Non-technical attributes have been identified as important and desirable qualities for all paramedics. Despite this, there is currently little research exploring the assessment of non-technical attributes in paramedicine. Situational judgement tests (SJT) have been identified as a valid and reliable assessment of non-technical attributes in medical education, however, it appears there is no research exploring the use of SJTs in the field of paramedicine. This paper outlines the background information on SJTs, what they are and their successful implementation in medicine. Additionally, this paper identifies potential uses for SJTs in paramedicine including admission and mental health screening based of previous research in medical education. This paper concludes that SJTs could be utilised in the field of paramedicine to measure non-technical attributes.
{"title":"Non-technical attributes in paramedicine: Is situational judgement testing the solution?","authors":"R. Bennett, B. Williams","doi":"10.32378/IJP.V4I1.171","DOIUrl":"https://doi.org/10.32378/IJP.V4I1.171","url":null,"abstract":"Non-technical attributes have been identified as important and desirable qualities for all paramedics. Despite this, there is currently little research exploring the assessment of non-technical attributes in paramedicine. Situational judgement tests (SJT) have been identified as a valid and reliable assessment of non-technical attributes in medical education, however, it appears there is no research exploring the use of SJTs in the field of paramedicine. This paper outlines the background information on SJTs, what they are and their successful implementation in medicine. Additionally, this paper identifies potential uses for SJTs in paramedicine including admission and mental health screening based of previous research in medical education. This paper concludes that SJTs could be utilised in the field of paramedicine to measure non-technical attributes.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126256082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scott Ramey BHSc, Alexander MacQuarrie Mba, A. Cochrane, I. McCann, C. William, BA Johnston, Alan M Batt MSc
BackgroundFatigue is a complex phenomenon that has effects on physical characteristics, cognition, behaviours, and physical and mental health. Paramedicine crosses the boundaries of many high-risk industries, namely medicine, transport and aviation. The effects of fatigue on paramedics thus need to be explored and considered in order to begin to identify appropriate interventions and management strategies.AimThe aim of this article was to provide an overview of fatigue in paramedics and its potential effects on various areas of paramedic practice and paramedic health, and to outline potential solutions to assess and manage the risk of fatigue in paramedics as suggested by the literature.MethodsWe conducted unstructured, non-systematic searches of the literature in order to inform an overview of the literature. An overview is a summary of the literature that attempts to survey the literature and describe its characteristics. We thematically structured the review under the following headings: defining occupational activity and health status; clinical performance and patient safety; shift length and time at work; effects on paramedic health; effects on driving abilities; fatigue risk management; and, fatigue proofing.DiscussionFatigue should be considered in the context of overall paramedic health status and paramedic occupational activity. The nature of paramedic shift work, and the associated occupational activity place paramedics at increased risk from fatigue. Shift work may also contribute to sleep disorders among paramedics. Fatigue is associated with increased errors and adverse events, increased chronic disease and injury rates, depression and anxiety, and impaired driving ability.ConclusionThe issue of fatigue in paramedicine is complex and has serious consequences for patients and paramedics. Paramedic services and paramedics need to work collaboratively to identify and action appropriate measures to reduce the effects of fatigue on the wellbeing of the workforce and mitigate its effects on clinical performance and safety.
