Objectives: Almost one third of pediatric 9-1-1 calls result in non-transport by Emergency Medical Services (EMS). It is unknown to what extent these decisions are driven by caregivers’ decisions to decline transport versus EMS advice that transport is unnecessary. Further, it is unknown whether demographic, encounter, or agency factors are associated with caregivers declining transport. Methods: We conducted a retrospective cross-sectional study with data from the national 2019 ESO Data Collaborative (a convenience sample with data from > 2,000 EMS agencies). We included 9-1-1 responses for children <18 years. The primary outcome was caregiver decision not to transport patient (per EMS documentation) compared to EMS-initiated non-transport. Descriptive data for patient dispositions were generated. Bivariable and multivariable logistic regression identified factors associated with caregiver decision not to transport. Results: Of 313,903 pediatric 9-1-1 activations, 37.2% resulted in non-transport, with 80.0% of pediatric non-transports attributable to a caregiver decision. The patient and encounter characteristics for children not transported by EMS were similar, regardless of whether the caregiver or EMS clinician made the decision not to transport. There was wide inter-agency variation in both the rate of non-transport (median 0.37, interquartile range (IQR 0.25 – 0.48)) and the proportion of these encounters attributable to a caregiver decision (median 0.82, IQR 0.68-0.94). Conclusions: In this large national dataset, pediatric non-transport by EMS was common, and in most cases non-transport was documented to result from a caregiver decision. Both the rates of non-transport and proportion of caregiver decision varied significantly between EMS agencies. Further research is needed to understand pediatric patient outcomes after non-transport and to identify the reasons for practice variability between EMS agencies. Developing standardized, evidence-based non-transport protocols for children may help reduce this potentially unwarranted clinical variation.
{"title":"Factors Associated with Caregiver Decision Not to Transport Pediatric Patients Assessed by Emergency Medical Services","authors":"Kristen Johnson, Caleb E Ward","doi":"10.56068/emrn2070","DOIUrl":"https://doi.org/10.56068/emrn2070","url":null,"abstract":"Objectives: Almost one third of pediatric 9-1-1 calls result in non-transport by Emergency Medical Services (EMS). It is unknown to what extent these decisions are driven by caregivers’ decisions to decline transport versus EMS advice that transport is unnecessary. Further, it is unknown whether demographic, encounter, or agency factors are associated with caregivers declining transport. \u0000Methods: We conducted a retrospective cross-sectional study with data from the national 2019 ESO Data Collaborative (a convenience sample with data from > 2,000 EMS agencies). We included 9-1-1 responses for children <18 years. The primary outcome was caregiver decision not to transport patient (per EMS documentation) compared to EMS-initiated non-transport. Descriptive data for patient dispositions were generated. Bivariable and multivariable logistic regression identified factors associated with caregiver decision not to transport. \u0000Results: Of 313,903 pediatric 9-1-1 activations, 37.2% resulted in non-transport, with 80.0% of pediatric non-transports attributable to a caregiver decision. The patient and encounter characteristics for children not transported by EMS were similar, regardless of whether the caregiver or EMS clinician made the decision not to transport. There was wide inter-agency variation in both the rate of non-transport (median 0.37, interquartile range (IQR 0.25 – 0.48)) and the proportion of these encounters attributable to a caregiver decision (median 0.82, IQR 0.68-0.94). \u0000Conclusions: In this large national dataset, pediatric non-transport by EMS was common, and in most cases non-transport was documented to result from a caregiver decision. Both the rates of non-transport and proportion of caregiver decision varied significantly between EMS agencies. Further research is needed to understand pediatric patient outcomes after non-transport and to identify the reasons for practice variability between EMS agencies. Developing standardized, evidence-based non-transport protocols for children may help reduce this potentially unwarranted clinical variation.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"507 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140750176","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: Emergency Medical Service (EMS) clinicians render care in less than ideal environments, and errors occur at high rates. Some cognitive aids (CAs) have been shown to reduce errors and improve adherence to evidence-based practices. However, there have been no widespread studies examining CA use in EMS. The objective of this study was to examine the frequency of CA use by EMS clinicians and which clinicians were using them more frequently during patient care. Methods: A cross-sectional online survey was developed using a modified Delphi method with items examining demographic information and the frequency that 15 selected CAs are used during patient care. A survey link was emailed to 136,093 EMS clinicians across six states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe frequencies. Kruskal-Wallis was used to assess if use differed among demographic or employment groups, and Spearman correlation was used to examine the relationship between clinician age and CA use. Results: A total of 2,251 respondents were included in the study after meeting the inclusion criteria. Of the 15 CAs examined, the length-based tape was the most used (Med= 3.0, IQR: 1.0 – 4.0). Overall CA use was limited, with a median score of 1.67 (IQR: 1.07 – 2.27). The following groups reported more frequent use of CAs: females (Med= 1.87, IQR: 1.27-2.47), Hispanics (Med= 1.93, IQR: 1.33-2.67), Black/African Americans (Med= 2.00, IQR: 1.20-2.53), air medical clinicians (Med= 2.00, IQR: 1.60-2.40) and clinicians working in military settings (Med= 2.23, IQR: 1.80-2.80). A small negative correlation was identified with age (r = -0.06, p = .005). Conclusions: Overall, CA use in EMS is limited. More effort is needed to increase their use in EMS. This data may provide insight to better target areas of need, improve design, and improve implementation of CAs in EMS.
