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The demographic makeup of fire departments, including firefighters and paramedics, often does not reflect communities. This thesis poses the following research question: What factors support and inhibit the recruitment and retention of African American firefighters and paramedics in the United States? The research relied on documented open-source information and data from fire and emergency medical service (EMS) departments in the United States. In examining issues affecting the recruitment and retention of African Americans in the profession, this study considers the history of the fire service and EMS, along with other internal and external factors that could support or inhibit the recruitment and retention of African Americans. The research offers several recommendations to remedy this issue, including mandating Courageous Conversations workshops, creating a diverse full-time recruiting team, developing pipeline partnerships, and changing hiring and training processes. Civilian, Memphis Fire Department Approved for public release. Distribution is unlimited.

The aim of this paper was a systematic review of quality improvement in paramedic care. Only very few reviews on some aspects of this have appeared so far. Hence a more comprehensive review including many aspects of paramedic care quality and its improvement was considered necessary. A Google Scholar search using the topic itself as the search term yielded 41 usable papers for this review. Both qualitative and quantitative papers were included to cover all possible aspects. The selected papers have been described under different sections. The papers on paramedic impact, roles, QI programmes and strategies, training and education and communication and collaboration were dominant. Much less research was observed on mobile enhanced healthcare, feedback to paramedics on their performance and research in developing countries. So, the recommendation is to increase research on these topics in future.

This scoping review will map the available research on the experiences of emergency prehospital practitioners who respond to and manage persons with self-harming or suicidal behaviors. It will report the experiences, perceptions and attitudes of pre-hospital emergency responders from allocation of incident through to when the responsibility for care is handed over or ends and document any strategies employed by them. It will determine the research undertaken, the methodologies used, the populations and sample sizes involved, any concepts or contexts described, and report the conclusions and areas for further research.

This scoping review aims to investigate the current state of evidence on the identification of potential organ donors in prehospital settings by healthcare professionals. The success of organ and tissue transplantation largely depends on timely identification, making it crucial for prehospital healthcare providers to identify potential donors in a time-sensitive context. However, the lack of guidance and evidence in this area can lead to missed opportunities for organ donation, ultimately exacerbating the organ scarcity problem and negatively impacting patients on transplant waiting lists. Therefore, this review will explore the ability of healthcare professionals to identify potential donors and any potential obstacles they may face in this process.

There is a knowledge gap regarding the use of the CFS in the prehospital emergency setting. The goal of this study is to assess the reliability of frailty assessment using the CFS and to identify factors associated with accurate CFS assessment.

Our work aims to map retracted publications associated with out-of-hospital care and paramedicine.

A scoping review aiming to summarise the present knowledge of paramedics' experiences regarding the decision to continue or terminate out-of-hospital resuscitation in the field.

The objective of this scoping review is to systematically scope the extent of published peer reviewed, and grey literature to identify how community paramedicine is supporting social needs along a health and social continuum, with a key focus on research implications and how this may inform future practice.

The aim of this scoping review is to determine how feedback is used in paramedicine

Objectives: While higher education institutions were looking for a solution to the problems with distance education, students' perceptions of distance education became a matter of curiosity. This study was conducted to evaluate the students' attitudes studying in the First and Emergency Aid Program towards distance education. Materials and Methods: The research was conducted with the students studying in the First and Emergency Aid Program in the spring semester of the 2019-2020 academic year. In this multicenter study, the "Attitude Scale towards Distance Education" was used. Results: Nine hundred forty-eight students who voluntarily participated in the study answered the questions comprehensively. It was determined that the attitude level of male students (26.4%) participating (m=92.00) was moderate, and the level of attitude of female students (73.6%) (m=81.00) was low (p, Amaç: Yükseköğretim kurumları uzaktan eğitimle ilgili sorunlara çözüm ararken, öğrencilerin uzaktan eğitime ilişkin algıları merak konusu olmuştur. Bu araştırma, İlk ve Acil Yardım Programında öğrenim gören öğrencilerin uzaktan eğitime yönelik tutumlarını değerlendirmek amacıyla yapılmıştır.Gereç ve Yöntem: Araştırma, 2019-2020 eğitim öğretim yılı bahar döneminde İlk ve Acil Yardım Programında öğrenim gören öğrencilerle yapılmıştır. Bu çok merkezli çalışmada “Uzaktan Eğitime Yönelik Tutum Ölçeği” kullanılmıştır.Bulgular: Araştırmaya gönüllü olarak katılan dokuz yüz kırk sekiz öğrenci soruları kapsamlı bir şekilde yanıtlamıştır. Araştırmaya katılan erkek öğrencilerin (%26.4) tutum düzeyinin (m=92.00) orta, kız öğrencilerin (%73.6) (m=81.00) tutum düzeyinin düşük (p

