Paramedic work can be stressful. Encountering clinically unwell patients, long shift hours and dealing with the unknown expose paramedics to mental, physical and emotional stress. In the learning environment, these types of stresses are difficult for educators to replicate. Traditionally, students have been tested under pressure in scenario-based situations as a means of stress inoculation. However, the literature is unclear as to whether this enhances or hinders learning. A recent scoping review identified an acceptable level of stress during simulation can be beneficial, although a level of a balance is required. Too much stress can hinder learning and lead to underperformance. Ideally, high-acuity patient scenarios should be designed to invoke a challenging state of appraisal in the student to support both their learning and knowledge retention. To obtain an understanding of how students appraise these types of scenarios, quantitative physiological and psychometric data needs to be obtained and analyzed. However, across the health care education literature, inconsistent methodologies and a variety of physiological and cognitive measures make it challenging to draw firm conclusions. This narrative review searched three prominent databases using common search terms to produce a subset of high-quality publications that we thought were most pertinent and insightful. Our paper establishes recommendations for appropriate physiological assessment and interpterion of challenge appraisal in students undertaking high-stress, low-frequency clinical scenarios.
{"title":"Quantifying Threat or Challenge Response of Undergraduate Paramedicine Students During High-Stress Clinical Scenarios","authors":"J. Betson, Erich Fein, David Long, Peter Horrocks","doi":"10.56068/qhqm3379","DOIUrl":"https://doi.org/10.56068/qhqm3379","url":null,"abstract":"Paramedic work can be stressful. Encountering clinically unwell patients, long shift hours and dealing with the unknown expose paramedics to mental, physical and emotional stress. In the learning environment, these types of stresses are difficult for educators to replicate. Traditionally, students have been tested under pressure in scenario-based situations as a means of stress inoculation. However, the literature is unclear as to whether this enhances or hinders learning. A recent scoping review identified an acceptable level of stress during simulation can be beneficial, although a level of a balance is required. Too much stress can hinder learning and lead to underperformance. Ideally, high-acuity patient scenarios should be designed to invoke a challenging state of appraisal in the student to support both their learning and knowledge retention. To obtain an understanding of how students appraise these types of scenarios, quantitative physiological and psychometric data needs to be obtained and analyzed. However, across the health care education literature, inconsistent methodologies and a variety of physiological and cognitive measures make it challenging to draw firm conclusions. This narrative review searched three prominent databases using common search terms to produce a subset of high-quality publications that we thought were most pertinent and insightful. Our paper establishes recommendations for appropriate physiological assessment and interpterion of challenge appraisal in students undertaking high-stress, low-frequency clinical scenarios.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"2 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141816282","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}
Background: In the United States, research has found that emergency medical service (EMS) clinicians contemplate and attempt suicide at a rate approximately 10 times higher than the general population. However, prior to this study, no comprehensive data existed on the mental health status and needs of Virginia’s EMS clinicians. Objective: To evaluate mental health conditions, substance use, COVID-19 stress, and job satisfaction among Virginia’s EMS clinicians and to assess the perceived mental health cultures, services, and barriers to seeking help within clinicians’ agencies. Methods: The [redacted institution name] constructed a comprehensive EMS clinician mental health cross-sectional survey during the spring of 2022. The survey was sent to every certified EMS clinician over the age of 18 with a working email address within the Commonwealth (N=36,376) as of April 15, 2022. Results: A total of 2,930 EMS clinicians who actively served in EMS within the past 12 months responded to the survey. On average, clinicians reported 9.9 days of perceived poor mental health out of a 30-day period, with 9.1% of clinicians seriously contemplating suicide within the past year. Almost 60% of respondents reported heavy alcohol consumption at least once in the year prior to the survey, while 6.5% had taken prescription drugs for non-medical reasons and 3.7% had used illegal drugs. Approximately 66% of clinicians felt the coronavirus pandemic increased workplace stress. More than half of respondents (57.3%) indicated they had intentions to quit working in EMS. Finally, 31.1% of clinicians disagreed or strongly disagreed that EMS clinician mental health is important to their agency. Conclusion: Virginia’s EMS clinicians experience a greater number of perceived poor mental health days, higher levels of suicide contemplation, and increased substance use as compared to the general population. Further health promotion actions are needed to address these disparities among Virginia’s EMS clinicians.