背景：紧急医疗服务（EMS）的临床医生在不太理想的环境中提供医疗服务，出错率很高。一些认知辅助工具（CA）已被证明可以减少失误，提高循证实践的依从性。然而，目前还没有关于在急救医疗中使用认知辅助工具的广泛研究。本研究的目的是检查急救医疗临床医生使用 CA 的频率，以及哪些临床医生在患者护理过程中使用 CA 的频率更高。研究方法：采用改良德尔菲法开发了一项横向在线调查，调查项目包括人口统计学信息和 15 种选定 CA 在患者护理过程中的使用频率。通过电子邮件向六个州（德克萨斯州、密歇根州、密歇根州、洛杉矶州、南卡罗来纳州和阿肯色州）的 136093 名急救临床医生发送了调查链接。描述性统计用于描述频率。Kruskal-Wallis 用于评估人口统计或就业群体之间的使用情况是否存在差异，Spearman 相关性用于研究临床医生年龄与 CA 使用情况之间的关系。结果：符合纳入标准的受访者共有 2,251 人。在所研究的 15 种 CA 中，使用最多的是基于长度的磁带（Med= 3.0，IQR：1.0 - 4.0）。CA 的总体使用率有限，中位数为 1.67（IQR：1.07 - 2.27）。以下群体更频繁使用 CA：女性（中位数= 1.87，IQR：1.27-2.47）、西班牙裔（中位数= 1.93，IQR：1.33-2.67）、黑人/非洲裔美国人（中位数= 2.00，IQR：1.20-2.53）、空中医疗临床医生（中位数= 2.00，IQR：1.60-2.40）和在军事环境中工作的临床医生（中位数= 2.23，IQR：1.80-2.80）。与年龄存在微小的负相关（r = -0.06，p = .005）。结论：总体而言，CA 在急救服务中的使用有限。需要做出更多努力来提高 CA 在急救服务中的使用率。这些数据可为更好地瞄准需求领域、改进设计和改善 CA 在 EMS 中的实施提供洞察力。
{"title":"Examining Cognitive Aid Use in Emergency Medical Services","authors":"Bryan Harmer, Melissa Ivey, John Hoyle, Jr., Kieran Fogarty","doi":"10.56068/jmrq7592","DOIUrl":"https://doi.org/10.56068/jmrq7592","url":null,"abstract":"Background: Emergency Medical Service (EMS) clinicians render care in less than ideal environments, and errors occur at high rates. Some cognitive aids (CAs) have been shown to reduce errors and improve adherence to evidence-based practices. However, there have been no widespread studies examining CA use in EMS. The objective of this study was to examine the frequency of CA use by EMS clinicians and which clinicians were using them more frequently during patient care. \u0000Methods: A cross-sectional online survey was developed using a modified Delphi method with items examining demographic information and the frequency that 15 selected CAs are used during patient care. A survey link was emailed to 136,093 EMS clinicians across six states (TX, ME, MI, LA, SC, and AR). Descriptive statistics were used to describe frequencies. Kruskal-Wallis was used to assess if use differed among demographic or employment groups, and Spearman correlation was used to examine the relationship between clinician age and CA use. \u0000Results: A total of 2,251 respondents were included in the study after meeting the inclusion criteria. Of the 15 CAs examined, the length-based tape was the most used (Med= 3.0, IQR: 1.0 – 4.0). Overall CA use was limited, with a median score of 1.67 (IQR: 1.07 – 2.27). The following groups reported more frequent use of CAs: females (Med= 1.87, IQR: 1.27-2.47), Hispanics (Med= 1.93, IQR: 1.33-2.67), Black/African Americans (Med= 2.00, IQR: 1.20-2.53), air medical clinicians (Med= 2.00, IQR: 1.60-2.40) and clinicians working in military settings (Med= 2.23, IQR: 1.80-2.80). A small negative correlation was identified with age (r = -0.06, p = .005). \u0000Conclusions: Overall, CA use in EMS is limited. More effort is needed to increase their use in EMS. This data may provide insight to better target areas of need, improve design, and improve implementation of CAs in EMS.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"19 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747900","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}
L. Finlayson-Short, O. Metcalf, Hussain-Abdulah Arjmand, Meaghan O'Donnell, Megan Dobbie, Danielle North, T. Varker
Objective: Paramedics are exposed to significant job-related stressors, which have been exacerbated by the pressures of the COVID-19 pandemic. Given the essential role that paramedics play in the health system, it is imperative that we understand how their health and wellbeing are affected by this range of stressors. Methods: We conducted a mixed-methods, cross-sectional statewide survey of the Ambulance Organization workforce between August and November 2021. A total of 690 paramedics (i.e., operational staff) answered a quantitative question about operational and organizational job stressors, while a subset (N=151) provided a response to a free-text qualitative question about stress related to COVID-19. Results: Quantitative data revealed that COVID-19-related stressors were more stressful than all other job-related factors at that time. In addition, paramedics reported moderate to high levels of stress for nearly three quarters of all stressors listed. Thematic analysis of the qualitative question showed that paramedics experienced: stress related to operational changes; personal protective equipment related stress; the everyday life impacts of the COVID-19 pandemic; work-related conflicts and concerns; exposure to COVID-19; vaccine-related stress; and issues with management and communication. Conclusions: Paramedics have been significantly affected by the unique stressors brought about by the COVID-19 pandemic, which have added strain onto an already stressful work environment. The stressors we have identified suggest that organizations should examine their internal practices and consider their impact on paramedics, along with offering mental health support to paramedics where appropriate.
