Defining priorities for emergency medical services education research: A modified Delphi study.

Objective: As out-of-hospital medicine evolves, emergency medical services (EMS) education practices must also be updated to ensure that EMS professionals acquire and maintain the skills needed to best serve patients. We aimed to identify and rank the top 10 research priorities related to EMS education in the United States. Methods: We conducted a convenience survey of EMS educators to identify challenges facing EMS education before leveraging a purposefully selected panel of EMS educators to prioritize research gaps through a modified Delphi approach. Data were collected electronically (March 2021-June 2021) over 4 survey rounds consisting of idea generation (Rounds 1 and 2), importance scoring (Round 3), and consensus ranking (Round 4). At the end of Round 4, composite scores were used to generate a list of 10 prioritized research gaps related to EMS education. Results: In the pre-Delphi survey, 463 EMS educators identified 2055 challenges facing EMS education. We recruited 32 EMS education experts as Delphi panelists and 28 completed all 4 rounds. Panelists submitted 77 knowledge gaps. The top 10 knowledge gaps included defining competency of EMS learners and educators, association of curricula and accreditation requirements with real-world practice, the effects of diversity and cultural humility among educators and learners on equitable patient care, evidence-based teaching methods, and public perception of the EMS profession and education system. Conclusions: Although 10 gaps were prioritized, panelists deemed all 77 gaps as having considerable importance for EMS education. This suite of knowledge gaps is intended to guide researchers and research-funding bodies for future resource allocation.

Reduced Emergency Department Length of Stay and Proportion of Patients Who Left Without Being Seen Following Implementation of an Interprofessional Vertical Flow Track With Pivot Triage: A Retrospective Pre-/Postintervention Evaluation.

Our objective was to assess change in length of stay and patients who left without being seen following implementation of a pivot triage and interprofessional vertical flow track process at a midwestern academic medical center emergency department. The intervention leveraged an existing interprofessional staffing model including a registered nurse and a paramedic to staff a vertical flow track daily from 1100 to 2300. Pre- and postintervention data were retrospectively abstracted from the electronic charting software. Outcomes included emergency department length of stay and percentage of patients leaving without being seen. Visits for patients during the postintervention period (May 10, 2019, to August 31, 2019) were compared with a corresponding preintervention time period 1 year prior (May 10, 2018, to August 31, 2018). The percentage of patients routed to the vertical flow track increased from 5% to 22% following the process intervention. Median emergency department length of stay decreased from 199 (interquartile range [IQR]: 129-282) to 159 (IQR: 98-232) min. The percentage of patients leaving without being seen decreased from 2.9% to 0.5%; between 1100 and 2300, these changes were more pronounced. Odds of a patient experiencing emergency department length of stay under 180 min increased nearly twofold (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.79-2.08) and odds that a patient stayed to be seen by a medical professional increased sixfold (OR: 5.94, 95% CI: 4.08-8.63). Overall, more than 20% of patients were routed through the vertical flow track following the process change. Implementation of an emergency department pivot triage approach with a dedicated interprofessional vertical flow track was associated with significantly shorter emergency department length of stay and reduced patients leaving without being seen.

Emergency medical services education research priorities during COVID-19: A modified Delphi study.

OBJECTIVE: Our objective was to identify research priorities to understand the impact of COVID-19 on initial emergency medical services (EMS) education. METHODS: We used a modified Delphi method with an expert panel (n = 15) of EMS stakeholders to develop consensus on the research priorities that are most important and feasible to understand the impact of the COVID-19 pandemic on initial EMS education. Data were collected from August 2020 to February 2021 over 5 rounds (3 electronic surveys and 2 live virtual meetings). In Round 1, participants submitted research priorities over 9 specific areas. Responses were thematically analyzed to develop a list of research priorities reviewed in Round 2. In Round 3, participants rated the priorities by importance and feasibility, with a weighted score (2/3*importance+1/3*feasibility) used for preliminary prioritization. In Round 4, participants ranked the priorities. In Round 5, participants provided their agreement or disagreement with the group's consensus of the top 8 research priorities. RESULTS: During Rounds 1 and 2, 135 ideas were submitted by the panel, leading to a preliminary list of 27 research priorities after thematic analysis. The top 4 research priorities identified by the expert panel were prehospital internship access, impact of lack of field and clinical experience, student health and safety, and EMS education program availability and accessibility. Consensus was reached with 10/11 (91%) participants in Round 5 agreeing. CONCLUSIONS: The identified research priorities are an important first step to begin evaluating the EMS educational infrastructure, processes, and outcomes that were affected or threatened through the pandemic.