{"title":"Drowsy and dangerous? Fatigue in paramedics: an overview","authors":"Scott Ramey BHSc, Alexander MacQuarrie Mba, A. Cochrane, I. McCann, C. William, BA Johnston, Alan M Batt MSc","doi":"10.32378/IJP.V4I1.175","DOIUrl":"https://doi.org/10.32378/IJP.V4I1.175","url":null,"abstract":"BackgroundFatigue is a complex phenomenon that has effects on physical characteristics, cognition, behaviours, and physical and mental health. Paramedicine crosses the boundaries of many high-risk industries, namely medicine, transport and aviation. The effects of fatigue on paramedics thus need to be explored and considered in order to begin to identify appropriate interventions and management strategies.AimThe aim of this article was to provide an overview of fatigue in paramedics and its potential effects on various areas of paramedic practice and paramedic health, and to outline potential solutions to assess and manage the risk of fatigue in paramedics as suggested by the literature.MethodsWe conducted unstructured, non-systematic searches of the literature in order to inform an overview of the literature. An overview is a summary of the literature that attempts to survey the literature and describe its characteristics. We thematically structured the review under the following headings: defining occupational activity and health status; clinical performance and patient safety; shift length and time at work; effects on paramedic health; effects on driving abilities; fatigue risk management; and, fatigue proofing.DiscussionFatigue should be considered in the context of overall paramedic health status and paramedic occupational activity. The nature of paramedic shift work, and the associated occupational activity place paramedics at increased risk from fatigue. Shift work may also contribute to sleep disorders among paramedics. Fatigue is associated with increased errors and adverse events, increased chronic disease and injury rates, depression and anxiety, and impaired driving ability.ConclusionThe issue of fatigue in paramedicine is complex and has serious consequences for patients and paramedics. Paramedic services and paramedics need to work collaboratively to identify and action appropriate measures to reduce the effects of fatigue on the wellbeing of the workforce and mitigate its effects on clinical performance and safety.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126309652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Devenish, G. McKay, D. Long, P. Horrocks, Michael Smith
AbstractThis study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking a non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through X University. Data were collected via one-on-one face-to-face interviews and analysed using holistic and focused coding. Results were divided into three main categories, namely pre-placement, intra-placement and post placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included improved maturity levels, acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced on traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports.
{"title":"Undergraduate paramedic student experiences working in snow resort medical clinics: a non-traditional interprofessional clinical placement model","authors":"A. Devenish, G. McKay, D. Long, P. Horrocks, Michael Smith","doi":"10.32378/IJP.V4I1.101","DOIUrl":"https://doi.org/10.32378/IJP.V4I1.101","url":null,"abstract":"AbstractThis study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking a non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through X University. Data were collected via one-on-one face-to-face interviews and analysed using holistic and focused coding. Results were divided into three main categories, namely pre-placement, intra-placement and post placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included improved maturity levels, acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced on traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports. ","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121307632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AbstractHealthcare professionals who transition into academic roles in universities are confronted with many challenges. Universities offering paramedicine degree programs struggle to find qualified paramedics to assume academic roles, while at the same time little is known about the issues that confront paramedics transitioning into academic roles in universities. A maximal variation sampling method was used to interview 16 paramedic academics in Australia and New Zealand and a thematic analysis was conducted that generated a thematic network that encompassed five areas: the community of practice of paramedicine, the community of practice of academia, entry into a new community of practice, professional identity, and expectations and challenges. The resulting analysis revealed that new paramedic academics transitioning to academic roles in universities are often under-qualified and underprepared for academic positions. The induction and mentoring processes are often ad hoc and ineffective leaving the new academics feeling isolated and disillusioned. They struggle with establishing or maintaining a professional identity and meeting university expectations related to teaching, research, acquiring a PhD, and publication. Both these communities of practice need to engage in the development and preparation of these new academics so that paramedics will be attracted to these new roles and their transition to academia is a positive process.
{"title":"Paramedic transition into an academic role in universities: A qualitative survey of paramedic academics in Australia and New Zealand.","authors":"G. Munro, P. O'Meara, B. Mathisen","doi":"10.32378/IJP.V4I1.107","DOIUrl":"https://doi.org/10.32378/IJP.V4I1.107","url":null,"abstract":"AbstractHealthcare professionals who transition into academic roles in universities are confronted with many challenges. Universities offering paramedicine degree programs struggle to find qualified paramedics to assume academic roles, while at the same time little is known about the issues that confront paramedics transitioning into academic roles in universities. A maximal variation sampling method was used to interview 16 paramedic academics in Australia and New Zealand and a thematic analysis was conducted that generated a thematic network that encompassed five areas: the community of practice of paramedicine, the community of practice of academia, entry into a new community of practice, professional identity, and expectations and challenges. The resulting analysis revealed that new paramedic academics transitioning to academic roles in universities are often under-qualified and underprepared for academic positions. The induction and mentoring processes are often ad hoc and ineffective leaving the new academics feeling isolated and disillusioned. They struggle with establishing or maintaining a professional identity and meeting university expectations related to teaching, research, acquiring a PhD, and publication. Both these communities of practice need to engage in the development and preparation of these new academics so that paramedics will be attracted to these new roles and their transition to academia is a positive process.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123413290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Leyenaar, W. Tavares, G. Agarwal, Andrew P. Costa
Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.
