RESUMEN
The heterogeneous nature of asthma results in a wide range of presentations during exacerbation. Despite UK pre-hospital management guidelines focusing on ß2 agonists, variables such as cause, severity, underlying health, comorbidities, and drug side effects can often make emergency treatment optimisation difficult. This article examines paramedics' methods of observing, perceiving, interpreting, and treating asthma with ß2 agonists, often acting on limited information in rapidly evolving situations. We recruited paramedics from a single UK National Health Service ambulance Trust for qualitative semi-structured interviews. Responses underwent framework analysis to identify data similarities and differences. Fifteen qualitative interviews with paramedics revealed three main themes affecting patient management: clinician experience of presentation, adaptation of patient management approaches, and severity of side effects. Paramedics felt their ability to manage various asthma presentations was enhanced through guideline adaptation based on their own clinical experience and understanding of ß2 agonist side effects, allowing tailored responses based on a set of reinforcing factors. Inductive analysis revealed additional complexities within these themes, such as anxiety and diabetes, which may influence ß2 agonist administration and result in multiple care pathways being initiated during exacerbation. Paramedic care mirrors asthma's complexity, accounting for a range of characteristics. A dynamic, critically thought approach enables patient management to be based on the presenting conditions rather than strict adherence to a single algorithm. Comprehending the complexities and variables in treatment can be crucial to how paramedics rationalise their treatment and optimise the care provided.
Asunto(s)
Agonistas de Receptores Adrenérgicos beta 2 , Técnicos Medios en Salud , Asma , Nebulizadores y Vaporizadores , Investigación Cualitativa , Humanos , Asma/tratamiento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Masculino , Femenino , Servicios Médicos de Urgencia/métodos , Entrevistas como Asunto , Adulto , Reino Unido , Auxiliares de Urgencia , ParamédicoRESUMEN
OBJECTIVE: Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs. METHODS: Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase. RESULTS: The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories. CONCLUSION: The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.
Asunto(s)
Servicios Médicos de Urgencia , Auxiliares de Urgencia , Violencia Laboral , Humanos , Irán , Masculino , Adulto , Femenino , Violencia Laboral/estadística & datos numéricos , Auxiliares de Urgencia/psicología , Encuestas y Cuestionarios , Investigación CualitativaRESUMEN
BACKGROUND: Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery. METHODS: A qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction. RESULTS: The analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources. CONCLUSIONS: Several approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.
Asunto(s)
Ambulancias , Parto Obstétrico , Servicios Médicos de Urgencia , Investigación Cualitativa , Humanos , Irán , Femenino , Embarazo , Servicios Médicos de Urgencia/organización & administración , Adulto , Partería , Auxiliares de Urgencia/psicología , Accesibilidad a los Servicios de Salud , Entrevistas como AsuntoRESUMEN
BACKGROUND: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality. METHODS: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs. RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.
Asunto(s)
Incidentes con Víctimas en Masa , Investigación Cualitativa , Realidad Virtual , Humanos , Masculino , Razonamiento Clínico , Femenino , Ambulancias , Competencia Clínica , Adulto , Entrenamiento Simulado/métodos , Entrevistas como Asunto , Auxiliares de Urgencia/educaciónRESUMEN
BACKGROUND: As the COVID-19 pandemic continues to unfold, there has been a substantial increase in the demand for prehospital services. Emergency medical service (EMS) providers have encountered a myriad of challenges that have had a discernible impact on their professional performance. This study was designed to explore the challenges faced by EMS providers during the initial phase of the COVID-19 pandemic. METHODS: This qualitative research was conducted using a content analysis approach at emergency medical centers affiliated with Hamadan University of Medical Sciences in Iran between April and August 2021. This study included the participation of 21 EMS personnel, which was conducted using purposive sampling and semistructured interviews, and continued until data saturation was reached. The conventional content analysis method, as outlined by Graneheim and Lundman, was applied for data analysis. RESULTS: The analysis of the interview data resulted in the identification of 219 primary codes, which were then organized into ten distinct categories. These categories were further consolidated into three overarching themes: personal safety challenges, professional-organizational challenges, and threatened mental health. CONCLUSIONS: EMS personnel play a critical role in healthcare during disasters and pandemics, facing challenges that can have negative effects. Managing these challenges can impact mental health and professional well-being, but awareness, support, resources, and services can help mitigate adverse consequences.