EMS Curriculum Should Educate Beyond a Technical Scope of Practice: Position Statement and Resource Document.

Position Statement and Resource document approved by the NAEMSP Board of Directors on April 27, 2021.

Geographic Distribution of Accredited Paramedic Education Programs in the United States.

Background: The geographic distribution and access to paramedic education programs is unclear but often cited as a reason for emergency medical services (EMS) workforce shortages. Our aims were: 1) to examine the spatial distribution of accredited paramedic programs and 2) to compare characteristics of communities with and without existing programs. Methods: We performed a cross-sectional study of US paramedic education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of April 2020. Program locations were geocoded to county, and population estimates from the US Census Bureau were used to determine the adult population within the program's potential catchment area (30, 50, and 100 miles). Clustering of programs was examined using Moran's I. We compared community characteristics obtained from the 2018 American Community Survey, 2018-2019 Area Health Resources Files, and 2018 National Emergency Department Inventory between counties with and without programs. Logistic regression models were used to determine associations of community characteristics and existence of a paramedic program, controlling for urbanicity. Results: There were 790 paramedic program locations in the US, located in 596/3142 (19%) counties. Every state, except Rhode Island and Washington, DC, had at least one paramedic program site. The population within potential catchment areas ranged from 182 million (30 miles) to 248 million (100 miles), representing 73% to 99% of the US adult population, respectively. However, among counties classified as rural (n = 644), this decreased to 22% (30 miles) to 95% (100 miles). There was significant clustering of programs (p < 0.001). There were significantly higher odds of having a paramedic program for counties classified as metro compared to non-metro (OR 4.42, 95% CI 3.60-5.42) and with the presence of healthcare resources (e.g., emergency department in the county: OR 2.42, 95% CI 1.87-3.14). Conclusions: Approximately 73% of the US adult population lives within 30 miles of an existing paramedic education program; however, this decreases to 22% in rural areas. Geographic barriers to accessing paramedic education remain a challenge for ongoing efforts to address the rural EMS workforce shortage.

Position Paper on Degree Requirements for EMS Educators.

Following an analysis of national EMS agendas, National Association of EMS Educators developed a position supporting educator degree requirements in EMS. This position provided a framework for degree requirements at varying levels of EMS education. Identified support and appreciation for interprofessional approaches as well as EMS specific education was included in the position. The need for an educational workforce capable of providing robust degree options and innovative education emerged in response to the growing academic needs and professional complexities within EMS.

Homeless Shelter Users and Their Experiences as EMS Patients: A Qualitative Study.

Introduction: Patients who are users of homeless shelters interact with EMS and Emergency Departments (ED) as means of accessing the healthcare system. Patients in this population are known to have chronic health conditions as well as being frequent users of EMS. In this study, we researched how patients living at a homeless shelter experienced EMS. Methods: A phenomenological qualitative approach methodology was used to interview individuals at the largest homeless shelter in Omaha, Nebraska in 2017. Data was transcribed then coded for thematic analysis. Results: Eighteen adult individuals participated with four major themes emerging: Frequency and Medical Histories, Perceived Positive Experiences, Perceived Negative Experiences, and Awareness of EMS. Professionalism and being non-judgmental toward a homeless shelter user appeared to best describe the difference between a positive EMS experience from a negative one. Patients of this population have an awareness and appreciation to the role of EMS. They are also aware and recognize overuse of EMS by others and biases from EMS towards patients of this population. There are recognized opportunities to improve the relationship and role of EMS with patients using homeless shelters and services. Conclusion: Support for increased EMS awareness, research, and relationship building with homeless shelter users and shelters is needed.

Advanced Placement Paramedic Education for Health Care Professionals: A Descriptive Evaluation.

