Showing papers in "Australasian Journal of Paramedicine in 2021"

A taxonomy of Australian and New Zealand paramedic clinical roles

Abstract: IntroductionThis article aims to summarise and categorise the current types of frontline paramedics in Australia and New Zealand, their relative scopes of practice, their qualifications and training, and the titles used in each jurisdictional ambulance service. Methods Each of the 10 jurisdictional ambulance services were contacted and their current clinical roles discussed with a manager or senior paramedic between June and October 2020. Information was summarised in tables and text. ResultsMinimum qualifications for paramedics range from a diploma to an undergraduate degree, with graduate programs ranging from six to 18 months’ duration. Additional minimum qualifications for Extended Care Paramedics range from no minimum qualifications to a nursing degree. Additional minimum qualifications for Intensive Care Paramedics range from no minimum qualifications to a postgraduate diploma. Additional minimum qualifications for Retrievalists range from no minimum qualifications to a master degree. Helicopter emergency medical services (HEMS) teams range from primarily physician-led in four services to autonomous paramedics in five services. Armed offender paramedics exist in four services; urban search and rescue paramedics exist in five services; wilderness paramedics exist in five services; CBRNE paramedics exist in three services; mental health paramedics exist in three services. Special Operations variously refers to HEMS, USAR, CBRNE or armed offender. Critical Care variously refers to Intensive Care, HEMS in a physician-led team and autonomous HEMS. Advanced life support refers to paramedics and intensive care. Rescue Paramedic refers to road crash extrication or wilderness paramedics. Flight Paramedic refers to Paramedics or Intensive Care Paramedics, either HEMS or fixed wing. ConclusionThe jurisdictional ambulance services are heterogenous in the structure, qualifications, training and terminology for their frontline paramedic roles. Due to this lack of consistency, roles for paramedics in Australasia are currently largely incomparable between services, rendering shared titles inoperable from intranational and international perspectives.

Are healthcare professionals in jordan willing to work and provide care for covid-19 patients?

Abstract: Introduction The outbreak of the novel coronavirus (COVID-19) has overwhelmed healthcare systems and exposed healthcare providers (and their families) to a high risk of infection and death. This study aimed to assess the willingness of healthcare providers in Jordan to report for duty and provide care to COVID-19 patients. Methods An online questionnaire was developed including questions about demographics, willingness to report to work and provide care to COVID-19 patients, and potential associated factors. Results A total of 253 participants completed the survey (mean age 33.8 years, 58.6% male). The sample included physicians (14.9%), nurses (61.1%) and paramedics (23%). Most participants (96.4%) were willing to come to work during the pandemic, although only 64.7% showed a willingness to provide care to COVID-19 patients. Being male (OR 3.21; 95% CI: 1.75-5.90) or having adequate training on COVID-19 (OR 5.16; 95% CI: 2.32-11.46) were the major predictors for willingness to care for COVID-19 patients, whereas concerns for family safety (OR 0.25; 95% CI: 0.14-0.47) or lack of information about COVID-19 (OR 0.43; 95% CI: 0.23-0.80) were the major predicting barriers for willingness to care for COVID-19 patients. Conclusion Although most participants were willing to report for duty, less than two-thirds were willing to care for COVID-19 patients. Being male and receiving training are associated with willingness; whereas concern for family is associated with less willingness to care for COVID-19 patients.

Coping mechanism and professional quality of life in northeast texas ems personnel during the covid-19 pandemic: An exploratory study

Abstract: Introduction The purpose of this study was to conduct an exploratory evaluation of employee professional quality of life and factors associated with it at an emergency medical service (EMS) agency in northeast Texas in the United States. Initially, we intended to evaluate typical day-to-day factors, however we ended up capturing these factors during the unique environment of the COVID-19 pandemic. Methods We conducted an exploratory cross-sectional survey at an EMS agency in northeast Texas in November 2020. Surveys were web-based and anonymous. They included the ProQOL 5, the Survey of Perceived Organizational Support, the Brief Resilience Survey, the RAND Social Support Survey Instrument, the Kessler-6, the Workplace Incivility Scale-Revised, the General Self-Efficacy Scale and the Brief Cope Scale. Results The survey had a response rate of 19% (38 participants). Findings suggest a positive relationship between utilising religion as a coping mechanism and higher compassion satisfaction. There was also a relationship associated between increased perceived organisational support leading to an increase in compassion satisfaction. The most significant predictors of burnout were two different coping mechanisms. Those who relied more heavily on behavioral disengagement and those who employed humour as a coping mechanism displayed average increased levels of burnout. Finally, those who experienced workplace incivility and those who relied on self-blame as a coping mechanism experienced on average higher levels of secondary traumatic stress. Conclusion This study adds to the limited literature examining coping mechanisms, stress and burnout in EMS personnel. It is also unique for examining how EMS personnel are coping with stress during a prolonged pandemic. © 2021, Paramedics Australasia. All rights reserved.