{"title":"The State of Emergency Medical Services Clinician Mental Health in Virginia","authors":"Vincent P. Valeriano, Karen Owens, Jessica Rosner","doi":"10.56068/uxzx1939","DOIUrl":"https://doi.org/10.56068/uxzx1939","url":null,"abstract":"Background: In the United States, research has found that emergency medical service (EMS) clinicians contemplate and attempt suicide at a rate approximately 10 times higher than the general population. However, prior to this study, no comprehensive data existed on the mental health status and needs of Virginia’s EMS clinicians. \u0000Objective: To evaluate mental health conditions, substance use, COVID-19 stress, and job satisfaction among Virginia’s EMS clinicians and to assess the perceived mental health cultures, services, and barriers to seeking help within clinicians’ agencies. \u0000Methods: The [redacted institution name] constructed a comprehensive EMS clinician mental health cross-sectional survey during the spring of 2022. The survey was sent to every certified EMS clinician over the age of 18 with a working email address within the Commonwealth (N=36,376) as of April 15, 2022. \u0000Results: A total of 2,930 EMS clinicians who actively served in EMS within the past 12 months responded to the survey. On average, clinicians reported 9.9 days of perceived poor mental health out of a 30-day period, with 9.1% of clinicians seriously contemplating suicide within the past year. Almost 60% of respondents reported heavy alcohol consumption at least once in the year prior to the survey, while 6.5% had taken prescription drugs for non-medical reasons and 3.7% had used illegal drugs. Approximately 66% of clinicians felt the coronavirus pandemic increased workplace stress. More than half of respondents (57.3%) indicated they had intentions to quit working in EMS. Finally, 31.1% of clinicians disagreed or strongly disagreed that EMS clinician mental health is important to their agency. \u0000Conclusion: Virginia’s EMS clinicians experience a greater number of perceived poor mental health days, higher levels of suicide contemplation, and increased substance use as compared to the general population. Further health promotion actions are needed to address these disparities among Virginia’s EMS clinicians.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"121 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141666454","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}
{"title":"Paramedicine Literature Surveillance","authors":"Shaughn Maxwell, Brenda Morrisey","doi":"10.56068/hgpv8747","DOIUrl":"https://doi.org/10.56068/hgpv8747","url":null,"abstract":"","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"11 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667929","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}
Background and Aim: Data suggests that finger palpation of the carotid and/or femoral pulses is significantly less sensitive than 100%. In some cases, a patient who does, in fact, have organized cardiac function, may be identified as being in Pulseless Electrical Activity (PEA). Chest compressions performed as indicated by these circumstances may not provide significant therapeutic benefit to those patients and may, in fact, distract from better directed therapies. Doppler Ultrasonography (DUSG) has been shown to be more sensitive than human fingers. This research aims to assess whether EMT-Basics and Paramedics can be quickly and inexpensively trained to use DUSG as a tool for pulse detection. Methods: Participants viewed a recorded video 4 minutes 18 seconds in length which detailed an anterior-to-posterior fanning technique for assessing presence of a carotid pulse using a doppler ultrasound device. The participants were given a short period of time to practice and familiarize themselves with the device. Participants were then timed while demonstrating application of ultrasound-conducting gel to a volunteer and using the device to detect a carotid pulse. The time recording ceased when the participant verbalized confirmation of the pulse, and their success or failure was annotated. Results: Credentialed EMT-Basics and Paramedics, with minimal training, consistently demonstrated the ability to accurately and rapidly assess a carotid pulse using a doppler ultrasound device. Conclusions: This research suggests that prehospital personnel can be efficiently trained to use available and inexpensive doppler ultrasound devices to determine cardiac pulse status. Furthermore, it suggests that the technique itself can be used to detect the carotid pulse quickly and accurately. Further research in patient care settings should be undertaken to evaluate the utility of doppler ultrasound devices in distinguishing PEA from Pseudo-PEA.
