PhD Abdullah Alshamrani, PhD Cameron Gosling, PhD Eihab Khasawneh, Sultan Alzobaidi, PhD Brett Williams
Introduction Trauma is a major problem in Saudi Arabia and a leading cause of mortality and morbidity in young age groups. In 2018, road traffic injuries and trauma were the second-leading cause of death after ischaemic heart disease. There is a lack of research that explores the psychological effects on emergency medical service (EMS) professionals of providing the required pre-hospital care for trauma cases. This study aims to identify which trauma cases cause the most anxiety and concern among a group of EMS professionals. Methods A study using a two-round Delphi method was undertaken online with EMS professionals working for the Saudi Red Crescent Authority (SRCA) across the country. Results The response rate was 70% (n=14) at the end of round two. All participants were male and the majority of professionals who participated were from the capital city, representing 36%. Most of the professionals held a bachelor’s degree as the highest level of education (78%). The initial round generated one item that achieved 70% of the consensus; however, the second round did not achieve any consensus. The overall top item for the trauma cases that caused the most anxiety and concern as identified by respondents was road traffic collision. Conclusion Road traffic collisions are a leading cause of death and based on the respondents’ agreement they cause paramedics the most anxiety and concern of the cases they attend.
{"title":"Paramedics’ Anxiety and Concerns Towards Attending Traumatic Events","authors":"PhD Abdullah Alshamrani, PhD Cameron Gosling, PhD Eihab Khasawneh, Sultan Alzobaidi, PhD Brett Williams","doi":"10.56068/owik8868","DOIUrl":"https://doi.org/10.56068/owik8868","url":null,"abstract":"Introduction\u0000Trauma is a major problem in Saudi Arabia and a leading cause of mortality and morbidity in young age groups. In 2018, road traffic injuries and trauma were the second-leading cause of death after ischaemic heart disease. There is a lack of research that explores the psychological effects on emergency medical service (EMS) professionals of providing the required pre-hospital care for trauma cases. This study aims to identify which trauma cases cause the most anxiety and concern among a group of EMS professionals. \u0000Methods\u0000A study using a two-round Delphi method was undertaken online with EMS professionals working for the Saudi Red Crescent Authority (SRCA) across the country. \u0000Results\u0000The response rate was 70% (n=14) at the end of round two. All participants were male and the majority of professionals who participated were from the capital city, representing 36%. Most of the professionals held a bachelor’s degree as the highest level of education (78%). The initial round generated one item that achieved 70% of the consensus; however, the second round did not achieve any consensus. The overall top item for the trauma cases that caused the most anxiety and concern as identified by respondents was road traffic collision.\u0000Conclusion\u0000Road traffic collisions are a leading cause of death and based on the respondents’ agreement they cause paramedics the most anxiety and concern of the cases they attend.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"118 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667524","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 El Paso-Juárez metroplex comprises one of the world's busiest international land border crossings. Although prior studies have described prehospital care along the US-Mexico border, the epidemiology of 9-1-1 calls to the El Paso-Juárez border crossings has not been previously reported. Investigators sought to evaluate responses by emergency medical services (EMS) at El Paso-Juárez ports of entry (POE). Methods: This cross-sectional, retrospective study evaluates prehospital care provided by EMS at three international bridges in El Paso. The El Paso Fire Department (EPFD) provided data for all encounters between February 2017 and January 2023. This included date, POE, patient demographics, chief complaint, computer-aided dispatch (CAD), provider impression (diagnosis), and time out of service. Results: Over the study period, 8,407 encounters occurred at one of the three El Paso-Juárez POE, averaging 1,680 per year or 140 calls per month. The busiest month was July, with a median of 132 encounters. 45% of these calls took place at the Paseo Del Norte POE. The study population comprised 59% Hispanics, 4129 (49%) male, and 4266 (51%) female, from 0 to 103 years of age. The most common diagnosis was neurological (1,908, 22.7%), GI/GU (1,263, 15%), and injury or trauma (1117, 13%). 6,420 hours were spent responding to POE calls, the average call resulting in a 46-minute out-of-service time. Conclusion: This was the first study to investigate the epidemiology of prehospital care provided by EMS at the El Paso-Juárez international border crossing. A total of 8,407 prehospital EMS encounters occurred over the study period, which is expected to grow. We found roughly equal proportions of male and female patients with a wide range of ages. The most common diagnoses were weakness, abdominal pain, and non-traumatic pain. The results of this study could be utilized to enhance the quality of EMS offered at international border crossings.
