The Regulatory Evolution of Paramedic Practice in Australia.

Australian paramedics have always been regulated as an occupation despite a significant regulatory evolution occurring in their discipline. Paramedics have progressed from stretcher-bearers, ambulance drivers, ambulance officers and finally to paramedics. However, as the paramedic discipline evolved, paramedicine's regulatory framework remained self-regulatory through employer governance which does not reflect the professionalised role of paramedics in society. The final step in securing professional regulation for paramedics is co-regulation under the Health Practitioner Regulation National Law Act 2009. Due to recent legislative amendments, paramedics will become a registered health profession in 2018. This article details the regulatory evolution of paramedic practice in Australia and how paramedicine has evolved beyond the current employer-based regulation to professional health practitioner regulation warranting a statutory framework of governance.

National Systematic Legal Review of State Policies on Emergency Medical Services Licensure Levels' Authority to Administer Opioid Antagonists.

OBJECTIVE: Previous research conducted in November 2013 found there were a limited number of states and territories in the United States (US) that authorize emergency medical technicians (EMTs) and emergency medical responders (EMRs) to administer opioid antagonists. Given the continued increase in the number of opioid-related overdoses and deaths, many states have changed their policies to authorize EMTs and EMRs to administer opioid antagonists. The goal of this study is to provide an updated description of policy on EMS licensure levels' authority to administer opioid antagonists for all 50 US states, the District of Columbia (DC), and the Commonwealth of Puerto Rico (PR). METHODS: State law and scopes of practice were systematically reviewed using a multi-tiered approach to determine each state's legally-defined EMS licensure levels and their authority to administer an opioid antagonist. State law, state EMS websites, and state EMS scope of practice documents were identified and searched using Google Advanced Search with Boolean Search Strings. Initial results of the review were sent to each state office of EMS for review and comment. RESULTS: As of September 1, 2017, 49 states and DC authorize EMTs to administer an opioid antagonist. Among the 40 US jurisdictions (39 states and DC) that define the EMR or a comparable first responder licensure level in state law, 37 states and DC authorize their EMRs to administer an opioid antagonist. Paramedics are authorized to administer opioid antagonists in all 50 states, DC, and PR. All 49 of the US jurisdictions (48 states and DC) that define the advanced emergency medical technician (AEMT) or a comparable intermediate EMS licensure level in state law authorize their AEMTs to administer an opioid antagonist. CONCLUSIONS: 49 out of 52 US jurisdictions (50 states, DC, and PR) authorize all existing levels of EMS licensure levels to administer an opioid antagonist. Expanding access to this medication can save lives, especially in communities that have limited advanced life support coverage.

Decálogo del ejercicio de la profesión del técnico en emergencias sanitarias / Ten commandments for emergency medical technicians

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How do emergency ambulance paramedics view the care they provide to people who self harm?: Ways and means.

The UK has one of the highest rates of self harm (SH) in Europe, and almost four times more people die by suicide than in road traffic collisions. Emergency ambulance paramedics are often the first health professionals involved in the care of people who have self-harmed, yet little is known about the care provided or issues raised in these encounters. The aim of this study is to explore paramedics' perceptions and experiences of caring for people who SH, to inform education and policy. Semi structured interviews were conducted with paramedics, and themes generated by constant comparison coding. This paper reports two emerging themes: Firstly, professional, legal, clinical and ethical tensions, linked to limited decision support, referral options and education. The second theme of relationships with police, revealed practices and surreptitious strategies related to care and detention, aimed at overcoming complexities of care. In the absence of tailored education, guidance or support for self-harm care, 'ways and means' have evolved which may negatively influence care and challenge ethical and legal frameworks. There is an urgent need to include evidence from this study in revised guidance and educational materials for paramedics working with people who self-harm in the prehospital emergency setting.

[Medical service for sports events]. / Medizinische Versorgung bei Sportanlässen.

The medical service for sports events is for physicians and other healthcare professionals a particular challenge, depending on type and size of the event. Planning criteria exist but only in general terms and are often inadequate, so the preparation should based principally on experience. In addition to a good cooperation with the other partners of the emergency medical services, specific accidents and clinical pictures, as well as legal implications have to observed.

