Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review.

Background: Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS. Methods: We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results. Results: The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department. Conclusion: The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.

Use of global rating scales and checklists in clinical simulation-based assessments: a protocol for a scoping review.

INTRODUCTION: Assessment in health sciences education remains a hotly debated topic, with measures of competency and how to determine them in simulation-based assessments enjoying much of the focus. Global rating scales (GRS) and checklists are widely used within simulation-based education but there is a question regarding how the two strategies are used within clinical simulation assessment. The aim of this proposed scoping review is to explore, map and summarise the nature, range and extent of published literature available relating to the use of GRS and checklists in clinical simulation-based assessment. METHODS: We will follow the methodological frameworks and updates described by Arksey and O'Malley, Levac, Colquhoun and O'Brien, and Peters, Marnie and Tricco et al and will report using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will search PubMed, CINAHL, ERIC, Cochrane Library, Scopus, EBSCO, ScienceDirect, Web of Science, the DOAJ and several sources of grey literature. We will be including all identified sources published in English after 1 January 2010 that relate to the use of GRS and/or checklists in clinical simulation-based assessments. The planned search will be conducted from 6 February 2023 to 20 February 2023. ETHICS AND DISSEMINATION: An ethical waiver was received from a registered research ethics committee and findings will be disseminated through publications. The overview of literature the produced will help to identify knowledge gaps and inform future research on the use of GRS and checklists in clinical simulation-based assessments. This information will be valuable and useful for all stakeholders that are interested in clinical simulation-based assessments.

Workplace violence against paramedic personnel: a protocol for a scoping review.

INTRODUCTION: There is evidence to suggest that violence against paramedic personnel is increasing. Several authors report adverse effects linked to exposure to workplace violence. There remain gaps in the knowledge related to specific aspects of workplace violence experienced by paramedics in the prehospital setting. METHODS AND ANALYSIS: This scoping review will consider evidence relating to workplace violence against paramedic personnel. All types of evidence will be considered, including quantitative and qualitative studies, systematic reviews, opinion papers, grey literature, text and papers as well as unpublished materials. This scoping review will be designed and conducted in accordance with the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews will guide the reporting process. Sources will include ERIC, Scopus, PubMed, CINAHL, Cochrane Library, ScienceDirect, Web of Science, Sabinet and the DOAJ as well as OpenGrey (https://opengrey.eu/). All sources published in English will be considered for inclusion and no date limit will be applied. The searching of the databases will begin 16 January 2023 and will be concluded by 30 January 2023. Three independent reviewers will conduct the study selection and data extraction process. In the event of disagreement related to a particular source, this will be resolved by discussion. The findings of the proposed review will be presented in a narrative style that uses diagrams and tables for reporting. ETHICS AND DISSEMINATION: This scoping review will use published literature available in the public domain and will involve no participants, meaning that ethical approval is not required. The findings of the proposed review will be published in topic relevant peer-reviewed journals and will be presented at associated conferences.

Simulation debriefing: a perspective from emergency medical care students at three South African Higher Education Institutions.

INTRODUCTION: simulation-based learning (SBL) is an educational technique that is used to create lifelike experiences within a controlled setting. Feedback and debriefing have been described as most important components in healthcare simulation. Providing feedback or debriefing loses its efficacy if it is not performed correctly. The results of poor feedback or debriefing practice may negatively affect future student performance. It is important to identify both positive and negative current practice so as to better understand the potential effects on student learning. There is a paucity of evidence relating to debriefing within the resource-constrained environment. METHODS: a cross-sectional design collected data using a purpose-designed, paper-based questionnaire that was validated using a pilot study. We collected data from three South African higher education institutions (HEI) offering emergency medical care qualifications. Questionnaires were distributed on-site at each HEI by an academic staff member and were returned to the researchers via courier. Participants were recruited from the second, third and fourth academic years of study. Responses were captured manually and imported into Microsoft Excel for analysis. RESULTS: we collected 153 completed questionnaires from three South African Higher Education Institutions (HEIs). Student perceptions of debriefing practices were generally positive. There were general feelings of psychological safety and an understanding between students and facilitator related to why debriefing took place. Linking debrief and learning outcomes was perceived as making debriefing meaningful to students. Question-asking techniques by facilitators were mixed, but were generally asked in a manner that encouraged self-reflection. Peer-led debriefing was perceived as good practice and a single facilitator was preferred to multiple facilitators. CONCLUSION: several strategies related to effective feedback and debriefing were identified by the student participants as already being employed by facilitators. The potentially negative effect of multiple facilitators was highlighted by participants who indicated that they preferred a single debriefer for the entire academic year. Peer-led debriefing was perceived as a positive practice and has a number of advantages and disadvantages that should be considered and mitigated by the facilitator.

The variables perceived to be important during patient handover by South African prehospital care providers.

INTRODUCTION: High-acuity patients are typically transported directly to the emergency centre via ambulance by trained prehospital care providers. As such, the emergency centre becomes the first of many physical transition points for patients, where a change of care provider (or handover) takes place. The aim of this study was to describe the variables perceived to be important during patient handover by a cohort of South African prehospital care providers. METHODS: A purpose-designed questionnaire was used to gather data related to prehospital emergency care provider opinions on the importance of certain patient variables. RESULTS: We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%) ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important, followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations and patient allergies. CONCLUSION: This study has provided some interesting results related to which handover elements prehospital care providers consider as most important to include in handover. More research is required to correlate these findings with the opinions of emergency centre staff.

For the students, by the students: Student perceptions of low cost medical moulage in a resource-constrained environment.

INTRODUCTION: Simulation-based learning affords participants the opportunity to practice high-acuity, low-incidence situations without risk to the patient. The realism of a simulated scenario is often referred to as fidelity. High levels of fidelity imply high levels of realism. One method of enhancing fidelity is the use of moulage. Commercially available moulage kits and professionally applied moulage are often expensive and therefore not practical in the resource-constrained environment. Cost-effective alternatives are required for the resource-constrained environment. METHODS: Students at a South African university used readily available, low cost materials to apply self-constructed, low cost moulage for a bandaging practical. A cross sectional design used a purpose-designed, validated questionnaire to gather data related to face and content validity of the self-constructed moulage. Frequency analysis formed the cornerstone of Likert-type quantitative data analysis. An open-ended question afforded participants the opportunity to express their own opinions related to the moulage experience. RESULTS: The results revealed that there was both high face validity and high content validity of the self-constructed moulage. Participants found the activity enjoyable and a generally positive learning experience. The self-constructed moulage was realistic and added to the fidelity of the scenario. Participant confidence was improved and their engagement in the learning activity was enhanced. Participants found the self-constructed, low-cost moulage more realistic that commercial products that they had been exposed to. CONCLUSION: The use of low-cost, self-constructed moulage is a feasible and economically viable means of enhancing fidelity within the resource-constrained simulation setting. This technique is not necessarily limited to emergency medical care and can be used in other areas of healthcare simulation.