Medical complications during interhospital transfer for thrombectomy in patients with acute ischemic stroke.

INTRODUCTION: Patients with acute ischemic stroke (AIS) and large-vessel occlusion are frequently transferred by emergency physicians (EPs) from primary to comprehensive stroke centers (CSC) for thrombectomy, particular when thrombolysed. Data on complications during such transfers are highly limited. PATIENTS AND METHODS: Consecutive AIS patients transferred between 01/2015 and 10/2021 to our CSC were included. Associations of major (MACO) and minor (MICO) complications with clinical and imaging data were assessed. RESULTS: In total, 985 patients were included in the analysis (58.5% thrombolysed). MACO developed in 1.6%, MICO in 14.6%. Compared to patients without complications (NOCO), patients with MACO did not differ in terms of demographics, cerebrovascular risk factors, or site of vessel occlusion. They had more severe strokes (p = 0.026), neurological worsening was more severe (p = 0.008), and transport duration was longer (p = 0.050) but geographical distances did not differ. Thrombolysed patients had any complication more often than patients without thrombolysis (20.3% vs 10.5%; p < 0.001); however, this finding was driven by patients with MICO (p < 0.001) only (MACO: p = 0.804). No associations were observed between stroke severity and complications in either thrombolysed or nonthrombolysed patients. Neurological deterioration during transfer was observed in 21.2%, but multivariate analysis revealed no association with thrombolysis (OR 0.962; 95%CI 0.670-1.380, p = 0.832). Asymptomatic intracerebral hemorrhage was present in 1.1%, symptomatic in 0.1%. DISCUSSION AND CONCLUSION: In this large cohort, no patient-specific factor increasing the risk of complications during interhospital transfer was identified. Specifically, our results do not indicate that thrombolysis increases MACO. Hence, interhospital transfer without EPs appears reasonable in most patients.

Paramedics Providing Palliative Care at Home: A Retrospective Cohort Study Comparing Symptom Management of Breathlessness and Pain in Cancer Versus Non-Cancer Conditions.

Background Palliative care aims to alleviate pain and distressing symptoms, affirm life, and offer support to patients and their caregivers. For many, the expressed preference is to die at home. As a result, there is growing recognition that paramedics can play an integral role at the end of life for symptom relief. Paramedic comfort with symptom management in the palliative care context is suspected, based on past work, to be higher for cancer as opposed to non-cancer life advanced disease. The objective of this study was to explore the paramedic management of patients with cancer and non-cancer advanced disease, using pain and breathlessness as key symptoms. Methods  A retrospective cohort study was conducted. Paramedic electronic patient care records were queried for calls with palliative goals of care between July 1, 2015, and June 30, 2016, in Nova Scotia, Canada, which was the first year of the Paramedics Providing Palliative Care program. A manual chart review of a subgroup of 100 consecutive charts was completed to gain deeper insight. A descriptive analysis was conducted to understand practice variation within this population.  Results The electronic query returned 1909 calls with a palliative approach. A total of 765 (40.1%) had cancer. The most common non-cancer disease category was respiratory. The top chief complaint was respiratory distress in both cancer and non-cancer populations. Medication was administered more often for pain (80%) compared to breathlessness (46.5%). Paramedics were more likely to call Medical Oversight Physicians for pain control advice. Post-treatment pain scores were documented infrequently. In the chart review, symptom management using the patient's own medications occurred in 17% of cases while an additional 5% of cases involved a combination of the patient's medications and paramedic service formulary. Conclusion  The non-cancer population was less likely to have a non-transport outcome. Opportunities for improvement of symptom management were noted for pain and particularly so for breathlessness. Increased comfort with a palliative approach in the non-cancer disease cohort as well as with this key symptom will be a key to the success of the program.

"SafetyNet": Evaluation of a Recovery Coach and Paramedic Intervention Following Naloxone Resuscitation From an Opioid Overdose.

