RESUMEN

OBJECTIVE: To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. METHODS: An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS: From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. CONCLUSIONS: Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.

Asunto(s)

RESUMEN

INTRODUCTION: Emergency ambulance clinicians attend a wide range of prehospital emergencies, including out-of-hospital births (OOHBs). Intrapartum care comprises approximately 0.05% of emergency medical services' caseload, with only ~10% of intrapartum cases progressing to birth in emergency ambulance clinician care. However, this low exposure rate potentially allows obstetric clinical skills and knowledge to decay, which may impact on patient care. Additionally, unplanned OOHBs are known to have a higher incidence of complications and adverse outcomes than their counterparts born in hospital, such as postpartum haemorrhage or hypothermia. This scoping review will explore OOHBs and associated complications in emergency ambulance clinician care, investigate birth parent, significant partner and clinician experiences regarding OOHBs, and consider barriers and challenges to optimal patient care, to identify future research opportunities and associated knowledge gaps for this patient cohort. METHODS AND ANALYSIS: This scoping review will follow the nine-step methodological framework suggested by the Joanna Briggs Institute and use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Five electronic databases (MEDLINE via EBSCO, CINAHL, Embase, Web of Science and Wiley Online) will be searched to identify articles for inclusion. The 'participant, concept, context' criteria will be used to identify suitable search words regarding OOHBs in emergency ambulance clinician care. The review will include peer-reviewed and preprint literature. Two reviewers will independently assess articles based on title and abstract for inclusion in the review. Data will be charted using a data extraction tool for consistency and provide a succinct descriptive summary of the results. ETHICS AND DISSEMINATION: This study does not require ethical review as all the information obtained will come from publicly available resources. Results will be disseminated via a peer-reviewed publication. This scoping review is preregistered with the Open Science Framework (https://osf.io/ta35q).

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response. METHODS: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged>18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 29% more often compared with non-indigenous participants. CONCLUSIONS: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.

Asunto(s)

RESUMEN

OBJECTIVE: Paramedics are at the forefront of emergency healthcare. Quick and careful decision making is required to effectively care for their patients; however, excessive sleepiness has the potential to impact on clinical decision making. Studies investigating the effects of night shift work on sleepiness, cognitive function and clinical performance in the prehospital setting are limited. Here, we aimed to determine the extent to which sleepiness is experienced over the course of a simulation-based 13-hour night shift and how this impacts on clinical performance and reaction time. METHODS: Twenty-four second year paramedic students undertook a 13-hour night shift simulation study in August 2017. The study consisted of 10 real-to-life clinical scenarios. Sleepiness, perceived workload and motivation were self-reported, and clinical performance graded for each scenario. Reaction time, visual attention and task switching were also evaluated following each block of two scenarios. RESULTS: The accuracy of participants' clinical decision making declined significantly over the 13-hour night shift simulation. This was accompanied by an increase in sleepiness and a steady decline in motivation. Participants performed significantly better on the cognitive flexibility task across the duration of the simulated night shift and no changes were observed on the reaction time task. Perceived workload varied across the course of the night. CONCLUSION: Overall, increased sleepiness and decreased clinical decision making were noted towards the end of the 13-hour simulated night shift. It is unclear the extent to which these results are reflective of practising paramedics who have endured several years of night shift work, however, this could have serious implications for patient outcomes and warrants further investigation.

Asunto(s)

RESUMEN

INTRODUCTION: As the understanding of health care worker lived experience during coronavirus disease 2019 (COVID-19) grows, the experiences of those utilizing emergency health care services (EHS) during the pandemic are yet to be fully appreciated. STUDY OBJECTIVE: The objective of this research was to explore lived experience of EHS utilization in Victoria, Australia during the COVID-19 pandemic from March 2020 through March 2021. METHODS: An explorative qualitative design underpinned by a phenomenological approach was applied. Data were collected through semi-structured, in-depth interviews, which were transcribed verbatim and analyzed using Colaizzi's approach. RESULTS: Qualitative data were collected from 67 participants aged from 32 to 78-years-of-age (average age of 52). Just over one-half of the research participants were male (54%) and three-quarters lived in metropolitan regions (75%). Four key themes emerged from data analysis: (1) Concerns regarding exposure and infection delayed EHS utilization among participants with chronic health conditions; (2) Participants with acute health conditions expressed concern regarding the impact of COVID-19 on their care, but continued to access services as required; (3) Participants caring for people with sensory and developmental disabilities identified unique communication needs during interactions with EHS during the COVID-19 pandemic; communicating with emergency health care workers wearing personal protective equipment (PPE) was identified as a key challenge, with face masks reported as especially problematic for people who are deaf or hard-of-hearing; and (4) Children and older people also experienced communication challenges associated with PPE, and the need for connection with emergency health care workers was important for positive lived experience during interactions with EHS throughout the pandemic. CONCLUSION: This research provides an important insight into the lived experience of EHS utilization during the COVID-19 pandemic, a perspective currently lacking in the published peer-reviewed literature.

