Iatrogenic events are common causes of EMS encounters. This report present the case of a 62-year-old male who presented with new-onset chest pain after his primary care provider increased his diltiazem dose to better control atrial fibrillation. The patient presented with nausea, vomiting, diaphoresis, and 8/10 sub-sternal chest pain. Sequential ECGs captured the initiation of a junctional rhythm indicated by negative (inverted) P waves and a shortened PR interval. The patient had also been prescribed dofetilide (Tikosyn), which can raise diltiazem levels. The case emphasizes the importance of recognizing arrhythmias associated with retrograde A/V conduction and raises awareness of potential iatrogenic events as causes for pre-hospital encounters.
{"title":"Serial Electrocardiograms Show Acute Onset of Inverted P Waves in a 62-Year-Old-Male with Chest Pain","authors":"Brenton Faber","doi":"10.56068/zmxe2675","DOIUrl":"https://doi.org/10.56068/zmxe2675","url":null,"abstract":"Iatrogenic events are common causes of EMS encounters. This report present the case of a 62-year-old male who presented with new-onset chest pain after his primary care provider increased his diltiazem dose to better control atrial fibrillation. The patient presented with nausea, vomiting, diaphoresis, and 8/10 sub-sternal chest pain. Sequential ECGs captured the initiation of a junctional rhythm indicated by negative (inverted) P waves and a shortened PR interval. The patient had also been prescribed dofetilide (Tikosyn), which can raise diltiazem levels. The case emphasizes the importance of recognizing arrhythmias associated with retrograde A/V conduction and raises awareness of potential iatrogenic events as causes for pre-hospital encounters.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"76 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139450383","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}
Lina Gyllencreutz, Sofia Karlsson, Andreas Sjölander, Johanna Björnstig, Pia Hedberg
Background: Hazardous chemicals are essential for modern society but the use and transportation of them bears the risk of major incidents. Past incidents have revealed the importance of preparation and training of emergency medical service (EMS) personnel when responding to these incidents. However, studies have shown the level of preparedness to be insufficient. There is a lack of knowledge as to how EMS personnel perceive their preparedness and response when facing chemical incidents. Aim: The aim of this study was to qualitative investigate working procedures regarding chemical incidents among a cohort of EMS personnel. Method: Seventeen ambulance nurses from rural and urban areas were individually interviewed using four different realistic scenarios (vignettes). The transcribed text from the interviews was analyzed using qualitative content analysis. Result: The results were derived into two categories with underlying sub-categories: a struggle to organize the onsite work situation (insufficient managerial support, limited resources, trust in rescue services, difficult decision making, stressful responsibilities); and decontamination—a demanding and risky situation (risk management, work in protective gear, aggravating circumstances). Participants often lack real life experience in facing a chemical incident and training that improves preparedness and the ability to respond adequately. Conclusion: Chemical incidents pose many challenges for EMS personnel, but with proper training efforts many of these challenges could be solved. This study has shown the need for more accessible chemical incident training targeting EMS personnel: especially focusing on risk assessment; managerial support; resource management; equipment; and decontamination, including stress management and decision-making. Research in the area of chemical incidents is sparse and there remains much to understand concerning work procedures during chemical incidents.
{"title":"Chemical Incident Preparedness Among Emergency Medical Service Personnel","authors":"Lina Gyllencreutz, Sofia Karlsson, Andreas Sjölander, Johanna Björnstig, Pia Hedberg","doi":"10.56068/zwic1429","DOIUrl":"https://doi.org/10.56068/zwic1429","url":null,"abstract":"Background: Hazardous chemicals are essential for modern society but the use and transportation of them bears the risk of major incidents. Past incidents have revealed the importance of preparation and training of emergency medical service (EMS) personnel when responding to these incidents. However, studies have shown the level of preparedness to be insufficient. There is a lack of knowledge as to how EMS personnel perceive their preparedness and response when facing chemical incidents. \u0000Aim: The aim of this study was to qualitative investigate working procedures regarding chemical incidents among a cohort of EMS personnel. \u0000Method: Seventeen ambulance nurses from rural and urban areas were individually interviewed using four different realistic scenarios (vignettes). The transcribed text from the interviews was analyzed using qualitative content analysis. \u0000Result: The results were derived into two categories with underlying sub-categories: a struggle to organize the onsite work situation (insufficient managerial support, limited resources, trust in rescue services, difficult decision making, stressful responsibilities); and decontamination—a demanding and risky situation (risk management, work in protective gear, aggravating circumstances). Participants often lack real life experience in facing a chemical incident and training that improves preparedness and the ability to respond adequately. \u0000Conclusion: Chemical incidents pose many challenges for EMS personnel, but with proper training efforts many of these challenges could be solved. This study has shown the need for more accessible chemical incident training targeting EMS personnel: especially focusing on risk assessment; managerial support; resource management; equipment; and decontamination, including stress management and decision-making. Research in the area of chemical incidents is sparse and there remains much to understand concerning work procedures during chemical incidents.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"60 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139449824","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}
Objectives
Following the launch of its ‘Long Term Plan’ in 2019, the English National Health Service (NHS England) started piloting body worn cameras (BWCs) in ambulance services. The intervention rationale was that BWCs would act as a deterrent and facilitate the prosecution of assailants, thus improving the safety and wellbeing of ambulance crew. This paper explores views on the purpose and value of BWCs among ambulance crews and leadership staff who have used them or supported their implementation.
