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}
Background: This study is to concentrate on adverse outcomes of CPR in out-of-hospital cardiac arrest (OHCA) among different performers that are trained first responders, professional practitioners, and automated devices by exploring types of injuries and comparing between datasets. It is also to find out potential contributing factors for each injury which display statistical significance. Methods: Forensic autopsy data from a single center covering almost half of Bangkok and her outskirts which were performed during October 2020 to January 2021 were retrospectively collected and analyzed. The data were divided into 3 groups, namely, TFR (trained first responder), PP (professional practitioner), and Auto (automated device i.e. LUCAS system). Thoraco-abdominal injuries were recorded including soft tissue, bone and internal viscera. Factors including age, BMI, sternal length (SL) and chest circumference (CC) were categorized in each injury. Statistical comparison between groups and analysis for significant factors were performed. Results: A total number of 158 cases reported as OHCA with exclusion of thoraco-abdominal injuries were recruited. The most commonly found as a hallmark of CPR injuries are chest wall fractures especially those of ribs (65.7%). Bilateral anterior rib fractures are more common than unilateral. Significantly associated factors to rib fractures are age and BMI. Other injuries are sternal fractures, lung contusions and lacerations, epicardial and subendocardial hemorrhages, cardiac contusions, liver lacerations, and pancreatic and splenic hemorrhages. No statistical difference between injuries generated by trained first responders and professional practitioners. LUCAS devices show higher incidence of injuries than manual CPR. Conclusion: This study may provide useful information for clinicians to investigate and monitor potential CPR complications as well as for forensic physicians to concern the injuries possibly caused by CPR.
{"title":"Injuries Associated with Prehospital CPR Provided by Professionals and Non-Professionals in Bangkok EMS","authors":"Chakrapong Victor, Nitikorn Poriswanish","doi":"10.56068/gvwa7665","DOIUrl":"https://doi.org/10.56068/gvwa7665","url":null,"abstract":"Background: This study is to concentrate on adverse outcomes of CPR in out-of-hospital cardiac arrest (OHCA) among different performers that are trained first responders, professional practitioners, and automated devices by exploring types of injuries and comparing between datasets. It is also to find out potential contributing factors for each injury which display statistical significance. \u0000Methods: Forensic autopsy data from a single center covering almost half of Bangkok and her outskirts which were performed during October 2020 to January 2021 were retrospectively collected and analyzed. The data were divided into 3 groups, namely, TFR (trained first responder), PP (professional practitioner), and Auto (automated device i.e. LUCAS system). Thoraco-abdominal injuries were recorded including soft tissue, bone and internal viscera. Factors including age, BMI, sternal length (SL) and chest circumference (CC) were categorized in each injury. Statistical comparison between groups and analysis for significant factors were performed. \u0000Results: A total number of 158 cases reported as OHCA with exclusion of thoraco-abdominal injuries were recruited. The most commonly found as a hallmark of CPR injuries are chest wall fractures especially those of ribs (65.7%). Bilateral anterior rib fractures are more common than unilateral. Significantly associated factors to rib fractures are age and BMI. Other injuries are sternal fractures, lung contusions and lacerations, epicardial and subendocardial hemorrhages, cardiac contusions, liver lacerations, and pancreatic and splenic hemorrhages. No statistical difference between injuries generated by trained first responders and professional practitioners. LUCAS devices show higher incidence of injuries than manual CPR. \u0000Conclusion: This study may provide useful information for clinicians to investigate and monitor potential CPR complications as well as for forensic physicians to concern the injuries possibly caused by CPR.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"5 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449904","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: Effective service delivery and the wellbeing of the paramedic workforce is reliant on confounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is limited literature available examining these. The objective of this review was to investigate where and how these disparities exist to make recommendations in achieving equity in the paramedic workforce and thus achieve patient-centred care universally across rural and urban populations. Methods: The JBI approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, EMT, urban OR metro*, rural OR remote and disparit* were inserted into the search engines MEDLINE, CINAHL Plus and Scopus. Titles and abstracts of the 282 results were screened by two authors and inclusion and exclusion criteria applied. The full text of the remaining 77 results were screened to inform the results of the review. Results: The search identified 282 potentially relevant articles, of which 33 informed the results of the review. The included studies identified emerging themes relevant to the objective including: (1) the skills, training availability and confidence of the workforce (2) resourcing of ambulances inclusive of both workload and case load; (3) timings of each group regarding response, scene, and transport; and (4) the health status of paramedics in each subset location. Conclusion: This review identified several disparities between rural and urban paramedic locations. However, it does not allow us to understand the extent at which these influence paramedics health and wellbeing and their ability to provide optimal patient-centred care which is equitable across locations. Further research is recommended to establish the extent to which these disparities are impacting the lives of paramedics and provision of emergency healthcare.