{"title":"Cross-Sectional Retrospective Epidemiological Study of 9-1-1 Calls to the El Paso, Texas, and Ciudad Juárez International Border Crossing","authors":"Sunny Baker, Russell Baker, Andrew Martinez","doi":"10.56068/cpiv3712","DOIUrl":"https://doi.org/10.56068/cpiv3712","url":null,"abstract":"The El Paso-Juárez metroplex comprises one of the world's busiest international land border crossings. Although prior studies have described prehospital care along the US-Mexico border, the epidemiology of 9-1-1 calls to the El Paso-Juárez border crossings has not been previously reported. Investigators sought to evaluate responses by emergency medical services (EMS) at El Paso-Juárez ports of entry (POE). Methods: This cross-sectional, retrospective study evaluates prehospital care provided by EMS at three international bridges in El Paso. The El Paso Fire Department (EPFD) provided data for all encounters between February 2017 and January 2023. This included date, POE, patient demographics, chief complaint, computer-aided dispatch (CAD), provider impression (diagnosis), and time out of service. Results: Over the study period, 8,407 encounters occurred at one of the three El Paso-Juárez POE, averaging 1,680 per year or 140 calls per month. The busiest month was July, with a median of 132 encounters. 45% of these calls took place at the Paseo Del Norte POE. The study population comprised 59% Hispanics, 4129 (49%) male, and 4266 (51%) female, from 0 to 103 years of age. The most common diagnosis was neurological (1,908, 22.7%), GI/GU (1,263, 15%), and injury or trauma (1117, 13%). 6,420 hours were spent responding to POE calls, the average call resulting in a 46-minute out-of-service time. Conclusion: This was the first study to investigate the epidemiology of prehospital care provided by EMS at the El Paso-Juárez international border crossing. A total of 8,407 prehospital EMS encounters occurred over the study period, which is expected to grow. We found roughly equal proportions of male and female patients with a wide range of ages. The most common diagnoses were weakness, abdominal pain, and non-traumatic pain. The results of this study could be utilized to enhance the quality of EMS offered at international border crossings.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"125 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141667868","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}
Michael Spigner, Christian Garcia, Luke Welle, Darren Braude, Shelby Cluff, Robert LaPrise, Jenna White
The majority of cardiac arrests that occur in the United States are treated by EMS, which has stimulated interest in the use of prehospital ultrasound as a prognostic tool. Though end-tidal carbon dioxide (EtCO2) and cardiac rhythm have demonstrated prognostic value in out-of-hospital cardiac arrest (OHCA), few studies of ultrasound in the prehospital setting have attempted to address the same question. This retrospective study assesses the association between sonographic cardiac activity and contemporaneous measurements of EtCO2 and cardiac rhythm. Sixty-six cases of paramedic-performed cardiac sonography for OHCA were reviewed and clinical data for each case was abstracted directly from the monitor/defibrillator record. The mean timing of the initial ultrasound was 21 minutes (95% CI [18.7,23.3]) into the resuscitation. Organized cardiac activity was associated with higher mean EtCO2 than absence of organized activity (49.7mmHg (95% CI [44.4,55.0]) versus 28.3mmHg (95% CI [24.3,32.3]), p<0.001). Organized sonographic activity was also associated with contemporaneous cardiac rhythm (p=0.018) and was most frequently observed in PEA with a sinus rhythm. Paramedics interpreted intra-arrest cardiac ultrasound with 95.7% agreement with physicians (κ = 0.940). Mean pause in compressions to acquire ultrasound was 14.9 seconds (95% CI [13.3,16.6]).
