Systematic Review of Incidence, Prevalence, and Trends in Health Outcomes for Australian and New Zealand Paramedics.

INTRODUCTION: The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organizations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this article was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context. METHODS: A systematic search of key databases and gray literature was conducted to identify all available studies reporting on quantitative health outcomes for paramedics working in Australia or New Zealand. The review was conducted using the JBI methodology for prevalence studies and uses a narrative synthesis approach to reporting. RESULTS: There were k = 20 studies that met inclusion criteria, and most used Australian samples. Results indicated between 57.3-66.5% of paramedics studied were classified as overweight or obese, while up to 80% reported poor sleep, and 55.6% reported fatigue. Incidence rates per 100,000 full-time equivalent (FTE) included 26.62 for completed suicide, 5.46 for drug-caused death, and 9.3 for workplace fatalities. The most recent incidence per 1,000 FTE for injury compensation claims was 141.4. CONCLUSIONS: Australian and New Zealand paramedics demonstrate poor health according to several metrics. Our sample demonstrated considerably worse health than the general population or similar occupations. There is a minimal amount of trend data available; therefore, it was difficult to ascertain if rates are changing. The range of health outcomes studied was limited, and correlations between different health outcomes were rarely considered by authors. Data relating to specific rates for gender and sexuality, location of work, and First Nations status or ethnicity was often not available. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO): CRD42021232196.

Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis.

BACKGROUND: The current guidelines of the American Heart Association (AHA) and European Society of Cardiology (ESC) recommend that when right ventricular myocardial infarction (RVMI) is present patients are not administered nitrates, due to the risk that decreasing preload in the setting of already compromised right ventricular ejection fraction may reduce cardiac output and precipitate hypotension. The cohort study (n=40) underlying this recommendation was recently challenged by new studies suitable for meta-analysis (cumulatively, n=1050), suggesting that this topic merits systematic review. METHODS: The protocol was registered on PROSPERO and published in Evidence Synthesis. Six databases were systematically searched in May 2022: PubMed, Embase, MEDLINE Complete, Cochrane CENTRAL Register, CINAHL and Google Scholar. Two investigators independently assessed for quality and bias and extracted data using Joanna Briggs Institute tools and methods. Risk ratios and 95% CIs were calculated, and meta-analysis performed using the random effects inverse variance method. RESULTS: Five studies (n=1113) were suitable. Outcomes included haemodynamics, GCS, syncope, arrest and death. Arrest and death did not occur in the RVMI group. Meta-analysis was possible for sublingual nitroglycerin 400 µg (2 studies, n=1050) and found no statistically significant difference in relative risk to combined inferior and RVMI at 1.31 (95% CI 0.81 to 2.12, p=0.27), with an absolute effect of 3 additional adverse events per 100 treatments. Results remained robust under sensitivity analysis. CONCLUSIONS: This review suggests that the AHA and ESC contraindications are not supported by evidence. Key limitations include all studies having concomitant inferior and RVMI, not evaluating beneficial effects and very low certainty of evidence. As adverse events are transient and easily managed, nitrates are a reasonable treatment modality to consider during RVMI on current evidence. PROSPERO REGISTRATION NUMBER: CRD42020172839.

Paramedic Students' Knowledge, Attitudes, and Preparedness to Manage Intimate Partner Violence Patients.

BACKGROUND: Intimate partner violence (IPV) refers to abuse transpiring between people in an intimate relationship. Intimate partner violence is a leading cause of morbidity and mortality for women that paramedics frequently report encountering and yet paramedics rarely receive formal education or training to manage. The response of paramedics to IPV is likely to be directed by their individual knowledge, attitudes, and preparedness; all of which are currently unknown. This study aimed to measure paramedic students' knowledge, attitudes, and preparedness to manage IPV patients, and provides baseline data to inform the development of contemporary curricula. METHODS: We surveyed a cohort of paramedic students from two Australian universities using the Modified Physician REadiness to Manage Intimate partner violence Survey (PREMIS). Internal consistency of previously identified scales was calculated and multiple linear regression was used to measure the association between previous training, knowledge, attitudes, and preparation. RESULTS: We received 260 surveys (80.5% response rate). Results show that actual knowledge, perceived knowledge, and preparedness to manage IPV patients were low. Students with previous training reported higher perceived knowledge (p <.05) and preparedness (p <.01). Participants reported low self-efficacy, confidence, and preparation to manage IPV patients and demonstrated mostly neutral attitudes toward women and patients. CONCLUSIONS: Results indicate students require increased IPV education. Education should improve knowledge and preparedness to recognize and refer IPV patients, as well as change neutral and inappropriate attitudes. Incorporating such education and training into the paramedic curricula may improve the preparedness of practitioners, resulting in an improved response to IPV patients.