Facilitators, barriers and motivators of paramedic continuing professional development

Abstract: Introduction As registered health professionals, Australian paramedics are required to abide by professional registration standards including the maintenance of continuing professional development (CPD). The broader health literature identifies facilitators, barriers and motivators for engaging in CPD, however the body of knowledge specific to paramedicine is weak. This research seeks to address this gap in the paramedicine body of knowledge. Methods This study adopts a constructivist grounded theory methodology. Data were collected through semi-structured interviews, and analysed using first and second cycle coding techniques. Paramedics from various state-based Australasian ambulance services and private industry (N=10) discussed their experiences specific to their attitudes, perceptions and engagement about CPD. Results Paramedic CPD goes beyond the traditional approach to mandatory training. Paramedics are motivated by factors such as modality of delivery, professional expectations, clinical/professional improvement and, sometimes, fear. Facilitators included organisational support, improved clinical knowledge, practitioner confidence, self-directed learning opportunities and perceived relevance of content. Barriers include cost, workload/fatigue, location, rostering, lack of incentive to engage, lack of employer support and technological problems. Conclusion By understanding what facilitates or motivates engagement in CPD activities, paramedics can navigate their CPD in conjunction with regulatory requirements. Although paramedics report some similar experiences to other health professionals, there are nuancethat appear specific to the discipline of paramedicine. Of interest, a unique finding related to fear influencing paramedic CPD engagement. The results of this study informs paramedic employers and paramedic CPD providers with insights to assist in the development of positive CPD experiences and interactions.

The need for purposeful teaching, learning and assessment of crisis resource management principles and practices in the undergraduate pre-hospital emergency care curriculum: A narrative literature review

Abstract: IntroductionTraditionally, undergraduate emergency medical care (EMC) training programs have, over the years, typically focussed on developing individuals with proficiency in clinical skills who can perform complex procedures in the act of administering safe and effective emergency care in the pre-hospital setting. A shortcoming of this training relates to the attention given to the soft skills needed to work efficiently in a team-based environment. Crisis resource management (CRM) is a structured, evidence-based approach to training that is designed to enhance teamwork performance in critical circumstances where the absence of coordinated teamwork could lead to undesired outcomes. MethodsA narrative review of GOOGLE SCHOLAR, MEDLINE, PUBMED, CINAHL as well as paramedic-specific journals was conducted. Articles were included if they examined the importance of CRM in pre-hospital emergency care; training undergraduate pre-hospital emergency care students on the principles and practices of CRM; and non-technical skills in pre-hospital emergency care. DiscussionResearchers found limited articles related to CRM and the pre-hospital emergency care setting. Our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness, decision-making, verbal communication, teamwork as well as leadership and followership skills. ConclusionEffective team management is a core element of expert practice in emergency medicine. When practised in conjunction with medical and technical expertise, CRM can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of a pre-hospital emergency care plan.

The effect of self-efficacy on maths anxiety among paramedic students

Abstract: Introduction Maths anxiety is defined as feelings of tension that interfere with dealing with numbers and mathematical problems. Self-efficacy, which is related to maths anxiety, can be defined as perceptions of one's abilities to math problems, tasks and math-related course work. This study aimed to investigate the effect of gender, age and year level on maths anxiety and self-efficacy and to study the relationship between self-efficacy and maths anxiety among paramedic students. Methods A cross-sectional study of paramedic students at Monash University in Victoria was conducted. Participants completed a 15-minute paper-based questionnaire which is composed of Maths Anxiety Rating Scale – Revised (MARS-R),) the Maths Self-Efficacy Scale (MSES) and demographic information. Results The questionnaires were completed and returned by 344 students. (81.3% return rate). The mean score for the MARS-R was 25.71 (SD=8.80) and for the MSES was 125.59 (SD=29.55). Females had higher maths anxiety levels (M=26.83, SD=9.00) than males (M=23.67, SD=8.26) and lower self-efficacy (M=119.59, SD=29.30) than males (M=135.73, SD=27.39). There was a significant negative relationship between MARS-R and MSES levels. Multiple linear regression indicated that maths self-efficacy (beta = -0.626, p<0.001) made the strongest contribution to maths anxiety levels. Conclusion There was a significant negative relationship between maths anxiety and self-efficacy levels reported by the paramedic student cohort. Gender plays an integral part in determining maths anxiety and self-efficacy level. To improve maths performance and reduce anxiety during calculation tasks, such as dose determinations, targeted education should be developed to improve maths self-efficacy.

The demographic and clinical practice profile of Australian remote and industrial paramedics: Findings from a workforce survey