在美国，大多数心脏骤停患者都是由急救中心救治的，这激发了人们将院前超声作为预后工具的兴趣。尽管潮气末二氧化碳（EtCO2）和心律对院外心脏骤停（OHCA）的预后具有重要价值，但很少有院前超声研究试图解决同样的问题。这项回顾性研究评估了超声心动图与当时测量的 EtCO2 和心律之间的关联。研究回顾了 66 例由医护人员为 OHCA 进行心脏超声检查的病例，并直接从监护仪/除颤仪记录中摘录了每个病例的临床数据。首次超声检查的平均时间为复苏后 21 分钟（95% CI [18.7,23.3]）。有组织的心脏活动与平均 EtCO2 高于无组织活动相关（49.7mmHg (95% CI [44.4,55.0]) 对 28.3mmHg (95% CI [24.3,32.3])，P<0.001）。有组织的声像图活动也与当时的心律有关（p=0.018），在窦性心律的 PEA 中最常观察到有组织的声像图活动。医护人员对心跳骤停时心脏超声波的解释与医生的一致率为 95.7%（κ = 0.940）。为获取超声波而进行的按压平均暂停时间为 14.9 秒（95% CI [13.3,16.6]）。
{"title":"Sonographic Cardiac Activity Correlates with End-Tidal Carbon Dioxide and Cardiac Rhythm in Out-of-Hospital Cardiac Arrest","authors":"Michael Spigner, Christian Garcia, Luke Welle, Darren Braude, Shelby Cluff, Robert LaPrise, Jenna White","doi":"10.56068/lxll1391","DOIUrl":"https://doi.org/10.56068/lxll1391","url":null,"abstract":"The majority of cardiac arrests that occur in the United States are treated by EMS, which has stimulated interest in the use of prehospital ultrasound as a prognostic tool. Though end-tidal carbon dioxide (EtCO2) and cardiac rhythm have demonstrated prognostic value in out-of-hospital cardiac arrest (OHCA), few studies of ultrasound in the prehospital setting have attempted to address the same question. This retrospective study assesses the association between sonographic cardiac activity and contemporaneous measurements of EtCO2 and cardiac rhythm. Sixty-six cases of paramedic-performed cardiac sonography for OHCA were reviewed and clinical data for each case was abstracted directly from the monitor/defibrillator record. The mean timing of the initial ultrasound was 21 minutes (95% CI [18.7,23.3]) into the resuscitation. Organized cardiac activity was associated with higher mean EtCO2 than absence of organized activity (49.7mmHg (95% CI [44.4,55.0]) versus 28.3mmHg (95% CI [24.3,32.3]), p<0.001). Organized sonographic activity was also associated with contemporaneous cardiac rhythm (p=0.018) and was most frequently observed in PEA with a sinus rhythm. Paramedics interpreted intra-arrest cardiac ultrasound with 95.7% agreement with physicians (κ = 0.940). Mean pause in compressions to acquire ultrasound was 14.9 seconds (95% CI [13.3,16.6]).","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 1099","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669021","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 Emergency Medical Services are strained in the face of high workforce turnover and substantial cost pressures. Voluntary workforce turnover exacerbates direct and indirect cost pressures including training, productivity loss, loss of talent, and covering vacancies. Reduction of voluntary turnover is therefore of practical interest for worker retention and cost reduction. While a robust body of literature is dedicated to exploring precursors of turnover, few studies have explored affective factors leading to turnover emergency medical service clinicians. Key questions investigated are (1) the relationship between trait emotional intelligence (EI) and turnover intention and (2) the relationship between EI and TI controlling for known predictors of turnover intention. A convenience sample (n=446) was obtained through an online survey created with validated EI, turnover, stress and other instruments and distributed to EMS providers via agencies and online forums. Analytic methods include t-tests, Pearson correlations, and linear regression. Higher trait EI was found to result in decreased turnover intention both at the global (r = -.31, p < 0.001) and factor levels (Wellbeing, r = -.22, p< 0.001; Self-Control r = -.19, p < 0.001; Emotionality, r = -.35, p < 0.001; Sociability, r = -.17, p < 0.001). While EI is found to predict turnover intention, other factors such as physical health, perceived stress, and income may be better predictors of turnover intent. Among the important implications of this study is trait EI should be included in discussions of job turnover of EMTs and paramedics, especially in human resource planning. In addition, it highlights that the mental and physical health of EMS clinicians deserves closer attentiveness by researchers, clinicians, policymakers and EMS managers.