背景和目的：数据表明，用手指触摸颈动脉和/或股动脉搏动的灵敏度明显低于 100%。在某些情况下，病人实际上具有有组织的心脏功能，但可能被认定为处于无脉搏电活动（PEA）状态。在这种情况下进行的胸外按压可能不会给这些患者带来明显的治疗效果，反而会分散他们对更好的治疗方法的注意力。多普勒超声（DUSG）已被证明比人的手指更灵敏。本研究旨在评估是否可以快速、低成本地培训急救员和辅助医务人员使用多普勒超声波检查仪作为脉搏检测工具：方法：参与者观看一段时长为 4 分 18 秒的录制视频，视频详细介绍了使用多普勒超声设备评估颈动脉脉搏的前后扇动技术。参与者有短暂的时间练习和熟悉设备。然后，参赛者在向一名志愿者演示涂抹超声传导凝胶和使用设备检测颈动脉脉搏时被计时。当参与者口头确认脉搏时，时间记录停止，并标注其成功或失败：结果：经过最低限度培训的合格急救员和辅助医务人员一致表现出有能力使用多普勒超声设备准确、快速地评估颈动脉脉搏。结论：这项研究表明，可以对院前人员进行有效培训，使其能够使用现有的廉价多普勒超声设备来确定心脏脉搏状态。此外，研究还表明该技术本身可用于快速准确地检测颈动脉脉搏。应在患者护理环境中开展进一步研究，以评估多普勒超声设备在区分 PEA 和假性 PEA 方面的实用性。
{"title":"Demonstration of Doppler Ultrasound Pulse Detection by Trained Prehospital Personnel","authors":"Daniel Martin","doi":"10.56068/qggb1958","DOIUrl":"https://doi.org/10.56068/qggb1958","url":null,"abstract":"Background and Aim: Data suggests that finger palpation of the carotid and/or femoral pulses is significantly less sensitive than 100%. In some cases, a patient who does, in fact, have organized cardiac function, may be identified as being in Pulseless Electrical Activity (PEA). Chest compressions performed as indicated by these circumstances may not provide significant therapeutic benefit to those patients and may, in fact, distract from better directed therapies. Doppler Ultrasonography (DUSG) has been shown to be more sensitive than human fingers. This research aims to assess whether EMT-Basics and Paramedics can be quickly and inexpensively trained to use DUSG as a tool for pulse detection.\u0000Methods: Participants viewed a recorded video 4 minutes 18 seconds in length which detailed an anterior-to-posterior fanning technique for assessing presence of a carotid pulse using a doppler ultrasound device. The participants were given a short period of time to practice and familiarize themselves with the device. Participants were then timed while demonstrating application of ultrasound-conducting gel to a volunteer and using the device to detect a carotid pulse. The time recording ceased when the participant verbalized confirmation of the pulse, and their success or failure was annotated.\u0000Results: Credentialed EMT-Basics and Paramedics, with minimal training, consistently demonstrated the ability to accurately and rapidly assess a carotid pulse using a doppler ultrasound device. \u0000Conclusions: This research suggests that prehospital personnel can be efficiently trained to use available and inexpensive doppler ultrasound devices to determine cardiac pulse status. Furthermore, it suggests that the technique itself can be used to detect the carotid pulse quickly and accurately. Further research in patient care settings should be undertaken to evaluate the utility of doppler ultrasound devices in distinguishing PEA from Pseudo-PEA.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"115 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141666584","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}
Purpose: Buprenorphine is a lifesaving medication in opioid use disorder (OUD). Emergency Medical Services (EMS) play a crucial role in responding to opioid overdoses. The pre-hospital use of buprenorphine by EMS can expand access to this important medication. This article aims to provide a narrative review of the use of buprenorphine in the pre-hospital setting. Methods: This is a narrative review of recent publications that describe the use of buprenorphine to treat opioid withdrawal in the pre-hospital setting. Results: There are a few well done studies that describe protocols, safety, and efficacy of the administration of buprenorphine in the pre-hospital setting by EMS providers. The pharmacology of buprenorphine makes it advantageous in treating opioid use disorder. Proper patient selection and protocols for the administration of buprenorphine are key to the success of implementing pre-hospital buprenorphine programs. Conclusions: The pre-hospital administration of buprenorphine for opioid use disorder should be considered by EMS agencies.