OBJECTIVE: Emergency department (ED)-initiated buprenorphine has proven efficacy, but many patients are reluctant to begin this treatment. This study evaluated SafetyNet, a program using a 2-person, recovery coach and paramedic (RCP) intervention postoverdose to reduce subsequent opioid overdose, engage patients in medications for opioid use disorder (MOUD), and reduce illicit drug use. METHODS: We conducted a prospective nonrandomized study in individuals who experienced opioid overdoses, received naloxone, but subsequently declined buprenorphine initiation in the ED. Each participant was followed by an RCP team that performed a brief negotiation interview (BNI) to motivate engagement in treatment, peer-recovery coaching to encourage recovery-related activities, and health education around medical concerns by trained paramedics. Participants were followed-up at 30 and 180 days. The primary hypothesized outcome was reduction in overdose events; the secondary hypothesized outcomes were engagement in MOUD and reduction in opioid positive urine tests. RESULTS: Eighty-one patients were enrolled and received BNIs; 45 (56%; 95% CI: 44-67) had at least 1 follow-up encounter. Twenty participants (25%; 95% CI: 16-36) had at least 1 overdose during follow-up. Fifty-five participants (68%; 95% CI: 57-78) were confirmed to have engaged in some form of medication treatment. Differences in subsequent overdose events (P = .95), engagement in MOUD (P = .49), and rates of opioid-positive urine toxicology rates within 30 days (P = .44) and between 31 and 180 days (P = .46) were not significantly different when comparing those who did and did not follow-up. CONCLUSION: There were no differences in rates of subsequent overdose, MOUD engagement, or positive urine toxicology screens in our intervention. However, 68% of participants engaged in outpatient MOUD, a treatment associated with fewer overdose events, particularly fatal ones. Substantial limitations occurred due to the COVID pandemic, and sample size estimates were not met. Further research is needed to investigate potential benefits of the SafetyNet program.

Evaluating soft collars in pre-hospital cervical spine immobilisation: A cohort study on neurological outcomes, patient comfort and paramedic perspectives.

OBJECTIVE: Cervical spinal immobilisation procedures often include rigid cervical collars which, despite associated complications, may provide less immobilisation than previously thought. The present study reports the incidence of worsening neurological outcomes following soft collar application, and additionally reports patient comfort, compliance with spinal immobilisation, and paramedic perspectives on usage. METHODS: This was an observational cohort study conducted in selected metropolitan and regional areas of NSW Ambulance between 1 May 2022 and 31 March 2023. Soft collars were used exclusively in place of rigid collars. The SPEED (SPinal Emergency Evaluation of Deficits) tool was used to evaluate new or worsening neurological deficits following pre-hospital soft collar application. Secondary outcomes included patient-reported comfort of the device, and paramedic assessment of efficacy. RESULTS: Overall, 2098 soft collars were applied, of which 74 patients (3.5%) were subsequently found to have a cervical spine injury. Eight patients had a spinal cord injury, of which two experienced a worsening neurological deficit after soft collar application. In both instances, comprehensive case reviews determined that this was unlikely to have been attributable to the soft collar. The majority of patients found the soft collar comfortable, and they were well-tolerated by patients who generally complied with immobility directions. Paramedics found the collar easy to apply, and felt it assisted in minimising patient movement. CONCLUSIONS: Pre-hospital use of soft collars does not appear to increase the risk of significant injury. Patients found these devices relatively comfortable, and clinicians reported overall ease of use with good patient compliance with immobility directives.

A mixed methods approach to describe the efficacy of lift assist device use to reduce low back musculoskeletal disorder risk factors during three common patient extrication scenarios.