简介:家庭护理客户代表了一个可以通过社区辅助医疗(CP)项目服务的患者群体。最近对急诊室就诊指标和脆弱性检测(DIVERT)量表进行了验证，以确定这一人群使用急诊护理的风险水平。本研究调查了是否虚弱的家庭护理客户被确定为高风险的基础上，他们的分数被确定为更高的风险，在90天内，更有可能使用护理服务进入急诊室与客户相比，有较低的分数。方法:采用定期收集的行政资料进行回顾性队列研究。家庭护理评估数据辅以急诊科(ED)就诊数据。救护车到达的模型控制了DIVERT分数以及几个社会和人口变量。结果:在队列中，大约40%的个体在家庭护理评估的90天内访问了急诊科，几乎一半的个体在一年内访问了急诊科不止一次。在评估后的90天内，约有三分之二的患者使用救护车进行运输。DIVERT评分可以预测这种使用，最高分表明使用护理人员服务的几率高出4.15倍(95% CI 3.60-4.78)。结论:DIVERT没有考虑到前往急诊科的交通工具。结果表明，它可以用来识别可能使用护理人员服务将他们送到急诊科的脆弱社区老年人。与ED放电相关的特征是有根据的。在这一人群中频繁使用救护车表明护理提供者之间的合作可能提供机会，以防止这些人不必要的急诊科就诊。
{"title":"Indicators of paramedic service use by community dwelling older adults","authors":"M. Leyenaar, W. Tavares, G. Agarwal, Andrew P. Costa","doi":"10.32378/IJP.V4I1.74","DOIUrl":"https://doi.org/10.32378/IJP.V4I1.74","url":null,"abstract":"Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133448878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. MacQuarrie, C. Robertson, P. Micalos, J. Crane, R. High, E. Drinkwater, J. Wickham
IntroductionParamedics are mobile health care workers who respond to trauma and medical emergencies. Worldwide, paramedics exhibit disturbingly high rates of injury and illness with increased markers of poor health, such as obesity and hypertension, being common. The primary aim of this study was to explore the self-reported health status of paramedics in New South Wales, Australia, by gender and geographic rostering pattern and to compare it with that of the Australian general population. A secondary aim was to examine paramedics’ attitudes towards exercise.MethodsIn 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey which composed of the Medical Outcomes Survey Short Form 36 (SF-36), and measures of attitudes towards exercise. Demographic information and participants’ height and weight (for calculating Body Mass Index (BMI)) were also collected. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.ResultsOf the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female). Mean age and mean years of service were 41.5 ±9.5 (SD) and 13.6 ±9.0 respectively. There were no differences in SF-36 scores except for the Vitality domain where males scored higher than females (p<0.001), and regional paramedics had a higher General Health domain score than metropolitan paramedics (p<0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m2 ± 3.99 vs. 26.81 kg/m2 ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p<0.001) but lower in summary scores for mental and physical health (p<0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m2 vs.26.47 ±5.42, p<0.001). Paramedics reported lack of time, family, lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.ConclusionsParamedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life. High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise and the effects of shift work, especially in regional areas. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that these essential health care providers are “fit for duty”. This survey should be repeated longitudinally to examine trends in the health status of paramedics. Nationally and internationally, ambulance management can and should foster innovative health promotion programs and paramedics themselves need to recognise and value good health.