{"title":"Australian Paramedics’ Experiences of Stressors During the COVID-19 Pandemic","authors":"L. Finlayson-Short, O. Metcalf, Hussain-Abdulah Arjmand, Meaghan O'Donnell, Megan Dobbie, Danielle North, T. Varker","doi":"10.56068/zuqh9521","DOIUrl":"https://doi.org/10.56068/zuqh9521","url":null,"abstract":"Objective: Paramedics are exposed to significant job-related stressors, which have been exacerbated by the pressures of the COVID-19 pandemic. Given the essential role that paramedics play in the health system, it is imperative that we understand how their health and wellbeing are affected by this range of stressors. \u0000Methods: We conducted a mixed-methods, cross-sectional statewide survey of the Ambulance Organization workforce between August and November 2021. A total of 690 paramedics (i.e., operational staff) answered a quantitative question about operational and organizational job stressors, while a subset (N=151) provided a response to a free-text qualitative question about stress related to COVID-19. \u0000Results: Quantitative data revealed that COVID-19-related stressors were more stressful than all other job-related factors at that time. In addition, paramedics reported moderate to high levels of stress for nearly three quarters of all stressors listed. Thematic analysis of the qualitative question showed that paramedics experienced: stress related to operational changes; personal protective equipment related stress; the everyday life impacts of the COVID-19 pandemic; work-related conflicts and concerns; exposure to COVID-19; vaccine-related stress; and issues with management and communication. \u0000Conclusions: Paramedics have been significantly affected by the unique stressors brought about by the COVID-19 pandemic, which have added strain onto an already stressful work environment. The stressors we have identified suggest that organizations should examine their internal practices and consider their impact on paramedics, along with offering mental health support to paramedics where appropriate.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140747442","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}
There are roughly 1000 prehospital cardiac arrests in the US daily with a mortality rate approaching 90%1. In 2011 and the national association of EMS physicians position statement supporting prehospital termination of cardiac arrest has led to an increase in the number of patients dying in the prehospital environment. EMS clinicians responding to these emergencies are often tasked with breaking bad news (BBN) to families that their loved one has died. Currently no national curriculum, standardized training or mandated education around this subject exists for EMS clinicians. Recent research suggests that EMS clinicians are breaking bad news with frequency, are not receiving training on how to break bad news, are motivated to receive additional training around this subject and are suffering negative sequalae directly related to these conversations. Current existing curriculums around breaking bad news are designed for in hospital and clinic-based settings and are not wholly applicable to the dynamic prehospital environment. The following paper is a guide created by clinicians with EMS, palliative care, pediatric palliative care, and emergency medicine backgrounds to better help EMS clinicians navigate these difficult conversations. This guide is a step wise approach including dos and don’ts to help them navigate these challenging conversations as well as to help them navigate special circumstances such as topics around anger and pediatric patients. Currently no such guide exists, and it is the authors hope that this guide will be utilized to help EMS clinicians successfully engage in these conversations as well as help to inspire future research and education around this topic.