Abstract: IntroductionA large workforce is employed in remote environments in the Australian mining and fuel sectors. Whereas paramedics are increasingly assuming roles as healthcare providers in these locations, little is known about industrial paramedic practice. The aim of this exploratory study was to better understand the demographics, education, clinical practice and work environment of the Australian paramedic workforce in remote and industrial settings to inform future research and education for the emerging specialty. Methods Web-based respondent driven network sampling was used to recruit remote and industrial paramedics in this cross-sectional descriptive study. A self-administered questionnaire elicited responses (n=111) about participant demographics, work environment, initial and continuing education, and clinical scope of practice. ResultsParamedic participants working in remote and industrial settings are predominately male (86.5%) with the majority aged 35 to 44 years (38.7%). Their job titles range widely and include paramedic, intensive care paramedic, industrial, mine and offshore paramedics. Participants report an average of 15.4 years of total healthcare experience and working in the remote or industrial health sector for a mean of 7.1 years, primarily in Western Australia (34.2%). These paramedics often engage in continuing education, with 45% studying at a vocational or tertiary institution at the time of the survey. Most respondents (63.9%) describe their employment as directly or indirectly related to the natural resource sector and 75.7% have experience in remote settings such as camps, mining sites, offshore platforms, vessels or small communities. Most practitioners (59.5%) work in a full-time capacity and can perform core paramedic skills including intravenous cannulation, 12-lead electrocardiogram interpretation, chest needle decompression and restricted drug administration. Additionally, more than 40% of those actively working in the sector report having endotracheal intubation and intraosseous access in their scope of practice. They also administer immunisations, antibiotics and other prescription medications, manage chronic diseases, and perform low acuity skills typically included in a community paramedic role. ConclusionThis workforce survey is the first of its kind designed to gain a broader understanding of the paramedic practitioners who work in remote and industrial settings and the characteristics of their work environment. Key areas highlighted by this study serve to inform professional regulators, educators and employers with respect to the skills that remote and industrial paramedics perform and the education that is required to support the evolving specialised practice.

Right ventricular myocardial infarction and adverse events from nitrates: A narrative review

Abstract: Introduction There is ubiquitous belief that right ventricular myocardial infarction (RVMI) patients are pre-load dependent, and that administering nitrates to this cohort may cause adverse events – most notably hypotension. This article charts a narrative history of RVMI and nitrates: from the initial recognition of RVMI and early support of the use of nitrates, through the spread of the view against nitrates, and to the recent publication of evidence once again supporting their use. Methods Four databases were systematically searched (PubMed, Embase, Medline, Web of Science) and results screened by title, then abstract, and finally full text. Results were presented using a chronological narrative structure. Results The view against the use of nitrates during RVMI can be traced back to a single 1989 cohort study of 28 patients, then later being adopted by a series of influential secondary evidence papers, and ultimately by international guidelines. In 2016, 2017 and 2019, new cohort studies totalling 1046 patients were presented, all of which concluded that nitrates are safe to administer during RVMI. Conclusion This article charts how a single retrospective cohort study with low statistical power came to form the dominant narrative on best practice despite complex and conflicting primary evidence.

Medical first response models in rural villages and towns: A simulation study of response times

Abstract: Introduction Medical first responders (MFR) shorten the response times and improve outcomes in, for example, out-of-hospital cardiac arrests. This study demonstrates the usability of open geographic data for analysing MFR service performance by comparing simulated response times of different MFR models in rural town and village settings in Finland. Methods Community first response (CFR) models with one to three responders obeying the speed limit were compared to a volunteer/retained fire department (FD) model where three responders first gather at a fire station and then drive to the scene with lights and siren. Five villages/towns, each with a volunteer/retained FD but no ambulance base within a 10 km radius, were selected to test the models. A total of 50,000 MFR responses with randomly selected buildings as potential responder and patient locations were simulated. Results In central areas, the simulated median response time for the one-responder model was 1.6 minutes, outperforming the FD model’s simulated response time median by 4.5 minutes. In surrounding rural areas, the median response times of one- and two-responder CFR models were still shorter (15.0 and 15.9 minutes, respectively) than in the FD model (16.4 minutes), but the FD model outperformed the three-responder CFR model (16.8 minutes). Conclusion Open geographic datasets were useful in performing logistic simulations of MFR. Based on the simulations, CFR without emergency vehicles may reach patients faster than FD-based MFR in central areas, whereas in surrounding rural areas the difference is less pronounced.

Assessing the usefulness of instant feedback and the Hawthorne effect: an audit of time indexes of EMS missions in Tehran

Abstract: Introduction It has been well established that if a person is aware that they are being monitored their commitment and effort will be maximised (the Hawthorne effect), which then leads to efficiency increase and optimal workflow. Objective Our aim was to evaluate the efficacy of instant feedback and the Hawthorne effect of this intervention on pre-hospital time indexes during emergency medical service (EMS) missions. Methods This is a cross-sectional auditing study on the missions of the Tehran EMS Center (performed over a 12-month period) in three phases: pre-intervention, instant feedback, and monitoring without feedback. The measured time indexes were the different parts of mission times. To collect data, a pre-prepared checklist was set up. For the first phase, data were extracted from the database of the Tehran EMS Center. In the second and third phases, the data were entered into the relevant forms for each mission by the researcher and executive colleagues. Results The data of 229,847 missions were analysed. In the instant feedback phase, compared to the pre-intervention phase, the mean activation time, response time, scene time, transfer time and hospital delay time were decreased. When we compared the mean time indexes in the monitoring phase compared to the instant feedback phase, we saw that the average activation time, response time and transfer time were increased but they were still less than that in the pre-intervention phase. However, the scene time and hospital delay time were not changed compared to the instant feedback phase but were lower than that in the pre-intervention phase. Conclusion Auditing was effective in reducing the total time of missions and this effect was largely maintained in the monitoring phase under the Hawthorne effect.