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COVID-19 , Servicios Médicos de Urgencia , Investigación Cualitativa , Humanos , COVID-19/epidemiología , Irán/epidemiología , Servicios Médicos de Urgencia/organización & administración , Femenino , Masculino , Adulto , Pandemias , Auxiliares de Urgencia/psicología , SARS-CoV-2 , Entrevistas como Asunto , Persona de Mediana EdadRESUMEN
BACKGROUND: Pre-hospital emergency technicians are crucial in managing patients with acute psychiatric symptoms. They must quickly assess the condition, make a primary diagnosis, and refer the patient to the appropriate treatment center. Insufficient skills in these situations can cause serious harm. Educating technicians on dealing with these patients may enhance their knowledge and skills; however, we do not know the extent and longevity of this improvement and which areas are affected. This study investigates the impact of training on pre-hospital emergency technicians' knowledge and skills. METHODS: This quasi-experimental study involved pre-hospital emergency technicians in Robat Karim and Nasim Shahr counties from December 2022 to January 2022. The technicians received workshops on interacting with psychiatric patients. The training topics included the basic principles of coping with a psychiatric patient. They also covered a step-by-step approach to dealing with an aggressive patient, dealing with a patient threatening suicide, managing agitation, managing a patient suffering from panic attacks, and finally dealing with a delirious patient. A pre-test assessed their baseline knowledge and skills, followed by a post-test after training and another test three months later. The test results were analyzed. RESULTS: This study involved forty male participants ranging in age from 25 to 44 and with work experience ranging from five to twenty years. As a result of training in dealing with acute psychiatric patients, technicians developed significant skills and knowledge immediately after training, and these improvements remained significant three months after training. Nevertheless, the correct answers decreased during the three-month follow-up compared to the pre-test. Education was less effective at managing panic, delirium, and agitation. CONCLUSION: In conclusion, technicians' knowledge and skills can be effectively enhanced through training; however, the impact diminishes with time. Theories and practical methods, periodic repetition, and real-world internships are the best ways to maximize training effectiveness.
Asunto(s)
Competencia Clínica , Auxiliares de Urgencia , Humanos , Masculino , Adulto , Auxiliares de Urgencia/educación , Trastornos Mentales/terapia , Servicios Médicos de UrgenciaRESUMEN
BACKGROUND: Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. OBJECTIVES: Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. METHODS: The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. RESULTS: The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20-60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. CONCLUSIONS: Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting.
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Servicios Médicos de Urgencia , Enfermedades del Sistema Nervioso , Examen Neurológico , Humanos , Encuestas y Cuestionarios , Examen Neurológico/métodos , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Masculino , Femenino , Convulsiones/diagnóstico , Adulto , Auxiliares de Urgencia , Urgencias Médicas , Persona de Mediana Edad , Alemania , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/diagnósticoRESUMEN
BACKGROUND: In the realm of trauma response preparation for prehospital teams, the combination of Augmented Reality (AR) and Virtual Reality (VR) with manikin technologies is growing in importance for creating training scenarios that closely mirror potential real-life situations. The pilot study focused on training of airway management and intubation for trauma incidents, based on a Trauma AR-VR simulator involving reserve paramedics of the National EMS service (Magen David Adom) who had not practiced for up to six years, activated during the Israel-Gaza conflict (October 2023). The trauma simulator merges the physical and virtual realms by utilizing a real manikin and instruments outfitted with sensors. This integration enables a precise one-to-one correspondence between the physical and virtual environments. Considering the importance of enhancing the preparedness of the reserve paramedics to support the prehospital system in Israel, the study aims to ascertain the impact of AR-VR Trauma simulator training on the modification of key perceptual attitudes such as self-efficacy, resilience, knowledge, and competency among reserve paramedics in Israel. METHODS: A quantitative questionnaire was utilized to gauge the influence of AR-VR training on specific psychological and skill-based metrics, including self-efficacy, resilience, medical knowledge, professional competency, confidence in performing intubations, and the perceived quality of the training experience in this pilot study. The methodology entailed administering a pre-training questionnaire, delivering a targeted 30-minute AR-VR training session on airway management techniques, and collecting post-training data through a parallel questionnaire to measure the training's impact. Fifteen reserve paramedics were trained, with a response rate of 80% (n = 12) in both measurements. RESULTS: Post-training evaluations indicated a significant uptick in all measured areas, with resilience (3.717±0.611 to 4.008±0.665) and intubation confidence (3.541±0.891 to 3.833±0.608) showing particularly robust gains. The high rating (4.438±0.419 on a scale of 5) of the training quality suggests positive response to the AR-VR integration for the enhancement of medical training, CONCLUSIONS: The application of AR-VR in the training of reserve paramedics demonstrates potential as a key tool for their swift mobilization and efficiency in crisis response. This is particularly valuable for training when quick deployment of personnel is necessary, training resources are diminished, and 'all hands on deck' is necessary.
