Impactful Approaches to Leadership on the Front Lines of the COVID-19 Pandemic: Lived Experiences of Canadian Paramedics.

The COVID-19 outbreak offered a unique opportunity to capture the experiences of front-line practitioners during substantial and rapid changes to their daily work, including workplace policy, protocols, environment and culture, as well as changes to their overall professional role in the healthcare system. Our team of paramedic researchers collected data throughout the first wave of the COVID-19 outbreak, exploring the lived experiences from a paramedic viewpoint. This article will discuss impactful approaches to leadership in paramedicine - differentiating between successful and failed strategies to leading and supporting teams amid rapid change on the front lines of the fight against COVID-19.

Volunteers' Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults.

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n = 22) and key informant interviews (n = 12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a 'stepping stone' position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.

Misdiagnosis of attention deficit hyperactivity disorder: 'Normal behaviour' and relative maturity.

Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders in children, yet it remains poorly understood. Substantial controversy exists regarding correct diagnosis of ADHD, and areas of subjectivity in diagnosis have been identified. Concerns for appropriate diagnosis are critical in terms of children's educational outcomes, as well as health concerns associated with the use and potential overuse of stimulant medications. There exists a relative-age effect in which children who are relatively younger than their peers and born closest to the school start age cut-off are more frequently diagnosed and treated for ADHD. Additionally, substantial variation exists in ADHD diagnosis between boys and girls, with boys often presenting with more stereotypical symptoms. Both the relative-age effect and variation in sex diagnosis, as well as the challenges of early preschool diagnosis, emphasize the importance of considering relative maturity in ADHD diagnosis of children. Implications and knowledge translation strategies for practitioners, parents and the education system are presented.

Le trouble de déficit de l'attention avec hyperactivité (TDAH) est l'un des troubles les plus diagnostiqués chez les enfants, mais il demeure mal compris. Il existe une controverse importante au sujet du bon diagnostic de TDAH, de même que des secteurs de subjectivité diagnostique. Il est essentiel de bien poser le diagnostic, qui a une incidence sur la réussite scolaire des enfants et qui s'associe à l'utilisation ou à la surutilisation possible de stimulants. L'âge relatif a un effet sur le diagnostic, car les enfants relativement plus jeunes que leurs camarades, nés plus près de la limite inférieure d'âge pour amorcer la scolarité, sont diagnostiqués et traités davantage pour le TDAH. De plus, on constate une variation importante quant au diagnostic de TDAH chez les garçons et les filles, les garçons ayant souvent des symptômes plus stéréotypés. L'effet de l'âge relatif, la variation du sexe sur le diagnostic et la difficulté de poser un diagnostic précoce à l'âge préscolaire font ressortir l'importance de la maturité relative dans le diagnostic de TDAH chez les enfants. L'auteure présente les conséquences et des stratégies de transfert du savoir pour les praticiens, les parents et le système d'éducation.

Examining an Alternate Care Pathway for Mental Health and Addiction Prehospital Emergencies in Ontario, Canada: A Critical Analysis.

Paramedics in Ontario have largely been limited to transporting those with mental health or addiction (MHA)-related emergencies to the emergency department (ED). The ED has repeatedly been identified as a problematic and challenging setting for people with MHA needs. This article examines an innovative patient care model (PCM) established by the Middlesex-London Paramedic Service and its partners for specific MHA emergencies where patients were given options for care that included transportation to a Canadian Mental Health Association (CMHA) Crisis Centre or information for support. Qualitative and quantitative data that were utilized for regular reporting to the Ministry were included in the analysis. The findings indicated that the goals of reducing pressures on EDs and paramedic services, enhancing paramedics' ability to address MHA calls, and improving patient care experiences were met. This model improves patient autonomy and options for care, improves the means for addressing patients' social determinants of health, and offers transportation to a non-medicalized facility.

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada.

Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n = 31), paramedic services management (n = 5), educators at paramedic college programmes (n = 5) and Base Hospital physicians/directors (n = 5). Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90 hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs. Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.

A Critical Analysis of Debates Around Mental Health Calls in the Prehospital Setting.

Paramedics, health care workers who assess and manage health concerns in the prehospital setting, are increasingly providing psychosocial care in response to a rise in mental health call volume. Observers have construed this fact as "misuse" of paramedic services, and proposed as solutions better triaging of patients, better mental health training of paramedics, and a greater number of community mental health services. In this commentary, we argue that despite the ostensibly well-intentioned nature of these solutions, they shift attention and accountability away from relevant public policies, as well as from broader economic, social, and political determinants of mental health, while placing responsibility on those requiring services or, at best, on the health care system. We also argue that the perspective of paramedics, who are exposed to, and interact with, individuals in their everyday environments, has the potential to inform a better, structural and critical, understanding of the factors driving the rise in psychosocial crises in the first place. Finally, we suggest that a greater engagement with the political and social determinants of mental health would lead to preventing, rather than primarily reacting to, these crises after the fact.