This mixed-method study evaluated the efficacy of lift assist device use (Binder®, Eagle®, Maxi Air®) relative to manual lifting/care-as-usual in reducing low back muscle activity and perceived exertion during simulated patient extrication tasks. User feedback was recorded to identify factors that might influence use. Twenty paramedics performed a floor to stretcher lift, lateral transfer, and confined space extrication care-as-usual and with lift assist devices. Use of a lift assist reduced low back muscle activity during floor to stretcher and confined space tasks by 34-47%. Paramedics perceived exertion decreased from 'somewhat hard' to 'light' or 'very light' when using an assistive device. Paramedics noted that ease of use, patient comfort, task time, patient acuity, among other considerations would influence use decisions. Lift assist devices were efficacious at reducing low back muscle activity and perceived exertion during floor to stretcher and patient extrication tasks.

Population-Based Analysis of 6534 Seizure Emergency Cases from Emergency Medical Services Data.

INTRODUCTION: Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. METHODS: This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. RESULTS: A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3% < 18 years) cases in Germany. A prehospital EMS physician was involved in 40.0% (SEPI) to 54.4% (PFS) of suspected seizure cases. Depending on the type of seizure, 70.7% (SEPI) to 80.9% (1stS) were admitted to hospital for inpatient stay of ≥ 24 h. An additional 4% (PFS) to 16% (1stS) of cases needed immediate intervention at hospital. Prehospital EMS staff needed 8:24 min:s (SD 7:24; n = 5004) after the emergency call to arrive at the scene of the ES and 10:58 min:s (SD 27:39; n = 321) for PFS. ES and PFS cases caused estimated costs of 48.5 and 8.1 million euros for Germany in 2019, respectively, not including hospital treatment-related costs. CONCLUSION: This study identified a high number of suspected seizure-related emergency cases and proportion of patients admitted to hospitals, as well as high associated costs in Germany.

Seizure occurrences among hypoglycemic patients in the emergency department.

Aim: Symptomatic hypoglycemia is a common problem in the emergency department (ED). However, without appropriate recognition and management, hypoglycemia remains a potentially fatal condition. The cause of sudden death associated with hypoglycemia might be attributed to cardiac arrhythmias and hypoxia with seizures. Despite advances in diabetes mellitus management and social background, the frequency and characteristics of patients with hypoglycemia-related seizures have remained unknown. Hence, our study aimed to investigate the frequency and characteristics of patients with hypoglycemia presenting with seizures in the ED. Methods: This retrospective observational study was conducted in a single tertiary care center. Patient information was retrieved from the final diagnostic records in the ED. We reviewed all medical records and included patients with symptomatic hypoglycemia aged 16 years or older. The primary outcome was the frequency of seizures in patients with hypoglycemia. We also compared the initial blood sugar levels of the patients with and without seizures. Results: We included a total of 380 patients (median age, 72 years, IQR 64-80 years; median initial blood sugar, 34 mg/dL, IQR 24-46; 62.9% male). Nineteen of 380 patients (5.0%) had seizures. Although 16 of the 19 patients had diabetes mellitus, none of the 19 patients had a history of epilepsy. The initial blood sugar levels of the patients with and without seizures were not significantly different (p = 0.97). Conclusion: Approximately 5% of the patients with hypoglycemia presented with seizures. Blood glucose levels of hypoglycemic patients with and without seizures did not differ.

Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature.

Background: Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed. Objectives: This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care. Methods: The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework. Results: The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols. Conclusions: Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.

Implementing Prehospital Ultrasound at the Saudi Red Crescent Authority: Perceived Barriers and Training Needs.