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Realidad Aumentada , Servicios Médicos de Urgencia , Realidad Virtual , Humanos , Proyectos Piloto , Israel , Servicios Médicos de Urgencia/métodos , Masculino , Adulto , Encuestas y Cuestionarios , Femenino , Maniquíes , Competencia Clínica/normas , Manejo de la Vía Aérea/métodos , Auxiliares de Urgencia/educación , Técnicos Medios en Salud/educación , Persona de Mediana EdadRESUMEN
BACKGROUND: The dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics' perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics' opinions of the factors contributing to human errors. METHOD: Data was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used. RESULTS: Contributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience. CONCLUSION: Various factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics' work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.
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Servicios Médicos de Urgencia , Errores Médicos , Investigación Cualitativa , Humanos , Servicios Médicos de Urgencia/normas , Finlandia , Masculino , Femenino , Auxiliares de Urgencia/normas , Adulto , Seguridad del Paciente , Entrevistas como Asunto , Actitud del Personal de Salud , Técnicos Medios en Salud , Persona de Mediana EdadRESUMEN
BACKGROUND: As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic. METHODS: This qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis. RESULTS: The emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere. CONCLUSIONS: Crisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.
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Técnicos Medios en Salud , COVID-19 , Emociones , Investigación Cualitativa , Humanos , COVID-19/psicología , COVID-19/epidemiología , Finlandia , Femenino , Masculino , Técnicos Medios en Salud/psicología , Adulto , SARS-CoV-2 , Pandemias , Auxiliares de Urgencia/psicología , Persona de Mediana Edad , ParamédicoRESUMEN
BACKGROUND: Adequate prehospital pain management is a critical component of emergency medical services. With the introduction of the paramedic profession and the Paramedics Act in Germany, the basis for more extensive competencies of paramedics was established. In many emergency medical service areas it is thus possible for paramedics to perform analgesia and sedation with esketamine/midazolam according to pre-established instructions and/or standard operating procedures. This study assessed the quality of analgesia administered to trauma patients by paramedics compared to emergency medical service physicians. MATERIAL AND METHODS: The study included trauma patients who received prehospital administration of analgesia by either emergency medical service physicians or paramedics and were subsequently admitted to the central emergency department of the Saarland University Hospital. A standardized data collection form was used to collect information from the emergency service protocol and initial emergency department assessment. The evaluation employed descriptive statistical methods and a total of 207 completed records were analyzed. RESULTS: Both professional groups achieved significant pain reduction and fulfilled the criteria for effective pain management (pain reduction: emergency medical service physicians 5.5⯱ 2.0/paramedic 4.4⯱ 2.1, pâ¯< 0.001). Emergency medical service physicians, however, more frequently attained a higher reduction in numerical rating scale scores and administered oxygen. Notable differences were observed in the range of medications used and the dosages. CONCLUSION: This study could show that prehospital analgesia is comparable between emergency medical service physicians and paramedics in terms of effectiveness for trauma patients if the indications are correctly set, while observing pre-existing instructions. With their competencies paramedics are able to perform an effective and safe analgesic treatment within the framework of preformulated procedural instructions, which can be equal to that of an emergency medical service physician.