Goldilocks in cardiac arrest: A scoping review of invasive hemodynamic monitoring in the pre-hospital setting for getting adrenaline dosing just right

Abstract: Introduction A one-size-fits-all approach to adrenaline dosing is likely to be sub-optimal for out-of-hospital cardiac arrest given the diverse nature of patient age, bodyweight, frailty and intra-arrest coronary perfusion pressure. An individualised adrenaline dosing approach to cardiac arrest using invasive blood pressure monitoring has been shown to increase rates of return of spontaneous circulation in the hospital setting, but evidence for this approach has not yet been reviewed in the pre-hospital setting. Methods A scoping review was undertaken using Science Direct, ProQuest, PubMed, CINAHL Complete and GALE Health and Wellness databases with the search terms ‘arterial line’, ‘pre-hospital’, ‘cardiac arrest’ and similar derivatives. Subject matter experts and authors of articles meeting inclusion criteria were also consulted to help identify further relevant studies. Articles were included if they pertained to the use of arterial lines in cardiac arrest in the pre-hospital field, and excluded if they related to traumatic cardiac arrest, in a language other than English, Dutch or French, or not retrievable as a full text. Results A total of 1408 articles were identified using the search method, of which three remained after de-duplication, use of inclusion and exclusion criteria, and full text appraisal. The current pre-hospital literature is lacking and avenues for further research to improve the evidence for hemodynamic guided resuscitation were identified. Conclusion Paramedic-initiated invasive arterial monitoring presents a new, but as yet unproven, intervention for improving cardiac arrest outcomes.

A comparison of Australasian jurisdictional ambulance services’ clinical practice guidelines series: An introduction

Abstract: Introduction There are 10 emergency paramedic services in Australia and New Zealand (Australasia), referred to as jurisdictional ambulance services (JASs). All 10 of the JASs in Australasia produce their own clinical practice guidelines (CPGs). With differing approaches to their review and implementation of new evidence, there is opportunity for differences to arise between guidelines. This article outlines a new series that will aim to identify interjurisdictional differences in CPGs and paramedic scopes of practice, and consequently differences in patient treatment depending on which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS will be obtained from each JAS, and content extracted by registered paramedics. The scope of practice for each intervention presented in the guideline will be classified as being at the level of ‘paramedic’, ‘intensive care paramedic’ (or equivalent, as titles vary by jurisdiction), or ‘restricted’. Each paper will be provided to each JAS for optional verification of content before publication, and the results of this will be stated. Conclusion This series will aim to provide a contemporary overview of Australasian JAS clinical practice guidelines and scopes of practice.

Towards a safer and more efficient neonatal transfer system in South Africa: A qualitative inquiry with advanced life support paramedics

Abstract: Introduction The inter-healthcare transfer of the critically ill neonate is a critical aspect of larger neonatal intensive care, as it influences the safe transport of neonates from the receiving to the referring hospital. It is crucial then that the transfer process be safe and efficient so as not to compromise the already fragile condition of the neonate. The aim of the study was to understand the challenges advanced life support (ALS) paramedics face during neonatal transfers and to understand how the process could be made safer and more efficient. The objectives related to understanding the transfer process, the challenges linked to the critically ill neonate and the difficulties associated with the ambulance vehicle and equipment. Methods Using a qualitative research approach we sought the views of ALS paramedics at the forefront of transfers nationally. In-depth interviews were held with eight paramedics in KwaZulu-Natal and four focus group discussions with ALS paramedics in KwaZulu-Natal, Gauteng, Free State and the Western Cape in South Africa. A total of 35 ALS paramedics were involved in these group discussions. Results The study uncovered several challenges that paramedics face related to poor organisational preparation for transfer of the critically ill neonate, and other crucial issues that compromise the transfer such as inadequate or defective equipment. Conclusion There is a need for greater scrutiny of the transfer process and a commitment from stakeholders to begin addressing the challenges confronting the safe transfer of critically ill neonates.

The identification of factors contributing to negative experiences of pre-hospital emergency care personnel in Johannesburg, South Africa

Abstract: Introduction The handover of a patient in the pre-hospital setting is different to other handover settings and therefore requires a different definition and description to that of other patient handover environments. Identifying those factors that affect the efficacy of handover could provide useful for formulating improvement strategies. Aim This research set out to describe the negative experiences of pre-hospital emergency care personnel handing over in the emergency centre in Johannesburg, South Africa, with a view to identifying potential areas for improvement. This paper reports on responses to an open-ended question that formed part of a purpose-designed, paper-based questionnaire that formed part of a mixed-methods study. Methods Data were collected from pre-hospital emergency care personnel within Johannesburg, South Africa. Responses from 140 participants were captured verbatim into Atlas.ti® for coding, analysis and interpretation using a qualitative descriptive methodology. Two themes were generated from a qualitative descriptive analysis of the data: communication barriers, and process barriers to emergency centre handover. These were confirmed by the categories and codes that made up these themes. Conclusion This study identifies some of the factors perceived by pre-hospital emergency care personnel to negatively affect emergency centre handover. It provides insights into how communication and process within the emergency centre have the potential to negatively impact emergency centre handover efficacy.