{"title":"Paramedic Workforce Disparities Marked by Geographical Positioning","authors":"Chloe Betts, Alannah Stoneley, Judith Anderson, Clare Sutton","doi":"10.56068/xdiv1632","DOIUrl":"https://doi.org/10.56068/xdiv1632","url":null,"abstract":"Introduction: Effective service delivery and the wellbeing of the paramedic workforce is reliant on confounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is limited literature available examining these. The objective of this review was to investigate where and how these disparities exist to make recommendations in achieving equity in the paramedic workforce and thus achieve patient-centred care universally across rural and urban populations. \u0000Methods: The JBI approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, EMT, urban OR metro*, rural OR remote and disparit* were inserted into the search engines MEDLINE, CINAHL Plus and Scopus. Titles and abstracts of the 282 results were screened by two authors and inclusion and exclusion criteria applied. The full text of the remaining 77 results were screened to inform the results of the review. \u0000Results: The search identified 282 potentially relevant articles, of which 33 informed the results of the review. The included studies identified emerging themes relevant to the objective including: (1) the skills, training availability and confidence of the workforce (2) resourcing of ambulances inclusive of both workload and case load; (3) timings of each group regarding response, scene, and transport; and (4) the health status of paramedics in each subset location. \u0000Conclusion: This review identified several disparities between rural and urban paramedic locations. However, it does not allow us to understand the extent at which these influence paramedics health and wellbeing and their ability to provide optimal patient-centred care which is equitable across locations. Further research is recommended to establish the extent to which these disparities are impacting the lives of paramedics and provision of emergency healthcare.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"38 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449555","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: The shock index is a valid tool used to detect impending circulatory collapse in the pre-hospital setting. As validation of the shock index requires high sample sizes, the majority of retrospective studies have been performed at urban level 1 trauma centers. We hypothesized that the shock index would accurately predict mortality in a rural level 1 trauma center. Objective - Determine if the shock index continues to be a reliable predictive value in trauma patients for morbidity and mortality. Setting - This retrospective study was performed at a state-designated level 1 trauma center in Johnson City, Tennessee. Patients were excluded from the study if they were under the age of 18, not immediately transported to the trauma center or if insufficient data was available. The shock index was calculated as heart rate/systolic blood pressure. Both the prehospital and emergency department shock indexes were calculated, with the emergency department vital signs being the first upon arrival. Patients were divided into three categories: SI ≤ 0.7, 0.71-0.89, and ≥ 0.9. We assessed the relationship between SI, blood product usage, and outcome variables using Pearson correlation coefficients and logistic regression. Chi-square analysis was used to show the difference in mortality between the groups. Results - A higher shock index score after arrival to the emergency department experienced longer hospital, intensive care unit, and mechanical ventilation days, injury severity scores, packed red blood cells, plasma, platelets, and total blood product usage. Mortality was higher in the groups with an SI of ≥ 0.9 at the scene and arrival to the emergency department. Conclusion - Patients with a shock index > 0.71-0.89 in both prehospital and emergency departments had higher mortality rates and need for transfusion. The shock index continues to be a reliable predictive value in trauma patients for morbidity and mortality.