面对高员工流失率和巨大的成本压力，紧急医疗服务部门的工作十分紧张。 劳动力的自愿流动加剧了直接和间接的成本压力，包括培训、生产力损失、人才流失和填补空缺。因此，减少自愿离职对留住员工和降低成本具有实际意义。 虽然有大量文献致力于探讨人员流失的前兆，但很少有研究探讨导致急救医疗服务临床医生流失的情感因素。研究的关键问题是：（1）特质情商（EI）与离职意向之间的关系；（2）在控制已知离职意向预测因素的情况下，情商与离职意向之间的关系。通过在线调查获得了方便样本（n=446），该调查使用了经过验证的情商、离职、压力和其他工具，并通过机构和在线论坛分发给了急救医疗服务提供者。分析方法包括 t 检验、皮尔逊相关和线性回归。在总体（r = -.31，p < 0.001）和因素（幸福感，r = -.22，p < 0.001；自控力，r = -.19，p < 0.001；情绪化，r = -.35，p < 0.001；社交能力，r = -.17，p < 0.001）两个层面上，都发现较高的特质 EI 会导致离职意向降低。虽然 EI 可以预测离职意向，但身体健康、感知压力和收入等其他因素可能更能预测离职意向。本研究的重要意义之一是，在讨论急救医生和护理人员的离职问题时，尤其是在人力资源规划中，应将特质 EI 纳入其中。此外，本研究还强调，研究人员、临床医生、政策制定者和急救医疗服务管理人员应更密切地关注急救医疗服务临床医生的身心健康。
{"title":"Role of Emotional Intelligence in Turnover Intention Among EMS Providers","authors":"Emily Kaplan, David Markenson","doi":"10.56068/ueui1980","DOIUrl":"https://doi.org/10.56068/ueui1980","url":null,"abstract":"The Emergency Medical Services are strained in the face of high workforce turnover and substantial cost pressures. Voluntary workforce turnover exacerbates direct and indirect cost pressures including training, productivity loss, loss of talent, and covering vacancies. Reduction of voluntary turnover is therefore of practical interest for worker retention and cost reduction. While a robust body of literature is dedicated to exploring precursors of turnover, few studies have explored affective factors leading to turnover emergency medical service clinicians. Key questions investigated are (1) the relationship between trait emotional intelligence (EI) and turnover intention and (2) the relationship between EI and TI controlling for known predictors of turnover intention. A convenience sample (n=446) was obtained through an online survey created with validated EI, turnover, stress and other instruments and distributed to EMS providers via agencies and online forums. Analytic methods include t-tests, Pearson correlations, and linear regression. Higher trait EI was found to result in decreased turnover intention both at the global (r = -.31, p < 0.001) and factor levels (Wellbeing, r = -.22, p< 0.001; Self-Control r = -.19, p < 0.001; Emotionality, r = -.35, p < 0.001; Sociability, r = -.17, p < 0.001). While EI is found to predict turnover intention, other factors such as physical health, perceived stress, and income may be better predictors of turnover intent. Among the important implications of this study is trait EI should be included in discussions of job turnover of EMTs and paramedics, especially in human resource planning. In addition, it highlights that the mental and physical health of EMS clinicians deserves closer attentiveness by researchers, clinicians, policymakers and EMS managers.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 570","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669633","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}
Ashley Gallagher, Sonja Maria, P. Micalos, Lauren Ahern
Objective: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality in Australia. Paramedics treating adults with STEMI in the out-of-hospital environment can use fentanyl or morphine to manage the patient’s pain, although there is little research comparing the efficacy and safety of these drugs. Therefore, the objective of this study was to compare the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in adult STEMI patients in the out-of-hospital environment. Methods: We conducted a retrospective analysis of records of 1902 STEMI cases attended by Queensland Ambulance Service paramedics during the 4-year interval from 2013 to 2016. We compared pain score, blood pressure, respiratory rate, and pulse rate between patients administered intravenous fentanyl and intravenous morphine. We used a two-way mixed effects model (drug, time) to assess for main and interaction effects, and where the interaction effect was significant, applied Mann-Whitney U tests to further analyze between-group differences at each time point. Results: We observed a significant main effect of time on pain score (p < 0.001), respiratory rate (p < 0.05), and pulse rate (p = 0.025), such that these variables all decreased over time. Additionally, we observed a significant drug-time interaction for systolic and diastolic blood pressures (both p < 0.01), such that blood pressures decreased over time in the morphine, but not fentanyl, group. Conclusion: We compared the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in out-of-hospital adult STEMI patients and observed differences in blood pressures only. Morphine appeared to have a depressive effect on systolic and diastolic blood pressure, whereas fentanyl did not. An unanticipated behavioural finding of this research is that, in the absence of a definitive guideline, paramedics appear to use fentanyl when patients may be at risk of developing hypotension.