Le service médical des événements sportifs est un challenge spécial pour les médecins et le personnel paramédical, selon le type et la dimension de cette manifestation. Les principes de planification existent seulement en termes généraux et sont souvent insuffisiants de sorte qu'il faut les baser sur l'expérience. En plus d'une bonne coopération avec les autres partenaires du service médical d'urgence, les accidents et pathologies spécifiques et leur conséquences légales doivent être prises en compte.

First responder and physician liability during an emergency.

First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

Correlates of perceived care comfort with an EMS professional having a legal conviction.

OBJECTIVES: The first objective was to examine the outcome of how comfortable a potential EMS-caller would be receiving care from an out-of-hospital-care EMS professional who might have a legal conviction. A second objective was to test for correlates that would explain this outcome. METHODS: In the autumn of 2010, a structured phone survey was conducted. To maximize geographical representation across the contiguous United States, a clustered, stratified sampling strategy was used based upon US Postal Service zip codes. RESULTS: Of the 2,443 phone calls made, 1,051 (43%) full survey responses were obtained. Data cleaning efforts reduced the total to 929 in the final model regression analysis. Results revealed significant public discomfort in receiving care from EMS professionals who may have such a conviction. In addition, respondents who are less educated and older more strongly (1) agree that EMS professionals should have their licenses revoked for wrong doing; (2) agree EMS professionals should be screened before being hired; (3) perceive EMS credentials to be important; (4) support a lawsuit for improper care; and (5) are collectively less comfortable with being cared for by an EMS professional who may have a legal conviction. Reliable scales were found for future research use. CONCLUSION: There is significant public discomfort in receiving care from EMS professionals who may have a legal conviction. The results of this study provide increased impetus for the careful screening of EMS professionals before they are hired or allowed to be volunteers. Beyond this due diligence, the results serve as a reminder for increased EMS provider awareness of the importance of exhibiting professionalism when dealing with the public.

Interevaluator reliability of a mock paramedic practical examination.

INTRODUCTION: Prior to graduation, paramedic students must be assessed for terminal competency and preparedness for national credentialing examinations. Although the procedures for determining competency vary, many academic programs use a practical and/or oral examination, often scored using skill sheets, for evaluating psychomotor skills. However, even with validated testing instruments, the interevaluator reliability of this process is unknown. Objective. We sought to estimate the interevaluator reliability of a subset of paramedic skills as commonly applied in terminal competency testing. METHODS: A mock examinee was videotaped performing staged examinations mimicking adult ventilatory management, oral board, and static and dynamic cardiac stations during which the examinee committed a series of prespecified errors. The videotaped performances were then evaluated by a group of qualified evaluators using standardized skill sheets. Interevaluator variability was measured by standard deviation and range, and reliability was evaluated using Krippendorff's alpha. Correlation between scores and evaluator demographics was assessed by Pearson correlation. RESULTS: Total scores and critical errors varied considerably across all evaluators and stations. The mean (± standard deviation) scores were 24.77 (±2.37) out of a possible 27 points for the adult ventilatory management station, 11.69 (±2.71) out of a possible 15 points for the oral board station, 7.79 (±3.05) out of a possible 12 points for the static cardiology station, and 22.08 (±1.46) out of a possible 24 points for the dynamic cardiology station. Scores ranged from 18 to 27 for adult ventilatory management, 7 to 15 for the oral board, 2 to 12 for static cardiology, and 19 to 24 for dynamic cardiology. Krippendorff's alpha coefficients were 0.30 for adult ventilatory management, 0.01 for the oral board, 0.10 for static cardiology, and 0.48 for dynamic cardiology. Critical criteria errors were assigned by 10 (38.5%) evaluators for adult ventilatory management, five (19.2%) for the oral board, and nine (34.6%) for dynamic cardiology. Total scores were not correlated with evaluator demographics. CONCLUSIONS: There was high variability and low reliability among qualified evaluators using skill sheets as a scoring tool in the evaluation of a mock terminal competency assessment. Further research is needed to determine the true overall interevaluator reliability of this commonly used approach, as well as the ideal number, training, and characteristics of prospective evaluators.