Asunto(s)

RESUMEN

Background: Mass-casualty incidents (MCIs) are catastrophic. Whether they arise from natural or man-made disasters, the nature of such incidents and the multiple casualties involved can rapidly overwhelm response personnel. Mass-casualty triage training is traditionally taught via either didactic lectures or table top exercises. This training fails to provide an opportunity for practical application or experiential learning in immersive conditions. Further, large-scale simulations are heavily resource-intensive, logistically challenging, require the coordination and time of multiple personnel, and are costly to replicate. This study compared the simulation efficacy of a bespoke virtual-reality (VR) MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Methods: Both simulations involved ten injured patients resulting from a police car chase and shooting. Twenty-nine second-year paramedicine students completed the live and VR simulation in a random order. The training efficacy of the VR and live simulation was evaluated with respect to student immersion and task-difficulty, clinical decision-making (i.e. triage card allocation accuracy and timeliness), learning satisfaction, and cost of delivery. Results: While perceived physical demand was higher in the live simulation compared to VR (p < 0.001), no differences were observed across mental demand, temporal demand, performance, effort or frustration domains. No differences were found for participant satisfaction across the two platforms. No differences were observed in the number of triage cards correctly allocated to patients in each platform. However, participants were able to allocate cards far quicker in VR (p < .001). Cost of running the VR came to AUD $712.04 (staff time), compared to the live simulations which came to AUD $9,413.71 (staff time, moulage, actors, director, prop vehicle), approximately 13 times more expensive. Conclusion: The VR simulation provided near identical simulation efficacy for paramedicine students compared to the live simulation. VR MCI training resources represent an exciting new direction for authentic and cost-effective education and training for medical professionals.

Asunto(s)

RESUMEN

INTRODUCTION: Many healthcare education commentators suggest that moulage can be used in simulation to enhance scenario realism. However, few studies investigate to what extent using moulage in simulation impacts learners. We undertook a mixed-methods pilot study investigating how moulage influences student immersion and performance in simulation. METHODS: Fifty undergraduate paramedicine students were randomized into two groups completing a trauma-based scenario with or without patient moulage. Task immersion was determined via a self-report questionnaire (National Aeronautics and Space Administration Task Load Index), eye-tracking, and postsimulation interviews. Performance was measured via independent observation of video by two paramedic clinical educators and time-to-action-when students first applied pressure to the primary wound. RESULTS: Eye-tracking suggested that students attended to the thigh wound more often with the inclusion of moulage than without. National Aeronautics and Space Administration Task Load Index data suggested that the inclusion of moulage heightened students' feeling of being rushed throughout the scenario. This elicited an expedited performance of tasks with moulage present compared with not. Students experienced greater immersion with the inclusion of moulage. However, including moulage enhanced scenario difficulty to the extent that overall clinical performance was negatively affected. However, no differences were found when more heavily weighting items felt to contribute most to the survivability of the patient. CONCLUSIONS: Including moulage engendered immersion and a greater sense of urgency and did not sacrifice performance of key life-saving interventions. As a result of undertaking this pilot project, we suggest that a large-scale randomized controlled trial is feasible and should be undertaken before implementing change to curricula.

Asunto(s)

RESUMEN

Introduction: Simulation-based education (SBE) literature is replete with student satisfaction and confidence measures to infer educational outcomes. This research aims to test how well students' satisfaction and confidence measures correlate with expert assessments of students' improvements in competence following SBE activities. Methods: N=85 paramedic students (mean age 23.7 years, SD=6.5; 48.2% female) undertook a 3-day SBE workshop. Students' baseline competence was assessed via practical scenario simulation assessments (PSSAs) administered by expert paramedics and confidence via a questionnaire. Postworkshop competence and confidence plus self-reported students' satisfaction were remeasured. Results: PSSA scores increased significantly between baseline and post workshop (35.7%→53.4%, p<0.001), as did students' confidence (55.7%→60.5%, p<0.001), and their workshop satisfaction was high (71.0%). Satisfaction and postworkshop confidence measures were moderately correlated (r=0.377, p=0.001). However, competence improvements were not significantly correlated with either satisfaction (r=-0.107 p=0.344) or change in confidence (r=-0.187 p=0.102). Discussion: Students' self-reported satisfaction and confidence measures bore little relation to expert paramedics' judgements of their educational improvements. Satisfaction and confidence measures appear to be dubious indicators of SBE learning outcomes.