{"title":"Fit for duty: The health status of New South Wales Paramedics","authors":"A. MacQuarrie, C. Robertson, P. Micalos, J. Crane, R. High, E. Drinkwater, J. Wickham","doi":"10.32378/IJP.V3I2.109","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.109","url":null,"abstract":"IntroductionParamedics are mobile health care workers who respond to trauma and medical emergencies. Worldwide, paramedics exhibit disturbingly high rates of injury and illness with increased markers of poor health, such as obesity and hypertension, being common. The primary aim of this study was to explore the self-reported health status of paramedics in New South Wales, Australia, by gender and geographic rostering pattern and to compare it with that of the Australian general population. A secondary aim was to examine paramedics’ attitudes towards exercise.MethodsIn 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey which composed of the Medical Outcomes Survey Short Form 36 (SF-36), and measures of attitudes towards exercise. Demographic information and participants’ height and weight (for calculating Body Mass Index (BMI)) were also collected. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.ResultsOf the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female). Mean age and mean years of service were 41.5 ±9.5 (SD) and 13.6 ±9.0 respectively. There were no differences in SF-36 scores except for the Vitality domain where males scored higher than females (p<0.001), and regional paramedics had a higher General Health domain score than metropolitan paramedics (p<0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m2 ± 3.99 vs. 26.81 kg/m2 ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p<0.001) but lower in summary scores for mental and physical health (p<0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m2 vs.26.47 ±5.42, p<0.001). Paramedics reported lack of time, family, lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.ConclusionsParamedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life. High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise and the effects of shift work, especially in regional areas. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that these essential health care providers are “fit for duty”. This survey should be repeated longitudinally to examine trends in the health status of paramedics. Nationally and internationally, ambulance management can and should foster innovative health promotion programs and paramedics themselves need to recognise and value good health.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114241111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Upon reflection over my past few years, thinking about the future is truly a unique experience. It allows for one to wander within the limits of your own creativity. It also potentially allows the stresses and fear of uncertainty to fester and experience the uncomfortable feelings of leaving what is known today. Ironically, the issues and conflicts we are experiencing today are somewhat comforting. Within the potentials of thinking about the future, is a real opportunity for a dialogue to envision a future and forming the guide to get there. This is essentially what a U.S. EMS Technical Expert Panel (TEP) of ten have done over the past two years. This letter is to introduce an overview of EMS Agenda 2050 as a spark for a global audience to reflect, think about their future of EMS, and engage in their own dialogue. In short, EMS Agenda 2050 is a guiding document for U. S. EMS, which was federally funded and supported. It follows the original 1996 federal document Emergency Medical Services for the Future, which was tasked with crafting a vision for U.S. EMS. Generally speaking, the Agenda 2050 process had two goals beyond articulating a vision. It was to be heavily influenced by the EMS profession and was to be a unifying document. Two strawman documents were used to spark thought, reaction, and feedback. Four in-person regional meetings were held utilizing a world café format with probing questions to facilitate dialogue and capture input. Smaller sessions were held at national and state conferences. Digital initiatives were launched with the assistance from national EMS organizations to submit feedback. National EMS organizations also designated liaisons to engage in the Agenda 2050 process. Captured feedback was continuously reviewed by the TEP throughout the process. EMS Agenda 2050 formed around a central value of being people centered. The word people was intentionally used with a broad and inclusive context in mind. This allowed for the document to be formed around a vision that was not limited to being patient, provider, or community centered. The value helped to form six guiding principles: Inherently Safe and Effective, Integrated and Seamless, Reliable and Prepared, Socially Equitable, Sustained and Efficient, and Adaptive and Innovative. The principles were not presented in a particular order of importance. All of the guiding principles formed with a people centered mindset and were rooted in feedback and professional passion. Inherently safe and effective focused on all systems of EMS embracing a culture of safety with practices that reduce harm and yield good outcomes. All of which support meaningful technology and policies that reduce safety risks in EMS. Integrated and seamless described strengthening the bridge between EMS and healthcare services and systems beyond just the local ER. Included, a more collaborative system of medical oversight and network of resources, professionals, and partners in public safety to deliver care and