Methods
We conducted a qualitative investigation with ambulance crew and leadership staff (N=16) in the first 7-10 months of the BWC pilot. Semi-structured interviews were held online between August 2021 and November 2021. Normalisation process theory was used to guide and structure the data analyses.
Results
There was only partial shared understanding between crew members and leadership staff on the purpose and value of BWCs. Drawing on their practical professional experiences of using BWCs, crews challenged the theory of change that BWCs function as deterrents while recognising their potential to facilitate prosecutions. Crews also highlighted technical, operational and social factors that are likely to mitigate the positive effects of (the implementation of) the cameras.
Conclusions
Violence reduction policies for health services should take heed of the variation in theories of change put forward by different stakeholders. Further research is required to better understand the range of factors that affect the occurrence and management of assaults against ambulance crew and the operational challenges and cost-effectiveness of body worn cameras relative to other interventions.
{"title":"Implementing Body Worn Cameras to Reduce Violence Against Ambulance Crew","authors":"Makeda Gerressu, Mark Newman, Jeff Bezemer","doi":"10.56068/eicw3180","DOIUrl":"https://doi.org/10.56068/eicw3180","url":null,"abstract":"Objectives
 Following the launch of its ‘Long Term Plan’ in 2019, the English National Health Service (NHS England) started piloting body worn cameras (BWCs) in ambulance services. The intervention rationale was that BWCs would act as a deterrent and facilitate the prosecution of assailants, thus improving the safety and wellbeing of ambulance crew. This paper explores views on the purpose and value of BWCs among ambulance crews and leadership staff who have used them or supported their implementation.
 Methods
 We conducted a qualitative investigation with ambulance crew and leadership staff (N=16) in the first 7-10 months of the BWC pilot. Semi-structured interviews were held online between August 2021 and November 2021. Normalisation process theory was used to guide and structure the data analyses. 
 Results 
 There was only partial shared understanding between crew members and leadership staff on the purpose and value of BWCs. Drawing on their practical professional experiences of using BWCs, crews challenged the theory of change that BWCs function as deterrents while recognising their potential to facilitate prosecutions. Crews also highlighted technical, operational and social factors that are likely to mitigate the positive effects of (the implementation of) the cameras.
 Conclusions
 Violence reduction policies for health services should take heed of the variation in theories of change put forward by different stakeholders. Further research is required to better understand the range of factors that affect the occurrence and management of assaults against ambulance crew and the operational challenges and cost-effectiveness of body worn cameras relative to other interventions.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Workflow analysis is an important approach for understanding clinical care in complex systems. This is particularly true for low frequency events such as the care of children in the out-of-hospital setting. The purpose of this study was to characterize emergency medical service (EMS) workflow in the care of children during simulated emergency, prehospital encounters.
Methods: This is a secondary analysis exploring high-fidelity videorecorded simulations, performed by emergency personnel. Two scenarios were used in 19 simulations which consisted of a 15-month and a 1-month old with respiratory decompensation and shock requiring intravenous fluid, respiratory support, and medication administration. One trained investigator performed review of the videos of teams EMS practitioners, quantifying the sequence and number of tasks performed and time to completion of the simulated intervention. The variance in sequence of tasks was quantified using the Levenshtein distance. We quantified the proportion of time with no activity (idle time) and temporal overlap (team multitasking time).
Results: We identified 17 types of distinct tasks performed during the simulation. There was high variability across simulations in the sequences, types, and number of tasks performed. Team multitasking was noted in all scenarios, with a mean of 99% multitasking ratio (range: 52-202%). Mean proportion of idle time was 4% (range: 0-11%). Weight estimate, intravenous or intraosseous access, radio report, blood glucose level (BGL), medication administration, pulse check and respiration check were observed in all videos. Other tasks were observed in only a proportion of scenarios with varying frequencies. Median number of differences in sequence of tasks between scenarios was 15.
Conclusions: Our analysis found a high percentage of team multitasking and significant variability in frequency and sequence of task completion. Further research is needed to assess the reasons and effect of this degree of variability on the efficiency and effectiveness of prehospital interventions.
{"title":"Examining Workflow for Simulated Pediatric Emergency Medical Services Care","authors":"Mustafa Ozkaynak, Zhan Zhang, Kathleen Adelgais","doi":"10.56068/ovsw1364","DOIUrl":"https://doi.org/10.56068/ovsw1364","url":null,"abstract":"Purpose: Workflow analysis is an important approach for understanding clinical care in complex systems. This is particularly true for low frequency events such as the care of children in the out-of-hospital setting. The purpose of this study was to characterize emergency medical service (EMS) workflow in the care of children during simulated emergency, prehospital encounters.