{"title":"Breaking Bad News in the Prehospital Setting","authors":"Zachary Tillett, Shelley Jacobs, Michelle Michelle","doi":"10.56068/glar2701","DOIUrl":"https://doi.org/10.56068/glar2701","url":null,"abstract":"There are roughly 1000 prehospital cardiac arrests in the US daily with a mortality rate approaching 90%1. In 2011 and the national association of EMS physicians position statement supporting prehospital termination of cardiac arrest has led to an increase in the number of patients dying in the prehospital environment. EMS clinicians responding to these emergencies are often tasked with breaking bad news (BBN) to families that their loved one has died. Currently no national curriculum, standardized training or mandated education around this subject exists for EMS clinicians. Recent research suggests that EMS clinicians are breaking bad news with frequency, are not receiving training on how to break bad news, are motivated to receive additional training around this subject and are suffering negative sequalae directly related to these conversations. Current existing curriculums around breaking bad news are designed for in hospital and clinic-based settings and are not wholly applicable to the dynamic prehospital environment. The following paper is a guide created by clinicians with EMS, palliative care, pediatric palliative care, and emergency medicine backgrounds to better help EMS clinicians navigate these difficult conversations. This guide is a step wise approach including dos and don’ts to help them navigate these challenging conversations as well as to help them navigate special circumstances such as topics around anger and pediatric patients. Currently no such guide exists, and it is the authors hope that this guide will be utilized to help EMS clinicians successfully engage in these conversations as well as help to inspire future research and education around this topic.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"39 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749926","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 purpose: A valid 12-lead electrocardiogram (ECG) depends on correct acquisition technique, particularly on the accurate location of precordial (chest) electrodes. The emergency medical services (EMS) segment of the care continuum is under-represented in previous clinically oriented studies of electrode placement. This study sought to assess the accuracy of chest electrode placement by EMS and clinical personnel in one geographic area, to identify patterns of misplacement to inform future training and continuing education, and to compare two methods of assessing electrode placement. Methods: This prospective observational study recruited a convenience sample of EMS and clinical personnel. Participants placed simulated electrodes on a CPR-style manikin and completed a questionnaire about their training and experience. A subset also marked electrode locations on a printed diagram of the ribcage. Digitized placement data and questionnaire responses were analysed statistically. Results: Findings from 149 participants showed misplacement patterns consistent with prior studies, with 41.6% rated as “acceptable” and 34.2% placing £ 3 electrodes acceptably. Correctness of electrode placement was comparable between EMS and clinical participants. More correct electrode placement correlated with classroom vs. on-the-job training, frequent vs. infrequent practice, and greater self-confidence. The diagram data collection method proved not equivalent to, and probably less reliable than, the hands-on manikin method for assessing placement skills. Conclusions: Significant variation in ECG chest electrode placement by EMS personnel was comparable to that previously reported for clinical personnel, suggesting that existing concerns about placement errors by clinical personnel may apply equally to EMS personnel. More frequent practice and classroom-based initial ECG training were associated with significantly greater placement accuracy. Participants used diverse strategies to identify electrode locations. Further research is warranted to clarify optimal strategies for placing chest electrodes, especially on diverse body types. Sound initial ECG training and continuing education are necessary to reinforce high-quality ECG skills.