{"title":"Correlation Between Shock Index and Mortality in the Prehospital and Level 1 Rural Trauma Center Emergency Department Settings","authors":"Victoria Clancy, Matthew Leonard, Bracken Burns","doi":"10.56068/tjao4623","DOIUrl":"https://doi.org/10.56068/tjao4623","url":null,"abstract":"Background: The shock index is a valid tool used to detect impending circulatory collapse in the pre-hospital setting. As validation of the shock index requires high sample sizes, the majority of retrospective studies have been performed at urban level 1 trauma centers. We hypothesized that the shock index would accurately predict mortality in a rural level 1 trauma center.\u0000Objective - Determine if the shock index continues to be a reliable predictive value in trauma patients for morbidity and mortality. \u0000Setting - This retrospective study was performed at a state-designated level 1 trauma center in Johnson City, Tennessee. Patients were excluded from the study if they were under the age of 18, not immediately transported to the trauma center or if insufficient data was available. The shock index was calculated as heart rate/systolic blood pressure. Both the prehospital and emergency department shock indexes were calculated, with the emergency department vital signs being the first upon arrival. Patients were divided into three categories: SI ≤ 0.7, 0.71-0.89, and ≥ 0.9. We assessed the relationship between SI, blood product usage, and outcome variables using Pearson correlation coefficients and logistic regression. Chi-square analysis was used to show the difference in mortality between the groups.\u0000Results - A higher shock index score after arrival to the emergency department experienced longer hospital, intensive care unit, and mechanical ventilation days, injury severity scores, packed red blood cells, plasma, platelets, and total blood product usage. Mortality was higher in the groups with an SI of ≥ 0.9 at the scene and arrival to the emergency department. \u0000Conclusion - Patients with a shock index > 0.71-0.89 in both prehospital and emergency departments had higher mortality rates and need for transfusion. The shock index continues to be a reliable predictive value in trauma patients for morbidity and mortality. ","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449811","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: Ambulance drivers are more likely to be involved in fatal or injury collisions compared to other professional drivers. Study Objective: This study is a retrospective study aimed to describe factors involved in paramedics’ collisions. Method: Spanning over 10 years of data (2010-2019) from a paramedic agency covering Montreal (Qc, Canada), links between the number of ambulance injuries and non-injury collisions and diverse characteristics like experience, sex, and age of paramedics, day and time of the collision, weather and surface conditions, type of environment, and type of driving activity. The distribution of characteristics involved in the severity of collisions is presented with descriptive analysis. The evaluation of trends of monthly and yearly ambulance collisions is conducted using the Mann-Kendal test. The logit model is also used to examine the effect of such factors on the odds of collision severity. Results: The results show although there is no significant reduction trend for the monthly ambulance collisions, the trend of incidence of annual non-injury collisions per paramedic is significantly decreasing. Also, young drivers with less experience are more involved in multiple collisions compared to their experienced colleagues. Furthermore, 62% of injury collisions happened when paramedics are responding to an emergency call. The logit model confirms a decrease in the odds of injury collisions (odds ratio: 0.48) during non-emergency activities. Also, intersections and traffic lights are the riskiest locations regarding injury collisions (43.5%, and 51%, respectively). In this case, collisions occurring at traffic lights can increase the odds of severity by 597%. Conclusion: This study exemplifies that preventive policy regarding paramedics (e.g., training programs) should focus on younger and less experienced paramedics, and risky locations, especially while driving on emergency calls. More oriented awareness and training programs for emergency respondents are required to reduce the number of work-related collisions.
{"title":"Navigating Paramedics' Safety","authors":"Milad Delavary, M. Tremblay, Martin Lavallière","doi":"10.56068/mhce4982","DOIUrl":"https://doi.org/10.56068/mhce4982","url":null,"abstract":"Background: Ambulance drivers are more likely to be involved in fatal or injury collisions compared to other professional drivers. \u0000Study Objective: This study is a retrospective study aimed to describe factors involved in paramedics’ collisions. \u0000Method: Spanning over 10 years of data (2010-2019) from a paramedic agency covering Montreal (Qc, Canada), links between the number of ambulance injuries and non-injury collisions and diverse characteristics like experience, sex, and age of paramedics, day and time of the collision, weather and surface conditions, type of environment, and type of driving activity. The distribution of characteristics involved in the severity of collisions is presented with descriptive analysis. The evaluation of trends of monthly and yearly ambulance collisions is conducted using the Mann-Kendal test. The logit model is also used to examine the effect of such factors on the odds of collision severity. \u0000Results: The results show although there is no significant reduction trend for the monthly ambulance collisions, the trend of incidence of annual non-injury collisions per paramedic is significantly decreasing. Also, young drivers with less experience are more involved in multiple collisions compared to their experienced colleagues. Furthermore, 62% of injury collisions happened when paramedics are responding to an emergency call. The logit model confirms a decrease in the odds of injury collisions (odds ratio: 0.48) during non-emergency activities. Also, intersections and traffic lights are the riskiest locations regarding injury collisions (43.5%, and 51%, respectively). In this case, collisions occurring at traffic lights can increase the odds of severity by 597%. \u0000Conclusion: This study exemplifies that preventive policy regarding paramedics (e.g., training programs) should focus on younger and less experienced paramedics, and risky locations, especially while driving on emergency calls. More oriented awareness and training programs for emergency respondents are required to reduce the number of work-related collisions.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450063","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}
Jackson Vescuso, Michael Dunn, Cayleigh A. Montaño, Fred Jeffries, Michael Frakes, Jason Cohen, Susan Wilcox
Supraglottic airways (SGAs) can be life-saving devices allowing for oxygenation and ventilation in patients who cannot be intubated. However, these devices also have a risk of high-pressure ventilation injuries, including pneumothoraces, pneumomediastinum, and massive subcutaneous air. We present two cases of patients with high-pressure ventilation injuries after the placement of SGAs in the prehospital setting. Clinicians should be aware of the risk of high-pressure ventilation injuries with SGAs, especially in older patients, those with a higher BMI, those with preexisting airway trauma, and those with high-pressure ventilation requirements.