{"title":"Use of Buprenorphine in the Prehospital Setting","authors":"Anthony Spadaro, Samantha Huo, Johnathan Bar","doi":"10.56068/crde9788","DOIUrl":"https://doi.org/10.56068/crde9788","url":null,"abstract":"Purpose: Buprenorphine is a lifesaving medication in opioid use disorder (OUD). Emergency Medical Services (EMS) play a crucial role in responding to opioid overdoses. The pre-hospital use of buprenorphine by EMS can expand access to this important medication. This article aims to provide a narrative review of the use of buprenorphine in the pre-hospital setting.\u0000Methods: This is a narrative review of recent publications that describe the use of buprenorphine to treat opioid withdrawal in the pre-hospital setting.\u0000Results: There are a few well done studies that describe protocols, safety, and efficacy of the administration of buprenorphine in the pre-hospital setting by EMS providers. The pharmacology of buprenorphine makes it advantageous in treating opioid use disorder. Proper patient selection and protocols for the administration of buprenorphine are key to the success of implementing pre-hospital buprenorphine programs.\u0000Conclusions: The pre-hospital administration of buprenorphine for opioid use disorder should be considered by EMS agencies.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141670481","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}
Background: Asthma is a significant contributor of respiratory illness throughout Australia, taking a toll on all genders and age groups. The rural healthcare workforce is currently undersupplied, and this worsens with the degree of rurality posing disadvantages in healthcare access. Lower asthma-related mortality rates in metropolitan cities than other areas of Australia indicate a need to explore the extent of the impact that residing rurally has on access to emergency healthcare for asthma-related emergencies. Methods: A scoping review of literature was conducted utilising the steps articulated in Peters et al. (2020)methodological approach. The databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Medline and PubMed were searched using key words. After screening 20 articles were included. Results: Four main themes emerged including the impact of access to resources; individual behaviours and attitudes; education and health literacy; and rural clinician adherence to guidelines. Conclusion: Several challenges are associated with living in rural areas which may impact patients ability to access emergency healthcare during an asthma-related emergency. Further research is recommended to determine the extent to which these challenges influence access to emergency healthcare and explore strategies to break down these barriers to ensure equitable emergency healthcare.
{"title":"Influence of Rurality When Accessing Emergency Healthcare During Exacerbation of Asthma","authors":"Alannah Stoneley, Judith Anderson, Clare Sutton","doi":"10.56068/qiwm3456","DOIUrl":"https://doi.org/10.56068/qiwm3456","url":null,"abstract":"Background: Asthma is a significant contributor of respiratory illness throughout Australia, taking a toll on all genders and age groups. The rural healthcare workforce is currently undersupplied, and this worsens with the degree of rurality posing disadvantages in healthcare access. Lower asthma-related mortality rates in metropolitan cities than other areas of Australia indicate a need to explore the extent of the impact that residing rurally has on access to emergency healthcare for asthma-related emergencies. \u0000Methods: A scoping review of literature was conducted utilising the steps articulated in Peters et al. (2020)methodological approach. The databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Medline and PubMed were searched using key words. After screening 20 articles were included. \u0000Results: Four main themes emerged including the impact of access to resources; individual behaviours and attitudes; education and health literacy; and rural clinician adherence to guidelines. \u0000Conclusion: Several challenges are associated with living in rural areas which may impact patients ability to access emergency healthcare during an asthma-related emergency. Further research is recommended to determine the extent to which these challenges influence access to emergency healthcare and explore strategies to break down these barriers to ensure equitable emergency healthcare.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"119 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141666768","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}
The prevalence of Helicobacter Pylori (H. Pylori) remains globally high, with an estimated 50% of the words population believed to be infected. Despite the continually high incident rates of infection 90% of those infected remain asymptomatic. H.Pylori is a gram-negative, microaerophilic bacteria, mostly found in stomach of affected individuals that causes inflammation and ulceration. Definitive routes of transmission and subsequent infection are still debated. The most likely mechanism of transmission is thought to be intrafamilliar, this encapsulates fecal-oral, gastric-oral, oral-oral and sexual vectors. Contaminated foods and water sources are also highly likely mechanisms of transmission. Therefore in developing countries with poor sanitation, potentially contaminated water sources and regions with social-economic hardship experience increased symptomatic cases of H.Pylori.
