Air Medical Journal最新文献

Past research has shown that EMS professionals are affected by many mental health issues such as PTSD, depression, anxiety, substance abuse, sleep disturbances, burnout, and even suicidal ideation. The research discussed herein assesses the levels of disordered eating and body image in EMTs/paramedics as compared to emergency department nurses using a disordered eating scale, an eating disorder scale, and a body image scale. Results showed that EMS workers had significantly lower body image satisfaction scores compared to ED nurses, and that those participants in 911/On Campus services showed lower body image scores than those in Interfacility Transport/Emergency Departments. Results trended towards showing that those with fewer lunches out of the past ten shifts had higher disordered eating. Additionally, fewer than half of participants felt that they could take regularly scheduled breaks for eating and 84.2% of participants answered “yes” or “sometimes” to the common phenomenon of “eating when and where you can” while on a shift. These results exhibit concerning issues of decreased body image across EMS professionals and deep-rooted problems with nourishment while on shift. These issues must be addressed as it is a matter of public safety to attend to the mental health of first responders so that they can attend to the critical requirements of their job.

Objective

The purpose of this quality improvement project was to determine what effect holding clinical debriefing following traumatic patient encounters has on employee intent to leave and job satisfaction.

Methods

This observational quality improvement project was undertaken at Augusta University AirCare a helicopter emergency medicine service, in a large, metropolitan city located in the southeast from September 12th, 2023, to October 12th, 2023. The mean of each survey section was utilized to compare the pre-and post-survey scores to determine the effect of a structured clinical debrief on employee intent to leave, burnout, and job satisfaction.

Results

A total of 6 flight clinicians completed the pre-test survey and 5 flight clinicians completed the post-test. Although results were not statistically significant, post-intervention scores reflected a decrease in the mean value after implementation of the STOP5 debrief model for both burnout (pre-intervention mean= 62, post intervention mean=56) and intent to leave (pre-intervention mean=17, post intervention mean= 9). However, job satisfaction mean value did not increase as expected (pre-intervention mean= 12, post-intervention mean=14), which may be due to the short implementation period between measurements.

Conclusion

This Doctor of Nursing Practice (DNP) quality improvement project determined that holding clinical debriefs following traumatic patient encounters may decrease employee intent to leave and burnout but did not show improvement in employee job satisfaction.

Introduction

Push dose vasopressors are administered to attenuate peri-intubation hypotension in critically ill patients. The benefit of push dose vasopressors over initiation of continuous vasopressor infusions is unclear. The aim of this study was to describe current use of push dose vasopressors in critical care transport.

Methods

This was a retrospective chart review of adult patients (≥18 years) intubated between January 2017 and May 2023 by a single critical care transport service who received peri-intubation push dose vasopressors. The primary outcome was incidence of push dose vasopressor administration. The secondary outcome was frequency of initiation or increase in continuous vasopressor infusion after intubation.

Results

Three hundred thirty-four patients were intubated during this period, 49 (14.7%) received push dose vasopressors in the peri-intubation period. The mean age was 55.8 ± 19.7 years and 28 (57.1%) were male. Forty-five (91.8%) were transported via rotor wing aircraft. Twenty-three (46.9%) were scene transports. The most common indication for intubation was trauma (n=30, 61.2%). The mean pre-intubation shock index was 1.1 ± 0.5. Of those who received push dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Forty-eight (97.9%) received push dose vasopressors prior to intubation and 36 (73.4%) received push doses post intubation. Fifteen (30.6%) were started on a continuous vasopressor infusion and 3 (11.1%) had an increase in an existing infusion post-intubation.

Conclusion

Push dose vasopressors were utilized in a heterogeneous manner in the peri-intubation period. It remains unclear which patients may benefit from initiation of continuous vasopressor infusion rather than push dose vasopressors. Further investigation is required to better elucidate the role of push dose and continuous vasopressors in the peri-intubation period.