Objective: This study examines the inherent barriers to implementing prehospital ultrasound within the Saudi Red Crescent Authority (SRCA) in Saudi Arabia. Methods: A qualitative study was conducted to explore the perceived barriers, mode of transportation, ultrasound familiarity, and self-efficacy level of relevant stakeholders in implementing the prehospital ultrasound in SRCA. Data was collected via surveys and interviews with 24 SRCA paramedics/EMTs, 4 SRCA station administrators, and two hospital physicians to further examine the inherent barriers of implementing the prehospital ultrasound. Results: Thematic analysis revealed the main barriers were costs of ultrasound equipment, environmental factors affecting image capture, and lack of training in ultrasound skills and interpretation. Administrators and physicians also noted concerns about machine portability and technical maintenance. Stakeholders agreed ultrasound could improve trauma diagnosis if barriers were addressed through extensive training and protocols. In prehospital care setting, the two main modes of transportation are "stay and play", involving on-scene interventions before transport, and "load and go", prioritizing rapid transport to the hospital, with the choice depending on various factors. An overwhelming 96% of paramedics/EMTs preferred a 'stay and play' approach to stabilize patients before transport, while 75% of administrators preferred 'load and go' for rapid transport to hospitals. 62.5% of paramedics were familiar with ultrasound, but only 20.8% had previously used it. Conclusion: This study provides important insights into stakeholder perspectives on the implementation of prehospital ultrasound within the Saudi Red Crescent Authority. The findings can guide efforts to implement appropriate ultrasound use through tailored training programs and enhanced coordination across groups, aimed at improving trauma outcomes.

Development of examination objectives for the Korean paramedic and emergency medical technician examination: a survey study.

PURPOSE: The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years' experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation. METHODS: A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed. RESULTS: The P&EMTs' most common tasks involved obtaining patients' medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection. CONCLUSION: Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.

Role identities of emergency medical services personnel and their associations with intention to leave the profession.

BACKGROUND: The scope of emergency medical services (EMS) has expanded from the urgent care of emergency patients to on-call healthcare services provided in the field with a holistic view of the patient's wellbeing. This challenges EMS to find solutions to cover all demands, while simultaneously setting high skill requirements for EMS personnel. Understanding personnel is a critical element in developing functional and resistant EMS. The aim of this study was to investigate how Finnish EMS personnel emphasize the Emergency Medical Services Role Identity Scale aspects of caregiving, thrill-seeking, duty, and capacity; and if these role identities are associated with intention to leave the profession. METHODS: We conducted a cross-sectional survey (N = 616, 52% women, mean age 32.9 years). Data were collected through social media platforms and analyzed with means, standard deviations, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and binary logistic regression analyses. RESULTS: Our results indicate that capacity is the most emphasized aspect among EMS personnel, and at the same time, it increases intention to leave EMS. Capacity was followed by caregiving, with no association with intention to leave. Duty and thrill-seeking were the least emphasized and were negatively associated with intention to leave. Additionally, there were also other factors that were associated with emphasizing EMS-RIS aspect and intention to leave. CONCLUSION: Capacity stands out most strongly in analysis being at the core of the role identity of EMS personnel and was associated with a higher likelihood of leaving intentions. Several other factors were also associated with the intention to leave. Future studies should examine the exact dimensions of capacity that are considered important among EMS personnel and why factors such as work experience are associated with intentions to leave.

A post-COVID-19 assessment of resilience of nurses and paramedical workers in municipal hospitals of urban Pune, India.

Objectives: To assess the resilience of primary healthcare workers (HCWs) by determining the factors associated with developing resilience post-coronavirus disease 2019 (COVID-19). Study Design: A cross-sectional study in selected municipal hospitals. Methods: Connor-Davidson Resilience Scale was used to assess the resilience of the 245 HCWs, including the nurses and paramedics working in Pune Municipal Corporation (PMC) hospitals in Pune City. Data were analysed using the Chi-square test, one-way analysis of variance (ANOVA), independent-samples t-test and correlational analysis using the Statistical Package for the Social Sciences (SPSS) version 28. Results: The mean resilience score of the HCWs in PMC hospitals post-COVID-19 was 75.09 (±9.25). The score for hardiness, optimism, resourcefulness and purpose was 20.15 (±3.87), 21.22 (±3.39), 17.24 (±2.76) and 16.40 (±2.17), respectively. Seven factors were significantly associated with the resilience of nurses and paramedics, namely age (P < 0.001), work experience (P < 0.001), monthly income (P < 0.001), having faced financial problems during COVID-19 (P < 0.001), hospital setting (P < 0.05), marital status (P < 0.01) and professional category (P < 0.001). In addition, 60% of the participants reported mental health issues due to routine workloads such as irritation/anger, frustration and tension/worry, fatigue and work-related stress, and sadness and anxiety. Suggestions for improvement were mainly increasing human resources, proper management, skilled staff, improved facilities and funding, and cooperation among staff. Conclusion: The resilience of primary HCWs in Pune post-COVID-19 was higher than HCWs in other countries assessed during COVID-19. Further, resilience was found more among nurses than paramedics. Modifiable factors affecting resilience must be addressed to improve the resilience of HCWs to build everyday resilience and strengthen health systems for public health emergencies.

