[Effort-Reward Imbalance in the Emergency Rescue Service - A Cross-Sectional Study on Prevalence and Influencing Factors among Full-Time Emergency Service Employees]. / Berufliche Gratifikationskrisen im Rettungsdienst ­ Eine Querschnittstudie zu Häufigkeit und Einflussfaktoren bei hauptamtlich tätigem Rettungsdienstpersonal.

INTRODUCTION: The emergency service is a challenging field of activity. The Effort-Reward Imbalance model explains on the basis of the ratio between reward/effort the appearance of occupational stress. For the first time, this study examines the extent of Effort-Reward Imbalance in rescue services in Germany. METHODS: Full-time emergency service employees of a German Red Cross District Association were consulted. N=82 employees (78.8%) participated (M age=37.78 years, 73.2% male). In addition to the Effort-Reward-Imbalance-Questionnaire, the study included other tools to measure anxiety, depression, health, social support, bullying and optimism of the employees. RESULTS: N=58 persons (70.7%) reported an effort-reward imbalance. The existence of an Effort-Reward Imbalance was related to older age, lower education, higher professional qualification (working as a paramedic) and existing partnership. Persons with an effort-reward imbalance reported poorer health and lower social support. DISCUSSION: The high number of persons with Effort-Reward Imbalance in emergency services in Germany coincides with international studies. CONCLUSION: The results demonstrates the need for preventive support and further research.

Effectiveness of a community paramedic-led health assessment and education initiative in a seniors' residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS).

BACKGROUND: Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls. METHODS: Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior's apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6-12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention. RESULTS: There were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant's 3rd visit to CHAP-EMS and diastolic by the 5th visit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years. CONCLUSIONS: CHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls. TRIAL REGISTRATION: Retrospectively registered on May 12th 2016 with clinicaltrials.gov: NCT02772263.

2014 critical care transport workplace and salary survey.

This 2014 survey polled critical care transport industry leaders, programs, and caregivers about workplace and salary information. Beyond descriptive information and salary data, the article details specific experience, education, and scope of practice within the critical care transport industry.

EMS provider determinations of necessity for transport and reimbursement for EMS response, medical care, and transport: combined resource document for the National Association of EMS Physicians position statements.

With increasing demands for emergency medical services (EMS), many EMS jurisdictions are utilizing EMS provider-initiated nontransport policies as a method to offload potentially nonemergent patients from the EMS system. EMS provider determination of medical necessity, resulting in nontransport of patients, has the potential to avert unnecessary emergency department visits. However, EMS systems that utilize these policies must have additional education for the providers, a quality improvement process, and active physician oversight. In addition, EMS provider determination of nontransport for a specific situation should be supported by evidence in the peer-reviewed literature that the practice is safe. Further, EMS systems that do not utilize these programs should not be financially penalized. Payment for EMS services should be based on the prudent layperson standard. EMS systems that do utilize nontransport policies should be appropriately reimbursed, as this represents potential cost savings to the health care system.

Is it cost effective to introduce paramedic practitioners for older people to the ambulance service? Results of a cluster randomised controlled trial.

BACKGROUND: A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK. OBJECTIVES: To assess the cost effectiveness of the paramedic practitioner (PP) scheme compared with usual emergency care. METHODS: A cluster randomised controlled trial was undertaken of PP compared with usual care. Weeks were allocated to the study group at random to the PP scheme either being active (intervention) or inactive (control). Resource use data were collected from routine sources, and from patient-completed questionnaires for events up to 28 days. EQ-5D data were also collected at 28 days. RESULTS: Whereas the intervention group received more PP contact time, it reduced the proportion of emergency department (ED) attendances (53.3% vs 84.0%) and time in the ED (126.6 vs 211.3 minutes). There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group. Overall, total costs in the intervention group were 140 UK pounds lower when routine data were considered (p = 0.63). When the costs and QALY were considered simultaneously, PP had a greater than 95% chance of being cost effective at 20 000 UK pounds per QALY. CONCLUSION: Several changes in resource use are associated with the use of PP. Given these economic results in tandem with the clinical, operational and patient-related benefits, the wider implementation and evaluation of similar schemes should be considered.

Effectiveness of emergency care practitioners working within existing emergency service models of care.