{"title":"Assessing the Accuracy of ECG Chest Electrode Placement by EMS and Clinical Personnel Using Two Evaluation Methods","authors":"Edwin Clopton, Eira Kristiina Hyrkäs","doi":"10.56068/jgdq2473","DOIUrl":"https://doi.org/10.56068/jgdq2473","url":null,"abstract":"Background and purpose: A valid 12-lead electrocardiogram (ECG) depends on correct acquisition technique, particularly on the accurate location of precordial (chest) electrodes. The emergency medical services (EMS) segment of the care continuum is under-represented in previous clinically oriented studies of electrode placement. This study sought to assess the accuracy of chest electrode placement by EMS and clinical personnel in one geographic area, to identify patterns of misplacement to inform future training and continuing education, and to compare two methods of assessing electrode placement. \u0000Methods: This prospective observational study recruited a convenience sample of EMS and clinical personnel. Participants placed simulated electrodes on a CPR-style manikin and completed a questionnaire about their training and experience. A subset also marked electrode locations on a printed diagram of the ribcage. Digitized placement data and questionnaire responses were analysed statistically.\u0000Results: Findings from 149 participants showed misplacement patterns consistent with prior studies, with 41.6% rated as “acceptable” and 34.2% placing £ 3 electrodes acceptably. Correctness of electrode placement was comparable between EMS and clinical participants. More correct electrode placement correlated with classroom vs. on-the-job training, frequent vs. infrequent practice, and greater self-confidence. The diagram data collection method proved not equivalent to, and probably less reliable than, the hands-on manikin method for assessing placement skills.\u0000Conclusions: Significant variation in ECG chest electrode placement by EMS personnel was comparable to that previously reported for clinical personnel, suggesting that existing concerns about placement errors by clinical personnel may apply equally to EMS personnel. More frequent practice and classroom-based initial ECG training were associated with significantly greater placement accuracy. Participants used diverse strategies to identify electrode locations. Further research is warranted to clarify optimal strategies for placing chest electrodes, especially on diverse body types. Sound initial ECG training and continuing education are necessary to reinforce high-quality ECG skills.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"194 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140750457","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}
Brad Buck, LaTosha Hogan, Julius McAdams, Sean Teed
{"title":"Paramedicine Contents","authors":"Brad Buck, LaTosha Hogan, Julius McAdams, Sean Teed","doi":"10.56068/rzla6487","DOIUrl":"https://doi.org/10.56068/rzla6487","url":null,"abstract":"","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"216 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140746445","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}
Introduction: Health and wellbeing is essential to perform professionally and personally. The demanding workload and high-pressure nature of the paramedic profession, undoubtably has an influence on the paramedic’s health and wellbeing however the individual variance and factors associated is poorly understood. The objective of this review is to identify what is known about the occupational factors that influence paramedic health and wellbeing to make recommendations in improving working conditions and thus health and wellbeing of the workforce. Methods: The JBI approach was used to perform a scoping review to assess the availability of literature dating from January 2003 to January 2023. Keywords including paramedic*, first responder*, influence* OR perception*, health, wellbeing were input into the OVID, PsycINFO and PubMed databases. Titles and abstracts were reviewed by two authors and inclusion and exclusion criteria applied. The remaining articles were then reviewed in full text by two authors and conflicts managed by the primary author. Results: The search of the electronic databases identified 314 articles. Of these, 33 informed the results of the review. The search highlighted the paramedics poor reportable levels of health compared to other occupations. An analysis identified themes emerging from the literature including: (1)shift work; (2) mental health issues; (3) exposure to critical incidents; and (4) the influence of the profession on physical activity and ailment. Conclusion: A paramedics occupation has a significant influence on the individual’s health and is associated with an increased incidence of reportable illness and injury. The review concluded that there is insufficient data to identify the paramedics personal perception of the influences on their health and wellbeing. Thus, there is a lack of understanding of why the paramedic has poor reportable levels of health in their own words, which would be invaluable to the formation of preventative and supportive approaches to this workforce.