Pre-hospital management, injuries and disposition of ambulance attended adults who fall: A scoping review protocol

Abstract: Introduction Falls are a globally prevalent health issue, with 37.3 million falls severe enough to require medical attention each year. Falls can result in major trauma and are the second leading cause of unintentional injury deaths worldwide. The role of emergency medical services (EMS) in the pre-hospital emergency treatment of falls is critical, however the sources describing this phase of care has not previously been synthesised. The aim of this scoping review is to identify and map the published literature on the characteristics and injuries of adults who fall, are attended by EMS, EMS interventions and patient disposition. Methods The methods for scoping reviews outlined by the JBI Manual for Evidence Synthesis will be used. Databases including Medline, Scopus, CINAHL Plus, Cochrane, EMBASE and ProQuest will be searched from inception. Reference lists of included sources will also be searched. Two reviewers will independently complete title, abstract and full text screening. Included sources will be summarised using narrative synthesis and conceptual categories including patient characteristics, injuries, EMS intervention and patient disposition will be mapped. Discussion This protocol describes the framework to identify the scope, comprehensiveness and concepts surrounding pre-hospital falls to identify gaps in knowledge regarding the role of EMS in attending patients who sustain a fall.

The process of handover in the busy emergency centre: A pre-hospital perspective from Johannesburg, South Africa

Abstract: Background Emergency centre handover usually takes place between the pre-hospital emergency care personnel who deliver the handover and the emergency centre personnel who receive the handover. Handover that is not effective may present risks to patient safety. One factor that may affect handover delivery is the process of handover within a busy emergency centre. Methods The data reported on in this study formed the qualitative component of a sequential explanatory mixed methods study. It used face-to-face, semi-structured interviews to gather data. Fifteen interviews were conducted with pre-hospital emergency care personnel from a range of qualification and scopes in South Africa. Interviews were transcribed verbatim and imported into Atlas.ti® for coding and analysis using a qualitative descriptive methodology. Results Pre-hospital emergency care participants identified a lack of emergency centre staff available to receive handover as a barrier to effective handover and attributed this to emergency centres being overworked and understaffed. This potentiated interruptions to handover and having to deliver multiple handovers for the same patient. Pre-hospital emergency care participants indicated a preference for handing over directly to a doctor. Conclusion Several potential process barriers to effective emergency centre handover were identified, including lack of personnel to receive handover, interruptions and the need to perform multiple handovers for the same patient. Generally, these barriers were attributed to the busy understaffed and overworked nature of emergency centres. We would encourage future research in emergency centre handover, specifically from the perspective of the personnel who receive handovers.

The regional resuscitation guidelines for pulseless electrical activity in emergency medical services in the United Kingdom: a systematic review

Abstract: Background Pulseless electrical activity (PEA) is managed in accordance with international and national guidelines. These guidelines are not fully evidenced, resulting in emergency medical services in the United Kingdom amending guidelines to support paramedics when making resuscitation decisions. This review examined the local guidelines of services to identify the local clinical management of PEA, summarise the available evidence and prioritise future research. Methods The review was conducted according to the Joanna Briggs Institute systematic review of text and opinion. The review included locally amended guidelines and cited evidence sources for the management of PEA. A three-step search strategy was applied. Textual data was extracted to form conclusions which were categorised into similar meaning and developed into synthesised findings. Results Twenty-two documents met the inclusion criteria; Twenty-seven conclusions were extracted and analysed to generate 10 categories, forming three synthesised themes: the variability in the clinical management of PEA between ambulance services; the early identification of reversible causes and appropriate treatment options to increase survivability; and the consensus for further research. Conclusion This review identified variability in the clinical management of PEA; the autonomy of paramedics, which patients to transport to hospital and the factors applied to inform resuscitation decisions. A summary of the evidence in support of the local guidelines found that the early identification and treatment to reverse the cause of PEA was important to patient survival, however, this was acknowledged as complex and challenging to achieve. There was a consensus to improve patient outcomes using prognostic research.

Challenges of scene management in traffic collisions from the perspective of road emergency responders in East Azerbaijan, Iran

Abstract: Introduction Thousands of traffic collisions occur each year on Iran’s roads. This study aimed to investigate the challenges of scene management in road traffic collisions in the East Azerbaijan Province of Iran. Methods Data were collected using in-depth semi-structured interviews and analysed by content coding and merging. Subcategories and themes were then extracted after integrating similar codes. Participants were selected using the purposive sampling method, and interviews continued until data saturation was reached. Results Twenty participants were interviewed; nine categories were extracted from the collected data: infrastructure problems, lack of responders’ preparedness, triage challenges, deficiencies and limitations, management of special (hazardous) incidents, communication problems with casualties, lack of coordination, lack of psychosocial support from responders, and cultural and social challenges. Conclusion Each traffic collision requires an immediate and effective response; however, this involves several challenges as its process is an inter-sectoral issue. The major challenge is the lack of coordination among different responders. Accordingly, these challenges need to be addressed by developing a comprehensive plan, designing a leading organisation, and developing a comprehensive trauma system.