{"title":"Assessment and Empirical Treatment of Chronic Abdominal Pain from Suspected Helicobacter Pylori Infection In a Remote Setting","authors":"Sean Ferguson","doi":"10.56068/tyij2188","DOIUrl":"https://doi.org/10.56068/tyij2188","url":null,"abstract":"The prevalence of Helicobacter Pylori (H. Pylori) remains globally high, with an estimated 50% of the words population believed to be infected. Despite the continually high incident rates of infection 90% of those infected remain asymptomatic. H.Pylori is a gram-negative, microaerophilic bacteria, mostly found in stomach of affected individuals that causes inflammation and ulceration. \u0000Definitive routes of transmission and subsequent infection are still debated. The most likely mechanism of transmission is thought to be intrafamilliar, this encapsulates fecal-oral, gastric-oral, oral-oral and sexual vectors. Contaminated foods and water sources are also highly likely mechanisms of transmission. Therefore in developing countries with poor sanitation, potentially contaminated water sources and regions with social-economic hardship experience increased symptomatic cases of H.Pylori. ","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668493","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}
{"title":"Paramedicine Contents","authors":"Brad Buck, Julius McAdams","doi":"10.56068/pcbn7731","DOIUrl":"https://doi.org/10.56068/pcbn7731","url":null,"abstract":"","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"107 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667005","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}
Charles Johndro, Sean Caffyn, Jasmine Chen, David Bailey, Michelle Burak, Emily Perriello, Daniel Youngstrom
Objective: Acute severe agitation often requires pharmacologic sedation. While benzodiazepines and antipsychotics are traditional first-line medications for this purpose, recent evidence has shown that prehospital intramuscular (IM) administration of ketamine results in rapid, effective sedation. However, ketamine may be associated with adverse clinical events including a higher intubation rate. The purpose of this study is to compare the efficacy and safety of IM ketamine versus IM midazolam as medications to achieve sedation in the prehospital setting. Methods: This is a retrospective cohort study of agitated patients with an initial Richmond Agitation-Sedation Scale (RASS) score of at least 3, who were sedated and transported by ambulance to Hartford Hospital. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergency department (ED). Secondary endpoints included the percentage of patients who achieved an improved RASS score post drug administration, the use of additional sedating agents and the need for airway and breathing support, and differences in adverse events. Results: 66 patients in the ketamine group and 68 patients in the midazolam group met inclusion criteria. While more patients in the midazolam group achieved target RASS score of -1, 0, or 1 post drug administration, patients in the ketamine group had a lower mean RASS score post drug administration. There was no difference in endotracheal intubation rates between the two groups (6.1% versus 2.9%, respectively; p = 0.383). However, upon arrival to the ED, more patients in the ketamine group required additional sedating agents as well as airway or respiratory support Conclusion: Both ketamine and midazolam are relatively safe and efficacious in the prehospital environment. IM ketamine resulted in deeper sedation without increasing intubation rate. However, ED providers receiving patients treated with IM ketamine should prepare for additional sedating agents and airway interventions.
目的：急性严重躁动通常需要药物镇静。虽然苯二氮卓类药物和抗精神病药物是传统的一线镇静药物，但最近的证据显示，院前肌肉注射氯胺酮（IM）可以快速、有效地镇静。然而，氯胺酮可能与不良临床事件有关，包括较高的插管率。本研究旨在比较院前环境中使用氯胺酮和咪达唑仑作为镇静药物的有效性和安全性：这是一项回顾性队列研究，研究对象是初始里士满躁动镇静量表（RASS）评分至少为 3 分的躁动患者，这些患者被镇静后由救护车送往哈特福德医院。主要终点是在转运途中和到达急诊科（ED）后一小时内发生的气管插管发生率。次要终点包括用药后RASS评分提高的患者比例、额外镇静剂的使用、气道和呼吸支持的需求以及不良事件的差异：氯胺酮组和咪达唑仑组分别有66名和68名患者符合纳入标准。虽然咪达唑仑组更多患者在用药后达到-1、0或1分的目标RASS评分，但氯胺酮组患者在用药后的平均RASS评分较低。两组患者的气管插管率没有差异（分别为 6.1% 对 2.9%；P = 0.383）。结论：氯胺酮和咪达唑仑两种镇静剂都有镇静作用，但在到达急诊室后，氯胺酮组有更多患者需要额外的镇静剂以及气道或呼吸支持：结论：氯胺酮和咪达唑仑在院前环境中都相对安全有效。IM氯胺酮能产生更深层的镇静效果，但不会增加插管率。不过，急诊室医护人员在接诊使用 IM 氯胺酮治疗的患者时应准备好额外的镇静剂和气道干预措施。
{"title":"Prehospital Use of Ketamine Versus Midazolam for Sedation in Acute Severe Agitation","authors":"Charles Johndro, Sean Caffyn, Jasmine Chen, David Bailey, Michelle Burak, Emily Perriello, Daniel Youngstrom","doi":"10.56068/rhlt6550","DOIUrl":"https://doi.org/10.56068/rhlt6550","url":null,"abstract":"Objective: Acute severe agitation often requires pharmacologic sedation. While benzodiazepines and antipsychotics are traditional first-line medications for this purpose, recent evidence has shown that prehospital intramuscular (IM) administration of ketamine results in rapid, effective sedation. However, ketamine may be associated with adverse clinical events including a higher intubation rate. The purpose of this study is to compare the efficacy and safety of IM ketamine versus IM midazolam as medications to achieve sedation in the prehospital setting.\u0000Methods: This is a retrospective cohort study of agitated patients with an initial Richmond Agitation-Sedation Scale (RASS) score of at least 3, who were sedated and transported by ambulance to Hartford Hospital. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergency department (ED). Secondary endpoints included the percentage of patients who achieved an improved RASS score post drug administration, the use of additional sedating agents and the need for airway and breathing support, and differences in adverse events.