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1.
BMC Emerg Med ; 24(1): 108, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956498

RESUMO

BACKGROUND: Teamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals and emergency services. It is essential to acquire a deeper understanding of how ambulance teams operate. Therefore, this study aimed to explore the experiences of ambulance professionals with teamwork and how they were influenced by the implementation of a team training programme. METHODS: A qualitative descriptive study was conducted involving ambulance professionals who took part in focus group interviews carried out both before and after the implementation of a team training program across seven ambulance stations within a Norwegian hospital trust. The data were analysed using reflexive thematic analysis based on a deductive-inductive approach. RESULTS: Our analysis revealed 15 subthemes that characterised ambulance professionals' experiences with teamwork and a team training programme, which were organised according to the five main themes of team structure, communication, leadership, situation monitoring, and mutual support. Ambulance professionals' experiences ranged from the significance of team composition and interpersonal and professional relationships to their preferences regarding different communication styles and the necessity of team leaders within the ambulance service. The team training programme raised awareness of teamwork, while the adoption of teamwork tools was influenced by both individual and contextual factors. The Introduction/Identity, Situation, Background, Assessment and Recommendation (ISBAR) communication tool was identified as the most beneficial aspect of the programme due to its ease of use, which led to improvements in the structure and quality of consultations and information handover. CONCLUSIONS: This study documented the diverse characteristics and preferences associated with teamwork among ambulance professionals, emphasising the particular importance of proficient partnerships in this context. Participation in a team training programme was perceived as a valuable reminder of the significance of teamwork, thus providing a foundation for the enhancement of communication skills. TRIAL REGISTRATION: ClinicalTrials.gov-ID: NCT05244928.


Assuntos
Ambulâncias , Grupos Focais , Equipe de Assistência ao Paciente , Pesquisa Qualitativa , Humanos , Equipe de Assistência ao Paciente/organização & administração , Noruega , Feminino , Masculino , Liderança , Comunicação , Adulto , Relações Interprofissionais , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Capacitação em Serviço , Auxiliares de Emergência/educação
2.
Air Med J ; 43(4): 288-294, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38897690

RESUMO

OBJECTIVE: Simulation education and assessment are increasingly used in prehospital curriculums. The objective of this study was to assess the challenges and feasibility of correlating evaluation data from an airway management simulation assessment with clinical performance. METHODS: This study was undertaken in Ontario, the most populous province in Canada, where 13 bases are distributed in geographically diverse areas, from urban to rural and remote locations. This is a retrospective cohort study of paramedics who had completed simulation education and assessment in rapid sequence intubation. Logistic regression was used to assess for correlation between assessment scores (ie, the global score and the overall score and the definitive airway sans hypoxia/hypotension on the first attempt [DASH-1A] success in the field). RESULTS: DASH-1A success when grouped by base varied from 25% to 100%. The odds of DASH-1A success increased for paramedics who had a higher overall score (odds ratio [OR]: 1.03; 95% confidence interval [CI], 0.96-1.11) and for paramedics who had a higher global rating (OR: 1.27; CI, 0.73-2.21) when accounting for base intubation frequency. The odds of DASH-1A success increased for paramedics who had a higher overall score (OR: 1.01; CI, 0.93-1.09) and decreased for paramedics who had a higher global rating (OR: 0.96; CI, 0.47-1.96) when accounting for base geography. CONCLUSION: Although this study lacked a sample size large enough to draw conclusions, it provides a foundation and areas to improve in future work exploring the relationship between simulation assessments and clinical performance.


