Well-being and PTSD in German emergency medical services - A nationwide cross-sectional survey.

BACKGROUND: Emergency medical service (EMS) can be a burdensome occupational field, and employees can be confronted with traumatizing events. Posttraumatic stress disorder (PTSD) and depression rates among paramedics are considered higher than those in the general population. In the German setting of a physician-based EMS system, the literature provides little data on PTSD or non-PTSD-related mental health or on the correlation between PTSD and well-being. METHODS: The study collected data through a nationwide cross-sectional questionnaire survey of the German EMS. Next to gathering sociodemographic data, it used the 5-item World Health Organization Well-Being Index (WHO-5) and the Short Screening Scale for the DSM-IV-PTSD to assess well-being and identify indicators of depression and PTSD. RESULTS: A total of 2,731 paramedics and emergency physicians participated in the survey; 2,684 questionnaires were submitted to analysis. The average WHO-5 score was 53.15%. A total of 43.4% of participants screened positive for possible depression, as indicated by a WHO-5 score below 50%. Female gender, older age, higher total years spent working in EMS and increased body mass index were significantly correlated with lower well-being. A total of 5.4% of respondents had a positive PTSD screening result. In particular, older employees were significantly more likely to test positive for PTSD (12.2% of those over 50 years, compared to 2.8% of those under 30 years). Positive PTSD screening results were associated with significantly lower well-being. Over an average period of 1 year, the paramedics reported perceiving a median of 2 emergency missions as mentally distressing. CONCLUSION: Low well-being and PTSD seem to be relevant experiences among German EMS despite their perception of low numbers of emergency responses as mentally distressing. Paramedics who have been diagnosed with PTSD should be investigated for depression and vice versa, as correlations in both directions exist. Special attention should be paid to older employees, who have significantly lower well-being and higher PTSD rates compared to younger employees.

Comparison of Metal and Plastic Disposable Laryngoscope Blade with Reusable Macintosh Blade in Difficult and Inhalation Injury Airway Scenario: A Manikin Study.

BACKGROUND: Single-use plastic blades (SUPB) and single-use metal blades (SUMB) for direct laryngoscopy and tracheal intubation have not yet been compared with reusable metal blades (RUMB) in difficult airway scenarios. OBJECTIVE: The purpose of our manikin study was to compare the effectiveness of these different laryngoscope blades in a difficult airway scenario, as well as in a difficult airway scenario with simulated severe inhalation injury. METHODS: Thirty anesthetists performed tracheal intubation (TI) with each of the three laryngoscope blades in the two scenario manikins. RESULTS: In the inhalation injury scenario, SUPB were associated with prolonged intubation times when compared with the metal blades. In the inhalation injury scenario, both metal laryngoscope blades provided a quicker, easier, and safer TI. In the difficult airway scenario, intubation times were significantly prolonged in the SUPB group in comparison to the RUMB group, but there were no significant differences between the SUPB and the SUMB. In this scenario, the RUMB demonstrated the shortest intubation times and seems to be the most effective device. CONCLUSIONS: Generally, results are in line with previous studies showing significant disadvantages of SUPB in both manikin scenarios. Therefore, metal blades might be beneficial, especially in the airway management of patients with inhalation injury.

The prehospital intravenous access assessment: a prospective study on intravenous access failure and access delay in prehospital emergency medicine.

OBJECTIVES: Intravenous access in prehospital emergency care allows for early administration of medication and extended measures such as anaesthesia. Cannulation may, however, be difficult, and failure and resulting delay in treatment and transport may have negative effects on the patient. Therefore, our study aims to perform a concise assessment of the difficulties of prehospital venous cannulation. METHODS: We analysed 23 candidate predictor variables on peripheral venous cannulations in terms of cannulation failure and exceedance of a 2 min time threshold. Multivariate logistic regression models were fitted for variables of predictive value (P<0.25) and evaluated by the area under the curve (AUC>0.6) of their respective receiver operating characteristic curve. RESULTS: A total of 762 intravenous cannulations were enroled. In all, 22% of punctures failed on the first attempt and 13% of punctures exceeded 2 min. Model selection yielded a three-factor model (vein visibility without tourniquet, vein palpability with tourniquet and insufficient ambient lighting) of fair accuracy for the prediction of puncture failure (AUC=0.76) and a structurally congruent model of four factors (failure model factors plus vein visibility with tourniquet) for the exceedance of the 2 min threshold (AUC=0.80). CONCLUSION: Our study offers a simple assessment to identify cases of difficult intravenous access in prehospital emergency care. Of the numerous factors subjectively perceived as possibly exerting influences on cannulation, only the universal - not exclusive to emergency care - factors of lighting, vein visibility and palpability proved to be valid predictors of cannulation failure and exceedance of a 2 min threshold.