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Técnicos Medios en Salud , Analgesia , Servicios Médicos de Urgencia , Médicos , Heridas y Lesiones , Humanos , Femenino , Masculino , Adulto , Servicios Médicos de Urgencia/normas , Servicios Médicos de Urgencia/métodos , Heridas y Lesiones/tratamiento farmacológico , Analgesia/métodos , Analgesia/normas , Persona de Mediana Edad , Técnicos Medios en Salud/normas , Auxiliares de Urgencia/normas , Dimensión del Dolor , Alemania , Ketamina/administración & dosificación , Ketamina/uso terapéutico , Analgésicos/uso terapéutico , Analgésicos/administración & dosificación , Anciano , Manejo del Dolor/métodos , Manejo del Dolor/normas , ParamédicoRESUMEN
INTRODUCTION: Unplanned out-of-hospital births represent less than 1% of ambulance requests for assistance. However, these call-outs have a high risk of life-threatening complications, which are particularly complex in rural or remote settings with limited accessibility to specialist care support. Many community hospitals no longer provide obstetrics care, so birth parents must travel to larger regional or metropolitan hospitals for assistance. Increased travel time may increase the risk of unplanned out-of-hospital birth and/or complications such as postpartum haemorrhage and neonatal mortality. Rural volunteer ambulance officers (VAOs) are an integral component of Australia's healthcare system, especially in regional and remote areas. Although VAO response to unplanned out-of-hospital births may be considered rare compared to calls to other case types, provision of adequate care is paramount in these potentially high-risk situations. This research investigates Australian rural VAOs' perceptions of their training, experience and confidence regarding unplanned out-of-hospital birth and planned homebirth with obstetric emergencies where ambulance assistance is required. METHODS: Semi-structured interviews and focus groups were undertaken from late 2021 to mid-2023 via telephone or online videoconference. Sessions were audio-recorded and transcribed verbatim. Data were analysed and coded into themes using Braun and Clarke's six-step process for semantic coding and reflexive thematic analysis. RESULTS: Twenty-eight participants were interviewed from six Australian states and territories, all of whom worked in rural and remote Australia. Ten participants were male, 17 female and one was male-adjacent, with length of VAO experience ranging from 3 months to 29 years. Participants came from seven jurisdictional ambulance services.| Four themes emerged from analysis: (1) Lack of education and exposure to birth resulted in low confidence. Most participants reported significant anxiety attending obstetric call-outs, and explained under-utilisation of specific obstetric and neonatal skills meant skills decay was an issue; (2) limitations were discussed regarding VAO scope of practice and accessing medical equipment specifically required for birthing and neonates that could impact patient care; (3) logistical and communication difficulties were discussed. Long distances to definitive care, potentially limited backup during emergencies and potential unavailability of aeromedical retrieval increased perceived complexity of cases. Telecommunication 'black holes' created a sense of further isolation for VAOs requiring support from senior clinicians; (4) there was a perception that many members of the general public were unaware VAOs often staffed the local ambulance, and expected VAOs to have the same scope of practice as a registered paramedic. Furthermore, VAOs can attend friends and family in an emergency, potentially creating psychological trauma. CONCLUSION: VAOs report being uncomfortable attending unplanned out-of-hospital births and obstetric emergencies, perceiving they have limited ability to manage complications. Backup from a registered paramedic is dependent on availability, and telecommunications are not always reliable in rural areas for online clinical advice and support. Given the distances to definitive care in regional Australia, this has serious implications for patient safety. Continued VAO education is essential for risk reduction in out-of-hospital births.
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Ambulancias , Voluntarios , Humanos , Femenino , Australia , Embarazo , Grupos Focales , Adulto , Servicios de Salud Rural/organización & administración , Entrevistas como Asunto , Masculino , Auxiliares de Urgencia/educación , Auxiliares de Urgencia/psicología , Parto ObstétricoRESUMEN
BACKGROUND: Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate their decision-making. Within the United Kingdom (UK), there is little evidence on how and why paramedics make their decisions at actual OHCA events. METHODS: We explored the experiences of UK paramedics using individually recalled OHCA events as catalysts for discussion. Pen portraits developed from semi-structured interviews with 31 paramedics across two UK ambulance services were thematically analysed, enabling cross-participant comparisons whilst retaining depth and context. RESULTS: We identified four themes: uncertainties encountered in resuscitation guidelines, influences on decision-making, holistic perspectives, and indirect moderators. We found that paramedics experienced uncertainty at all stages of the resuscitation process. Uncertainties arose from indeterminate, ambiguous or complex information and were described as having both clinical and ethical dimensions. Whilst guidelines drove paramedics' decisions, non-clinical personal, practical and relational factors moderated their assessments of survivability and decision-making, with attitudes to interactions between patient age, frailty and quality of life playing a substantial role. Coping strategies such as uncertainty reduction, assumption-based reasoning and weighing pros and cons were evident from interviews. CONCLUSIONS: The complexity of interactions between clinical and non-clinical factors points to an element of variability in paramedics' responses to uncertainty. Exploring UK paramedics' uncertainties and decision-making during specific OHCA events can help acknowledge and address uncertainties in resuscitation guidelines and paramedic training, providing paramedics with the tools to manage uncertainty in a consistent and transparent way.