Assuntos
Competência Clínica , Estudos de Viabilidade , Treinamento por Simulação , Humanos , Ontário , Estudos Retrospectivos , Masculino , Feminino , Adulto , Serviços Médicos de Emergência , Auxiliares de Emergência/educação , Intubação Intratraqueal/métodos , Manuseio das Vias Aéreas/métodos , Estudos de Coortes , Modelos Logísticos
3.
Air Med J ; 43(4): 313-320, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38897694

RESUMO

OBJECTIVE: Given the recommendations against the use of critical incident stress debriefing, the emergency medical services (EMS) Code Lavender program was created as a mechanism to consistently recognize and reach out to EMS clinicians after acute crisis events, offer nonintrusive informal peer support and acts of kindness, and provide stepwise support via mental health professionals as needed. The study aimed to assess program utilization and evaluate the program's impact on EMS clinicians' perceptions of support and resources available to them after an acute crisis event. METHODS: Anonymous surveys were distributed before program implementation and 18 months later. Program utilization was tracked using REDCap (Vanderbilt University, Nashville, TN). Fisher exact tests and logistic regression were used to analyze the survey results. RESULTS: Within 30 months, 87 referrals were made. Seventy-seven preprogram (59% response rate) and 104 intraprogram (88% response rate) surveys were collected. There were no differences between respondents by sex or role. There were significant improvements in knowing where to go for help (from 40% to 85%, P < .001) and willingness to seek help if needed (from 40% to 59%, P = .02). CONCLUSION: The implementation of an EMS Code Lavender program led to significant increases in EMS clinician self-reported knowledge of where to go and willingness to seek help after acute crisis events.


Assuntos
Serviços Médicos de Emergência , Humanos , Masculino , Feminino , Adulto , Intervenção em Crise , Grupo Associado , Inquéritos e Questionários , Pessoa de Meia-Idade , Auxiliares de Emergência/psicologia , Apoio Social
4.
BMC Emerg Med ; 24(1): 96, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840088

RESUMO

BACKGROUND: The scope of emergency medical services (EMS) has expanded from the urgent care of emergency patients to on-call healthcare services provided in the field with a holistic view of the patient's wellbeing. This challenges EMS to find solutions to cover all demands, while simultaneously setting high skill requirements for EMS personnel. Understanding personnel is a critical element in developing functional and resistant EMS. The aim of this study was to investigate how Finnish EMS personnel emphasize the Emergency Medical Services Role Identity Scale aspects of caregiving, thrill-seeking, duty, and capacity; and if these role identities are associated with intention to leave the profession. METHODS: We conducted a cross-sectional survey (N = 616, 52% women, mean age 32.9 years). Data were collected through social media platforms and analyzed with means, standard deviations, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and binary logistic regression analyses. RESULTS: Our results indicate that capacity is the most emphasized aspect among EMS personnel, and at the same time, it increases intention to leave EMS. Capacity was followed by caregiving, with no association with intention to leave. Duty and thrill-seeking were the least emphasized and were negatively associated with intention to leave. Additionally, there were also other factors that were associated with emphasizing EMS-RIS aspect and intention to leave. CONCLUSION: Capacity stands out most strongly in analysis being at the core of the role identity of EMS personnel and was associated with a higher likelihood of leaving intentions. Several other factors were also associated with the intention to leave. Future studies should examine the exact dimensions of capacity that are considered important among EMS personnel and why factors such as work experience are associated with intentions to leave.


Assuntos
Auxiliares de Emergência , Humanos , Feminino , Masculino , Estudos Transversais , Adulto , Finlândia , Auxiliares de Emergência/psicologia , Reorganização de Recursos Humanos , Intenção , Inquéritos e Questionários , Pessoa de Meia-Idade , Serviços Médicos de Emergência , Papel Profissional
5.
Air Med J ; 43(4): 333-339, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38897697

RESUMO

OBJECTIVE: Emergency medical services (EMS) Code Lavender was developed to support EMS clinicians after stressful events via consistent recognition of events, informal peer support, and intentional acts of kindness. This study evaluated changes in burnout screening tool responses of EMS clinicians in response to program implementation and the coincidental start of coronavirus disease 2019. METHODS: Anonymous surveys with demographic questions and 2 burnout screening tools were distributed before program implementation (spring 2020) and 20 months later (fall 2021). Analysis included t-tests, Fisher exact tests, and multivariable linear regression. RESULTS: Seventy-seven preprogram (59% response rate) and 108 intraprogram (88% response rate) survey responses were included. No changes existed between preprogram and intraprogram responses across all subscale scores. Sex was associated with depersonalization subscale scores, with men having scores 1.53 (95% confidence interval [CI] 0.11-2.95) higher than women. Compared with emergency medical technicians, paramedics had higher compassion satisfaction (OR 3.50; 95% CI 1.79-5.70) and personal accomplishment scores (OR 2.40; 95% CI 1.08-3.71). Transport nurses had higher personal accomplishment (OR 3.29; 95% CI 1.18-5.40), depersonalization (OR 3.73; 95% CI 1.19-6.26), and rates of burnout symptoms (OR 0.54; 95% CI 0.09-0.98) than emergency medical technicians. CONCLUSION: The organizational commitment, peer support, and authentic leadership of EMS Code Lavender may attenuate work-related stressors among EMS clinicians.