{"title":"Introduction to U.S. EMS Agenda 2050","authors":"William J Leggio","doi":"10.32378/IJP.V3I2.169","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.169","url":null,"abstract":"Upon reflection over my past few years, thinking about the future is truly a unique experience. It allows for one to wander within the limits of your own creativity. It also potentially allows the stresses and fear of uncertainty to fester and experience the uncomfortable feelings of leaving what is known today. Ironically, the issues and conflicts we are experiencing today are somewhat comforting. Within the potentials of thinking about the future, is a real opportunity for a dialogue to envision a future and forming the guide to get there. This is essentially what a U.S. EMS Technical Expert Panel (TEP) of ten have done over the past two years. This letter is to introduce an overview of EMS Agenda 2050 as a spark for a global audience to reflect, think about their future of EMS, and engage in their own dialogue. In short, EMS Agenda 2050 is a guiding document for U. S. EMS, which was federally funded and supported. It follows the original 1996 federal document Emergency Medical Services for the Future, which was tasked with crafting a vision for U.S. EMS. Generally speaking, the Agenda 2050 process had two goals beyond articulating a vision. It was to be heavily influenced by the EMS profession and was to be a unifying document. Two strawman documents were used to spark thought, reaction, and feedback. Four in-person regional meetings were held utilizing a world café format with probing questions to facilitate dialogue and capture input. Smaller sessions were held at national and state conferences. Digital initiatives were launched with the assistance from national EMS organizations to submit feedback. National EMS organizations also designated liaisons to engage in the Agenda 2050 process. Captured feedback was continuously reviewed by the TEP throughout the process. EMS Agenda 2050 formed around a central value of being people centered. The word people was intentionally used with a broad and inclusive context in mind. This allowed for the document to be formed around a vision that was not limited to being patient, provider, or community centered. The value helped to form six guiding principles: Inherently Safe and Effective, Integrated and Seamless, Reliable and Prepared, Socially Equitable, Sustained and Efficient, and Adaptive and Innovative. The principles were not presented in a particular order of importance. All of the guiding principles formed with a people centered mindset and were rooted in feedback and professional passion. Inherently safe and effective focused on all systems of EMS embracing a culture of safety with practices that reduce harm and yield good outcomes. All of which support meaningful technology and policies that reduce safety risks in EMS. Integrated and seamless described strengthening the bridge between EMS and healthcare services and systems beyond just the local ER. Included, a more collaborative system of medical oversight and network of resources, professionals, and partners in public safety to deliver care and","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"226 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125700406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Study aimThis study aims to determine the impact of the red arrest teams (RATs) on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.MethodsA retrospective cohort study analysing routinely collected data was undertaken. All adult (≥18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between the 1st October, 2015 and 30th September, 2017 were included if the patient was resuscitated, and the cause of the arrest was considered to be medical in origin. Multivariable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.ResultsDuring the 2-year data collection period, 15,151 cardiac arrests that were attended by Yorkshire Ambulance Service. After removing ineligible cases, 5,868 cardiac arrests remained. RATs attended 2,000/5,868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, minimum 1, maximum 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95%CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95%CI 0.99–1.29), compared to the odds of not having a RAT present, although neither results are statistically significant.ConclusionThe presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA
