Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey.

AIM: To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession. DESIGN: A cross-sectional survey. METHODS: Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests. RESULTS: Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Patient experience of non-conveyance in the EMS of Southwest Finland: a descriptive survey study.

BACKGROUND: Emergency Medical Services are dispatched more frequently than before. However, many non-urgent patients do not need ambulance transportation to a healthcare facility after evaluation and treatment on scene. This study explored the experiences of non-conveyed patients. Our research questions were: (1) How have non-conveyed patients experienced the service received from EMS? (2) Does a patient's age, gender, or time of the emergency call impact the patient's experience? METHODS: This descriptive survey study examined non-conveyed Emergency Medical Services patients in the Wellbeing Services County of Southwest Finland. The study period was from March 1, 2023, to March 31, 2023. The study population was 1017. They received a questionnaire that was sent by mail. The questionnaire was formed based on questions previously used in four different questionnaires. We received 247 answers (24.3% response rate). Percentages, medians with interquartile ranges, and non-parametric tests were used in the descriptive analyses. RESULTS: Non-conveyed patients were very satisfied with the paramedics' expertise and behavior, their ability to meet their individual needs, the sense of safety provided by the paramedics, and the instructions given to the patients. Time to receive help (19% rated 3 or less on a scale from 1 to 5), how paramedics introduced themselves (16.5%), and satisfaction with non-conveyance decisions (14.6%) were more frequently rated lower than other areas. Further, pain management stood out in the less favorable evaluations. Still, patients' experiences of the service were positive. The age group, gender, or time of the emergency call were not associated with patient experience. CONCLUSIONS: Patients were very satisfied with the paramedics' interpersonal skills. A more focused approach to pain management and developing EMS to ensure faster patient outreach and clearer explanations of non-conveyance decisions could further enhance the patient experience.

Technological development roles and needs in pre-hospital emergency care from the advanced level paramedics' perspective.

INTRODUCTION: The work environment of paramedics is rapidly becoming more technology-oriented, and new innovations are constantly being introduced. The aim of this study was to determine the roles Finnish advanced level paramedics identify for themselves within technological development processes in their experience and what kinds of technological development in pre-hospital emergency care are needed. METHODS: This qualitative study utilised essay material written by experienced advanced level paramedics (n = 20), which was analysed using inductive content analysis. RESULTS: The paramedics identified direct and indirect roles and clear obstacles. The roles were related to expertise, their own professional skills, supporting development and implementation. The obstacles to participation in technological developed were perceived as the employer's unwillingness to involve grassroots level paramedics, lack of training or expertise, and overall unrecognised role. Technological development was seen to be needed regarding information and communication technology, treatment tools, and equipment. Further, nationally homogenous technological development that supports the quality and safety of nursing work and the integration of digitalization into education were also seen as needed. CONCLUSIONS: Paramedics can be innovative and active technology developers with extensive expertise in the technology of their field. Employers and technology developers should be encouraged to enable user-oriented product development and to involve paramedics in development work.

Supporting emergency service workers to cope with critical incidents that can lead to psychological burden at work - developing skills in the Post Critical Incident Seminar: a qualitative interview study.

BACKGROUND: Emergency service workers face critical incidents causing psychological burden. This qualitative study investigates how attending a Post Critical Incident Seminar could affect the skills of emergency service workers to overcome incidents that can cause psychological burden at work and their consequences with the following research questions: (1) How did attending the Post Critical Incident Seminar impact the skills to overcome work incidents that can lead to psychological burden? and (2) How have these skills been manifested since attending the Post Critical Incident Seminar? METHODS: The data consists of individual interviews with fifteen emergency services workers who attended a Post Critical Incident Seminar in April 2021 in Finland. The interviews were conducted six months after the Post Critical Incident Seminar and analysed using inductive content analysis. RESULTS: The results of the first research question formed two main categories: improved performance abilities and improved self-regulation abilities. From the results of the second research question two main categories were created: new kind(s) of well-being and readiness to help. Several upper categories and sub-categories were discovered. CONCLUSIONS: Based on the results, attending a Post Critical Incident Seminar may be effective in developing skills to overcome critical incidents that can lead to psychological burden. Further follow-up studies should investigate how acquired skills from the Post Critical Incident Seminar practically affect emergency service workers and their well-being in the longer term.

Explanations for sickness absence due to common mental disorders: A narrative study of young health and social care workers.

Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health-related sickness absence in the narrative accounts of young workers in high-risk health and social care occupations. Semi-structured narrative interviews were conducted with 23 Finnish young workers (aged 21-34), with self-reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health-related sickness absences form a complex phenomenon related to various life and work-related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers.