Assuntos
Esgotamento Profissional , COVID-19 , Auxiliares de Emergência , Empatia , Humanos , Esgotamento Profissional/psicologia , Masculino , Feminino , Adulto , Auxiliares de Emergência/psicologia , COVID-19/psicologia , Inquéritos e Questionários , Grupo Associado , Pessoa de Meia-Idade , Serviços Médicos de Emergência , Satisfação no Emprego , Estresse Ocupacional/psicologia , Fadiga de Compaixão/psicologia
6.
Air Med J ; 43(4): 340-344, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38897698

RESUMO

OBJECTIVE: The objective of this study was to assess the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on the self-reported rates of posttraumatic stress disorder (PTSD) among emergency medical services (EMS) clinicians in urban and suburban settings that were one of the primary epicenters during the first wave of the COVID-19 pandemic. METHODS: Anonymous surveys containing the PTSD Checklist-Specific (PCL-S) were sent electronically between November 2020 and April 2021 to EMS clinicians working in 2 EMS agencies. A threshold score ≥ 36 was considered a positive screen for PTSD symptomology; a score ≥ 44 was considered a presumptive PTSD diagnosis. RESULTS: Of the 214 surveys sent, 107 responses were returned. The total PCL-S scores suggested PTSD symptoms were present in 33% of responding EMS clinicians (95% confidence interval [CI], 24.1%-42.5%), and 25% (95% CI, 17.6%-34.7%) met the criteria for a presumptive diagnosis of PTSD. Regression revealed increasing PCL-S scores were associated with thoughts of job resignation (+3.8; 95% CI, 1.1-6.4; P = .006), whereas lower PCL-S scores were related to the degree that respondents believed emotional support was available at their institution (-3.6; 95% CI, -6.8 to -0.4; P = .03). CONCLUSION: Sixth months after the first wave of the COVID-19 pandemic, one third of participating EMS clinicians screened positive for PTSD symptoms. Pandemic planning must address the mental health of EMS clinicians to reduce subsequent burnout and maintain a healthy workforce.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Masculino , Feminino , Adulto , Serviços Médicos de Emergência , Pessoa de Meia-Idade , Inquéritos e Questionários , Pandemias , New York/epidemiologia , Auxiliares de Emergência/psicologia , Programas de Rastreamento/métodos , SARS-CoV-2
7.
BMC Emerg Med ; 24(1): 106, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926678

RESUMO

BACKGROUND: Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers. METHODS: This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45-60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman's conventional content analysis approach. RESULTS: The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses. CONCLUSIONS: The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.


Assuntos
Pesquisa Qualitativa , Humanos , Irã (Geográfico) , Masculino , Feminino , Adulto , Serviços Médicos de Emergência , Entrevistas como Assunto , Estresse Ocupacional/terapia , Adaptação Psicológica , Auxiliares de Emergência/psicologia , Pessoa de Meia-Idade , Gestão de Riscos , Estresse Psicológico/terapia , Pessoal de Saúde/psicologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-38862391

RESUMO

PURPOSE: The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years' experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation. METHODS: A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed. RESULTS: The P&EMTs' most common tasks involved obtaining patients' medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection. CONCLUSION: Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.


