absorb water’
- rectum
- The anus
(Boyle and Senior, 2008: 130-131)
The digestive system is therefore consisted of all of the above as well as the liver ‘and its adjuncts – the gallbladder and bile ducts’ (Keeton et al, 2020), pancreas, and the salivary glands.
Of course, each component has its own functions and parts. As such, this answer could be extended even further.
References
Boyle, M. And Senior, K. 2008. Human Biology, Third Edition, Collins: London
Collison, P. et al, 2001. Nelson Modular Science 1, Nelson Thornes: Cheltenham
Keeton, W.T. et al, 2020. Human Digestive System, Available Online: https://www.britannica.com/science/human-digestive-system (Accessed 13/09/20)
Digestive system with salivary glands (licensed Adobe image) -
What does NICE say about head injuries?
This post is based on the NICE Clinical Guidelines, 2014. One part of their guidelines was in turn updated in 2019.
This post shows the key points and quotes as they relate to frontline ambulance staff; anything not relevant has not been included, but you may read more by following the link to the guidelines here.
Remember to read our disclaimer before putting into practice anything you see, hear, or read here. Also remember to check your local guidelines and the scope of practice for your role before putting any of this into practice.
Article 999: Simplifying the Long Stuff; Presenting the Relevant Stuff; Refreshing you on the Important Stuff.
www.article999.co.uk
Definition of Head Injuries
‘any trauma to the head other than superficial injuries to the face.’ p6
National Institute for Health and Care Excellence [NICE], 2014: 6Statistics
‘Head injury is the commonest cause of death and disability in people aged 1-40 years in the UK.’
NICE, 2014: 6‘The incidence of death from head injury is low, with as few as 0.2% of all patients attending emergency departments with a head injury dying as a result of this injury.’
NICE, 2014: 6‘the majority of fatal outcomes are in the moderate (GCS 9-12) or severe (GCS 8 or less) head injury groups’
NICE, 2014: 6
When might adults need to attend A&E for a CT head scan following a head injury?
‘For adults who have sustained a head injury and have any of the following risk factors’
- Reduced GCS, ‘less than 13’ initially, or ‘less than 15 at 2 hours after the injury on assessment in the emergency department’*
- suspected skull fracture of any type
- ‘post-traumatic seizure’
- Neurological deficit
- ‘More than 1 episode of vomiting’
–> This should happen within one hour of identifying the situation.
(NICE, 2014: 10)
*Consider ‘the pre-injury baseline GCS may be less than 15. Establish this where possible’ (NICE, 2014: 19).
If the patient is on anticoagulants and has none of the above, they should have a CT head ‘within 8 hours of the injury’. (NICE, 2014: 12)
When might adults need to attend A&E for a CT cervical spine following a head injury?
- ‘The patient has been intubated’
- ‘The patient is having other body areas scanned for head injury
- ‘…there is clinical suspicion of cervical spine injury and any of the following apply:
- => 65
- ‘dangerous mechanism of injury’
- neuro deficit
- ‘paraesthesia in the upper or lower limbs’
(NICE, 2014: 13)
When might children need to attend hospital for a CT head scan following a head injury?
Any of:
- ‘Suspicion of non-accidental injury’
- ‘Post-traumatic seizure but no history of epilepsy’
- Reduced GCS <14 initially, <15 2 hours later
- For under 1 year olds, Reduced GCS <15 on the paediatric scale
- Suspected skull fracture of any type
- Neuro deficit
- For under 1 year olds, ‘presence of bruise, swelling or laceration of more than 5 cm on the head’
(NICE, 2014: 11)
If a child has ‘more than one’ of these, he/she should have a CT scan within an hour:
- ‘Loss of consciousness lasting more than 5 minutes (witnessed)’
- ‘Abnormal drowsiness’
- Vomiting x3 or more episodes
- ‘Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 metres, high-speed injury from a projectile or other object)’
- ‘Amnesia […] lasting more than 5 minutes’
(NICE, 2014: 11)
Note: If the child has just one of these, he/she ‘should be observed for a minimum of 4 hours after the head injury’ and if he/she then develops more of the above, a CT is warranted. (NICE, 2014: 12)
The rules regarding CT cervical spine scans are different in children, compared to adults, due to the risk of radiation to their thyroid.
‘Consider or suspect abuse as a contributory factor to or cause of head injury in children’ (NICE, 2014: 7) 
For what other reasons should an adult or child with a head injury attend A&E?
- loss of consciousness
- ‘Amnesia for events before or after the injury’
- ‘Persistent headache since the injury’
- ‘Any vomiting episodes since the injury’ – but NICE advise considering the causes of single vomiting episodes in those under 12
- ‘Any seizure since the injury’
- ‘Any previous brain surgery’
- ‘A high-energy head injury’
- ‘Any history of bleeding and clotting disorders’
- Anticoagulants
- ‘Current drug or alcohol intoxication’
- Safeguarding issues
- ‘Continuing concern by the professional about the diagnosis’
(NICE, 2014: 17-18)
And:
- Patients who, 48 hours later, have ‘any persistent complaint relating to the initial head injury’
(NICE, 2014: 23)
Also, ‘depending on judgement of severity:’
- ‘irritability or altered behaviour’
- Other ‘Visible trauma to the head […] of concern to the professional’
- ‘No one is able to observe the injured person at home’
- ‘Continuing concern by the injured person or their family or carer about the diagnosis’
(NICE, 2014: 18)
What else should I consider in my assessment and treatment of a patient with a head injury?
- For adults, NICE recommends ‘managing their care according to clear principles and standard practice’ as in the ATLS and PHTLS courses, and the JRCALC for adults, and the APLS and PHPLS courses for children. There are others referenced, but Article 999 has included the most relevant here.
(NICE, 2014: 19-20) - ‘Manage pain effectively because it can lead to a rise in intracranial pressure’
(NICE, 2014: 21) - ‘Ascribe depressed conscious level to intoxication only after a significant brain injury has been excluded’
(NICE, 2014: 21-22) - Pre-alert patients with a reduced GCS, especially of <8. They will most likely need anesthetist or critical care involvement
(NICE, 2014: 21-22)
What’s worth bearing in mind during hospital-neuroscience unit transfers of patients with head injuries?
- Patients who have a GCS of less than 8 should be intubated
- Before transporting, make sure to stabilise the patient and ensure monitoring is attached
- A patient ‘with persistent hypotension’ should not be transported until they are ‘stabilised’
(NICE, 2014: 32-33)
During these transfers, patients ‘should be accompanied by a doctor with appropriate training and experience in the transfer of patients with acute brain injury. […] Patients requiring non-emergency transfer should be accompanied by appropriate clinical staff.’
NICE, 2014: 32-33
Reference
National Institute for Health and Care Excellence. (2014). Head injury: assessment and early management (NICE Clinical Guideline 176). Retrieved from https://www.nice.org.uk/guidance/cg176
Article 999: Simplifying, Presenting, Refreshing #medicalwriting #nice #paramedic #emt #frontline #emergency #ambulance #headinjury
