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

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

EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care.

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

Background Increasing access to high-quality emergency and prehospital care is an important priority in low- and middle-income countries (LMICs). However, ensuring that emergency medical technicians (EMTs) maintain their clinical knowledge and proficiency with procedural skills is challenging, as continuing education requirements are still being introduced, and clinical instructional efforts need strengthening. We describe the development and implementation of an innovative asynchronous learning tool for EMTs in the form of a Web-based trivia game. Methods Over 500 case-based multiple-choice questions (covering 10 essential prehospital content areas) were created by experts in prehospital education, piloted with EMT educators from LMICs, and delivered to EMTs through a Web-based quiz game platform over a 12-week period. We enrolled 252 participants from nine countries. Results Thirty-two participants (12.7%) completed the entire 12-week game. Participants who completed the game were administered a survey with a 100% response rate. Ninety-three percent of participants used their mobile phone to access the game. Overall, participants reported that the interface was easy to use (93.8% agreed or strongly agreed), the game improved their knowledge (100% agreed or strongly agreed), and they felt better prepared for their jobs (100% agreed or strongly agreed). The primary motivators for participation were improving patient care (37.5%) and being recognized on the game's leaderboard (31.3%). All participants reported that they would engage in the game again (43.8% agreed and 56.3% strongly agreed) and would recommend the game to their colleagues (34.4% agreed and 65.6% strongly agreed). Conclusions In conclusion, a quiz game targeting EMT learners from LMICs was viewed as accessible and effective by participants. Future efforts should focus on increasing retention and trialing languages in addition to English.

Background: The geographic distribution and access to paramedic education programs is unclear but often cited as a reason for emergency medical services (EMS) workforce shortages. Our aims were: 1)...

This brief report introduces and provides a reflection on the interprofessional role of an annual cadaver laboratory experience in the paramedic program at Creighton University, United States. Similar experiences in paramedic education have been noted to be beneficial in increasing paramedic student’s knowledge of anatomy and ability to perform procedures. Learners that participated in this report and reflection reported gains in their education and appreciation of other professions that support previous research on the topic and the value of this distinct experience.

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

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

Introduction This article is a first-hand report on the experience of paramedic students providing emergency medical services (EMS) at Hajj, an annual mass gathering of Muslim pilgrims in Makkah, Saudi Arabia. Previous quantitative research on Hajj has primarily reported on demographic descriptive data. A qualitative approach to understanding Hajj was not discovered in the literature. This qualitative phenomenological study was conducted to investigate the experiences of EMS students providing patient care at Hajj. Methods This research was conducted using a qualitative phenomenological methodology. Focus group interviews were conducted on Bachelor degree students studying EMS at a public college in Riyadh, Saudi Arabia, who were all required to serve as support providers at Hajj as part of their paramedic training. Results Participants described their experiences as honorable and beneficial to their EMS education. Participants encountered medical and trauma patients and this provided opportunities to apply their EMS knowledge and medical skills. They reported an increase in motivation, confidence and ability to think critically. Common challenges included language barriers and difficulty reaching patients due to massive crowds. Participants provided recommendations for improving the EMS provided at Hajj, which were generally focused on increasing utilisation of EMS students, development of standards and scope of practice for EMS at Hajj and a preceptor-training program. Conclusion Attending the Hajj mass gathering was found to have significant educational value for EMS students. Specific recommendations on how to improve this education experience and provided emergency care at Hajj are made. These recommendations hold practical implications for EMS training programs and Hajj organizers.

Objectives: To report the characteristics of adult out-of-hospital arrest patients and their outcomes in Riyadh, Saudi Arabia. Methods: This is a prospective descriptive study of out-of-hospital adult arrests incident transported to King Khalid University Hospital, Riyadh, Saudi Arabia between July 2012 and September 2013. Results: A total of 96 adult patients were enrolled in this study. Males represented 62.5% of the participants. The mean age of the study population was 58.9 years, and specifically 30.8 years for traumatic arrests, and 62.9 for non-traumatic. An over-all mortality rate of 95.8% was documented, as well as a low rate of bystander cardiopulmonary resuscitation being performed, and a family member transported most patients to the hospital. Conclusion: A low survival rate for non-traumatic out-of-hospital adult arrest patients and a 100% mortality rate in traumatic arrests were discovered. Saudi Med J 2015; Vol. 36 (9): 1071-1075 doi: 10.15537/smj.2015.9.12081

This article discusses the profile of an Emergency Medical Services (EMS) leader that emerged from a larger study on how EMS leadership is learned from a multinational qualitative study of EMS providers working in Riyadh, Kingdom of Saudi Arabia. EMS is a team-oriented profession designed to respond to emergencies and disasters. Within EMS are leaders responsible for ensuring response capabilities, which has been plagued with criticisms and shortcomings. Different leadership styles have been applied to EMS but no one style is ideal for every situation or circumstance encountered by EMS leaders. The findings discovered that EMS leaders are found throughout an EMS system and need to understand the importance of their actions, have integrity and take responsibility. Among other characteristics and qualities, EMS leaders needed to be communicators who solve problems and lead by example, are fair and able to separate personal from professional.

Objective: To identify influences on learning for Saudi male students studying Emergency Medical Services at a college in Riyadh, Saudi Arabia. Previous research on influences on student learning in the Kingdom of Saudi Arabia focused on the historical development of education in Saudi Arabia, English language development, and intrinsic motivations of students and excluded a focus on students studying Emergency Medical Services. Methods: Exploratory sequential mixed-methods study was deployed. Results: Family support was an exceptionally strong predictor of student confidence in both skills and post-graduate EMS employment. Concepts involving application, memorization, motivation, and English language did not present as statically significant. The discovery of the strong influences that a family can have on Saudi EMS student’s confidence is noteworthy, as this was not previously discovered in the literature. Conclusion: This discovery holds practical implications for EMS education and training programs as emphasizes the importance of developing practical ways to include a student’s family as a source of support in ensuring student success and confidence.