Assuntos
Pessoal Técnico de Saúde , Competência Clínica , Avaliação Educacional , Auxiliares de Emergência , Humanos , Auxiliares de Emergência/educação , República da Coreia , Inquéritos e Questionários , Pessoal Técnico de Saúde/educação , Avaliação Educacional/métodos , Feminino , Masculino , Grupos Focais , Adulto , Serviços Médicos de Emergência , Reanimação Cardiopulmonar/educação , Comunicação , Paramédico
9.
BMC Emerg Med ; 24(1): 98, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858640

RESUMO

INTRODUCTION: This study aimed to investigate the work problems and challenges of male prehospital emergency technicians when faced with female medical emergencies. Given that qualitative research has not been done in this field, planning to find the weak points and improve the quality of prehospital emergency as the first line of treatment for female emergency patients, which is considered an important part of the health care system, is considered important and valuable. Therefore, this phenomenological study was conducted in 2023. METHODS: This study was conducted using a qualitative method of phenomenology in 2023. The environment of the research was urban and road prehospital emergency centers in Iran and the data were collected through interviews with EMS technicians. The collected data were analyzed using Smith's approach to explain the lived experiences of EMS technicians facing female emergencies or women's emergencies in Iran. RESULTS: All the 15 participants were men. Their mean age was 35 years, with a range of 25 to 45 years, and with a mean work experience of 10.54 years with a range of 4 to 20 years. The lived experiences of 115 emergency technicians in facing women's emergencies in Iran were placed in four main themes cultural-social factors, organizational factors, human resources-related factors, and administrative-legal factors. CONCLUSION: EMS personnel face various obstacles in carrying out missions related to women's emergencies, Considering the critical nature of women's emergencies, it is recommended that policymakers and clinical educators improve the level of community culture, communication skills, theoretical and practical training, respecting privacy, hiring female personnel, adding specialized equipment, amending and changing laws, removing road-traffic obstacles and to support personnel, patients and their families psychologically to optimize performance in women's emergencies.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Pesquisa Qualitativa , Humanos , Irã (Geográfico) , Adulto , Feminino , Auxiliares de Emergência/psicologia , Masculino , Pessoa de Meia-Idade , Serviços Médicos de Emergência/organização & administração , Entrevistas como Assunto , Emergências
10.
BMC Health Serv Res ; 24(1): 678, 2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38811956

RESUMO

BACKGROUND: Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases. METHODS: This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers. RESULTS: Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers. CONCLUSIONS: This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.


Assuntos
Pessoal Técnico de Saúde , COVID-19 , Pesquisa Qualitativa , SARS-CoV-2 , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Queensland/epidemiologia , Pessoal Técnico de Saúde/psicologia , Feminino , Masculino , Adulto , Entrevistas como Assunto , Pandemias/prevenção & controle , Atitude do Pessoal de Saúde , Equipamento de Proteção Individual/provisão & distribuição , Auxiliares de Emergência/psicologia , Liderança , Pessoa de Meia-Idade , Paramédico
11.
J Emerg Med ; 66(6): e680-e689, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38734546

RESUMO

BACKGROUND: The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet, the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement. OBJECTIVE: This systematic review aimed to explore paramedics' views and experiences of research as researchers during training and within practice. METHODS: A systematic search was performed across six databases. Qualitative empirical peer-reviewed articles that discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles identified initially, 11 were included in the final synthesis after quality appraisal. Data were extracted and subjected to narrative synthesis. RESULTS: The following four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes toward research, understanding of related concepts, and the drive for patient benefit were interwoven core issues. CONCLUSIONS: Research was highly valued when links to patient benefit were obvious, however, this review highlights some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently, there is inadequate organizational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited.


Assuntos
Pessoal Técnico de Saúde , Humanos , Pessoal Técnico de Saúde/psicologia , Atitude do Pessoal de Saúde , Auxiliares de Emergência/psicologia , Auxiliares de Emergência/educação , Motivação , Paramédico
12.
PLoS One ; 19(5): e0302524, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38753728