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Entrevistas como Asunto , Paro Cardíaco Extrahospitalario , Humanos , Incertidumbre , Paro Cardíaco Extrahospitalario/terapia , Reino Unido , Masculino , Femenino , Adulto , Técnicos Medios en Salud , Toma de Decisiones , Auxiliares de Urgencia/psicología , Investigación Cualitativa , Reanimación Cardiopulmonar , Persona de Mediana Edad , Actitud del Personal de Salud , ParamédicoRESUMEN
Introduction: Emergency medical services rely heavily on paramedics who, as frontline responders, face unique stressors that can potentially lead to burnout. This pilot study utilizes the Oldenburg Burnout Inventory (OLBI) to assess burnout levels among Polish paramedics. The aim is to contribute to the understanding of burnout in this specific professional context and identify key factors influencing burnout dimensions. Future research will build on these preliminary findings. Materials and methods: A cross-sectional study was conducted from March 01 to April 30, 2023, utilizing an online survey accessible to Polish paramedics. The OLBI, a validated tool, was employed to measure burnout, focusing on two dimensions: exhaustion and withdrawal of involvement. Results: Among the 147 participating paramedics, the majority were male (65.99%). Paramedics exhibited burnout symptoms across both dimensions measured by The Oldenburg Burnout Inventory scale (OLBI), with an average level for lack of commitment recorded at 20.09, an average level for exhaustion at 20.60. The study revealed that 41.5% of paramedics experienced low burnout, 44.9% reported moderate burnout, and 13.6% faced high burnout risks. Analysis showed that women experienced significantly higher levels of exhaustion compared to men (p = 0.01). Conclusion: This pilot study provides valuable initial insights into burnout among Polish paramedics. The OLBI's two-factor structure, evaluating exhaustion and disengagement, proved reliable and valid in this context. The prevalence of burnout, with over 60% of paramedics experiencing moderate to high levels, highlights the urgency of addressing burnout in this profession. Future research will be essential to explore the underlying causes and develop targeted interventions. Practical implications: Understanding the factors contributing to burnout among paramedics is crucial for developing targeted interventions. Strategies should focus on stress management training, organizational support, and well-being initiatives. Addressing gender-specific differences in burnout experiences is essential for tailoring interventions effectively. Proactive psychological support mechanisms and optimized working conditions can enhance paramedics' overall well-being, ensuring their continued effectiveness in providing emergency medical services.
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Técnicos Medios en Salud , Agotamiento Profesional , Humanos , Masculino , Polonia , Femenino , Agotamiento Profesional/psicología , Agotamiento Profesional/epidemiología , Adulto , Estudios Transversales , Proyectos Piloto , Encuestas y Cuestionarios , Técnicos Medios en Salud/psicología , Técnicos Medios en Salud/estadística & datos numéricos , Persona de Mediana Edad , Auxiliares de Urgencia/psicología , Auxiliares de Urgencia/estadística & datos numéricos , ParamédicoRESUMEN
INTRODUCTION: Between 2011 and 2014, The Combat Casualty Training Consortium research study sought to evaluate all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among U.S. combat fatalities. This study identified a major training gap in critical airway management. To address this gap, the Advanced Joint Airway Management System (AJAMS) was designed and assessed for physical fidelity and educational utility in a population of paramedic instructors. MATERIALS AND METHODS: Paramedic instructors served as participants in this prospective observational pilot study (n = 12). Participants interacted with three airway management trainers: The AJAMS trainer, the Laerdal Airway Management Trainer, and the TruCorp AirSim Advance Bronchi X Trainer. Participants then completed an evaluation of the trainer using a purpose-built data collection instrument that queried the trainer's realism and educational utility. Within-group differences were analyzed via a 1-way repeated measures ANOVA, with a Bonferroni post hoc analysis. Rank data were analyzed via non-parametric Freidman's test, and Wilcoxon signed-rank test post hoc analysis, corrected using the Bonferroni correction. RESULTS: The AJAMS trainer conveys significantly more physical fidelity (visual: P < .001, ηp2 = 0.977; tactile: P < .001, ηp2 = 0.983; and behavioral: P = .001, ηp2 = 0.971) and overall educational utility (χ2(2) = 15.273, P < .001) than the two commercially available skill trainers. CONCLUSIONS: These data suggest that physical fidelity is an important attribute in the design of simulators for health care, as perceived by expert instructors. These data illustrate that the AJAMS-integrated simulator demonstrates unparalleled physical fidelity, relative to commercially available airway management skill trainers.