 Methods: This is a secondary analysis exploring high-fidelity videorecorded simulations, performed by emergency personnel. Two scenarios were used in 19 simulations which consisted of a 15-month and a 1-month old with respiratory decompensation and shock requiring intravenous fluid, respiratory support, and medication administration. One trained investigator performed review of the videos of teams EMS practitioners, quantifying the sequence and number of tasks performed and time to completion of the simulated intervention. The variance in sequence of tasks was quantified using the Levenshtein distance. We quantified the proportion of time with no activity (idle time) and temporal overlap (team multitasking time).
 Results: We identified 17 types of distinct tasks performed during the simulation. There was high variability across simulations in the sequences, types, and number of tasks performed. Team multitasking was noted in all scenarios, with a mean of 99% multitasking ratio (range: 52-202%). Mean proportion of idle time was 4% (range: 0-11%). Weight estimate, intravenous or intraosseous access, radio report, blood glucose level (BGL), medication administration, pulse check and respiration check were observed in all videos. Other tasks were observed in only a proportion of scenarios with varying frequencies. Median number of differences in sequence of tasks between scenarios was 15.
 Conclusions: Our analysis found a high percentage of team multitasking and significant variability in frequency and sequence of task completion. Further research is needed to assess the reasons and effect of this degree of variability on the efficiency and effectiveness of prehospital interventions.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"25 Suppl 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Guidelines for Authors","authors":"","doi":"10.56068/sqgq5729","DOIUrl":"https://doi.org/10.56068/sqgq5729","url":null,"abstract":"","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014288","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}
Hisanori Kurosaki, Yasuharu Yasuda, Eiji Sakaguchi, Koji Yamamoto
Aim: The aim of this study was to investigate whether the height of a stretcher is associated with the risk of tipping, and to examine strategies to prevent the tipping of a stretcher during transportation. Methods: This was a mechanical simulation study using Stryker’s Power-PRO™ XT. The stretcher and manikin were placed on a board and the board was inclined at a gradient of approximately 1 degree per second. Tipping was defined as the point at which the weight of the manikin caused one of the wheels to lift off the ground upon the application of a specific angle. The tipping angles were measured and examined. The position of the stretcher was varied between supine, seated, high (96cm), middle (66cm), and low (36cm). Results: In the supine position, the tipping angles were smaller in the order of high, middle, and low position, with a mean (degree) and 95% confidence intervals (CI) of 12.4 (12.2‒12.6) for the high position, 18.4 (18.1‒18.7) for the middle position, and 26.3 (25.9‒26.7) for the low position. In the seated position, the tipping angles were also smaller in the order of high, middle, and low position [11.9 (11.7‒12.1) for the high position, 16.2 (15.3‒17.0) for the middle position, and 20.2 (19.8‒20.6) for the low position, respectively]. Additionally, it was observed that the tipping angles were smaller in the seated position at all stretcher heights, when compared to the supine position. Conclusion: The risk of a stretcher tip was found to be greater in the high position compared to the low position, as well as in the seated position compared to the supine position. It is recommended that EMS providers should lower the position of the stretcher as much as possible while ensuring appropriate patient monitoring and care.
{"title":"Investigation of Strategies to Prevent Stretcher Tripping","authors":"Hisanori Kurosaki, Yasuharu Yasuda, Eiji Sakaguchi, Koji Yamamoto","doi":"10.56068/ckfy9492","DOIUrl":"https://doi.org/10.56068/ckfy9492","url":null,"abstract":"Aim: The aim of this study was to investigate whether the height of a stretcher is associated with the risk of tipping, and to examine strategies to prevent the tipping of a stretcher during transportation. Methods: This was a mechanical simulation study using Stryker’s Power-PRO™ XT. The stretcher and manikin were placed on a board and the board was inclined at a gradient of approximately 1 degree per second. Tipping was defined as the point at which the weight of the manikin caused one of the wheels to lift off the ground upon the application of a specific angle. The tipping angles were measured and examined. The position of the stretcher was varied between supine, seated, high (96cm), middle (66cm), and low (36cm). Results: In the supine position, the tipping angles were smaller in the order of high, middle, and low position, with a mean (degree) and 95% confidence intervals (CI) of 12.4 (12.2‒12.6) for the high position, 18.4 (18.1‒18.7) for the middle position, and 26.3 (25.9‒26.7) for the low position. In the seated position, the tipping angles were also smaller in the order of high, middle, and low position [11.9 (11.7‒12.1) for the high position, 16.2 (15.3‒17.0) for the middle position, and 20.2 (19.8‒20.6) for the low position, respectively]. Additionally, it was observed that the tipping angles were smaller in the seated position at all stretcher heights, when compared to the supine position. Conclusion: The risk of a stretcher tip was found to be greater in the high position compared to the low position, as well as in the seated position compared to the supine position. It is recommended that EMS providers should lower the position of the stretcher as much as possible while ensuring appropriate patient monitoring and care.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014280","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}
LaTosha Hogan, Brad Buck, Julius McAdams, Sean Teed
{"title":"Paramedicine Contents","authors":"LaTosha Hogan, Brad Buck, Julius McAdams, Sean Teed","doi":"10.56068/clez2974","DOIUrl":"https://doi.org/10.56068/clez2974","url":null,"abstract":"","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014442","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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