RESUMO

Acute behavioural disturbance (ABD), sometimes called 'excited delirium', is a medical emergency. In the UK, some patients presenting with ABD are managed by advanced paramedics (APs), however little is known about how APs make restraint decisions. The aim of this research is to explore the decisions made by APs when managing restraint in the context of ABD, in the UK pre-hospital ambulance setting. Seven semi-structured interviews were undertaken with APs. All participants were experienced APs with post-registration, post-graduate advanced practice education and qualifications. The resulting data were analysed using reflexive thematic analysis, informed by critical realism. We identified four interconnected themes from the interview data. Firstly, managing complexity and ambiguity in relation to identifying ABD patients and determining appropriate treatment plans. Secondly, feeling vulnerable to professional consequences from patients deteriorating whilst in the care of APs. Thirdly, negotiating with other professionals who have different roles and priorities. Finally, establishing primacy of care in relation to incidents which involve police officers and other professionals. A key influence was the need to characterise incidents as medical, as an enabler to establishing clinical leadership and decision-making control. APs focused on de-escalation techniques and sought to reduce physical restraint, intervening with pharmacological interventions if necessary to achieve this. The social relationships and interactions with patients and other professionals at the scene were key to success. Decisions are a source of anxiety, with fears of professional detriment accompanying poor patient outcomes. Our results indicate that APs would benefit from education and development specifically in relation to making ABD decisions, acknowledging the context of inter-professional relationships and the potential for competing and conflicting priorities. A focus on joint, high-fidelity training with the police may be a helpful intervention.


Assuntos
Ambulâncias , Tomada de Decisões , Serviços Médicos de Emergência , Pesquisa Qualitativa , Restrição Física , Humanos , Reino Unido , Masculino , Pessoal Técnico de Saúde/psicologia , Feminino , Auxiliares de Emergência/psicologia , Auxiliares de Emergência/educação , Adulto , Paramédico
13.
BMC Med Ethics ; 25(1): 58, 2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762457

RESUMO

BACKGROUND: Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. METHODS: We explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. RESULTS: We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. CONCLUSION: Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Grupos Focais , Confiança , Humanos , Serviços Médicos de Emergência/ética , Auxiliares de Emergência/ética , Feminino , Masculino , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisões/ética , Princípios Morais , Pessoa de Meia-Idade , Pessoal Técnico de Saúde/ética , Esgotamento Profissional/prevenção & controle
14.
BMC Emerg Med ; 24(1): 66, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38627662

RESUMO

PURPOSE: Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations. METHODS: 19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes. RESULTS: Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions. CONCLUSIONS: While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Humanos , Paramédico , Alberta , Pesquisa Qualitativa
15.
BMC Emerg Med ; 24(1): 69, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38649815

RESUMO

OBJECTIVE: This survey aims to comprehensively understand occupational burnout among pre-hospital emergency medical personnel and explore associated risk factors. METHODS: A cross-sectional online survey using a census method was conducted between 15 July, 2023, and ends on 14 August, 2023, in Chengdu, SiChuan province, China. The questionnaire included general demographic information, the Maslach Burnout Inventory-General Survey (MBI-GS) with 15 items, and the Fatigue Scale-14 (FS-14) with 14 items. Univariate analysis was conducted on all variables, followed by multivariate logistic regression models to examine the associations between occupational burnout and the risk factors. RESULTS: A total of 2,299 participants,99.57% completed the survey effectively The participants were from 166 medical institutions in Chengdu, comprising 1,420 nurses (61.50%) and 889 clinical doctors (38.50%). A total of 33.36% participants experienced burnout, predominantly mild (30.27%), followed by moderate (2.78%) and severe (0.3%). Physicians, higher fatigue scores, age, work experience appeared to be related to burnout. Logistic regression models revealed that individuals aged over 50 were less prone to experience burnout compared to medical staff aged 18-30 (OR: 0.269, 95% CI: 0.115-0.627, p = 0.002). Physicians were more prone to experience burnout compared to nursing staff (OR: 0.690, 95% CI: 0.531-0.898, p = 0.006). Those with 0-5 years of experience were more prone to experience burnout compared to those with 6-10 years or over 15 years of experience (OR: 0.734, 95% CI: 0.547-0.986, p = 0.040; OR: 0.559, 95% CI: 0.339-0.924, p = 0.023). Additionally, for each 1-point increase in the fatigue score, the likelihood of burnout in medical staff increased by 1.367 times (OR: 1.367, 95% CI: 1.323-1.412, p < 0.0001). CONCLUSION: Pre-hospital emergency medical personnel demonstrate a notable prevalence of mild job burnout. These results provide a groundwork for future focus on the various stages of job burnout within pre-hospital emergency staff, alerting hospital and departmental managers to promptly address the mental well-being of their personnel and intervene as needed.