\u0000Results: 66 patients in the ketamine group and 68 patients in the midazolam group met inclusion criteria. While more patients in the midazolam group achieved target RASS score of -1, 0, or 1 post drug administration, patients in the ketamine group had a lower mean RASS score post drug administration. There was no difference in endotracheal intubation rates between the two groups (6.1% versus 2.9%, respectively; p = 0.383). However, upon arrival to the ED, more patients in the ketamine group required additional sedating agents as well as airway or respiratory support\u0000Conclusion: Both ketamine and midazolam are relatively safe and efficacious in the prehospital environment. IM ketamine resulted in deeper sedation without increasing intubation rate. However, ED providers receiving patients treated with IM ketamine should prepare for additional sedating agents and airway interventions.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"2 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668152","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}
Bryan Harmer, Melissa Ivey, John Hoyle, Jr., Kieran Fogarty
Background: Cognitive aids are an essential aspect of patient care within emergency medical services (EMS). Despite their availability in EMS, these aids are underutilized. Understanding factors associated with increased use of cognitive aids can help guide the development of effective implementation strategies. This study examines the association between the frequency of cognitive aid use in EMS and three factors: the use of these aids into initial education programs, policies mandating their use, and clinicians’ perceptions of cognitive aid usefulness. Methods: This study used a cross-sectional survey examining the use, previous training, policy, and perceived usefulness of 15 selected cognitive aids. The survey was emailed to 136,093 EMS clinicians in six participating states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe the examined factors. Bivariate analysis was used to examine the relationship between the use of each cognitive aid and previous training with the aid, requirements for use, and perceived usefulness. Results: A total of 2,251 respondents met inclusion criteria and were included in the study. The length-based tape was the most common aid used during initial education programs (n=1724, 77.0%) and to have policy requiring its use during patient care (n=1194, 53.0%). Aids associated with pediatric medication administration were perceived as most useful. Clinicians were more likely to use a specific aid if there was policy requiring its use, if they used the aid during their initial education programs, or if they perceived it to be useful. Conclusions: The results of this study suggest that integrating a cognitive aid into EMS initial education programs, having policy requiring its use, and the aid being perceived as useful are all associated with increased use the aid during patient care. These results may provide valuable insights for devising more effective implementation strategies for cognitive aids.
{"title":"Factors Associated with Increased Use of Cognitive Aids in Emergency Medical Services","authors":"Bryan Harmer, Melissa Ivey, John Hoyle, Jr., Kieran Fogarty","doi":"10.56068/vgmr5544","DOIUrl":"https://doi.org/10.56068/vgmr5544","url":null,"abstract":"Background: Cognitive aids are an essential aspect of patient care within emergency medical services (EMS). Despite their availability in EMS, these aids are underutilized. Understanding factors associated with increased use of cognitive aids can help guide the development of effective implementation strategies. This study examines the association between the frequency of cognitive aid use in EMS and three factors: the use of these aids into initial education programs, policies mandating their use, and clinicians’ perceptions of cognitive aid usefulness. \u0000Methods: This study used a cross-sectional survey examining the use, previous training, policy, and perceived usefulness of 15 selected cognitive aids. The survey was emailed to 136,093 EMS clinicians in six participating states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe the examined factors. Bivariate analysis was used to examine the relationship between the use of each cognitive aid and previous training with the aid, requirements for use, and perceived usefulness. \u0000Results: A total of 2,251 respondents met inclusion criteria and were included in the study. The length-based tape was the most common aid used during initial education programs (n=1724, 77.0%) and to have policy requiring its use during patient care (n=1194, 53.0%). Aids associated with pediatric medication administration were perceived as most useful. Clinicians were more likely to use a specific aid if there was policy requiring its use, if they used the aid during their initial education programs, or if they perceived it to be useful. \u0000Conclusions: The results of this study suggest that integrating a cognitive aid into EMS initial education programs, having policy requiring its use, and the aid being perceived as useful are all associated with increased use the aid during patient care. These results may provide valuable insights for devising more effective implementation strategies for cognitive aids.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 882","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669164","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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