{"title":"Effect of Fentanyl Compared to Morphine on Pain Score and Cardiorespiratory Vital Signs in Out-of-Hospital Adult STEMI Patients","authors":"Ashley Gallagher, Sonja Maria, P. Micalos, Lauren Ahern","doi":"10.56068/hjnx4647","DOIUrl":"https://doi.org/10.56068/hjnx4647","url":null,"abstract":"Objective: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality in Australia. Paramedics treating adults with STEMI in the out-of-hospital environment can use fentanyl or morphine to manage the patient’s pain, although there is little research comparing the efficacy and safety of these drugs. Therefore, the objective of this study was to compare the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in adult STEMI patients in the out-of-hospital environment. \u0000Methods: We conducted a retrospective analysis of records of 1902 STEMI cases attended by Queensland Ambulance Service paramedics during the 4-year interval from 2013 to 2016. We compared pain score, blood pressure, respiratory rate, and pulse rate between patients administered intravenous fentanyl and intravenous morphine. We used a two-way mixed effects model (drug, time) to assess for main and interaction effects, and where the interaction effect was significant, applied Mann-Whitney U tests to further analyze between-group differences at each time point. \u0000Results: We observed a significant main effect of time on pain score (p < 0.001), respiratory rate (p < 0.05), and pulse rate (p = 0.025), such that these variables all decreased over time. Additionally, we observed a significant drug-time interaction for systolic and diastolic blood pressures (both p < 0.01), such that blood pressures decreased over time in the morphine, but not fentanyl, group. \u0000Conclusion: We compared the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in out-of-hospital adult STEMI patients and observed differences in blood pressures only. Morphine appeared to have a depressive effect on systolic and diastolic blood pressure, whereas fentanyl did not. An unanticipated behavioural finding of this research is that, in the absence of a definitive guideline, paramedics appear to use fentanyl when patients may be at risk of developing hypotension.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 877","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669168","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}
Z. Tillett, Andrew Spruce, Shelley Jacobs, Sharon Granville, John Martel, Michelle Crispo
Out-of-hospital cardiac arrest (OHCA) can have significant adverse sequelae for both the patient’s families, as well as the responding EMS clinicians. Despite advances in medicine, 90% of OHCA result in death. The sudden and unexpected nature of these events, adds to the complexity of grief for the surviving family members. OHCA specifically has been shown to have deleterious mental health impacts on EMS clinicians who have self-reported experiencing negative emotions after delivering bad news to families such as a death notification. Given the grim prognosis associated with OHCA outcomes and associated emotional fallout, we must find ways to better support our patients, families, and EMS clinicians. The goal of this paper is to offer recommendations and tools that can be used by EMS clinicians to better address the emotional burden experienced by families during an OHCA resuscitation. Many Pre-hospital clinicians receive limited training around the psychologic and emotional consequences that accompany OHCA scenarios. Currently no national curriculum or writings that the authors are aware of have covered the concept of how to run an emotionally supportive OHCA. The following is an expert consensus of recommendations from a group of experienced EMS clinicians, a child life specialist, a licensed clinical social worker and physicians with backgrounds in emergency medicine, palliative care and EMS. The strategies outlined would ideally be utilized by first responders helping to anticipate and subsequently support the emotional needs of families. The strategies range from ways to enhance communication, help combat common misperceptions from families around cardiac arrest and prepare EMS clinicians for what to do if a resuscitation is unsuccessful. Ultimately the goal of this paper is to provide the tools to help EMS clinicians better align themselves with families to minimize the emotional impact on all involved.