Assuntos
Esgotamento Profissional , Humanos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Estudos Transversais , Masculino , Feminino , Adulto , China/epidemiologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Risco , Adulto Jovem , Auxiliares de Emergência/psicologia , Fadiga/epidemiologia , Médicos/psicologia , Adolescente , Modelos Logísticos
16.
BMC Emerg Med ; 24(1): 70, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38654181

RESUMO

BACKGROUND: Emergency Medical Services (EMS) staff often encounter various safety incidents. Work-related factors can lead to unsafe behaviors and safety incidents. This study assessed unsafe behaviors and their relationship with work-related factors among EMS staff. METHODS: This descriptive-correlational study used census sampling method to select 284 EMS staff in Ardabil Province, northwest of Iran, from April to June 2023. The data collection tools were demographic and occupational information form, Mearns Unsafe Behavior Scale, Cohen Perceived Stress Scale, Michielsen Fatigue Scale, and Patterson Teamwork Scale. The data were analyzed using the SPSSv-16, descriptive statistics, Pearson correlation, and multiple linear regression. RESULTS: The mean of unsafe behavior, fatigue, perceived stress, non-conflict of teamwork, and conflict of teamwork were 15.80 (± 4.77), 20.57 (± 6.20), 16.10 (± 6.13), 117.89 (± 17.24), and 40.60 (± 9.59), respectively. Multiple linear regression analysis showed that "partner trust and shared mental models (PTSMM)," "physical fatigue," "age," "type of shift," "employment status," and "overtime hours per month" were predictors of general unsafe behavior (P < 0.001) and "mild task conflict (MTC)," "employment status," "partner trust and shared mental models (PTSMM)" were predictors of unsafe behavior under incentives EMS staff (P < 0.001). CONCLUSION: The present study showed that some work-related factors were predictors of unsafe behaviors. The negative consequences of unsafe behaviors should be considered, and long-term planning should be done to reduce them. Developing specific guidelines for addressing unsafe behaviors, implementing measures to reduce fatigue, managing overtime hours in the workplace, and Establishing a system where novice staff work with experienced staff during their first year can be beneficial in reducing these behaviors among EMS staff.


Assuntos
Fadiga , Humanos , Estudos Transversais , Irã (Geográfico) , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Inquéritos e Questionários , Serviços Médicos de Emergência , Auxiliares de Emergência/psicologia
17.
BMC Emerg Med ; 24(1): 50, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561672

RESUMO

BACKGROUND: Community paramedicine (CP) is an extension of the traditional paramedic role, where paramedics provide non-acute care to patients in non-emergent conditions. Due to its success in reducing burden on hospital systems and improving patient outcomes, this type of paramedic role is being increasingly implemented within communities and health systems across Ontario. Previous literature has focused on the patient experience with CP programs, but there is lack of research on the paramedic perspective in this role. This paper aims to understand the perspectives and experiences, both positive and negative, of paramedics working in a CP program towards the community paramedic role. METHODS: An online survey was distributed through multiple communication channels (e.g. professional organizations, paramedic services, social media) and convenience sampling was used. Five open-ended questions asked paramedics about their perceptions and experiences with the CP role; the survey also collected demographic data. While the full survey was open to all paramedics, only those who had experience in a CP role were included in the current study. The data was qualitatively analyzed using a comparative thematic analysis. RESULTS: Data was collected from 79 respondents who had worked in a CP program. Three overarching themes, with multiple sub-themes, were identified. The first theme was that CP programs fill important gaps in the healthcare system. The second was that they provide paramedics with an opportunity for lateral career movement in a role where they can have deeper patient connections. The third was that CP has created a paradigm shift within paramedicine, extending the traditional scope of the practice. While paramedics largely reported positive experiences, there were some negative perceptions regarding the slower pace of work and the "soft skills" required in the role that vary from the traditional paramedic identity. CONCLUSIONS: CP programs utilize paramedic skills to fill a gap in the healthcare system, can improve paramedic mental health, and also provide a new pathway for paramedic careers. As a new role, there are some challenges that CP program planners should take into consideration, such as additional training needs and the varying perceptions of CP.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Humanos , Paramédico , Auxiliares de Emergência/educação , Projetos de Pesquisa , Inquéritos e Questionários , Pesquisa Qualitativa , Pessoal Técnico de Saúde/educação
18.
Z Evid Fortbild Qual Gesundhwes ; 187: 61-68, 2024 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-38653638