{"title":"Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing","authors":"Chloe Betts, Alannah Stoneley, Judith Anderson, Clare Sutton","doi":"10.56068/mnrg8307","DOIUrl":"https://doi.org/10.56068/mnrg8307","url":null,"abstract":"Introduction: Health and wellbeing is essential to perform professionally and personally. The demanding workload and high-pressure nature of the paramedic profession, undoubtably has an influence on the paramedic’s health and wellbeing however the individual variance and factors associated is poorly understood. The objective of this review is to identify what is known about the occupational factors that influence paramedic health and wellbeing to make recommendations in improving working conditions and thus health and wellbeing of the workforce. \u0000Methods: The JBI approach was used to perform a scoping review to assess the availability of literature dating from January 2003 to January 2023. Keywords including paramedic*, first responder*, influence* OR perception*, health, wellbeing were input into the OVID, PsycINFO and PubMed databases. Titles and abstracts were reviewed by two authors and inclusion and exclusion criteria applied. The remaining articles were then reviewed in full text by two authors and conflicts managed by the primary author. \u0000Results: The search of the electronic databases identified 314 articles. Of these, 33 informed the results of the review. The search highlighted the paramedics poor reportable levels of health compared to other occupations. An analysis identified themes emerging from the literature including: (1)shift work; (2) mental health issues; (3) exposure to critical incidents; and (4) the influence of the profession on physical activity and ailment. \u0000Conclusion: A paramedics occupation has a significant influence on the individual’s health and is associated with an increased incidence of reportable illness and injury. The review concluded that there is insufficient data to identify the paramedics personal perception of the influences on their health and wellbeing. Thus, there is a lack of understanding of why the paramedic has poor reportable levels of health in their own words, which would be invaluable to the formation of preventative and supportive approaches to this workforce.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"231 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140746544","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}
Introduction As the global demand for emergency health services continues to expand, the role of paramedics persists and grows alongside the expansion of ambulance services. The need to explore alternative pathways for enhancing service efficiency and alleviating hospital demands is increasingly evident, particularly for low-acuity cases. Non-traumatic dental conditions (NTDC) can be ongoing and have far-reaching health implications if not treated correctly. This scoping review aims to explore what is known about the incidence of NTDC cases attended by paramedics internationally. Methods Three electronic databases (Medline, Scopus, CINAHL) were searched between 1 Jan 2000 and 30 April 2023, using the primary search terms “paramedics,” “prehospital,” and “dental emergency.” In addition, grey literature was examined using Google Scholar. Studies were included if they investigated NTDC as the primary treatment condition in the prehospital setting (excluding clinical settings) and were written in English. Results Of 1755 articles identified only four studies met the inclusion criteria. Three were quantitative descriptive surveys, and one study included interview data. Studies originated in Poland, the United States, Turkey, and India. Paramedics who reported attending an NTDC case varied between 28% and 72%. Two papers reported on the demographics of patients most affected by NTDC, including young children aged 7-15 and older individuals between the ages of 45-64. Despite limitations and bias across all studies, results indicated insufficient knowledge and education of paramedics regarding dental anatomy or proper management of NTDC. Conclusion This scoping review identified a paucity of robust research and publications investigating the paramedic role in initial treatment and referral pathways of dental injuries. There was limited information on the paramedic’s knowledge, attitude, and training in dental injuries. Further research is required to determine paramedics’ preparedness to manage and improve patient outcomes to reduce the growing burden on emergency departments.
{"title":"Paramedic Exposure and Response to Non-Traumatic Dental Conditions","authors":"Rachael Berry, Silvana Bettiol, Dale G Edwards","doi":"10.56068/wnsv5250","DOIUrl":"https://doi.org/10.56068/wnsv5250","url":null,"abstract":"Introduction As the global demand for emergency health services continues to expand, the role of paramedics persists and grows alongside the expansion of ambulance services. The need to explore alternative pathways for enhancing service efficiency and alleviating hospital demands is increasingly evident, particularly for low-acuity cases. Non-traumatic dental conditions (NTDC) can be ongoing and have far-reaching health implications if not treated correctly. This scoping review aims to explore what is known about the incidence of NTDC cases attended by paramedics internationally.\u0000Methods Three electronic databases (Medline, Scopus, CINAHL) were searched between 1 Jan 2000 and 30 April 2023, using the primary search terms “paramedics,” “prehospital,” and “dental emergency.” In addition, grey literature was examined using Google Scholar. Studies were included if they investigated NTDC as the primary treatment condition in the prehospital setting (excluding clinical settings) and were written in English.\u0000Results Of 1755 articles identified only four studies met the inclusion criteria. Three were quantitative descriptive surveys, and one study included interview data. Studies originated in Poland, the United States, Turkey, and India. Paramedics who reported attending an NTDC case varied between 28% and 72%. Two papers reported on the demographics of patients most affected by NTDC, including young children aged 7-15 and older individuals between the ages of 45-64. Despite limitations and bias across all studies, results indicated insufficient knowledge and education of paramedics regarding dental anatomy or proper management of NTDC.\u0000Conclusion This scoping review identified a paucity of robust research and publications investigating the paramedic role in initial treatment and referral pathways of dental injuries. There was limited information on the paramedic’s knowledge, attitude, and training in dental injuries. Further research is required to determine paramedics’ preparedness to manage and improve patient outcomes to reduce the growing burden on emergency departments.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"148 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140746503","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}
Matthew Cividin, M. Wilkinson-Stokes, Alice D'Arcy, Alexander Olaussen
Objective: The objectives of this systematic review were to evaluate the incidence, patient demographics and associated outcomes of adult syncope presentations to emergency medical services (EMS) within current literature. Methods: Inclusion criteria were contact with an EMS, a provisional diagnosis of syncope and epidemiological data regarding EMS contact with these patients. Exclusion criteria were all non-primary studies, patients given an alternative provisional diagnosis or who received life supporting interventions, studies that examined only presyncope presentations or were limited to paediatric patients, or that examined syncope within highly specific non-generalisable settings. Databases were searched on April 5th, 2022, and included Emcare, AMED, Medline, and CINAHL Plus. Quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tool. Data were manually extracted and collated with results synthesised using descriptive statistics and a narrative synthesis. Results: 12 studies were included in this review. Studies were primarily completed in Europe or the USA, and sample sizes ranged from 500 to 16 million. Most studies were rated as good to fair in quality. No studies specifically looked at the incidence or outcomes of syncope presentations to EMS. The reported incidence of syncope ranged between 0.09% and 24%. Discussion: Most studies were generalised epidemiological studies looking at EMS presentations. There were no studies that specifically looked at the incidence and outcomes of syncope presentations to EMS together. Instead, they were either large scale epidemiological studies that lack detailed analysis or had small samples focusing only on certain patient characteristics or presentations. An improved understanding of the epidemiological features of syncope presentations within the prehospital setting and their associated outcomes are of critical importance for the determination of risk stratification that can help guide clinical decision making by EMS.