{"title":"High Pressure Ventilation Injuries from Supraglottic Airway Devices","authors":"Jackson Vescuso, Michael Dunn, Cayleigh A. Montaño, Fred Jeffries, Michael Frakes, Jason Cohen, Susan Wilcox","doi":"10.56068/nram4387","DOIUrl":"https://doi.org/10.56068/nram4387","url":null,"abstract":"Supraglottic airways (SGAs) can be life-saving devices allowing for oxygenation and ventilation in patients who cannot be intubated. However, these devices also have a risk of high-pressure ventilation injuries, including pneumothoraces, pneumomediastinum, and massive subcutaneous air. We present two cases of patients with high-pressure ventilation injuries after the placement of SGAs in the prehospital setting. Clinicians should be aware of the risk of high-pressure ventilation injuries with SGAs, especially in older patients, those with a higher BMI, those with preexisting airway trauma, and those with high-pressure ventilation requirements.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450018","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}
Daniel Du Pont, Jonathan Bar, James Baca, Krystal Hunter, Alexander Kuc, Aman Shah, Gerard Carroll
Objective Determining the decision-making capacity of patients in the prehospital setting is a high-risk area for EMS systems. This risk is only enhanced by the growing prevalence of mental, neurological, and substance use disorders. This study sought to evaluate the feasibility of on-shift simulation as an educational method, in this case to improve EMS clinicians’ ability and confidence in performing capacity assessments. Methods This was a prospective experimental feasibility study performed at an urban, tertiary, academic medical center that operates its own EMS service. All participants were active EMTs or Paramedics. Subjects completed a pretest containing 10 patient scenarios addressing specific components of a complete capacity assessment. For each, participants were asked to decide if the patient had capacity and to rate how confident they were. They then participated in a simulated encounter with a standardized patient, designed to evaluate and teach skills in capacity assessment. A post-scenario debrief and didactic session were conducted. Lastly, subjects took a post-test consisting of the same 10 scenarios and confidence assessments. Results 22 subjects completed the study. While there was no significant difference between the number of scenarios answered correctly before and after the intervention (9.18 vs 9.27), participants’ confidence scores did significantly increase (87.2 to 95.2, p < 0.001). This increase was driven by scenarios pertaining to mild dementia, pediatrics, and substance use. Conclusions Prehospital clinicians were able to correctly assess capacity in a variety of scenarios. A didactic session including a simulated patient encounter led to a significant increase in participants’ confidence in performing capacity assessments. This study revealed specific areas in which clinicians would likely benefit from further education, but further research is needed to ensure generalizability.