BACKGROUND: An emergency care practitioner (ECP) is a generic practitioner drawn mainly from paramedic and nursing backgrounds. ECPs receive formal training and extended clinical skills to equip them to work as an integral part of the healthcare team working within and across traditional boundaries of emergency and unplanned care. Currently, ECPs are working in different healthcare settings in the UK. OBJECTIVES: (1) To evaluate appropriateness, satisfaction and cost of ECPs compared with the usual service available in the same healthcare setting, (2) to increase understanding of what effect, if any, ECPs are having on delivery of health services locally and (3) to evaluate whether ECP working yields cost savings. METHODS: Using a mixed-methods approach, data were collected quantitatively and qualitatively from three different types of health provider setting where ECPs are operational, in three areas of England. Data were collected by sending two questionnaires to each patient eligible to be seen by an ECP, at 3 and 28 days after presentation; telephone interviews were conducted with a sample of staff that included ECPs, other health professionals and stakeholders (eg, managers) in each of the three settings; and routine data were analysed to provide a perspective on costs. RESULTS: After adjusting for age, sex, presenting complaint and service model, some differences in the processes of care between the ECPs and the usual providers in the three settings were observed. Overall, ECPs carried out fewer investigations, provided more treatments and were more likely to discharge patients home than the usual providers. Patients were satisfied with the care received from ECPs, and this was consistent across the three different settings. It was found that ECPs are working in different settings across traditional professional boundaries and are having an impact on reconfiguring how those services are delivered locally. Costs information (based on one site only) indicated that ECP care may be cost effective in that model of ECP working. CONCLUSION: Care provided by ECPs appears to reduce the need for subsequent referral to other emergency and unscheduled care services in a large proportion of cases. We found no evidence that the care provided by an ECP was less appropriate than the care by the usual providers for the same type of health problem.

Results from the first 12 months of a fire first-responder program in Australia.

STUDY OBJECTIVE: We aimed to reduce response times and time to defibrillation for out-of-hospital cardiac arrest patients through fire first-responders equipped with automatic external defibrillators (AEDs). The fire first-responders were added as an extra tier to the existing two-tired ambulance response. METHODS: This prospective controlled trial set in Melbourne, Australia, consisted of a control area (277 km2, population density 2343/km2-ambulance only dispatch) and a pilot area (171 km2, population density 2290/km2-ambulance and fire first-responder dispatch). The main outcome measures were time to emergency medical service (EMS) arrival at scene for all cardiac arrest patients and time to defibrillation for cardiac arrest patients presenting in ventricular fibrillation (VF). The study participants were patients who suffered a cardiac arrest of presumed cardiac aetiology for which a priority 0 emergency response was activated. A total of 268 patients were located in the control area and 161 in the pilot (intervention) area. RESULTS: The mean response time to arrival at scene was reduced by 1.60 (95% CI 1.21, 1.99) min, P < 0.001. A large reduction in prolonged responses (> or = 10 min) to cardiac arrests was also observed in the pilot area (2%) compared with the control area (18%), chi = 23.19, P < 0.001. Mean time to defibrillation was reduced by 1.43 (95% CI 0.11, 2.98) min, P = 0.068. CONCLUSION: The results from this study suggest that fire officers can be successfully trained in the use of AEDs and can integrate well into a medical response role. The combined response of ambulance and fire personnel significantly reduced the response interval and reduced time to defibrillation. This suggests that in appropriate situations other agencies could be considered for involvement in co-ordinated first-responder programs.

A more cost-effective use of medical air evacuation personnel.

Air transport of severely traumatized patients has evolved from novel pilot programs into integral services provided by tertiary care health centers. Medical air evacuation (MedEvac) effectiveness is mainly due to the rapid transport of critically injured (90% blunt trauma) patients to the hospital by highly trained medical personnel. A recent self-study of a University-based MedEvac crew showed that 67 per cent of their on-duty time was "available." Only 33 per cent of duty time was flying or related patient care. In this era of cost containment, the optimal use of materials and services must be reassessed. The most cost-effective use of the crew may require expanding the role of the MedEvac to include Emergency Department responsibilities as part of the job description. This represents change and stressful group dynamics. However, by coordinating the Emergency Department and MedEvac schedules, the hospital is able to make more efficient use of resources. No flight was delayed by this work proposal.

Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico.

INTRODUCTION: In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico. METHODS: In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site. RESULTS: The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site. CONCLUSIONS: This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.

1997 JEMS salary survey. Long hours, modest pay.

As in years past, the 1997 Jems salary survey tracks trends in compensation and career development in both the public and private sectors. This year, we've included some information about volunteer agencies as well. While the survey serves as a barometer for EMS wages and benefits, relying solely on the absolute numbers may create an incomplete picture because of changes in the number of respondents, organizational characteristics and other variables. However, combined with other industry data, the annual salary survey is a useful tool for comparing your pay with that of your peers. The survey should also prove useful to organizations and labor groups planning and preparing competitive compensation packages.

JEMS' 1997 Provider Income Survey.

Each year the JEMS salary survey presents the organizational perspective of salaries, benefits and working conditions in EMS. In 1997, JEMS editors wanted to know whether an individual provider's financial perspective changed meaningfully when their non-EMS income was also considered. That question led to the provider income survey, which accompanied last November's feature on salaries. For a review of the most interesting trends and tidbits on EMS provider income, read on.