{"title":"Incidence and Outcomes of Adult Syncope Presentations to Emergency Medical Services","authors":"Matthew Cividin, M. Wilkinson-Stokes, Alice D'Arcy, Alexander Olaussen","doi":"10.56068/gigj5887","DOIUrl":"https://doi.org/10.56068/gigj5887","url":null,"abstract":"Objective: The objectives of this systematic review were to evaluate the incidence, patient demographics and associated outcomes of adult syncope presentations to emergency medical services (EMS) within current literature. \u0000Methods: Inclusion criteria were contact with an EMS, a provisional diagnosis of syncope and epidemiological data regarding EMS contact with these patients. Exclusion criteria were all non-primary studies, patients given an alternative provisional diagnosis or who received life supporting interventions, studies that examined only presyncope presentations or were limited to paediatric patients, or that examined syncope within highly specific non-generalisable settings. Databases were searched on April 5th, 2022, and included Emcare, AMED, Medline, and CINAHL Plus. Quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tool. Data were manually extracted and collated with results synthesised using descriptive statistics and a narrative synthesis. \u0000Results: 12 studies were included in this review. Studies were primarily completed in Europe or the USA, and sample sizes ranged from 500 to 16 million. Most studies were rated as good to fair in quality. No studies specifically looked at the incidence or outcomes of syncope presentations to EMS. The reported incidence of syncope ranged between 0.09% and 24%. \u0000Discussion: Most studies were generalised epidemiological studies looking at EMS presentations. There were no studies that specifically looked at the incidence and outcomes of syncope presentations to EMS together. Instead, they were either large scale epidemiological studies that lack detailed analysis or had small samples focusing only on certain patient characteristics or presentations. An improved understanding of the epidemiological features of syncope presentations within the prehospital setting and their associated outcomes are of critical importance for the determination of risk stratification that can help guide clinical decision making by EMS.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"56 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140749775","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}
Chris Kuhner, John Su, E. Quinn, Jennifer Wolin, Joshua Kimbrell, Matt Friedman, D. Lobel, Eitan Dickman, David Eng
Background: Emergency Department (ED) overcrowding limits patient care in the prehospital and hospital system. A program was implemented to decrease the time to patient handoff from EMS arrival to ED staff, also known as the delivery interval and total turnaround interval. Paramedics were added to the ED ambulance triage staff to receive verbal reports and perform certain tasks done traditionally by nurses. We hypothesized adding paramedics to the ED triage process would reduce delivery interval times and total turnaround times. Methods: This was a retrospective observational study comparing delivery and turnaround intervals for patients brought to the ED by ambulance, before and after the addition of a paramedic in triage. The study period included all adult ED patients brought in by ambulance between 11 AM and 11 PM. Pediatric patients (<21 years old), direct-to-inpatient interfacility transfers, and critical patients requiring immediate care in the resuscitation area and thus bypassing normal triage processes were excluded. The data was analyzed with two-sample t-tests with a confidence interval of a = 0.05. Results: Delivery interval pre-implementation of the program was 15:48 minutes (95% CI [15:28, 16:09]) compared to 14:04 minutes (95% CI [13:44, 14:25]) post-implementation. The mean turnaround interval pre-implementation was 35:21 minutes (95% CI [35:01, 35:42]) and 36:04 minutes (95% CI [35:40, 36:29]) post-implementation. The mean difference for the delivery interval was shortened by 01:44 minutes (p<0.0001; 95% CI [01:15, 02:13]). The mean turnaround interval increased by 00:43 seconds (p<0.01; 95% CI [00:11, 01:16]). Conclusion: Staffing a paramedic in ED triage decreased delivery interval by 1:44 minutes but did not affect ambulance turnaround times. Further research is needed to determine if the decrease in delivery interval improved patient outcomes and ways to translate the time saved in the delivery interval to total turnaround times.