{"title":"Supporting Families and Our Own","authors":"Z. Tillett, Andrew Spruce, Shelley Jacobs, Sharon Granville, John Martel, Michelle Crispo","doi":"10.56068/wybm9414","DOIUrl":"https://doi.org/10.56068/wybm9414","url":null,"abstract":"Out-of-hospital cardiac arrest (OHCA) can have significant adverse sequelae for both the patient’s families, as well as the responding EMS clinicians. Despite advances in medicine, 90% of OHCA result in death. The sudden and unexpected nature of these events, adds to the complexity of grief for the surviving family members. OHCA specifically has been shown to have deleterious mental health impacts on EMS clinicians who have self-reported experiencing negative emotions after delivering bad news to families such as a death notification. Given the grim prognosis associated with OHCA outcomes and associated emotional fallout, we must find ways to better support our patients, families, and EMS clinicians. \u0000The goal of this paper is to offer recommendations and tools that can be used by EMS clinicians to better address the emotional burden experienced by families during an OHCA resuscitation. Many Pre-hospital clinicians receive limited training around the psychologic and emotional consequences that accompany OHCA scenarios. \u0000Currently no national curriculum or writings that the authors are aware of have covered the concept of how to run an emotionally supportive OHCA. The following is an expert consensus of recommendations from a group of experienced EMS clinicians, a child life specialist, a licensed clinical social worker and physicians with backgrounds in emergency medicine, palliative care and EMS. The strategies outlined would ideally be utilized by first responders helping to anticipate and subsequently support the emotional needs of families. The strategies range from ways to enhance communication, help combat common misperceptions from families around cardiac arrest and prepare EMS clinicians for what to do if a resuscitation is unsuccessful. Ultimately the goal of this paper is to provide the tools to help EMS clinicians better align themselves with families to minimize the emotional impact on all involved.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668431","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}
This paper highlights key research areas within paramedicine education in Australia. Firstly, it discusses the need for a comparative analysis of accreditation standards, focusing on the recent shift towards a pre-employment model and its impact on program content, particularly the balance between theoretical and practical components. Secondly, it addresses the importance of exploring the influence of ethics education on paramedic practice, investigating how a robust ethical foundation acquired during education translates into ethical practices in real-world scenarios. Additionally, it suggests conducting a comparative study of international models to understand different education approaches, emphasising the importance of identifying best practices to enhance paramedic education in Australia. Lastly, it emphasises the significance of assessing the impact of accreditation changes in 2018, specifically the shift in accreditation responsibilities from the Council of Ambulance Authorities to the Paramedicine Board of Australia, aiming to understand its implications on the quality and consistency of paramedicine education across various institutions. Overall, this paper highlight the critical research gaps and areas of investigation essential for advancing paramedicine education and improving the quality of paramedic training in Australia.