Uncharted waters: The effects of COVID-19 on student paramedics

Abstract: Introduction: The effect of COVID-19 pandemic shutdowns on education has been discussed broadly in both the media and among academics, however its true effects on paramedicine students and their ability to attend in-person lectures, skill sessions and clinical placements has not been widely researched. This study aimed to investigate the impact of COVID-19 on a group of paramedicine students at an Australian university. Methods: A cross-sectional study using a convenience sample of first and second year paramedicine students was undertaken to explore their perceived experiences of COVID-19 through both qualitative and quantitative responses. Results: A total of 83 paramedicine students from Griffith University in Queensland participated in the survey, demonstrating an 84.7% response rate. Of the participants, 78.3% (n=65) disagreed that online workshop sessions were as valuable as face-to-face sessions. Similarly, the majority of participants (61.5%, n=51) disagreed that online lectures and tutorials were as beneficial as in-person equivalents. A further 61.4% (n=51) of students agreed that COVID-19-associated lockdowns had negatively impacted their ability to formulate strong personal relationships that are important for university, however 78.3% of students agreed that communication platforms assisted in maintaining some form of social interaction. Conclusion: The results from this study demonstrate that the educational and social impacts of COVID-19 on paramedicine students were highly diverse, and were contingent on several factors including but not limited to: year of study, learning style, previously established social connections and extenuating life circumstances.

The transition from clinician to manager: the paramedic experience

Abstract: Introduction Promotion from paramedic to manager is common in ambulance services, yet there is limited research concerning paramedics’ experience of this role transition. The purpose of this qualitative study was to explore the experiences of paramedics who have transitioned from clinician to manager. Methods A qualitative approach was used for this study. Through purposive sampling, semi-structured interviews were conducted with paramedics who had made the transition to manager. The participants were asked to describe how they felt and what their experiences were concerning this transition. Thematic analysis was undertaken identifying themes within participant responses. Results Six key themes emerged during the data analysis. Participants described feelings of isolation on moving from the frontline, a lack of feeling part of the team ‘in green’; however, they also reported that previously being a paramedic in some instances gave credibility in their new manager roles. Challenges reported concerned no formal training before transitioning into the role, and the lack of essential managerial experience. Conclusion This research provided insight into how paramedics feel and perceive the transition from clinician to management roles. A review of the organisational approach to role transition is of benefit to paramedics. Such a review may help identify what changes could be made in support of paramedics transitioning to management roles. Further research is required across other ambulance services to determine the efficacy of these results in the broader ambulance service environment.

The preparedness of emergency care providers to deal with death, dying and bereavement in the pre-hospital setting in Dubai

Abstract: Introduction This study sought to investigate how prepared emergency care providers are to deal with death, dying and bereavement in the pre-hospital setting in Dubai, and to make recommendations related to such events. Methods A quantitative descriptive prospective design was utilised. Data was collected using an online self-report questionnaire sent to all operational emergency care providers in the Dubai Corporation of Ambulance Services. The data was analysed using the IBM Statistical Package for Social Sciences version 25.0. Results Nearly 65% of participants (n=316) reported that they had not received any formal education or training on death, dying and bereavement. Those that did, reported that the training was conducted mainly by nursing (25.9%; n=124) and paramedic (13.6%; n=65) instructors. One-quarter of participants (25.4%; n=126) reported experiencing intrusive symptoms such as sleep loss, nightmares and missing work as a result of a work-related death or dying incident, but only 4.1% (n=20) had received professional counselling. Conclusion This study found that emergency care providers are underprepared to deal with death, dying and bereavement. A comprehensive death education program encompassing the unique challenges that emergency and pre-hospital setting presents should be implemented to reduce emotional anxiety and help emergency care providers cope better with death, and decrease abnormal grief reactions of the bereft. Abnormal grief reactions can include restlessness, searching for the lost person and disrupted autonomic nervous system functions.

Paramedics’ perceptions, knowledge and skills regarding emergency psychiatric patients in Riyadh, Saudi Arabia

Abstract: Introduction Mental healthcare experts worldwide have been calling for increased contributions from medical professionals and organisations to improve the skills of healthcare practitioners and their coordination with mentally ill patients. However, the contributions and roles of paramedics in treating the mentally ill are still considered limited, and few studies have been conducted on paramedics’ judgement and decision-making when caring for patients with mental illness. This study aimed to assess paramedics’ perceptions, knowledge and skills in dealing with psychiatric emergencies. Methods A cross-sectional study was conducted among participants from the Saudi Red Crescent Authority; different hospitals in Riyadh were invited from September to October 2019 to complete a validated structured questionnaire. The Statistical Package for the Social Sciences version 22 (SPSS 22) software was used for data analysis. Results A total of 124 participants were included in this study; their mean age was 29.93 years, 95.2% were male, 78.9% had a bachelor degree and 12.1% had higher education. The majority of participants agreed that it is important for paramedics to know about mental illness (91.1%) and stated that they were comfortable managing a person with mental illness (63.7%). Almost half (49.6%) disagreed with the statement that psychiatric disorders are caused by religious or supernatural factors, whereas 24% were unsure, and 26.4% agreed. On assessing paramedics’ knowledge and skills, 31.4% scored above average, 42% scored average (average defined as answering six to seven out of 10 questions correctly), and 26.6% scored below average. However, when asked if they carry out the mental status examination on mentally ill patients, 66.1% stated ‘no’. Conclusion This study indicated that the majority of paramedics have positive perceptions regarding mental illness; moreover, it was shown that paramedics are knowledgeable and trained in dealing with emergency psychiatric patients. Further investigation regarding the practice and role of paramedics is necessary.