Objectives

Extracorporeal membrane oxygenation (ECMO) is a form of complete cardiopulmonary support that has been associated with improved survival in severe acute respiratory failure and refractory cardiac arrest. Current data provided by the Extracorporeal Life Support Organization demonstrate that the use of ECMO is increasing. However, ECMO remains a highly specialized and resource-intensive intervention with improved outcomes associated with higher ECMO center volumes, supporting the creation of regionalized care models. As such, the role of critical care transport is vital. Presently, there is little known about methods, crew configurations, protocols, and training for ECMO-capable transport teams. We aimed to descriptively analyze established ECMO transport programs across multiple countries.

Methods

A standardized, 27-item survey was distributed to 16 transport organizations across nine different countries. The survey included items such as transport team composition, training requirements, transport method, and various technical aspects. If available, transport organizations provided ECMO transport protocols and transport configuration schematics.

Results

To date, twelve ECMO programs responded from five countries (75% response rate). Most programs (83%) offer ground, 67% offer rotor-wing, and 50% offer fixed wing transport. A minority of programs (25%) were capable of any method of transport. Nearly half (42%) of programs did not require a separate ECMO team. A physician was present always or variably during ECMO transports in 67% of programs, and 92% of transport teams had a perfusionist or ECMO specialist and a nurse. All twelve programs required initial team ECMO training, and most programs also provided continuing education on an annual basis. Of the nine transport teams capable of performing ECMO cannulation, four programs (44%) could cannulate in any prehospital or in-hospital location.

Conclusions

Critical care transport teams play an essential role in increasing access to ECMO for patients with severe cardiopulmonary failure. There is significant variability in team composition and specialization as well as transport modality, but training requirements are commonly seen across programs. Further study is needed to define the optimal components for safe interfacility transport of ECMO patients.

Background

Distributed mobile care teams such as emergency medical services and critical care transport teams face constraints of time, funding, staffing and access to high-fidelity training environments. Introducing skills into resource limited settings using innovative low-fidelity methods expand opportunities for development.

Objective

We aim to test the feasibility of low-fidelity point of care ultrasound (POCUS) simulation training for assisted peripheral intravenous (PIV) placement to develop baseline competence and confidence in critical care transport team clinicians.

Methods

A low-fidelity simulation model was developed using off the shelf items including canned-meat (i.e. Spam), modeling balloons, and dyed water to provide a similar image as a POCUS-PIV high-fidelity mannequin and human training subject. A convenience sample of seven staff were recruited to undergo didactic and hands-on training using the low-fidelity model. Training was led by an emergency ultrasound fellow in our affiliated hospital system. A non-compulsory post-training survey using structured questions and Likert-scale was electronically distributed to the training participants, with one hundred percent of the surveys returned.

Results

Use of a low-fidelity simulation model required no formal meetings or utilization of an off-site simulation center, reducing administrative burden. Low cost of simulation model supplies allowed for multiple simulators to be available, enabling concurrent use among participants which decreased total time spent in the training session. Post-training survey data indicated the following results: overall participants found that low-fidelity training developed their initial clinical decision making for completing this intervention in clinical practice. Eighty-six percent report increased confidence in placing ultrasound guided PIV after the lab. Seventy-one percent of participants identified as entry-level handheld ultrasound users. Most providers report receiving proper knowledge and skillset with the use of this low-fidelity task trainer and that the training successfully allowed them to perform the simulated intervention. One learner does remark subjectively that they did not receive proper knowledge and skillset in this lab.

Conclusions

A low-fidelity simulation model using off-the-shelf items allowed for successful psychomotor training for ultrasound assisted peripheral IV insertion. The low-cost simulation model allowed for multiple models to be present during training, enabling multiple repetitions to be completed when compared to having one, high-fidelity simulator. Practicing this intervention in a safe learning environment, without outside spectators, was found to promote confidence and increase self-reported likelihood of completing the intervention in clinical practice. Use of low-fidelity simulation models appears