{"title":"Vocational and University Paramedicine Education","authors":"Anthony Weber, Scott Devenish, Louisa Lam","doi":"10.56068/intx9615","DOIUrl":"https://doi.org/10.56068/intx9615","url":null,"abstract":"This paper highlights key research areas within paramedicine education in Australia. Firstly, it discusses the need for a comparative analysis of accreditation standards, focusing on the recent shift towards a pre-employment model and its impact on program content, particularly the balance between theoretical and practical components. Secondly, it addresses the importance of exploring the influence of ethics education on paramedic practice, investigating how a robust ethical foundation acquired during education translates into ethical practices in real-world scenarios. Additionally, it suggests conducting a comparative study of international models to understand different education approaches, emphasising the importance of identifying best practices to enhance paramedic education in Australia. Lastly, it emphasises the significance of assessing the impact of accreditation changes in 2018, specifically the shift in accreditation responsibilities from the Council of Ambulance Authorities to the Paramedicine Board of Australia, aiming to understand its implications on the quality and consistency of paramedicine education across various institutions. Overall, this paper highlight the critical research gaps and areas of investigation essential for advancing paramedicine education and improving the quality of paramedic training in Australia.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141668675","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. Ciaraglia, Alison Smith, Benjamin Axtman, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins
Introduction: Tension pneumothorax related to chest trauma is a rapidly lethal condition that requires immediate treatment, often prior to arrival at definitive care. Recent concerns regarding the safety and efficacy of needle thoracostomy (NT) have led to alternatives. Finger thoracostomy (FT) is a potential life-saving treatment performed by prehospital providers as an alternative to NT. We hypothesize that FT has improved rates of prehospital thoracic decompression and is a safe alternative to NT. Materials and Methods: Retrospective cohort study of consecutive adult trauma patients presenting to a Level 1 trauma center who sustained chest trauma. A matched cohort of patients who underwent prehospital FT was compared to patients who underwent prehospital NT for thoracic decompression. Wilcoxon Rank Sum Test and Chi-Squared Analyses were performed for comparison of prehospital and in-hospital outcome variables. Results: 34 patients were compared, of which 15 underwent prehospital FT and 19 underwent prehospital needle thoracostomy NT. Groups were well matched in terms of demographics and injury characteristics. No difference in transport times were observed. All 15 patients in the FT group sustained cardiac arrest prior to arrival with 20% achieving return of spontaneous circulation (ROSC), while 6/19 NT patients arrived in cardiac arrest, with 66.7% achieving ROSC (p = 0.04). The rate of successful intrathoracic decompression was higher in the FT group (93.3% vs 47.4%, p<0.001). The NT group had a higher rate of chest tube placement (p=0.005). In-hospital mortality was not different between the two groups (p=0.213). Conclusions: FT is a viable alternative to NT for emergent thoracic decompression. The higher success rate of intrathoracic decompression supports the use of FT as an alternative to NT for prehospital tension pneumothorax, although future studies are needed establish superiority and further evaluate mortality and in-hospital outcomes.
导言：与胸部创伤有关的张力性气胸是一种迅速致命的疾病，需要立即治疗，通常是在到达最终治疗机构之前。最近，人们对针刺胸腔造口术（NT）的安全性和有效性产生了担忧，因此出现了替代方法。指套胸腔造口术（FT）是院前医疗服务提供者实施的一种潜在的救生治疗方法，可替代针刺胸腔造口术。我们假设 FT 可提高院前胸廓减压率，并且是 NT 的安全替代方案。材料和方法：回顾性队列研究，研究对象为前往一级创伤中心就诊的连续胸部创伤成人患者。将接受院前 FT 的患者与接受院前 NT 进行胸廓减压的患者进行匹配队列比较。院前和院内结果变量的比较采用 Wilcoxon 秩和检验和 Chi-Squared 分析。结果比较了 34 名患者，其中 15 人接受了院前 FT，19 人接受了院前针刺胸腔造口术 NT。两组在人口统计学和损伤特征方面完全匹配。转运时间无差异。FT 组的 15 名患者在到达前均出现心脏骤停，其中 20% 实现了自主循环 (ROSC)，而 NT 组有 6/19 名患者在到达时心脏骤停，其中 66.7% 实现了自主循环 (ROSC)（p = 0.04）。FT 组胸腔内减压成功率更高（93.3% 对 47.4%，P<0.001）。NT 组的胸管置入率更高（P=0.005）。两组的院内死亡率无差异（P=0.213）。结论：在急诊胸腔减压术中，FT 是 NT 的可行替代方案。胸腔内减压的成功率较高，这支持使用 FT 替代 NT 治疗院前张力性气胸，但仍需今后的研究来确定其优越性，并进一步评估死亡率和院内预后。