‘Is the patient completely alert?’ – accuracy of emergency medical dispatcher determination of patient conscious state

Abstract: Introduction During emergency ambulance calls, one of the key issues assessed is the patient’s level of consciousness. An altered conscious state can be indicative of a need for a high priority response; however, the reliability of the resulting triage depends on how accurately alertness can be ascertained over the phone. This study investigated the accuracy of emergency medical dispatcher (EMD) determination of conscious state in emergency ambulance calls in Perth, Western Australia. Methods The study compared EMD determination of patient alertness based on the Medical Priority Dispatch System (MPDS), with conscious state as recorded by paramedics on arrival, for all emergency ambulance calls in a 1-year period in metropolitan Perth. Diagnostic accuracy was reported across the whole system and stratified by MPDS chief complaint. Results There were 109,678 calls included for analysis. In terms of identifying patients as not alert, the overall positive predictive value was 6.62% and negative predictive value was 99.93%, with 10 times as many patients dispatched as not alert than found to be not alert at scene. Sensitivity was only 69.94%. There was significant variation in accuracy between chief complaints. Conclusion The study found high levels of inaccuracy between dispatch identification of not-alert patients, and what paramedics found on scene. While not-alert dispatch was 10 times more common than patients being determined not-alert on scene, only 70% of not-alert patients on scene were classified as such during dispatch. Further research is suggested into the factors that affect the accuracy of EMD determination of patient conscious state.

Critical issues underpinning the safe transfer of ill neonates: A review of the literature

Abstract: Introduction Critically ill neonates often require urgent transport to a neonatal care facility shortly after birth. The safe transfer of ill neonates is a critical part of their continuum of care. Methods A review of the empirical work and literature around the safe transfer of ill neonates was undertaken to explore what factors influence a safe transfer. Results What emerged was that a multitude of adverse events influence the clinical deterioration of the neonate, including the physiological condition of the neonate, equipment-related challenges and the unpreparedness of those involved to deal with neonatal clinical emergencies. Conclusion This review highlights the necessary equipment required, the nature of clinical emergencies that may arise, and the need to consider utilising specialised neonatal transfer units to effect the safe transfer of the critically ill neonate.

Protocol for development of a consensus-based reporting guideline extension for pre-hospital case reports (PREHOSPITAL-CARE)

Abstract: Introduction Case reports make important contributions to evidence-based practice. As with research of any methodological design, the quality and completeness in how the evidence is reported influences the strength of the evidence. Quality in reporting is best achieved through the use of a consensus-based reporting guideline. ‘Case Reports’ (CARE) is a 13-item reporting guideline for case reports. To make CARE more applicable, several discipline specific ‘extensions’ have been developed. Pre-hospital care is an emerging clinical discipline rich in its own specific context and character. Therefore, the aim of this project is to develop and disseminate a pre-hospital extension of the CARE reporting guideline (PREHOSPITAL-CARE). Methods This project will consist of four phases and will be undertaken in accordance with the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network’s guidance for developers of health research reporting guidelines. Phase 1 will comprise a systematic review aimed at identifying features commonly reported in pre-hospital case reports. In phase 2, two consensus-based processes will be conducted, including a Delphi method and an interactive consensus meeting, to produce a list of items that will form the draft guideline items for PREHOSPITAL-CARE. Phase 3 will see this draft being piloted among a selected group of pre-hospital clinicians, academics and students. In the fourth and final phase, an extensive dissemination strategy will be executed, including publication of the PREHOSPITAL-CARE reporting guideline and an ‘elaboration and explanation’ (E&E) companion paper to advocate for the standardised, high-quality reporting of pre-hospital case reports. Outcomes The final outcome will be the publication of the PREHOSPITAL-CARE reporting guideline with an associated E&E paper. Discussion The reporting of health research, including pre-hospital case reports, has been criticised for a lack of completeness and consistency. The development of PREHOSPITAL-CARE will enable the improvement and standardised reporting of pre-hospital case reports.

Public perceptions of the cost of paramedic services in Saskatchewan, Canada

Abstract: Introduction Despite the increasingly important role of paramedics in Canada’s healthcare system, the Canadian Health Act does not cover paramedic services. Anecdotal evidence indicates that the cost of paramedic services prevents many people in need from accessing this care. This article explores public perceptions of the cost of paramedic services in Saskatchewan, Canada. Methods Using a qualitative research design, we collected data from 56 participants in focus group sessions and semi-structured interviews designed to explore perceptions of paramedic services in Saskatchewan. Results The data indicated that participants perceived the cost of paramedic services to be too high, and that this perception may limit the use of paramedic services during medical emergencies. The data also suggested a lack of understanding of how paramedic service costs are calculated. Overall, participants expected the government to do more to subsidise these costs. Conclusion The results revealed a disconnect between public perceptions about the cost of paramedic services and the initiatives designed by the provincial government to alleviate these costs. They also highlight the need for better public education about and access to government programs designed to alleviate the cost of paramedic services.

