Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/emp2.12917

Paramedic educational program attrition accounts for significant loss of potential EMS workforce

As out‐of‐hospital medicine evolves, emergency medical services (EMS) education practices must also be updated to ensure that EMS professionals acquire and maintain the skills needed to best serve patients. We aimed to identify and rank the top 10 research priorities related to EMS education in the United States.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/emp2.12882

Defining priorities for emergency medical services education research: A modified Delphi study

/pdf/paramedicine-literature-search-march-may-2023-28wf2yuf.pdf

Paramedicine Literature Search: March-May 2023

Abstract Introduction: Paramedics are a vital component of the Emergency Medical Services (EMS) workforce and the United States health care system. The continued provision of high-quality care demands constantly improving education at accredited institutions. To date, only limited characteristics of paramedic education in the United States have been documented and studied in the literature. The objective of this study was to describe the educational infrastructure of accredited paramedic programs in the United States in 2018. Methods: This is a retrospective, cross-sectional evaluation of the 2018 paramedic program annual report from The Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP; Rowlett, Texas USA). The dataset includes detailed program metrics. Additionally, questions concerning program characteristics, demographics, and resources were asked as part of the evaluation. Resource availability was assessed via the Resource Assessment Matrix (RAM) with a benchmark of 80%. Included in the analysis are all paramedic programs with students enrolled. Descriptive statistics were calculated (median, [interquartile range/IQR]). Results: A total of 677 programs submitted data (100% response rate). Of these, 626 met inclusion criteria, totaling 17,422 students. Program annual enrollment varied greatly from one to 362 with most programs having small sizes (18 students [IQR 12-30]). Program duration was 12 months [IQR 12-16] with total hours of instruction being approximately 1,174 [IQR 1069-1304], 19% of which were dedicated to clinical experience. Full-time faculty sizes were small (two faculty members [IQR 1-3]) with most programs (80%) having annual operating budgets below USD$500,000. For programs with an annual budget below USD$100,000 (34% of programs), annual enrollment was approximately 14 students [IQR 9-21]. Degrees conferred by programs included certificates (90%), associate degrees (55%), and bachelor’s degree (2%). Simulation access was assessed with nearly all (100%) programs reporting simple task trainers and 84% of programs investing in advanced simulation manikins. Seventy-eight percent of programs met the RAM benchmark. Conclusion: Most paramedic educational programs in the United States have small annual enrollments with low numbers of dedicated faculty and confer certificates and associate degrees. Nearly one-quarter of paramedic educational programs are not adequately resourced. This study is limited by self-reported data to the national accreditation agency. Future work is needed to identify program characteristics that are associated with high performance.

Administrative and Educational Characteristics of Paramedic Programs in the United States

Since 2015, development of competencies by emergency medical services (EMS) fellows have been evaluated using the EMS Milestones 1.0 developed by a working group consisting of relevant stakeholders convened by the Accreditation Council for Graduate Medical Education (ACGME). Feedback from users and data collected from the milestones assessments in the interim indicated a need for revision of the original milestones. In May 2021, the Milestones 2.0 working group was convened for the purpose of revising this specialty‐specific assessment tool.

Emergency medical services Milestones 2.0: What has changed?

Comparison of the scope of practice of the army combat medic specialist and civilian national EMS certification levels.


 
 Prehospital identification of large vessel occlusion (LVO) ischemic stroke using stroke scoring tools based upon physical exam findings is highly user‐dependent and associated with poor specificity. Measurement of the “headpulse” by cranial accelerometry has been previously shown to reliably identify LVO in a hospitalized group of suspected stroke patients, but the utility of this technology in the prehospital environment remains unclear. The EPISODE‐PS‐COVID study was designed to evaluate the use of a novel triaxial cranial accelerometry device (Harmony, MindRhythm, Inc.) for predicting LVO using prehospital data.
 
 
 
 Paramedics from multiple emergency medical services (EMS) agencies were trained in placement of the Harmony device. Patients suspected of LVO stroke by EMS personnel received placement of the non‐invasive headband device in the field, and prehospital data were collected over a 3‐minute period prior to hospital arrival. Headpulse data were then compared to clinical data collected during a subsequent emergency department (ED) and hospital visit, including results of brain computed tomography angiogram (CTA) as the gold standard for LVO diagnosis. Patients were consented for inclusion in the study after hospital arrival, utilizing a delayed consent model, as approved by the local institutional review board (IRB). Los Angeles Motor Scale (LAMS) scores were also calculated by prehospital providers for comparison with headpulse measurements.
 
 
 
 A total of 377 enrollments were made at six participating hospitals over a period of 18 months (April 2021 – September 2022), including 92 subjects with recordings free of technical recording errors who were able to provide informed consent for use of their data. Nine (9.8%) subjects were confirmed to have LVO by subsequent CTA, while 15 (16.3%) were diagnosed with non‐LVO ischemic stroke, seven (7.6%) with intracranial hemorrhage, and 61 (66.3%) with stroke mimics. The Harmony device algorithm correctly identified seven of nine LVO strokes, resulting in 78% sensitivity, as well as 82 of 83 non‐LVO diagnoses (99% specificity, p < 0.0001). In this data set, contemporaneous LAMS score demonstrated 44% sensitivity and 82% specificity (p = 0.087). Device innovation during the trial significantly reduced the number of technical errors. Device performance numerically exceeded the LAMS score, with p = 0.099.
 
 
 
 Data from this pilot study suggest that the Harmony device has a sensitivity and specificity that may be non‐inferior to the LAMS score when tested in an undifferentiated population of suspected stroke patients. Although the sample size is underpowered to test for superiority, enrollment in the trial is ongoing. A blinded, pivotal trial will begin soon. The use of a non‐invasive device to detect LVO has substantial implications for prehospital LVO stroke management, including the potential for improved triage and improved outcomes for patients with LVO stroke, without delaying care for non‐LVO stroke patients.


Matthew T. Ball

Papers

Administrative and Educational Characteristics of Paramedic Programs in the United States

Paramedic educational program attrition accounts for significant loss of potential EMS workforce

Emergency medical services Milestones 2.0: What has changed?

Comparison of the scope of practice of the army combat medic specialist and civilian national EMS certification levels.

Abstract Number: LBA3 Head Pulse For Ischemic Stroke Detection Prehospital Study During COVID‐19 Pandemic (EPISODE‐PS‐COVID): Initial Trial Results