A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners.

CONTEXT: Intimate partner violence (IPV) is a significant cause of morbidity and mortality in women worldwide. Numerous health organisations have called for increased education for health care practitioners who encounter IPV patients and the first clinical guidelines for health services responding to IPV were recently published. This renewed focus has created a need to examine the current evidence for IPV education so that it may inform the next generation of educational interventions. OBJECTIVES: This study was designed to examine the effects of IPV educational interventions on the knowledge, attitudes, skills and behaviours of allied health care practitioners (AHCPs). METHODS: We conducted a systematic search of multiple databases up to the end of May 2015. We selected studies that included IPV educational interventions for AHCPs and that measured knowledge, attitude, skill or behavioural outcomes. Studies were evaluated based on methodological quality, education context and outcome measurement. RESULTS: We found 2757 articles from which 18 were selected for inclusion. Study participants included nurses, dentists, social workers and paramedics. Educational interventions ranged widely in length, delivery format and topics covered. Findings indicate that improvements in some knowledge, attitudes, skills and behaviours are associated with education, although the lack of high-quality studies indicates that conclusions should be treated with caution. CONCLUSIONS: Future studies should be conducted using rigorous methodology and validated instruments to measure evidence-based outcomes and should target a wider range of AHCPs. Recommendations are provided on education content and delivery, study methodology and outcome measurement based on insights gained from selected studies.

A New Scale of Readiness for Health Care Students to Encounter Partner Abuse.

Partner abuse (PA) is associated with significant morbidity and mortality worldwide. Health care practitioners regularly encounter patients experiencing PA and require comprehensive education on how to respond. This study describes the creation and validation of a new measure of readiness to encounter patients experiencing PA for health care practitioners and students.Initial item development and content validation were informed by expert feedback. Psychometric properties were assessed using data collected from Australian health care students, using Principal Components Analysis (PCA) and Confirmatory Factor Analysis (CFA). Internal consistency, inter-scale correlations, and test-retest analysis were performed.An initial pool of 67 items was reduced to 48 following content validation by 5 experts as a measure of construct validity. A total of n = 926 responses were collected, which were randomly split into two groups to perform a PCA and CFA. The PCA resulted in a 31-item version, which was further reduced to a 27-item version following the CFA, containing four factors. Internal consistency and test-retest analyses demonstrated good reliability.The produced scale is a 27-item measure of readiness to encounter patients experiencing PA, which has demonstrated good psychometric properties with a sample of Australian health care students. Results indicate that self-efficacy and Emotional-readiness are a large component of readiness. The scale may be used to measure the readiness of a cohort, or as a pre and post-intervention measure, and results may provide insight into the educational needs of a cohort.

The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse.

Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.

Paramedics as a New Resource for Women Experiencing Intimate Partner Violence.

Intimate partner violence (IPV) has a major impact on the health and well-being of women. The need for a coordinated response from health care professions encountering IPV patients is well established, and guidelines for individual health care professions are needed. Paramedics are believed to frequently encounter IPV patients, and this study aims to create a guideline to direct their response based on expert opinion. A clinical guideline for paramedics was created using current evidence and recommendations from health agencies. A panel of family violence researchers and service delivery experts such as physicians, family violence support agencies, and police commented on the guideline via a Policy Delphi Method to obtain consensus agreement. A total of 42 experts provided feedback over three rounds resulting in 100% consensus. Results include clinical indicators to recognize IPV patients in the prehospital environment, a description of how paramedics should discuss IPV with patients, recommended referral agencies and pathways, and appropriate documentation of case findings. This study has created the first comprehensive, consensus-based guideline for paramedics to recognize and refer IPV patients to care and support. The guideline could potentially be modified for use by ambulance services worldwide and can be used as the basis for building the capacity of paramedics to respond to IPV, which may lead to increased referrals to care and support.