Motivating factors influencing student paramedic choice of paramedicine as a career

Abstract: Introduction This study aimed to identify and assess the factors, motivations and influences on undergraduate students’ choice of paramedicine for their studies and ultimately a career in paramedicine. Methods A survey was available to 205 first-year Bachelor of Paramedic Science students to assess background, motivational factors and influences on choosing their undergraduate studies. Results The response rate to an online survey distributed to 205 students yielded an almost 25% response rate (n=51). Altruistic factors were the main reason students chose to study for a degree in paramedic science and ultimately a career in paramedicine. Although essential, extrinsic, sociodemographic and interpersonal factors were less motivating factors. Despite other research suggesting media coverage leads to increased student enrolments, the media coverage of paramedics as frontline health professionals during the COVID-19 pandemic and the ‘lights and sirens’ effect of ambulance/paramedic reality television shows as influences were not highly regarded. Conclusion The altruistic factors influencing career choices in paramedicine are generally similar across the healthcare industry. In this review, the motivating nature of extrinsic, interpersonal and sociodemographic factors was generally inconclusive. However, these factors may well apply to a university’s initial recruitment strategy and as a factor for ambulance services to consider when identifying the motivating factor of a student paramedic to join the workforce.

Lecture attendance among university paramedic students: A sequential mixed methods study

Abstract: Background Lecture absenteeism is a widespread issue and has been reported for a large range of university disciplines. The aim of this study was to describe face-to-face lecture attendance within a Bachelor of Paramedicine cohort at a large Australian university and explore associated factors. Methods A sequential mixed method study was undertaken using lecture attendance counts, a cross-sectional questionnaire and semi-structured interviews. Attendance was recorded at four time points throughout one semester. The Lecture Attendance Scale, a standardised 34-item questionnaire with a 7-point Likert rating scale, was used to examine reasons behind students’ choice to attend lectures or not, followed by further exploration via semi-structured interviews. Results Lecture attendance ranged from 30% to 76%, with a mean of 49.2%. On analysis of the questionnaire, eight factors were identified, and these were largely supported by the interview data. Conclusion High levels of lecture attendance were not observed. This study suggests that the decision to attend a lecture can be complex and is influenced by a range of student and organisation-related factors. Understanding and utilising this information to modify and improve healthcare curricula delivery is vital, especially where there may be an association between attendance and the development of clinical skills, and professional attitudes and qualities. This is especially important in healthcare education in the post-COVID-19 pandemic era where the value of in-person education will continue to be examined.

The efficacy of using Google Maps in accessing nearby public automated external defibrillators in Thailand

Abstract: Introduction Early defibrillation remains the highest priority in the chain of survival for out-of-hospital cardiac arrest. Shock delivery should be performed within 5 minutes of collapse to achieve a 50% survival rate. Google Maps has been one of the most popular mobile navigation applications worldwide. Our primary objective was to assess the efficacy of Google Maps in locating nearby public automated external defibrillators (AEDs). Methods Local and non-local populations were enrolled. Participants were randomly assigned to locate AEDs with or without the assistance of Google Maps. Participants used Google Maps on the same smartphone and cellular data network, an activity tracker recorded data for distance covered and time required to retrieve the AED. AEDs were located within 150 seconds of the starting point. Results Out of 100 recruited participants there was no difference in baseline characteristics. In the local population group, Google Maps assistance did not show statistical significance in successfully locating the AED within 150 seconds. Correspondingly, the travel time also showed no difference (173.52 ± 50.99 seconds for Google Maps vs. 206.20 ± 159.53 seconds for control group). The result in the non-local population group revealed no significant difference in successfully locating AEDs within 150 seconds: Google Maps (18.52%) vs. control group (39.13%); p=0.126. The recorded travel time between the Google Maps group and control group were similar (307.59 ± 220.10 seconds vs. 284.0 ± 222.37 seconds; p=0.709). Conclusion In Thailand, using Google Maps mobile assistance was found to be unhelpful in accessing nearby public AEDs.

Paramedic-delivered teleconsultations: A scoping review

Abstract: Introduction Progression in the field of paramedicine has resulted in the development of novel roles within the profession, including the role of advanced paramedics providing teleconsultations for frontline paramedics. Little is known about the experience of paramedics providing or receiving teleconsultations. This scoping review aimed to investigate paramedic perceptions of physician and paramedic-delivered teleconsultations. Methods A scoping review of MEDLINE, CINAHL and EBM Reviews as well as paramedic-specific journals and the grey literature was conducted. Articles were included if they examined advanced paramedics, paramedics, emergency ambulance crew or emergency medical technicians receiving teleconsultations, or physicians and advanced paramedics providing teleconsultations. Results A total of 7461 unique citations were identified. Two citations were ultimately included in the review. One study examined the delivery of teleconsultations by advanced paramedics and one by physicians, both from the perspective of paramedics. Paramedics delivering teleconsultations generally considered the experience to be positive, while those receiving paramedic-delivered teleconsultations felt the level of advice was appropriate and assisted in expanding their own knowledge base. Paramedics receiving physician-delivered teleconsultations reported variable understanding of the unique challenges of out-of-hospital care and tension in the relationship between paramedics and physicians. Conclusion Little literature was identified examining the perceptions of paramedics delivering or receiving physician-delivered or paramedic-delivered teleconsultations. Given the continuing expansion of teleconsultation programs for out-of-hospital staff, this represents a significantly understudied area.