{"title":"Assessing the Feasibility of On-Shift Simulation to Improve Capacity Assessments by EMS Clinicians","authors":"Daniel Du Pont, Jonathan Bar, James Baca, Krystal Hunter, Alexander Kuc, Aman Shah, Gerard Carroll","doi":"10.56068/xcqz5297","DOIUrl":"https://doi.org/10.56068/xcqz5297","url":null,"abstract":"Objective \u0000Determining the decision-making capacity of patients in the prehospital setting is a high-risk area for EMS systems. This risk is only enhanced by the growing prevalence of mental, neurological, and substance use disorders. This study sought to evaluate the feasibility of on-shift simulation as an educational method, in this case to improve EMS clinicians’ ability and confidence in performing capacity assessments. \u0000Methods \u0000This was a prospective experimental feasibility study performed at an urban, tertiary, academic medical center that operates its own EMS service. All participants were active EMTs or Paramedics. Subjects completed a pretest containing 10 patient scenarios addressing specific components of a complete capacity assessment. For each, participants were asked to decide if the patient had capacity and to rate how confident they were. They then participated in a simulated encounter with a standardized patient, designed to evaluate and teach skills in capacity assessment. A post-scenario debrief and didactic session were conducted. Lastly, subjects took a post-test consisting of the same 10 scenarios and confidence assessments. \u0000Results \u000022 subjects completed the study. While there was no significant difference between the number of scenarios answered correctly before and after the intervention (9.18 vs 9.27), participants’ confidence scores did significantly increase (87.2 to 95.2, p < 0.001). This increase was driven by scenarios pertaining to mild dementia, pediatrics, and substance use. \u0000Conclusions \u0000Prehospital clinicians were able to correctly assess capacity in a variety of scenarios. A didactic session including a simulated patient encounter led to a significant increase in participants’ confidence in performing capacity assessments. This study revealed specific areas in which clinicians would likely benefit from further education, but further research is needed to ensure generalizability.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"18 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450059","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}
Objective: The aim of this scoping review is to determine how feedback is used in paramedicine. Introduction: Feedback is widely recognised as essential for clinician growth in healthcare however there is limited research on its use within paramedicine. Paramedics place high value on effective feedback and different types and methods are used depending on context. Methods: Peer-reviewed primary research involving any type of feedback used in paramedicine was included. We searched MEDLINE, CINAHL, EMCARE, SCOPUS and grey literature from inception to March 2023. Two authors independently screened and selected studies for full-text review. One reviewer performed data extraction. This reviewfollowed JBI methodological guidance and PRISMA extension for scoping reviews. Results: From 413 articles 20 were included in this review (16 quantitative, 3 qualitative and 1 mixed-methods). Feedback is generally given under the themes of professional and personal development, quality improvement, resuscitation and education. Paramedics have a strong desire for feedback to meet personal and professional needs. However, current provisions are inadequate and compounded by existing barriers. Informal routes of feedbackare sought when formal routes are inadequate despite the latter having more weighting. Feedback in resuscitation either in real-time or post-incident positively modifies paramedic behaviour to improve performance. Feedback is used in paramedic services to standardize care as part of quality improvement. Within an education setting feedback as an education tool is well received and improves confidence for future performance. Conclusion: Paramedics display a positive attitude to receiving feedback to meet personaland professional requirements. Desires for feedback outweigh provisions compounded by existing barriers, potentially creating a paramedic wellbeing issue. Feedback is an effective tool within paramedicine in modifying behaviours either immediately or post-incident to improve clinical performance.
{"title":"Feedback Use in Paramedicine","authors":"James Foster, Stacey Todd, Brett Williams","doi":"10.56068/flgc4650","DOIUrl":"https://doi.org/10.56068/flgc4650","url":null,"abstract":"Objective: The aim of this scoping review is to determine how feedback is used in paramedicine.\u0000Introduction: Feedback is widely recognised as essential for clinician growth in healthcare however there is limited research on its use within paramedicine. Paramedics place high value on effective feedback and different types and methods are used depending on context.\u0000Methods: Peer-reviewed primary research involving any type of feedback used in paramedicine was included. We searched MEDLINE, CINAHL, EMCARE, SCOPUS and grey literature from inception to March 2023. Two authors independently screened and selected studies for full-text review. One reviewer performed data extraction. This reviewfollowed JBI methodological guidance and PRISMA extension for scoping reviews.\u0000Results: From 413 articles 20 were included in this review (16 quantitative, 3 qualitative and 1 mixed-methods). Feedback is generally given under the themes of professional and personal development, quality improvement, resuscitation and education. Paramedics have a strong desire for feedback to meet personal and professional needs. However, current provisions are inadequate and compounded by existing barriers. Informal routes of feedbackare sought when formal routes are inadequate despite the latter having more weighting. Feedback in resuscitation either in real-time or post-incident positively modifies paramedic behaviour to improve performance. Feedback is used in paramedic services to standardize care as part of quality improvement. Within an education setting feedback as an education tool is well received and improves confidence for future performance.