Aims The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to describe their activity and impact. Background Demographic changes, increased demands for health services, altered working practices, and health system economic pressures have led to the development of a disparate set of new health care roles. Data sources MEDLINE, EMBASE and CINAHL databases, and the two search engines Google and Google Scholar were searched for contemporary studies in the identified study area. Review methods All publications identified through the search were assessed for relevance. Those that discussed new roles were included (n = 34) and empirical studies (n = 14) analysed in detail. Results Emergency care and paramedic practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data suggests savings of between £31 (USD 55) and £37 (USD 65) per case when ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and training levels, regulatory and role implementation issues. Conclusion Further work is required to fully understand the patient safety, clinical practice, professional role and financial implications of these new roles.
This paper explores the prevalence of ‘near death experience’ phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients’ reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4–9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.