The significance of paramedic communication during women's birth experiences: A scoping review.

BACKGROUND: Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked. METHODS: A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint. RESULTS: Three themes were generated: 1. First Impressions Count: paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. Choice as a Pathway to Control: when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. Exposed, Violated and Disempowered: some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby. CONCLUSIONS: This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.

Developing emotional preparedness and mental resilience through high-fidelity simulation: a 'bridge too far' for institutions teaching major trauma management and mass-casualty medicine?

BACKGROUND: Clinical acumen represents only part of being adequately equipped to attend a major incident. The emotive sights, sounds and smells of these dynamic environments are all-encompassing experiences, and responders must also be armed with the emotional preparedness to perform their clinical or managerial duties effectively, as well as the mental resilience to facilitate professional continuance. Despite this, limited training and a sparsity of evidence exists to guide developments within this domain. Historically, major incident training has focused on clinical theory acquisition, but irrespective of how comprehensive the learning materials, they are of little consequence if tandem steps to cultivate mental resilience and emotional preparedness are absent. High-Fidelity Simulation (HFS) has a growing reputation as an effective means of bridging important gaps between theory and practice. This pilot study aimed to measure student's self-reported perception of their readiness to respond to a major incident following a large-scale HFS. METHODS: Quantitative data was obtained from a sample of 108 students undertaking paramedic science, physician associate studies and adult nursing degree programmes. A bespoke questionnaire was developed to measure self-reported clinical acumen, mental and emotional preparedness. RESULTS: 91% of students agreed the combination of theoretical training and HFS provided made them feel clinically prepared to attend a real major incident; 86% agreed this experience had developed their mental resilience and 90% agreed that they felt emotionally prepared to attend a major incident. CONCLUSION: Within this pilot study, the blend of theoretical training and HFS contributed to self-reported clinical acumen, mental and emotional preparation, in learners training to work in disaster environments or emergency medicine settings.

Paramedics as Researchers: A Systematic Review of Paramedic Perspectives of Engaging in Research Activity From Training to Practice.

BACKGROUND: The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet, the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement. OBJECTIVE: This systematic review aimed to explore paramedics' views and experiences of research as researchers during training and within practice. METHODS: A systematic search was performed across six databases. Qualitative empirical peer-reviewed articles that discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles identified initially, 11 were included in the final synthesis after quality appraisal. Data were extracted and subjected to narrative synthesis. RESULTS: The following four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes toward research, understanding of related concepts, and the drive for patient benefit were interwoven core issues. CONCLUSIONS: Research was highly valued when links to patient benefit were obvious, however, this review highlights some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently, there is inadequate organizational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited.

Hazard Flagging as a Risk Mitigation Strategy for Violence against Emergency Medical Services.

Paramedics are increasingly being subjected to violence, creating the potential for significant physical and psychological harm. Where a patient has a history of violent behavior, hazard flags-applied either to the individual, their residential address, or phone number-can alert paramedics to the possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting process embedded in the electronic patient care record, we reviewed violence reports filed over a thirteen-month period since its inception in February 2021 to assess the effectiveness of hazard flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic supervisors can generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence reports were filed, for which paramedic supervisors generated hazard flags in 20% of cases (n = 99). In general, cases were not flagged either because the incident occurred at a location not amenable to flagging or because the supervisors felt that a hazard flag was not warranted based on the details in the report. Hazard flagging was associated with an increased risk of violence during subsequent paramedic attendance (Odds Ratio [OR] 6.21, p < 0.001). Nevertheless, the process appears to reliably identify persons who may be violent towards paramedics.

