Paramedics' experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study.

BACKGROUND: Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases. METHODS: This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers. RESULTS: Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers. CONCLUSIONS: This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

The implementation of interprofessional education: a scoping review.

INTRODUCTION: Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. METHODS: Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. RESULTS: Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. CONCLUSION: Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

Enhancing Nursing and Midwifery Student Learning Through the Use of QR Codes.

A recent teaching and learning innovation using new technologies involves the use of quick response codes, which are read by smartphones and tablets. Integrating this technology as a teaching and learning strategy in nursing and midwifery education has been embraced by academics and students at a regional university.

*SMARTSIM* A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation.

Objective: Simulations are an integral part of paramedic education. Technological advancements have introduced three-dimensional virtual reality patient simulations (3DVRS), offering a low-cost, accessible alternative. This study compares the impact of 3DVRS and traditional simulation on paramedic students. Methods: Students selected from a convenience sample of 11 cohorts in 10 accredited programs distributed across the United States were allocated to 2 groups using a stratified random sampling. One group received simulations via 3DVRS, the second used traditional in-person simulation. Students were exposed to 6 scenarios over 2 h from the National Association of Emergency Medical Technicians (NAEMT) Advanced Medical Life Support (AMLS) program. Altered mental status scenarios were selected a priori by the research team containing approximately 30 potential differential diagnoses. A 50-item posttest was administered using validated cognitive items provided by Fisdap. Results: A multicenter prospective randomized trial of 174 paramedic students was undertaken from April until August of 2022. The traditional simulation group was comprised of 88 students and the 3DVRS group had 86 students. A Mann-Whitney U test (U = 4064.5, n 1 = 88, n 2 = 86, p = 0.396) detected no statistical difference between two distributions or median exam score (70%), the range of values and interquartile range (IQR) for both groups: TS IQR = 64-75 (range, 32-82); 3DVRS IQR = 64-76 (range, 34-86). Conclusion: No difference in exam scores using 3DVRS versus traditional simulation was detected. Paramedic programs may have an effective new option when incorporating simulation with 3DVRS, potentially reducing financial and real-estate resources required with in-person simulations. Larger studies are needed to truly evaluate the impact and usability of virtual reality on paramedic education.

Barriers to, and enablers of, paramedics responding to suspected or confirmed COVID-19 cases: An integrative review.

BACKGROUND: The coronavirus pandemic (COVID-19) has focused attention on healthcare workers' concerns about working during a pandemic, yet research on the effect of the pandemic specifically on paramedics is lacking. This literature review aims to critically examine the current knowledge of paramedics' experience of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases. METHODS: An integrative review was undertaken using articles found by a systematic search of four research databases. Inclusion criteria included paramedics or emergency medical technicians who had experience of barriers or enablers responding to patients during the coronavirus pandemic. RESULTS: Nine articles met the inclusion and exclusion criteria. Barriers included communication and poor leadership, fear of infection to self and family, frequent changes in guidelines and inconsistencies across agencies, stress/burnout, and concerns with personal protective equipment. Enablers included job security, perceived social support, solidarity with other paramedics, and use of modern technologies for communication. CONCLUSIONS: There are unique experiences of working during the COVID-19 pandemic in the prehospital environment. Particular challenges occurred with leadership, communication within the organisation and between agencies, and working in an unpredictable environment.

Pre-hospital peripheral intravenous catheter insertion practice: An integrative review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making. METHODS: A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS: Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified. CONCLUSION: There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.

Paramedic insertion of peripheral intravenous catheters, unused catheter rates, and influencing factors: A retrospective review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are associated with adverse events such as bloodstream infections; thus clinically appropriate practice is important. However, there is limited research on PIVC use in ambulance settings. This study investigated the incidence of paramedic-inserted PIVCs, unused PIVCs, and factors that influenced practice. METHODS: Electronic patient care records for Western Australian ambulance service patients who attended between January 1 and December 31, 2020 were retrospectively reviewed. Patient, environmental, and paramedic characteristics were explored. Binominal logistical regression models were used to identify factors associated with PIVC insertion and unused PIVCs. RESULTS: A total of 187,585 records were included; 20.3% had a PIVC inserted and 44% remained unused. Factors associated with PIVC insertion were gender, age, problem urgency, chief complaint, and operational region. Age, chief complaint, and paramedic years of experience were associated with unused PIVCs. DISCUSSION: This study identified multiple modifiable factors for the unnecessary insertion of PIVCs, which may be addressed through better education and mentoring of paramedics supported by clearer clinical guidelines. CONCLUSIONS: This is, to our knowledge, the first Australian state-wide study to report unused paramedic-inserted PIVC rates. As 44% remained unused, clinical indication guidelines and intervention studies to reduce PIVC insertion are warranted.

An observational study of peripheral intravenous and intraosseous device insertion reported in the United States of America National Emergency Medical Services Information System in 2016.