{"title":"Do RATs save lives? A retrospective analysis of out-of-hospital cardiac arrest in an English Ambulance Service","authors":"R. Pilbery, M. Teare","doi":"10.32378/ijp.v3i2.165","DOIUrl":"https://doi.org/10.32378/ijp.v3i2.165","url":null,"abstract":"Study aimThis study aims to determine the impact of the red arrest teams (RATs) on survival to 30 days and return of spontaneous circulation (ROSC) at hospital.MethodsA retrospective cohort study analysing routinely collected data was undertaken. All adult (≥18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between the 1st October, 2015 and 30th September, 2017 were included if the patient was resuscitated, and the cause of the arrest was considered to be medical in origin. Multivariable logistic regression models were created to enable adjustment for common predictors of survival and ROSC.ResultsDuring the 2-year data collection period, 15,151 cardiac arrests that were attended by Yorkshire Ambulance Service. After removing ineligible cases, 5,868 cardiac arrests remained. RATs attended 2,000/5,868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7–23, minimum 1, maximum 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95%CI 0.74–1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95%CI 0.99–1.29), compared to the odds of not having a RAT present, although neither results are statistically significant.ConclusionThe presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132068763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Response to Knox, S. (2018). Helicopter EMS in Cork: a paramedicine perspective. Irish Journal of Paramedicine, 3(2). doi:http://dx.doi.org/10.32378/ijp.v3i2.113 Dear Editor,I read Dr. Shane Knox’s commentary “Helicopter EMS in Cork” (1) in the current edition of the Journal with interest. Firstly, to be clear, I have the utmost respect for paramedics. The commencement of an EMS helicopter in Cork is a landmark step forward in prehospital care. The ‘Toyota’ reference made in the Knox article is in relation to a misquote published in the Irish Times from a recent RTE Radio interview I gave around the staffing model of a Helicopter EMS (HEMS). The reference I made to Toyota was in fact with respect to the physician-paramedic HEMS model that is the norm in Australia, Northern Ireland, Scotland, England, Wales and mainland Europe. I don’t view a physician-paramedic team as a Rolls-Royce, platinum or gold standard model, but rather more like a Toyota; attainable and highly durable. In August 2015, the College of Paramedics (UK) stated “The College of Paramedics support proposals for a HEMS service in Northern Ireland, with a view that this service should be integrated within a trauma network in Northern Ireland and consist of a specialist pre-hospital Doctor and Paramedic team.” (2) The HEMS in Northern Ireland is now staffed with this model by the Northern Ireland Ambulance Service (NIAS). The Irish government recently endorsed the development of a Trauma System for Ireland. Inherent to any trauma system is enhanced prehospital trauma care capability. Albeit the air ambulance will certainly bring speed, it will not bring enhanced skills without a doctor-paramedic team that will save additional lives, nor will it meet the PHECC dispatch standards for emergency calls by road (dual paramedic). The doctor-paramedic model can provide advanced prehospital critical interventions such as balanced emergency anaesthesia, mechanical ventilation, finger thoracostomy, blood transfusion and eye, life and limb-saving procedures (e.g. lateral canthotomy, resuscitative thoracotomy) as well as enhanced system activation such as prehospital massive transfusion activation and bringing a patient direct to theatre from helipad (code crimson). Recently, Mark Winter, an operations manager of Wales Air Ambulance (doctor-paramedic EMRTS team) said: “One of the things we talk about in our world is ‘unexpected survivors’-those patients who have had emergency front line treatment at the roadside or at the home who otherwise would have to be taken to the hospital, where it might have been too late.” (3) The similar EMRS in Scotland is increasing coverage as I write this to meet the demands of the newly developed Scottish Trauma Network. I’m sure the patient needs are the same in Ireland as they are in Northern Ireland or Great Britain. A doctor-paramedic team extends critical care to life-threatening prehospital and medical emergencies such as STEMI with cardiogenic shock requi