背景：急诊室（ED）过度拥挤限制了院前和医院系统对病人的护理。我们实施了一项计划，以缩短从急救人员到达急诊室到工作人员交接病人的时间，也称为运送间隔和总周转间隔。急诊室救护车分诊人员中增加了辅助医务人员，以接收口头报告并执行传统上由护士完成的某些任务。我们假设在急诊室分诊流程中加入辅助医务人员将缩短运送间隔时间和总周转时间。方法：这是一项回顾性观察研究：这是一项回顾性观察研究，比较了在分诊过程中增加辅助医务人员之前和之后，救护车送来急诊室的病人的送达时间和周转时间间隔。研究期间包括上午 11 点至晚上 11 点之间所有由救护车送来的急诊室成人患者。小儿患者（年龄小于 21 岁）、直接转院至医院间的患者以及需要在抢救区立即接受治疗从而绕过正常分诊流程的危重患者不在研究范围内。数据采用双样本 t 检验进行分析，置信区间为 a = 0.05。结果计划实施前的运送间隔为 15:48 分钟（95% CI [15:28，16:09]），而实施后为 14:04 分钟（95% CI [13:44，14:25]）。实施前的平均周转间隔为 35:21 分钟（95% CI [35:01，35:42]），实施后为 36:04 分钟（95% CI [35:40，36:29]）。平均运送间隔缩短了 01:44 分钟（p<0.0001；95% CI [01:15，02:13]）。平均周转间隔增加了 00:43 秒（p<0.01；95% CI [00:11, 01:16]）。结论在急诊室分诊中配备一名辅助医务人员可将分娩间隔缩短 1:44 分钟，但不会影响救护车的周转时间。还需要进一步研究，以确定分娩间隔的缩短是否改善了患者的预后，以及如何将节省的分娩间隔时间转化为总周转时间。
{"title":"Effect of Paramedics in Emergency Department Triage on Ambulance Patient Offload Times","authors":"Chris Kuhner, John Su, E. Quinn, Jennifer Wolin, Joshua Kimbrell, Matt Friedman, D. Lobel, Eitan Dickman, David Eng","doi":"10.56068/vapf4488","DOIUrl":"https://doi.org/10.56068/vapf4488","url":null,"abstract":"Background: Emergency Department (ED) overcrowding limits patient care in the prehospital and hospital system. A program was implemented to decrease the time to patient handoff from EMS arrival to ED staff, also known as the delivery interval and total turnaround interval. Paramedics were added to the ED ambulance triage staff to receive verbal reports and perform certain tasks done traditionally by nurses. We hypothesized adding paramedics to the ED triage process would reduce delivery interval times and total turnaround times. Methods: This was a retrospective observational study comparing delivery and turnaround intervals for patients brought to the ED by ambulance, before and after the addition of a paramedic in triage. The study period included all adult ED patients brought in by ambulance between 11 AM and 11 PM. Pediatric patients (<21 years old), direct-to-inpatient interfacility transfers, and critical patients requiring immediate care in the resuscitation area and thus bypassing normal triage processes were excluded. The data was analyzed with two-sample t-tests with a confidence interval of a = 0.05. Results: Delivery interval pre-implementation of the program was 15:48 minutes (95% CI [15:28, 16:09]) compared to 14:04 minutes (95% CI [13:44, 14:25]) post-implementation. The mean turnaround interval pre-implementation was 35:21 minutes (95% CI [35:01, 35:42]) and 36:04 minutes (95% CI [35:40, 36:29]) post-implementation. The mean difference for the delivery interval was shortened by 01:44 minutes (p<0.0001; 95% CI [01:15, 02:13]). The mean turnaround interval increased by 00:43 seconds (p<0.01; 95% CI [00:11, 01:16]). Conclusion: Staffing a paramedic in ED triage decreased delivery interval by 1:44 minutes but did not affect ambulance turnaround times. Further research is needed to determine if the decrease in delivery interval improved patient outcomes and ways to translate the time saved in the delivery interval to total turnaround times.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"8 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140748315","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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