Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020).

OBJECTIVE: Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS: This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS: The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS: Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.

A Cohort Study of Occupational Fatalities among Paramedicine Clinicians: 2003 through 2020.

INTRODUCTION/STUDY OBJECTIVES: Emergency medical technicians (EMTs) and paramedics respond to 40 million calls for assistance every year in the United States; these paramedicine clinicians are a critical component of the nation's health care, disaster response, public safety, and public health systems. The study objective is to identify the risks of occupational fatalities among paramedicine clinicians working in the United States. METHODS: To determine fatality rates and relative risks, this cohort study focused on 2003 through 2020 data of individuals classified as EMTs and paramedics by the United States Department of Labor (DOL). Data provided by the DOL and accessed through its website were used for the analyses. The DOL classifies EMTs and paramedics who have the job title of fire fighter as fire fighters and so they were not included in this analysis. It is unknown how many paramedicine clinicians employed by hospitals, police departments, or other agencies are classified as health workers, police officers, or other and were not included in this analysis. RESULTS: An average of 206,000 paramedicine clinicians per year were employed in the United States during the study period; approximately one-third were women. Thirty percent (30%) were employed by local governments. Of the 204 total fatalities, 153 (75%) were transportation-related incidents. Over one-half of the 204 cases were classified as "multiple traumatic injuries and disorders." The fatality rate for men was three-times higher than for women (95% confidence interval [CI], 1.4 to 6.3). The fatality rate for paramedicine clinicians was eight-times higher than the rate for other health care practitioners (95% CI, 5.8 to 10.1) and 60% higher than the rate for all United States workers (95% CI, 1.24 to 2.04). CONCLUSIONS: Approximately 11 paramedicine clinicians are documented as dying every year. The highest risk is from transportation-related events. However, the methods used by the DOL for tracking occupational fatalities means that many cases among paramedicine clinicians are not included. A better data system, and paramedicine clinician-specific research, are needed to inform the development and implementation of evidence-based interventions to prevent occupational fatalities. Research, and the resulting evidence-based interventions, are needed to meet what should be the ultimate goal of zero occupational fatalities for paramedicine clinicians in the United States and internationally.

Identifying the core components of a nursing home hospital avoidance programme.

BACKGROUND: Nursing home hospital avoidance programmes have contributed to a reduction in unnecessary emergency transfers but a description of the core components of the programmes has not been forthcoming. A well-operationalised health-care programme requires clarity around core components to evaluate and replicate the programme. Core components are the essential functions and principles that must be implemented to produce expected outcomes. OBJECTIVES: To identify the core components of a nursing home hospital avoidance programme by assessing how the core components identified at one nursing home (Site One) translated to a second nursing home (Site Two). METHODS: Data collected during the programme's implementation at Site Two were reviewed for evidence of how the core components named at Site One were implemented at Site Two and to determine if any additional core components were evident. The preliminary updated core components were then shared with seven evaluators familiar with the hospital avoidance programme for consensus. RESULTS: The updated core components were agreed to include the following: Decision Support Tools, Advanced Clinical Skills Training, Specialist Clinical Support and Collaboration, Facility Policy and Procedures, Family and Care Recipient Education and Engagement, Culture of Staff Readiness, Supportive Executive and Facility Management. CONCLUSION: This study launches a discussion on the need to identify hospital avoidance programme core components, while providing valuable insight into how Site One core programme components, such as resources, education and training, clinical and facility support, translated to Site Two, and why modifications and additions, such as incorporating the programme into facility policy, family education and executive support were necessary, and the ramifications of those changes. The next step is to take the eight core component categories and undertake a rigorous fidelity assessment as part of formal process evaluation where the components can be critiqued and measured across multiple nursing home sites. The core components can then be used as evidence-based building blocks for developing, implementing and evaluating nursing home hospital avoidance programmes.

International Survey of Violence Against EMS Personnel: Physical Violence Report.