RESUMO

BACKGROUND: In order to evaluate whether the new rescue means "community emergency paramedics" (Gemeindenotfallsanitäter [G-NFS]) relieves the emergency medical service (EMS) in the care of low-priority emergencies, the perspective of general practitioners and patients was also surveyed in a written questionnaire as part of an innovation fund project. Recruitment for participation in the study proved to be difficult. The aim of this study is to evaluate why the G-NFS decided against providing information on study participation and what measures would be necessary to include more emergency patients in surveys in the future. METHODS: Retrospective analysis of the assignment protocols from April 1, 2021 to June 30, 2022. In addition to patient characteristics, data on treatments, interventions and recommendations to patients as well as reasons for non-participation in the patient survey were collected. RESULTS: 5,395 G-NFS protocols that contained information on non-participation were included in the analysis. The average age of the patients was 62.4 years (SD 22.7), and 50.2% were female. 57.4% of the cases were categorised as non-urgent, and 35.2% of the cases required an additional ambulance to be alerted. 404 (7.5%) patients used the EMS more than once, 1,120 (20.8%) did not have sufficient language skills, 1,012 (18.8%) patients declined study participation, and 2,975 (55.1%) patients were not able to participate according to the G-NFS assessment. Dementia/neurocognitive impairment (35%), acute/emergency situation (26.5%), mental health impairment (10.3%), and substance abuse (6.5%) were given as reasons for non-participation from the G-NFS perspective. DISCUSSION: The results show that more than half of the patients were unable to take part in a written survey for various reasons, even though there was no need for urgent care. This could be due to a high demand for care and the complex consent procedure. In addition, further resources are required to provide needs-based care for these patients in order to relieve the burden on emergency medical care. Over half of the patients were unable to take part in a written survey for various reasons. Further research is needed to determine what consent procedures are appropriate to facilitate patients' study participation.


Assuntos
Serviços Médicos de Emergência , Humanos , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Masculino , Idoso , Adulto , Alemanha , Idoso de 80 Anos ou mais , Inquéritos e Questionários , Auxiliares de Emergência , Paramédico
19.
Int J Occup Saf Ergon ; 30(2): 651-661, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38632949

RESUMO

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.


Assuntos
Estilo de Vida , Humanos , Feminino , Masculino , Adulto , Estudos Transversais , Suécia/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Ambulâncias/estatística & dados numéricos , Nível de Saúde , Inquéritos e Questionários , Serviços Médicos de Emergência/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Saúde Ocupacional , Auxiliares de Emergência/estatística & dados numéricos , Carga de Trabalho
20.
Am Heart J ; 271: 182-187, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38658076

RESUMO

In the Emergency Department, patients with suspected myocardial infarction can be risk stratified using the HEART pathway, which has recently been amended for prehospital use and modified for the incorporation of a high-sensitivity cardiac troponin test. In a prospective analysis, the performance of both HEART pathways in the prehospital setting, with a high-sensitivity cardiac troponin test using 3 different thresholds, was evaluated for major adverse cardiac events at 30 days. We found that both low-risk HEART pathways, when using the most conservative cardiac troponin thresholds, approached but did not reach accepted rule-out performance in the Emergency Department.


Assuntos
Serviços Médicos de Emergência , Infarto do Miocárdio , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/sangue , Serviços Médicos de Emergência/métodos , Estudos Prospectivos , Medição de Risco/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores/sangue , Serviço Hospitalar de Emergência , Pessoal Técnico de Saúde , Troponina/sangue , Auxiliares de Emergência , Paramédico
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