Impacts of Post Critical Incident Seminar on emergency service personnel: The critical incident-related experiences and psychological state.

INTRODUCTION: Post Critical Incident Seminar (PCIS) is an intervention originally developed by the Federal Bureau of Investigation (FBI) for supporting law enforcement officers who have faced critical incidents (CIs) at work. In Finland, police forces have arranged modified PCIS regularly since 2012, but the first PCIS for emergency service personnel was organized in 2020. PCIS consists of psychoeducation, peer support, and mental health professional support/Eye Movement Desensitization and Reprocessing (EMDR). Previous international studies of PCIS are scarce. Our research question was this: After 6 months, how do emergency service personnel who have participated in the PCIS describe the impacts of PCIS on experiences and psychological state evoked by the CI that was the reason to apply for it? METHODS: The data consisted of individual interviews 6 months after attending the PCIS. The number of participants in this study was 15 (94%). The data was analyzed qualitatively with inductive content analysis. RESULTS: The impacts of PCIS on incident-related experiences and state 6 months afterward were divided into five main categories: social changes, new perspectives and sensations, incident-related components, future-oriented processes, and new abilities and actions. CONCLUSIONS: PCIS can have multilevel impacts on the experiences and psychological state caused by a CI. These impacts are reflected, for example, in their inner experience, choices, emotions, actions, and relationships with others in different areas of life. As a result of PCIS, the emergency service personnel's relationship with CIs in the past and the ability to function in the future can change. Further study is needed to investigate the long-term impacts of the PCIS.

The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls - A descriptive retrospective register-based study.

BACKGROUND: Medical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. METHODS: Descriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. RESULTS: In total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. CONCLUSIONS: Hospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.

Learning Lessons for Future Preparedness: Exploring Work Well-Being-Related Leadership Challenges among Paramedics during the Early Stage of the COVID-19 Pandemic-A Qualitative Study.

The beginning of the COVID-19 pandemic majorly impacted the population and public services. In Finland, a state of emergency was declared to ensure the security of healthcare resources, and prehospital emergency medical service (EMS) organizations faced emergency conditions for the first time. This study explores the leadership challenges related to well-being experienced during the early phase of the pandemic. This qualitative study utilized reflective essay material written between August and November 2020 by experienced advanced-level paramedics (n = 30) who participated actively in EMS fieldwork at the beginning of the pandemic. The material (32,621 words) was analyzed with inductive content analysis. The work well-being-related leadership challenges experienced by paramedics during the early phase of the pandemic were divided into four upper categories: inadequate guidance, workplace reorganization, atmosphere mismanagement, and insufficient resources to cope. These upper categories were comprised of 17 subcategories. Several actions can be taken to enhance personnel well-being and prepare for similar challenges. Guidance and support should be clear and timely. Visible leadership should be emphasized and enhanced with modern communication. Efforts should be made to strengthen the work atmosphere to support those on the front lines of healthcare. This study was not registered on a publicly accessible registry.

External context in individual placement and support implementation: a scoping review with abductive thematic analysis.

BACKGROUND: Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS: The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS: Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION: Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION: Open Science Framework.

Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey.

Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.

Consultation Processes With Helicopter Emergency Medical Service Physicians in Finnish Prehospital Emergency Care: The Paramedics' Perspective.

OBJECTIVE: The Finnish emergency medical services operates mainly with highly educated paramedic-staffed units. Helicopter emergency medical services (HEMS) physicians alongside other physicians provide consultations to paramedics on the scene without the physician physically participating in the mission. We examined the Finnish paramedics' views regarding the consultation processes involving HEMS physicians. METHODS: This was a cross-sectional survey study among paramedics (n = 200). Assessments of the performance of HEMS physicians and other physicians in the consultation process were analyzed descriptively. The effect of the physician being expressly part of the HEMS was analyzed with inductive content analysis. RESULTS: Overall, consultations with the HEMS physician were well received among paramedics, and the HEMS physicians received higher assessments than other physicians. The familiarity with the prehospital environment, limitations, and local possibilities was valued. Expertise is particularly valuable in challenging emergency medical services missions but unnecessary in many nonurgent missions. There is scope for improvement in the attitudes and technical fluency of the consultation processes of HEMS physicians. CONCLUSION: Using HEMS physicians in prehospital consultations could be recommended. Further studies are still needed to ensure the efficacy and efficiency of the consultation process and explore the integration of video connections into current consultation practices.

Critical incident experiences, related stress and support among Finnish paramedics: A cross-sectional survey study.