ObjectivesThe purpose of this study was twofold: (1) establish the prevalence of safety threats and workplace violence (WPV) experienced by emergency medical technicians (EMTs) in a low/middle-income country with a new prehospital care system, India and (2) understand which EMTs are at particularly high risk for these experiences.SettingEMTs from four Indian states (Gujarat, Karnataka, Tamil Nadu and Telangana) were eligible to participate during the study period from July through November 2017.MethodsCross-sectional survey study.Participants386 practicing EMTs from four Indian states.ResultsThe overall prevalence of any WPV was 67.9% (95% CI 63.0% to 72.5%). The prevalence of physical assault was 58% (95% CI 52.5% to 63.4%) and verbal assault was 59.8% (95% CI 54.5% to 65%). Of physical assault victims, 21.7% were injured and 30.2% sought medical attention after the incident. Further, 57.3% (n=216) of respondents reported they were ‘somewhat worried’ and 28.4% (n=107) reported they were ‘very worried’ about their safety at work.ConclusionWPV and safety fears were found to be common among EMTs in India. Focused initiatives to counter WPV in countries developing prehospital care systems are necessary to build a healthy and sustainable prehospital healthcare workforce.

Background: Paramedic programs use formative assessments to determine cognitive competency. Understanding the number of failed formative units as a probability of passing the summative exam will allow programs to set additional benchmarks. The purpose of this study was to determine whether failure in formative exams determines success on a summative exam. Methods: Formative and summative scores from 2011 – 2016 for paramedic students with accounts in Fisdap™, an Internet-based administrative database, were retrospectively reviewed for the following criteria: provided consent for research, completed all six formative (unit) examinations, and completed a summative (comprehensive) examination. Analyses were performed with Pearson correlations and linear regression. Results: A total of 1,406 student records were included based on inclusion criteria. Correlation with each formative and the summative examination were all significant, p < 0.001: Cardiology 0.597; Airway 0.571; Medical 0.571; Trauma 0.566; Ob/Pediatrics 0.549; Operations 0.495. The cardiology exam was shown to have a moderate correlation on summative performance, whereas the operations exam had the weakest correlation. The number of formative examination failures was a significant predictor of the probability of passing the summative examination, t(1405) = –31.02, p < 0.001. Zero failed unit examinations yielded a 100% probability of passing. Three failed formative exams yielded a 60.4% probability. Four failed attempts yielded a 44.8% probability. Failure of all six formative exams yielded a 13.4% probability of passing the Paramedic Readiness Exam Version 3. Conclusion: Not all formative examinations hold the same predictive power on the probability of passing a summative examination. Each had their own correlation value. Students who did not fail formative examinations have a 100% likelihood of passing the summative examination.

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

ObjectiveThis study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia.MethodsA phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings.ResultsEmergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training.ConclusionEmergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.LeggioWJJr. The state of leadership education in Emergency Medical Services: a multi-national qualitative study. Prehosp Disaster Med. 2014;29(5):1-6.

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

Bernie Mayer, Ph.D., author of four books related to conflict engagement joined Bryan Hanson, Michael Miller, and William Leggio to discuss the relationship between a leader’s ability to transform complex environments and the leader’s capacity to engage constructively with conflict. Throughout the interview, Dr. Mayer shared concepts from his two most recent books, Staying with Conflict and The Conflict Paradox. Among the many important takeaways for current and aspiring leaders, Dr. Mayer emphasized the importance of: recognizing the enduring nature of conflict, the roots to the conflict that emerges within organizations, the influence cultural and power dynamics have on conflict, and the understanding that conflict is actually healthy for an organization.The video of this interview can be found at, https://www.youtube.com/watch?v=psxIoPRBx3Y

This article analyzes the need for Emergency Medical Services (EMS) educational programs and academicians to develop interdisciplinary educational and training opportunities with other healthcare disciplines. A literature review was conducted on EMS education and interdisciplinary approaches in healthcare education. In general, support for both didactic and simulated interdisciplinary education in healthcare is supported by positive impacts on student learning and improved patient outcomes. Support for interdisciplinary approaches in EMS education was constructed by applying research on interdisciplinary healthcare education to the identified criticisms of EMS education. A critical analysis of the literature allowed for recommendations to be made on the implementation of and further research for interdisciplinary approaches in EMS education. This article supports EMS students to be educated in a way that is reflective of a profession that must work collaboratively to provide out-of-hospital healthcare.

The role of a paramedic has primarily been to provide emergency care. This role is being rethought of with discussions of developing a community paramedic. The reach of this development and expanded scope of practice remained unknown. This article reviewed scholarly literature on the topic of community paramedics to present a critical analysis and triangulation of community oriented and community based education (CBE) to current paramedic education guidelines to identify shared objectives. The focus of paramedic education was identified to be on emergency assessment and intervention. Whereas, CBE was focused on assessing community needs to develop, implement and evaluate community intervention. A limited number of shared objectives were identified. The time spent on these shared objectives was unclear. Additional education will be required to cover the unshared objectives, and the profession must consider educational standards, requirements and how to increase inter professional collaboration within health systems, academic settings and within communities, which are core objectives of community-based providers. It must also be considered if the needs for community paramedics represent the pinnacle of current emergency medical services and time to evolve organizations, the profession and standards.