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Manejo de la Vía Aérea , Intubación Intratraqueal , Paramédico , Humanos , Manejo de la Vía Aérea/métodos , Manejo de la Vía Aérea/normas , Manejo de la Vía Aérea/instrumentación , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Auxiliares de Urgencia/educación , Auxiliares de Urgencia/normas , Auxiliares de Urgencia/estadística & datos numéricos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Intubación Intratraqueal/instrumentación , Paramédico/educación , Paramédico/normas , Paramédico/estadística & datos numéricos , Proyectos Piloto , Estudios ProspectivosRESUMEN
Emergency medical service (EMS) personnel and firefighters (FFs) are first responders in dangerous and stressful situations. They experience high stress due to the nature of their jobs, which can affect their quality of life and various health dimensions. This study aimed to compare quality of life, job stress, and coping strategies in a sample of EMS personnel and FF employees in Iran. This cross-sectional study included 186 FFs and EMS, who were selected using a census sampling method. Our results showed that FFs had a better quality of life, lower perceived stress, and better coping skills than EMS. Individuals living in rural areas, government officials, and staff with regular work shifts also reported less perceived stress. Furthermore, our results indicated a negative and significant correlation between perceived stress and quality of life and a positive and significant correlation between stress management and quality of life in both groups. Given the inevitability of stress in EMS and FF jobs, policymakers need to take interventional measures to reduce anxiety and enhance the quality of life and work for these personnel. Occupational health policies in Iran generally follow the International Labor Organizational recommended standards, however, more attention to managerial interventions that reduce job demands and job stress combined with health promotion programs to improve coping are advised.
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Habilidades de Afrontamiento , Auxiliares de Urgencia , Bomberos , Estrés Laboral , Calidad de Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Transversales , Servicios Médicos de Urgencia , Auxiliares de Urgencia/psicología , Bomberos/psicología , Irán , Estrés Laboral/psicología , Calidad de Vida/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Point-of-care ultrasound (POCUS) is steadily growing in use in prehospital emergency medicine. While currently used primarily by emergency physicians, POCUS could also be employed by paramedics to support diagnosis and decision-making. Yet to date, no paramedicine-targeted POCUS curricula exist in Germany. Furthermore, given time and resource constraints in paramedic training, it is unclear whether paramedics could feasibly learn POCUS for prehospital deployment. Hence, this study outlines the development and implementation of a comprehensive POCUS curriculum for paramedics. Through this curriculum, we investigate whether paramedics can attain proficiency in POCUS comparable to other user groups. METHODS: In this prospective observational study, we first developed a blended learning-based POCUS curriculum specifically for paramedics, focusing on basic principles, the RUSH-Protocol and ultrasound guided procedures. Participants underwent digital tests to measure their theoretical competence before (T1) and after the digital preparation phase (T2), as well as at the end of the on-site phase (T3). At time point T3, we additionally measured practical competence using healthy subjects and simulators. We compared the theoretical competence and the practical competence on a simulator with those of physicians and medical students who had also completed ultrasound training. Furthermore, we carried out self-assessment evaluations, as well as evaluations of motivation and curriculum satisfaction. RESULTS: The paramedic study group comprised n = 72 participants. In the theoretical test, the group showed significant improvement between T1 and T2 (p < 0.001) and between T2 and T3 (p < 0.001). In the practical test on healthy subjects at T3, the group achieved high results (87.0% ± 5.6). In the practical test on a simulator at T3, paramedics (83.8% ± 6.6) achieved a lower result than physicians (p < 0.001), but a comparable result to medical students (p = 0.18). The results of the study group's theoretical tests (82.9% ± 9.2) at time point T3 were comparable to that of physicians (p = 0.18) and better than that of medical students (p < 0.01). The motivation and attitude of paramedics towards the prehospital use of POCUS as well as their self-assessment significantly improved from T1 to T3 (p < 0.001). The overall assessment of the curriculum was positive (92.1 ± 8.5). CONCLUSION: With our tailored curriculum, German paramedics were able to develop skills in POCUS comparable to those of other POCUS learners. Integration of POCUS into paramedics' training curricula offers opportunities and should be further studied.