INTRODUCTION: Paramedics work in diverse, demanding prehospital settings. We examined the prevalence of critical incident (CI) experiences, critical incident stress (CI-S), and CI-S association with the intention to leave the paramedic profession, as well as the needed and received support for CI-S among Finnish paramedics. METHODS: In 2022, n = 427 Finnish paramedics from eight different organizations responded to a modified Emergency Medical Services (EMS) Critical Incident Stress Inventory and reported the CIs experienced during their EMS careers and the related CI-S within the last six months. Statistical analyses were stratified by gender. RESULTS: All the listed 31 CIs had been experienced by the Finnish paramedics, and the experiences increased with work experience, especially among men. CI-S had wide variation, seemed to increase with work experience, and was mainly not associated with the intention to leave the profession. Support for coping with CI-S was most often received from colleagues, then from family members, friends, and to some extent, managers. CONCLUSIONS: Because of the inherent nature of the demands and features of the paramedic work, experiencing CIs is unavoidable. Examining effective coping strategies, organizational support, and managerial practices are needed to support highly skilled paramedics in their demanding work.

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland.

BACKGROUND: The amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 - 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care. METHODS: This was a retrospective register study where the information of patients conveyed to university hospital during nighttime (20 - 08) were analyzed. Frequencies of the dispatch codes presenting complaints, medical treatments, and diagnostic tests were calculated. Age significance (under/over 70 years) was also tested. RESULTS: 73.5% of the patients received neither medical treatment nor had diagnostic tests taken before morning. Most of these were patients with mental disorder(s), hip pain/complaint, or laceration/cut. Almost half of the patients with abdominal pain or fever had laboratory tests taken. Patients over 70 years old received more medications and had more diagnostic tests taken than younger patients. CONCLUSIONS: Some of the low-acuity patients could be non-conveyed or referred to alternative pathways of care to avoid impolitic use of emergency medical service and to reduce the workload of emergency departments. Further research is needed to ensure patient safety for patients who are not conveyed at night.

Applying Crew Resource Management tools in Emergency Response Driving and patient transport-Finding consensus through a modified Delphi study.

BACKGROUND: Emergency Response Driving (ERD) comprises a significant risk to safety in Emergency Medical Services (EMS). Crew Resource Management (CRM) tools play a major role in securing actions in high-risk procedures. The aim of this study was to find consensus on the important factors to consider when applying CRM tools in ERD and patient transport. METHODS: ERD experts (n = 50) were recruited for a modified three-round Delphi study. Round 1 was based on previous research. The experts evaluated the items as important, neutral, or not important. The predetermined level of consensus was set at ≥ 80%. Answers given to the open-ended questions were analyzed using inductive content analysis. RESULTS: Predetermined consensus was reached on 64 of 86 presented items (74.4 %). The mean values of items reaching consensus varied between 3.81 and 4.86 on a five-point Likert scale. The items where consensus was reached were rated as "important" on a trichotomized scale. CONCLUSION: Multiple important factors to consider when applying CRM tools to ERD and patient transport were highlighted. This study provides valuable information to consider regarding EMS safety improvements. Further scientific research is needed to develop comprehensive recommendations.

Maintenance and Development of Paramedics' Competence on Joint Emergency Medical Service and Helicopter Emergency Medical Service Missions.

OBJECTIVE: In health care, learning and collaboration between professions are crucial in providing patient-centered, responsive, and high-quality care. Given that interprofessional learning can occur indirectly while working but is scarcely studied in the context of prehospital emergency care, we examined the maintenance and development of paramedic competence on joint emergency medical service (EMS) and helicopter emergency medical service (HEMS) missions. METHODS: Qualitative methodology was chosen. Sixty-one Finnish paramedics and EMS field supervisors answered a single open-ended survey question. Inductive content analysis was used to analyze the data. RESULTS: The maintenance and development of paramedics' competence on joint EMS and HEMS missions formed 2 main categories: the transfer of professional skills and interactive competence development. The transfer of skills was formed by 3 upper categories: practicing working as part of the team, transmission of tacit knowledge, and deepening of clinical knowledge. Interactive competence development was formed by 2 upper categories: ensuring one's own competence and educational working model as built-in. All the upper categories had several subcategories. CONCLUSION: EMS and HEMS joint missions provide an additional learning opportunity for paramedics. The expertise, examples, and educational attitudes shared by the HEMS are valued. The results reveal the need for further research on this subject.

Urgent hospital transfers - The experiences and required skills of paramedics.