INTRODUCTION: The delivery of emergency medical services is primarily performed by emergency medical technicians and paramedics in the United States. More recently, nurses and physicians have become more involved in the delivery of emergency medical services. Advanced placement paramedic education bridging programs have been developed to prepare the workforce, but the success of these programs is unknown. This study evaluated the demographics and performance of nonemergency medical services health care professionals who attended an advanced placement paramedic education program at a Midwestern university. METHODS: This was a retrospective evaluation of student data from 2007 to 2017. Descriptive statistics were used to tabulate demographics, program performance, and individual performance in the National Paramedic Certification Examination. RESULTS: The program admitted 305 students; registered nurses (95%) were the majority of students. Of the 305 admitted students, 271 (88.9%) fulfilled all program requirements and were eligible to take the National Registry of Emergency Medical Technicians paramedic certification examination. Of these 271 eligible students, 201 (74.2%) took the National Paramedic Certification Examination. A total of 195 (97%) obtained certification at the first test attempt, whereas 200 (99.5%) obtained certification within 3 attempts. Of the 200 who passed the test, 175 (88%) successfully demonstrated entry-level competency in paramedic-level psychomotor testing. DISCUSSION: The advanced placement paramedic program evaluated in this study had high rates of successful program completion, as well as high first-time and cumulative passing rates for the National Paramedic Certification Examination. Further research is needed to identify the best practices in determining student requirements and the methodologies in delivering advanced placement paramedic education bridging programs.

Executive Summary of Educational Content from EMS Agenda 2050.

EMS Agenda 2050 follows the original EMS Agenda for the Future and EMS Education Agenda for the Future. These visionary documents discussed and described learning content, requirements, and design of EMS education. This article written by members of the EMS Agenda 2050 Technical Expert Panel highlights the content in the preceding agendas for the future and content from EMS Agenda 2050 in an effort to provide a summarized guide for new and existing EMS education curriculums.

Patient Safety Organizations and Emergency Medical Services.

Providing safe and error-free patient care should resonate well with all healthcare providers including emergency medical technicians. The environments and circumstances in which emergency medical services (EMS) provide patient care inevitably create risks to both the provider and patient. This article explores the concepts of patient safety, errors, near misses, adverse events, and Just Culture. Literature raises concerns about the lack of data collection on both patient and provider safety and research on these safety topics in EMS. It is the intent of this article to serve as a starting point for continued efforts in developing a culture of safety and providing safer care in EMS by reviewing, discussing, and bringing attention to the need for improved data collection and reporting to patient safety organizations.

Out-of-hospital adult cardiac arrests in a university hospital in central Saudi Arabia.

OBJECTIVES: To report the characteristics of adult out-of-hospital arrest patients and their outcomes in Riyadh, Saudi Arabia.   METHODS: This is a prospective descriptive study of out-of-hospital adult arrests incident transported to King Khalid University Hospital, Riyadh, Saudi Arabia between July 2012 and September 2013.   RESULTS: A total of 96 adult patients were enrolled in this study. Males represented 62.5% of the participants. The mean age of the study population was 58.9 years, and specifically 30.8 years for traumatic arrests, and 62.9 for non-traumatic. An over-all mortality rate of 95.8% was documented, as well as a low rate of bystander cardiopulmonary resuscitation being performed, and a family member transported most patients to the hospital.   CONCLUSION: A low survival rate for non-traumatic out-of-hospital adult arrest patients and a 100% mortality rate in traumatic arrests were discovered.

World's largest gathering. Muslim mass pilgrimage poses EMS logistical & planning challenges.

The Hajj is a "mega-gathering" event attended yearly by millions of Muslims from across the world. Planning, communications and logistical support are the foundations of its success. EMS systems and major event planners throughout the world can learn from studying the special challenges involved with managing such a large multilingual, multicultural crowd. Current studies predict that by 2020 there will be more than 10 million pilgrims in attendance for the event. New construction and supportive infrastructures are already underway to meet the ever-growing needs of the pilgrims. With the improvement of systems and design, there is already a steady decrease in the number of accidents and requests for help. Continuous monitoring of emerging health situations ensures that a simple case of the flu does not become a worldwide epidemic. There will always be a need for emergent care during the Hajj and the Saudi Red Crescent Authority and supportive agencies will be ready to serve those who come to participate.