The psychometric properties of an intimate partner violence education outcome measure.

BACKGROUND: The need for increased education on intimate partner violence (IPV) for healthcare practitioners has been well established. Most Australian healthcare practitioners are educated at university, where educational interventions could be delivered to students. Specific IPV outcome measurement instruments demonstrating sound psychometric properties would enable accurate evaluation of educational interventions to ensure effectiveness. METHODS: The psychometric properties of the Modified Physician REadiness to Manage Intimate partner violence Scale (Modified PREMIS) were measured when delivered to a cohort of Australian paramedic and nursing students, performing principal component analysis, and evaluating dimensionality, internal consistency, and test-retest reliability. RESULTS: In total, 260 responses were received, participants were primarily paramedicine students (85.0%) with the remainder double degree nursing and paramedicine students (15.0%). Actual and Perceived Knowledge and Perceived Preparation subscales demonstrated variable validity and reliability. Principal component analysis of opinion items revealed a 5-factor solution, with identified subscales demonstrating mostly low internal consistency (Cronbach's alpha between 0.47 and 0.80). Correlations between subscales demonstrated few significant correlations above r = 0.3 which may indicate problems with construct validity. Medium to high test-retest reliability was found for subscales with spearman's rho values between 0.63 and 0.88. CONCLUSIONS: The scale did not demonstrate robust psychometric properties and some items may not be appropriate for use with Australian healthcare student cohorts. Pending revisions and subsequent psychometric appraisal the instrument should be used with caution; however an updated instrument may contribute as a valuable tool for IPV educational research and this paper provides several findings which may be of use when revising the scale.

Preventing and reducing the impacts of intimate partner violence: Opportunities for Australian ambulance services.

BACKGROUND: Violence against women is pervasive worldwide, and a high proportion of the most damaging violence is perpetrated by male intimate partners. The Australian government is committed to action to prevent such violence; however, strategies require input and collaboration from all agencies engaging patients, including ambulance services. To date no Australian ambulance service has published comprehensive guidelines or strategies to improve health outcomes for intimate partner violence patients in line with national strategies. OBJECTIVE: To propose key actions for Australian ambulance services to undertake to reduce the impacts of intimate partner violence in line with national strategies. METHODS: We reviewed the Australian government's National Plan to reduce violence towards women and its supporting literature, and created key actions for Australian ambulance services. RESULTS: Our review has yielded four key actions that Australian ambulance services could undertake immediately for the benefit of intimate partner violence patients. Actions include collaboration with external agencies, education, data collection and championing values promoting zero tolerance of violence towards women. CONCLUSIONS: Australian ambulance services are currently underserving intimate partner violence patients and must undertake immediate action. Successful strategies to address knowledge and policy gaps will require significant input and guidance from key organisations, including advocacy groups, police and EDs. It is likely that EDs will need to take the lead in creating comprehensive policies and guidelines from which ambulance services can derive their own policies. Failure to address this practice gap might result in paramedics becoming a barrier for intimate partner patients to receive appropriate care and support.

Are Australian paramedics adequately trained and prepared for intimate partner violence? A pilot study.

Intimate partner violence (IPV) is a common occurrence in Australian society and has far reaching health, social and economic impacts, particularly for females who are the most common victims. It is theorised that paramedics frequently encounter IPV in the field and in some cases are the only agency which deal with IPV victims in the out-of-hospital setting. Thus paramedics have a unique opportunity to increase discovery, treatment and reporting, however there is little formal training in managing IPV for most Australian paramedics. We evaluated the level of basic knowledge as well as self-reported preparedness and frequency of encountering IPV in a selection of 50 Australian paramedics using a cross-sectional descriptive study design with a paper-based questionnaire. Ninety percent of the paramedics reported encountering at least 1 case of suspected IPV in the last year, with the average number of cases being 3.66. Only 22% reported that they felt confident managing IPV cases. Sixty six percent of participants were unaware there is no mandatory reporting of IPV in their region. The vast majority of participants stated that they felt additional education and training would be most helpful to improving their ability to manage IPV cases. Participants had a poor knowledge and poor preparedness for IPV prior to undertaking a targeted education session. There is an urgent need for additional research of the needs and best methods to educate and train paramedics to appropriately respond to IPV cases.