IntroductionEach year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally. METHODS: An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016. RESULTS: There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as "urban." Approximately 68% described their employer as a "public provider." The majority of respondents were from the US.When asked "Have you ever been physically attacked while on-duty?" 761 (65%) of the 1,172 who answered the question answered "Yes." In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers. CONCLUSIONS: In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals. MaguireBJ, BrowneM, O'NeillBJ, DealyMT, ClareD, O'MearaP. International survey of violence against EMS personnel: physical violence report. Prehosp Disaster Med. 2018;33(5):526-531.

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics.

OBJECTIVE: To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel. METHODS: This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented. RESULTS: Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.

Violence against emergency medical services personnel: A systematic review of the literature.

BACKGROUND: Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel. METHODS: We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria. RESULTS: The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base. CONCLUSIONS: EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour.

AIMS AND OBJECTIVES: To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting. BACKGROUND: Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area. DESIGN: A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework. METHODS: Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis. RESULTS: Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene. CONCLUSION: The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home. RELEVANCE TO CLINICAL PRACTICE: Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies.

Emergency Medical Service Personnel's Risk From Violence While Serving the Community.

OBJECTIVES: To determine the risks of violence-related injury among emergency medical services (EMS) personnel in the United States. METHODS: We analyzed 1630 violence-related occupational injury cases reported to the US Bureau of Labor Statistics for the years 2012 to 2015 and conducted secondary searches within the Bureau of Labor Statistics Web site. RESULTS: The number of cases per year varied between 250 and 560. Perpetrators included patients (77%) and coworkers (8%). Female EMS personnel had a disproportionately greater risk of violence-related injuries. The most common (35%) injury type was "sprains-strains-tears"; about 4% of the assault cases resulted in fractures, 13% resulted in surface wounds, and 190 were head injuries. About a third of the cases were classified as intentional. CONCLUSIONS: The findings indicate a clear need for reliable interventions. The differences in risk for women indicate that some interventions may need to be demographic-specific. Because of the limitations of national data, future researchers will need access to agency-level data that include hours worked and call volume by demographic factors such as gender.

Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective.

BACKGROUND: Hospital avoidance programmes aim to reduce the number of emergency transfers from nursing homes to hospitals and facilitate early discharge for hospitalised residents. Nursing staff are at the forefront of these efforts, yet little is known about how the programmes affect them and their management of the deteriorating resident. This information is needed to inform hospital avoidance programmes and better understand their work. AIM: To examine nursing home nursing staff perceptions regarding their management of the deteriorating resident after the introduction of a hospital avoidance programme. METHODS: A thematic analysis was conducted of focus group data collected from nursing staff 14 to 15 months after the introduction of a pilot hospital avoidance programme at an Australian nursing home. FINDINGS: The programme was well received and filled a gap in nursing staff management of residents with deteriorating health by providing structure and support. Staff were more confident and focused on this area of their work. Nursing assistants felt more integrated into the system and were supported and learning from nurses. Workload remained heavy and there was a shift in how time was allocated, but nursing staff preferred to keep residents at the facility. CONCLUSION: Nursing staff welcomed the programme and benefitted from its implementation. However, strategies must be explored to accommodate the staffing needs associated with providing emergency and subacute care in the nursing home setting.

Occupational injury risk among Australian paramedics: an analysis of national data.

OBJECTIVE: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports. DESIGN AND PARTICIPANTS: Retrospective descriptive study using data provided by Safe Work Australia for the period 2000-2010. The subjects were paramedics who had been injured in the course of their duties and for whom a claim had been made for workers compensation payments. MAIN OUTCOME MEASURES: Rates of injury calculated from the data provided. RESULTS: The risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average. The fatality rate for paramedics was about six times higher than the national average [corrected].On average, every 2 years during the study period, one paramedic died and 30 were seriously injured in vehicle crashes. Ten Australian paramedics were seriously injured each year as a result of an assault. The injury rate for paramedics was more than two times higher than the rate for police officers. CONCLUSIONS: The high rate of occupational injuries and fatalities among paramedics is a serious public health issue. The risk of injury in Australia is similar to that in the United States. While it may be anticipated that injury rates would be higher as a result of the nature of the work and environment of paramedics, further research is necessary to identify and validate the strategies required to minimise the rates of occupational injury for paramedics.