Identifying and validating perceived workload metrics for emergency medical services.

The most common workload surrogates used by Emergency Medical Services (EMS)- overall call volume (CV) and unit hour utilization (UHU)-have not been validated. This study investigates the relationship between EMS operational metrics and perceived workload, measured through the NASA task load index (TLX) survey. We paired crew member survey responses with the operational metrics based on dispatch data. Linear regression was used to evaluate the influence of each metric on perceived workload. Logistic regression was used to identify values of workload indicating a fair day's work. We found that the overall CV (p < 0.001, R2=0.32) and UHU (p < 0.001, R2=0.22) explained less variability in perceived workload than a priority (P)-stratified CV (p < 0.001, R2=0.41). However, we found no clear fair day's workload threshold. We conclude that a priority-stratified CV is a better workload surrogate than a CV and UHU.

The Effectiveness of Different Teaching Modalities for the Detection of Heart Murmurs in Undergraduate Medical Education: A Review.

One of the many physical exam skills introduced to medical students during their pre-clerkship education is cardiac auscultation, one purpose of which is to teach the detection and identification of heart murmurs. Cardiac auscultation with a stethoscope has been the standard method of teaching. Another method, point-of-care ultrasound (POCUS), has been recently introduced as another modality by which students learn to detect and identify murmurs. The emerging popularity of POCUS in undergraduate medical curricula has led many institutions to include it in their curricula; however, doing so is challenging. Not only is cost a major factor, but reorganizing curricula to allow sufficient time for POCUS training has proven to be difficult. Additionally, the presence of notable gaps in the literature regarding the efficacy of POCUS for teaching the detection and identification of heart murmur has increased scrutiny of its value. Studies that assessed teaching cardiac auscultation to medical students in their pre-clinical years via stethoscope have used different teaching methods. However, evaluation of these studies identified numerous limitations, one being little long-term retention of cardiac auscultation knowledge. Furthermore, several barriers to integration of POCUS in undergraduate medical education were identified. The purpose of this review is to synthesize the literature comparing the effectiveness of these different tools of a cardiac exam for detection of heart murmurs in undergraduate medical education and identify gaps in literature requiring future exploration.

Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors.

Lack of verification is often cited as a root cause of medication errors; however, medication errors occur in spite of conventional verification practices and it appears that human factors engineering (HFE) can inform the design of a more effective method. To this end, an HFE-driven process was designed and implemented in an urban, Midwestern emergency medical service agency. Medication error data were collected over a 54-month period, 27 months before and after implementation. A decrease in the average monthly error rate was realized for all medications administered (49.0%) during the post-intervention time period. The average monthly error rate for fentanyl, a commonly administered analgesic, demonstrated a 71.1% error rate decrease. This study is the first to evaluate the effectiveness of a team-based cross-check process for medication verification to prevent errors in the prehospital setting.

Considerations for Multiteam Systems in Emergency Medical Services.

OBJECTIVE: Despite good intentions, mishaps in teamwork continue to affect patient's lives and plague the medical community at large and Emergency Medical Services (EMS) in particular. Effective and efficient management of patient care necessitates that sets of multiple teams (i.e., multiteam systems [MTSs] - EMS ground crews, EMS air crews, dispatch, and receiving hospital teams) seamlessly work together. Although advances have been made to improve teams, little research has been dedicated to enhancing MTSs especially in the critical yet often under studied domain of EMS. The purpose of this paper is to assist the pre-hospital community in strengthening patient care by presenting considerations unique to multiteam systems. METHODS: We synthesized the literature pertinent to multi-team systems and emergency medical services. RESULTS: From this synthesis, we derived five unique considerations: goals, boundary spanning, adaptation, leadership, and social identity. CONCLUSIONS: MTSs are prevalent in prehospital care, as they define how multiple component healthcare teams work together to intervene in emergency situations. We provided some initial directions regarding considerations for success in EMS MTSs based on existing research, but we also recognize the need for further study on these issues.