{"title":"Retrospective Matched Cohort Comparison of Prehospital Finger Thoracostomy and Needle Thoracostomy Performed by Ground Emergency Medical Services","authors":"A. Ciaraglia, Alison Smith, Benjamin Axtman, Brian Eastridge, Ronald Stewart, Susannah Nicholson, Donald Jenkins","doi":"10.56068/xigr4635","DOIUrl":"https://doi.org/10.56068/xigr4635","url":null,"abstract":"Introduction: Tension pneumothorax related to chest trauma is a rapidly lethal condition that requires immediate treatment, often prior to arrival at definitive care. Recent concerns regarding the safety and efficacy of needle thoracostomy (NT) have led to alternatives. Finger thoracostomy (FT) is a potential life-saving treatment performed by prehospital providers as an alternative to NT. We hypothesize that FT has improved rates of prehospital thoracic decompression and is a safe alternative to NT. \u0000Materials and Methods: Retrospective cohort study of consecutive adult trauma patients presenting to a Level 1 trauma center who sustained chest trauma. A matched cohort of patients who underwent prehospital FT was compared to patients who underwent prehospital NT for thoracic decompression. Wilcoxon Rank Sum Test and Chi-Squared Analyses were performed for comparison of prehospital and in-hospital outcome variables. \u0000Results: 34 patients were compared, of which 15 underwent prehospital FT and 19 underwent prehospital needle thoracostomy NT. Groups were well matched in terms of demographics and injury characteristics. No difference in transport times were observed. All 15 patients in the FT group sustained cardiac arrest prior to arrival with 20% achieving return of spontaneous circulation (ROSC), while 6/19 NT patients arrived in cardiac arrest, with 66.7% achieving ROSC (p = 0.04). The rate of successful intrathoracic decompression was higher in the FT group (93.3% vs 47.4%, p<0.001). The NT group had a higher rate of chest tube placement (p=0.005). In-hospital mortality was not different between the two groups (p=0.213). \u0000Conclusions: FT is a viable alternative to NT for emergent thoracic decompression. The higher success rate of intrathoracic decompression supports the use of FT as an alternative to NT for prehospital tension pneumothorax, although future studies are needed establish superiority and further evaluate mortality and in-hospital outcomes.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"641 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749499","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}
Elise Solazzo, Kerry McCans, Sylvia Owusu-Ansah, Kenneth Williams
Age may be a factor in Emergency Medical Services (EMS) treatment of patients, and understanding of age-related patient differences is important to those providing care in the prehospital environment. The US Health Resources and Services Administration’s Maternal Child Health Bureau (HRSA MCHB) through their Emergency Medical Services for Children (EMSC) program has coordinated a focus on pediatric EMS care. However, there is a wide variety of age and other categorizations used to define the pediatric EMS population. This paper reviews the current state of pediatric EMS categorization from several sources, including national-level agencies and organizations, EMS Protocols, and other sources, and provides an overview of the anatomic, physiologic, and behavioral parameters that are generally expected within the range of pediatric ages. We found that, of 32 states publishing statewide EMS protocols online, there was great variability in the definition of a pediatric patient. The age at which states identified the transition from pediatric to adult patient ranged from 12-18 years old, and several states used non-aged-based definitions.
{"title":"When Should EMS Call a Child a Small Adult: Inconsistency in Protocol Definitions","authors":"Elise Solazzo, Kerry McCans, Sylvia Owusu-Ansah, Kenneth Williams","doi":"10.56068/kcyd7018","DOIUrl":"https://doi.org/10.56068/kcyd7018","url":null,"abstract":"Age may be a factor in Emergency Medical Services (EMS) treatment of patients, and understanding of age-related patient differences is important to those providing care in the prehospital environment. The US Health Resources and Services Administration’s Maternal Child Health Bureau (HRSA MCHB) through their Emergency Medical Services for Children (EMSC) program has coordinated a focus on pediatric EMS care. However, there is a wide variety of age and other categorizations used to define the pediatric EMS population. This paper reviews the current state of pediatric EMS categorization from several sources, including national-level agencies and organizations, EMS Protocols, and other sources, and provides an overview of the anatomic, physiologic, and behavioral parameters that are generally expected within the range of pediatric ages. We found that, of 32 states publishing statewide EMS protocols online, there was great variability in the definition of a pediatric patient. The age at which states identified the transition from pediatric to adult patient ranged from 12-18 years old, and several states used non-aged-based definitions.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140750886","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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