\u0000Conclusion: Paramedics display a positive attitude to receiving feedback to meet personaland professional requirements. Desires for feedback outweigh provisions compounded by existing barriers, potentially creating a paramedic wellbeing issue. Feedback is an effective tool within paramedicine in modifying behaviours either immediately or post-incident to improve clinical performance.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449804","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}
N. Glober, Thomas A. Lardaro, M. Supples, M. Liao, J. Vaizer, Greg Faris, Paige Ostahowski, Daniel P. O'Donnell, Christopher Kao
Background: Interfacility transfer between hospitals is an integral component of regional healthcare systems. The decisions referring providers make regarding emergency medical services (EMS) level of care and transport modality (ground versus air) can dramatically impact patient care, emergency departments' workflow, hospital length of stay, and EMS resource availability. Limited research has been done to assess understanding of interfacility transport by emergency medicine providers. Methods: We developed six patient scenarios to test knowledge of level of care and mode of interfacility transfer. Seven board-certified EMS physicians determined the optimal answer to each patient scenario. We distributed a survey with the scenarios to regional healthcare partners via a database of persons who utilize or interface with interfacility transport services. We collected answers to the patient scenarios and provider characteristics (primary practice site, sex, age, specialty, years since graducation, provider degree, EMS training received). Descriptive statistics were performed and Fisher's exact tests described differences in correct answers as they varied by specialty (emergency medicine or other specialty), provider type (physician or advanced practice provider), and reported training in EMS level of care. Results: Seventy-six emergency medicine providers responded, including 68 physicians and 8 advanced practice providers. The mean total score on the case scenarios was 66%, with scores ranging from 33% to 100%. The mean scores on questions testing level of care and transport modality were 67% and 70%, respectively. No significant difference was found in test scores between emergency medicine and other specialties (p=0.718) or provider level of training (p=0.799). Training in EMS level of care was correlated with higher scores on the transport modality questions (p=0.003) but not on the level of care questions (p=0.231). Conclusion: Variability exists in the knowledge of providers on interfacility transport throughout the state. Emergency medicine providers could benefit from education on interfacility transfer resources.
{"title":"Assessing Provider Understanding of Interfacility Emergency Medical Services Transport","authors":"N. Glober, Thomas A. Lardaro, M. Supples, M. Liao, J. Vaizer, Greg Faris, Paige Ostahowski, Daniel P. O'Donnell, Christopher Kao","doi":"10.56068/tgxv9507","DOIUrl":"https://doi.org/10.56068/tgxv9507","url":null,"abstract":"Background: Interfacility transfer between hospitals is an integral component of regional healthcare systems. The decisions referring providers make regarding emergency medical services (EMS) level of care and transport modality (ground versus air) can dramatically impact patient care, emergency departments' workflow, hospital length of stay, and EMS resource availability. Limited research has been done to assess understanding of interfacility transport by emergency medicine providers. \u0000Methods: We developed six patient scenarios to test knowledge of level of care and mode of interfacility transfer. Seven board-certified EMS physicians determined the optimal answer to each patient scenario. We distributed a survey with the scenarios to regional healthcare partners via a database of persons who utilize or interface with interfacility transport services. We collected answers to the patient scenarios and provider characteristics (primary practice site, sex, age, specialty, years since graducation, provider degree, EMS training received). Descriptive statistics were performed and Fisher's exact tests described differences in correct answers as they varied by specialty (emergency medicine or other specialty), provider type (physician or advanced practice provider), and reported training in EMS level of care. \u0000Results: Seventy-six emergency medicine providers responded, including 68 physicians and 8 advanced practice providers. The mean total score on the case scenarios was 66%, with scores ranging from 33% to 100%. The mean scores on questions testing level of care and transport modality were 67% and 70%, respectively. No significant difference was found in test scores between emergency medicine and other specialties (p=0.718) or provider level of training (p=0.799). Training in EMS level of care was correlated with higher scores on the transport modality questions (p=0.003) but not on the level of care questions (p=0.231). \u0000Conclusion: Variability exists in the knowledge of providers on interfacility transport throughout the state. Emergency medicine providers could benefit from education on interfacility transfer resources.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"94 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450322","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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