OBJECTIVE: To investigate the prevalence of intravenous and interosseous device insertion in the prehospital setting by prehospital clinicians, and the characteristics of patients receiving these devices as reported to the United States of America National Emergency Medical Services Information System. METHODS: A retrospective analysis of the United States of America National Emergency Medical Services Information System public release dataset for the 2016 calendar year. RESULTS: A total of 20,454,975 events involving 40,438,959 procedures were analysed. One or more peripheral intravenous catheters were inserted during 27.4 % of events, and one or more intraosseous devices in 0.4 % of events. Insertion was completed with one attempt in 71.6 % of peripheral intravenous catheter insertions and 86.9 % of intraosseous devices insertions. Insertion was successful for 74.7 % of peripheral intravenous catheter insertions and 85.4 % of intraosseous device insertions. High rates of peripheral intravenous catheter insertion were found with: being female (51.6 %), aged 40-90 years (80.2 %), having a cardiac rhythm disturbance (70.3 %), having a primary symptom of change in responsiveness (58.7 %), or when there was initiation of chest compressions (50.4 %). There were high rates of intraosseous device insertion if the patient was male (57.8 %), aged 40-90 years (77.2 %), experienced a cardiac arrest (29.2 %), had chest compressions initiated (33.6 %), or died (16.4 %). Scene time was longest for events with intraosseous devices inserted (19.7 min, IQR 13.2-28.6) but transport time shortest (9.0 min, IQR 5.0-15.0). CONCLUSIONS: The distribution of patient factors and the insertion of peripheral intravenous catheters and intraosseous devices is described at a national level for the first time. The results provide prehospital clinicians and Emergency Medical Services rigorous data to compare, and possibly improve, practice.

Peripheral intravenous catheter and intraosseous device insertions reported from the 1st July 2016 to 30th June 2017 in an Australian state ambulance service: An observational study.

OBJECTIVE: To overcome the lack of larger, population-based studies reporting the prevalence of insertion of PIVCs and IO devices, and to describe the patient-related and service-related characteristics of these devices, inserted by paramedics, in an Australian state ambulance service. METHODS: A retrospective analysis of the electronic Ambulance Report Form (medical record) and Computer Aided Dispatch system from the 1st July 2016 until 30th June 2017. RESULTS: 709,217 events were analysed. Of these, 20.4% involved at least one successful PIVC insertion and 0.07% involved at least one successful IO device insertion; most of the time on first attempt (89% and 86.4% respectively). Most PIVCs were inserted into the right antecubital fossa or dorsum of the right hand while IO devices were inserted into the proximal tibia. Of male patients, 21.4% received PIVCs while 19.5% of female patients received PIVCs. Very low numbers of both male and female patients received IOs (0.1%). Medical, non-traumatic presentations were the most common presentation and received the most insertions of both devices, followed by trauma presentations. Advanced Care Paramedics inserted 84.0% of PIVCs while Critical Care Paramedics inserted 94.4% of IO devices. Time treating and transporting patients generally increased with number of attempts at vascular access undertaken. CONCLUSIONS: Queensland paramedic practices relating to insertion of PIVCs, and IO devices appears consistent with documented practice internationally. Further study is required to determine whether the antecubital fossa and dorsum of the hand insertions are clinically necessary in this population as areas of flexion and distal extremities are generally to be avoided for PIVC insertion.

Prehospital use of peripheral intravenous catheters and intraosseous devices: An integrative literature review of current practices and issues.

INTRODUCTION: Peripheral intravenous catheters and intraosseous devices have been widely used in the prehospital setting for a considerable period. Changes in technology and guidelines have led to an increase in situations where use of these devices in a prehospital setting is recommended. Despite being commonplace they are not without risk of harm to the patient. STUDY OBJECTIVE: To examine critically the research-based literature related to incidence of insertion of peripheral intravenous catheters and intraosseous devices, the use of these vascular access devices and to determine which health professionals insert them, most commonly, in the prehospital setting. METHODS: An integrative review was undertaken using material retrieved following a systematic search of research literature databases, grey literature and secondary sources written in English. No date limit was applied to the search and the searching was undertaken until September 2019. Articles specifically addressing peripheral intravenous catheter and intraosseous device use in the prehospital setting were selected. RESULTS: The search resulted in 20 articles being included in the review, 17 related to peripheral intravenous catheters and three for intraosseous devices. All articles related to observational studies across a variety of services and settings. CONCLUSION: The role of vascular access in the prehospital setting continues to be significant, particularly for patients who are critically unwell. This review identified that differences in service structure, geography and the patient's condition all impact on the insertion and use of these vascular access devices. Despite this there are limited data reported that can allow prehospital clinicians and services to benchmark their practice.

Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report.

This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety.

Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care.

BACKGROUND: Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care-associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care. METHODS: A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. RESULTS: Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. CONCLUSIONS: Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.

Use of videos to support teaching and learning of clinical skills in nursing education: A review.

Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.