{"title":"Re: Helicopter EMS in Cork: a paramedicine perspective","authors":"B. Burns","doi":"10.32378/IJP.V3I2.151","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.151","url":null,"abstract":"Response to Knox, S. (2018). Helicopter EMS in Cork: a paramedicine perspective. Irish Journal of Paramedicine, 3(2). doi:http://dx.doi.org/10.32378/ijp.v3i2.113 Dear Editor,I read Dr. Shane Knox’s commentary “Helicopter EMS in Cork” (1) in the current edition of the Journal with interest. Firstly, to be clear, I have the utmost respect for paramedics. The commencement of an EMS helicopter in Cork is a landmark step forward in prehospital care. The ‘Toyota’ reference made in the Knox article is in relation to a misquote published in the Irish Times from a recent RTE Radio interview I gave around the staffing model of a Helicopter EMS (HEMS). The reference I made to Toyota was in fact with respect to the physician-paramedic HEMS model that is the norm in Australia, Northern Ireland, Scotland, England, Wales and mainland Europe. I don’t view a physician-paramedic team as a Rolls-Royce, platinum or gold standard model, but rather more like a Toyota; attainable and highly durable. In August 2015, the College of Paramedics (UK) stated “The College of Paramedics support proposals for a HEMS service in Northern Ireland, with a view that this service should be integrated within a trauma network in Northern Ireland and consist of a specialist pre-hospital Doctor and Paramedic team.” (2) The HEMS in Northern Ireland is now staffed with this model by the Northern Ireland Ambulance Service (NIAS). The Irish government recently endorsed the development of a Trauma System for Ireland. Inherent to any trauma system is enhanced prehospital trauma care capability. Albeit the air ambulance will certainly bring speed, it will not bring enhanced skills without a doctor-paramedic team that will save additional lives, nor will it meet the PHECC dispatch standards for emergency calls by road (dual paramedic). The doctor-paramedic model can provide advanced prehospital critical interventions such as balanced emergency anaesthesia, mechanical ventilation, finger thoracostomy, blood transfusion and eye, life and limb-saving procedures (e.g. lateral canthotomy, resuscitative thoracotomy) as well as enhanced system activation such as prehospital massive transfusion activation and bringing a patient direct to theatre from helipad (code crimson). Recently, Mark Winter, an operations manager of Wales Air Ambulance (doctor-paramedic EMRTS team) said: “One of the things we talk about in our world is ‘unexpected survivors’-those patients who have had emergency front line treatment at the roadside or at the home who otherwise would have to be taken to the hospital, where it might have been too late.” (3) The similar EMRS in Scotland is increasing coverage as I write this to meet the demands of the newly developed Scottish Trauma Network. I’m sure the patient needs are the same in Ireland as they are in Northern Ireland or Great Britain. A doctor-paramedic team extends critical care to life-threatening prehospital and medical emergencies such as STEMI with cardiogenic shock requi","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130905060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trevor Hines Duncliffe, Brittany D'Angelo, Michael Brock, Cal Fraser, Nick Austin, J. Lamarra, Matt Pusateri, Lauran Livingston, A. Batt
BackgroundPrevious research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.MethodsParamedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.Results36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= <0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).ConclusionParamedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics.
之前的研究表明，压力对医护人员在执行医疗相关任务时的表现有负面影响。急性压力也被证明对一般人群的驾驶能力产生负面影响，增加了严重驾驶失误的数量。没有文献讨论压力对护理人员驾驶能力的影响。方法在驾驶模拟器中对急诊学生进行驾驶能力评估。然后我们把他们暴露在一个压力诱导的医疗场景中。然后进行另一次驾驶评估。在场景之前和之后记录了错误的数量和类型。结果36名学生参与了研究。护理专业的学生在压力情景下的总体错误率没有增加，但三个关键驾驶错误增加;未系安全带(3基线v 10后应力，p= 0.0087)，红灯或停车标志未停车(7 v 35, p= <0.0001)，以及失去对车辆的控制(2 v 11, p= 0.0052)。结论在紧张的模拟临床情景后，护理专业学生的严重驾驶错误增加。护理人员在工作过程中经常面临严重的压力。这种压力可能会增加发生严重驾驶错误的次数。这些结果强调了进一步研究的必要性，并强调了增加驾驶员培训和压力管理教育的潜在需求，以减少护理人员驾驶错误的频率和严重程度。
{"title":"Driving me crazy: the effects of stress on the driving abilities of paramedic students","authors":"Trevor Hines Duncliffe, Brittany D'Angelo, Michael Brock, Cal Fraser, Nick Austin, J. Lamarra, Matt Pusateri, Lauran Livingston, A. Batt","doi":"10.32378/IJP.V3I2.163","DOIUrl":"https://doi.org/10.32378/IJP.V3I2.163","url":null,"abstract":"BackgroundPrevious research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.MethodsParamedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.Results36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= <0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).ConclusionParamedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics.","PeriodicalId":367364,"journal":{"name":"Irish Journal of Paramedicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130017546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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