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Competencia Clínica , Curriculum , Sistemas de Atención de Punto , Ultrasonografía , Adulto , Femenino , Humanos , Masculino , Auxiliares de Urgencia/educación , Medicina de Emergencia/educación , Alemania , Paramédico/educación , Estudios ProspectivosRESUMEN
BACKGROUND AND OBJECTIVE: Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. METHODS: A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line ('000', '111', '999', '911' or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. RESULTS: Eleven studies (n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. CONCLUSIONS: Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient's medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.
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Servicios Médicos de Urgencia , Humanos , Servicios Médicos de Urgencia/economía , Análisis Costo-Beneficio , Técnicos Medios en Salud/economía , Auxiliares de Urgencia/economía , ParamédicoRESUMEN
BACKGROUND: Teamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals and emergency services. It is essential to acquire a deeper understanding of how ambulance teams operate. Therefore, this study aimed to explore the experiences of ambulance professionals with teamwork and how they were influenced by the implementation of a team training programme. METHODS: A qualitative descriptive study was conducted involving ambulance professionals who took part in focus group interviews carried out both before and after the implementation of a team training program across seven ambulance stations within a Norwegian hospital trust. The data were analysed using reflexive thematic analysis based on a deductive-inductive approach. RESULTS: Our analysis revealed 15 subthemes that characterised ambulance professionals' experiences with teamwork and a team training programme, which were organised according to the five main themes of team structure, communication, leadership, situation monitoring, and mutual support. Ambulance professionals' experiences ranged from the significance of team composition and interpersonal and professional relationships to their preferences regarding different communication styles and the necessity of team leaders within the ambulance service. The team training programme raised awareness of teamwork, while the adoption of teamwork tools was influenced by both individual and contextual factors. The Introduction/Identity, Situation, Background, Assessment and Recommendation (ISBAR) communication tool was identified as the most beneficial aspect of the programme due to its ease of use, which led to improvements in the structure and quality of consultations and information handover. CONCLUSIONS: This study documented the diverse characteristics and preferences associated with teamwork among ambulance professionals, emphasising the particular importance of proficient partnerships in this context. Participation in a team training programme was perceived as a valuable reminder of the significance of teamwork, thus providing a foundation for the enhancement of communication skills. TRIAL REGISTRATION: ClinicalTrials.gov-ID: NCT05244928.
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Ambulancias , Grupos Focales , Grupo de Atención al Paciente , Investigación Cualitativa , Humanos , Grupo de Atención al Paciente/organización & administración , Noruega , Femenino , Masculino , Liderazgo , Comunicación , Adulto , Relaciones Interprofesionales , Persona de Mediana Edad , Actitud del Personal de Salud , Conducta Cooperativa , Capacitación en Servicio , Auxiliares de Urgencia/educaciónRESUMEN
BACKGROUND: Dementia encompasses neurodegenerative disorders that account for a global estimated healthcare expenditure of 1.3 trillion US dollars. In Australia, one in 12 people aged ≥65 has a diagnosis of dementia and it is the second leading cause of death. Paramedics play a crucial role in person-centred dementia care, particularly in the community. While consensus has been established on paramedicine's integration into interdisciplinary care teams, there remains a lack of clarity regarding the paramedic role in dementia care. OBJECTIVE: This study aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting. DESIGN AND SETTING: This was a scoping review study of paramedics and people living with dementia within the out-of-hospital setting. METHODS: This study was guided by the Joanna Briggs Institute (JBI) scoping review framework. Databases were searched without date limits, up to 4 April 2023. These encompassed OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English and reporting on paramedic-specific interactions with people living with dementia in the out-of-hospital setting. Data extraction was performed based on study setting, design, population and key findings. RESULTS: Twenty-nine articles were included in the thematic analysis. Four themes emerged: need for training, patterns of attendances, patterns of documentation and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and unprepared in caring for patients living with dementia due to challenges in assessment and management of caregiver tensions. They were often called as a last resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated. Underdocumentation of dementia and pain was found. CONCLUSION: Emergency ambulance conveyance of people living with dementia is a surface reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to improve paramedic training in dementia-specific skillsets.