[Reasons for non-participation in a patient survey in the context of prehospital emergency medical care by community emergency paramedics - A retrospective observational study]. / Gründe für die Nichtteilnahme an einer Patientenbefragung im Kontext der prähospitalen Notfallversorgung durch Gemeindenotfallsanitäter - eine retrospektive Beobachtungsstudie.

BACKGROUND: In order to evaluate whether the new rescue means "community emergency paramedics" (Gemeindenotfallsanitäter [G-NFS]) relieves the emergency medical service (EMS) in the care of low-priority emergencies, the perspective of general practitioners and patients was also surveyed in a written questionnaire as part of an innovation fund project. Recruitment for participation in the study proved to be difficult. The aim of this study is to evaluate why the G-NFS decided against providing information on study participation and what measures would be necessary to include more emergency patients in surveys in the future. METHODS: Retrospective analysis of the assignment protocols from April 1, 2021 to June 30, 2022. In addition to patient characteristics, data on treatments, interventions and recommendations to patients as well as reasons for non-participation in the patient survey were collected. RESULTS: 5,395 G-NFS protocols that contained information on non-participation were included in the analysis. The average age of the patients was 62.4 years (SD 22.7), and 50.2% were female. 57.4% of the cases were categorised as non-urgent, and 35.2% of the cases required an additional ambulance to be alerted. 404 (7.5%) patients used the EMS more than once, 1,120 (20.8%) did not have sufficient language skills, 1,012 (18.8%) patients declined study participation, and 2,975 (55.1%) patients were not able to participate according to the G-NFS assessment. Dementia/neurocognitive impairment (35%), acute/emergency situation (26.5%), mental health impairment (10.3%), and substance abuse (6.5%) were given as reasons for non-participation from the G-NFS perspective. DISCUSSION: The results show that more than half of the patients were unable to take part in a written survey for various reasons, even though there was no need for urgent care. This could be due to a high demand for care and the complex consent procedure. In addition, further resources are required to provide needs-based care for these patients in order to relieve the burden on emergency medical care. Over half of the patients were unable to take part in a written survey for various reasons. Further research is needed to determine what consent procedures are appropriate to facilitate patients' study participation.

Sexist, Racist, and Homophobic Violence against Paramedics in a Single Canadian Site.

Violence against paramedics is widely recognized as a serious, but underreported, problem. While injurious physical attacks on paramedics are generally reported, non-physical violence is less likely to be documented. Verbal abuse can be very distressing, particularly if the harassment targets personal or cultural identities, such as race, ethnicity, gender, or sexual orientation. Leveraging a novel, point-of-event reporting process, our objective was to estimate the prevalence of harassment on identity grounds against paramedics in a single paramedic service in Ontario, Canada, and assess its potentially differential impact on emotional distress. In an analysis of 502 reports filed between 1 February 2021 and 28 February 2022, two paramedic supervisors independently coded the free-text narrative descriptions of violent encounters for themes suggestive of sexism, racism, and homophobia. We achieved high inter-rater agreement across the dimensions (k = 0.73-0.83), and after resolving discrepant cases, we found that one in four violent reports documented abuse on at least one of the identity grounds. In these cases, paramedics were 60% more likely to indicate being emotionally distressed than for other forms of violence. Our findings offer unique insight into the type of vitriol paramedics experience over the course of their work and its potential for psychological harm.

Exploring paramedic perspectives on emergency medical service (EMS) delivery in Alberta: a qualitative study.

PURPOSE: Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations. METHODS: 19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes. RESULTS: Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions. CONCLUSIONS: While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.