INTRODUCTION: Global changes in the health and social care sector have centralized the treatment of emergency patients, leading to an increase of urgent hospital transfers. The aim of this study is to describe paramedics' experiences gained while working in prehospital emergency care, regarding urgent hospital transfers and the skills that performing urgent hospital transfers requires. METHODS: Twenty paramedics with experience in urgent hospital transfers participated in this qualitative study. The data collected via individual interviews were analyzed using inductive content analysis. RESULTS: Paramedics' experiences of urgent hospital transfers resulted in two upper categories: Factors related to paramedics, and factors related to transfer, conditions, and technology. The upper categories were grouped from six subcategories. Paramedics' experiences of skills required in urgent hospital transfers resulted in two upper categories: Professional competence, and interpersonal skills. The upper categories were grouped from six subcategories. CONCLUSIONS: Organizations should support and promote training related to urgent hospital transfers to enhance the quality of care and patient safety. Paramedics play a key role in successful transfer and collaboration, and thus the required professional competences and interpersonal skills should be addressed in their education. Furthermore, developing standardized procedures is recommended to enhance patient safety.

Advanced-level paramedics' support needs for developing and utilising competence.

INTRODUCTION: Paramedic competence plays a vital role in emergency medical services (EMS), as the pre-hospital setting demands a wide variety of competencies from paramedics. The aim of the study was to examinethesupportthatadvanced-level paramedics need from their supervisors to develop and utilise their competence. METHODS: Qualitative essay material was collected from a group of experienced advanced-level paramedics (n = 41). The material was analysed with inductive content analysis. RESULTS: Twenty-eight sub-categories emerged, forming 6 categories further leading to the grouping of two main categories: 1) the enablement of human resource (HR) management and leadership; and 2) guidelines on how to operate EMS adequately. CONCLUSIONS: Supervisors can and should support advanced-level paramedics in their competence utilisation and development. This can be achieved by enabling professional growth by recognising competencies and generating supportive leadership in EMS. Paramedics would also benefit from clear operative guidelines. Overall, supporting paramedics' competence utilisation and development is strongly connected with leadership standards in daily practices.

Working conditions and mental health functioning among young public sector employees.

Background: The associations between adverse working conditions and mental disorders are well established. However, associations between adverse working conditions and poor mental health functioning is a less explored area. This study examines these associations among younger public sector employees of the City of Helsinki, Finland. Methods: We use data from the Young Helsinki Health Study with a representative sample of the employees of the City of Helsinki, aged 19-39 years (n=4 217). Mental health functioning was measured with mental composite summary of the Short Form 36. Working conditions included factors related to both the psychosocial (job control and job demands) and the physical work environment (physical workload). To examine the associations, we used logistic regression models with adjustments for socio-demographics, other working conditions and health-related covariates. Results: After adjustment for sociodemographic characteristics, poor health, health behaviours and other occupational exposures, high job demands (OR=1.69; 95% CI=1.45-1.97) and low job control (OR=1.65; 95% CI=1.40-1.94) were associated with poor mental health functioning. High physical workload was not associated with the outcome (OR=0.87; 95% CI=0.72-1.05) after the adjustments. Conclusions: Adverse psychosocial working conditions were associated with mental health functioning, whereas physical working conditions were not. As impaired functioning is likely to cause health-related lost productivity and can lead to work disability, further research and interventions with a balanced approach focusing on both psychosocial working conditions and mental health functioning are recommended.

Paramedics' perceptions of job demands and resources in Finnish emergency medical services: a qualitative study.

BACKGROUND: Paramedics' fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics' strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics' perceptions of job demands and resources. METHODS: Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the SRQR checklist. RESULTS: We identified paramedics' job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics' job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development. CONCLUSIONS: Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities. PATIENT OR PUBLIC CONTRIBUTION: This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.

Perceived human factors from the perspective of paramedics - a qualitative interview study.

BACKGROUND: The work environment in prehospital emergency medical care setting is dynamic and complex and includes many stressors. However, little is known about the perceived human factors from the perspective of paramedics. In this study, we investigated, from the perspective of paramedics, what are the human factors, and how are they linked to prehospital emergency medical care? METHODS: Data were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis. RESULTS: Three main categories of human factors were identified. The first main category consisted of factors related to work which were divided into two generic categories: "Challenging organizational work environment" and "Changing external work environment." The second main category comprised factors related to paramedics themselves and were divided into three generic categories: "Issues linked to personality," "Personal experiences", and "Factors resulting from personal features." The third main category described that paramedics have difficulties in understanding and describing human factors. CONCLUSION: This study revealed numerous factors that can affect paramedics' work in the EMS setting. Increased knowledge about human factors in the EMS setting provides organizations with the opportunity to develop procedures that can support paramedics' cognitive and physical work. Human factors in different situations can be addressed to improve occupational and patient safety.