ZusammenfassungPatienten mit Schmerzen können durch den nichtärztlichen Rettungsdienst mitunter nur inadäquat versorgt werden, da aufgrund rechtlicher Einschränkungen die Anwendung stark wirksamer Schmerzmittel (Opioide) bzw. ausbildungsbedingt eine i.v.-Therapie in Deutschland und Österreich oft nicht möglich ist. Häufig müssen Notärzte für schmerzgeplagte Patienten nachgefordert werden, wodurch deren Verfügbarkeit für z. B. vitale Notfälle reduziert sein kann. Inhalativ zu verabreichende Analgetika könnten hierfür eine interessante Alternative darstellen.Derzeit steht dazu in Deutschland und Österreich Lachgas (N2O, als Livopan® im Handel) zur Verfügung, eine Mischung aus jeweils 50 % Lachgas und Sauerstoff. In Österreich ist seit 2018 auch Methoxyfluran (Penthrop®) zur Behandlung mäßiger bis starker Schmerzen nach einem Trauma für die prä- und innerklinische Anwendung bei Erwachsenen zugelassen.In der Zusammenschau der vorhandenen Literatur, jahrzehntelanger Erfahrung in der Anwendung der Sauerstoff-Lachgas-Mischung im angloamerikanischen Bereich und von inhalativem Methoxyfluran v. a. in Australien sowie aktuellen Studien aus Europa kann gefolgert werden, dass diese bei Einhaltung der Anwendungsvorschriften effektiv, sicher und nebenwirkungsarm sind. Dies bestätigt auch eine eigene Untersuchung zu Methoxyfluran im präklinischen Einsatz. Die Anwendung von Lachgas ist aufgrund des Druckgaszylinders von der Handhabung her etwas aufwendig; Methoxyfluran ist einfacher anzuwenden und bei starken Schmerzen auch wirksamer. Die Zulassung von Methoxyfluran ist jedoch auf Erwachsene beschränkt, wo es mit zunehmendem Alter deutlich besser wirkt. Der Einsatz von Lachgas und insbesondere Methoxyfluran könnte aufgrund der Datenlage wie auch eigener Erfahrungen für rettungsdienstliches Fachpersonal nach entsprechender Einweisung empfohlen werden.

Background: Paramedicine is a new profession in Thailand. The most important role is to provide pre-hospital advanced life support for emergency patients. So, they often need to assist the injured at crime scenes. However, many do not know their role or how to preserve the forensic evidence and crime scene. Currently in Thailand, their role in forensic evidence and crime scene preservation (FECSP) is unclear. Hence, the management of the evidence and the crime scene depends on individual knowledge and experience. Objectives: 1. To study the perceptions of roles and understanding of FECSP of Thai paramedics. 2. To study the problems, obstacles, and solutions for development of Thai paramedics FECSP practices. 3. To study the factors affecting the perceptions of roles and understanding of FECSP in Thai paramedics.Method: Thai paramedics data over the country registered with National Institute for Emergency Medicine (NIEMS) during 1st March – 31st March 2021 was collected in this cross-sectional survey. The questionnaires were sent as Google forms to them by e-mail. Results: 382 questionnaires were sent, and 281 responses (74%) were obtained. Most were female (61.9%). The average age was 26.09±4.44 years. The most common crime scene experienced was traffic accidents. Most had never had additional training related to forensic science. The perceptions of roles and understanding about FECSP were at the highest level. The most common problem and hindrance about FECSP was no FECSP law and the most common solution for improvement of the FECSP was the standard FECSP guideline development. Hospital level was found to be a factor related to the perceptions of roles of FECSP in Thai paramedics. Average score of a cohort who worked at university hospital was higher than those working at tertiary hospitals 0.220 (B = -0.220 , p-value = 0.018). Additionally, hospital level was also a factor concerning the understanding about FECSP of Thai paramedics. The average score of cohorts who worked at university hospitals was greater than those working in primary or secondary hospitals 0.197 (B = -0.197, p-value = 0.022). Conclusion: The paramedics had the perception of the roles and understanding about FECSP at the highest level. Hospital level was a significant factor related to the perception of the roles and understanding about FECSP. Relevant health institutes should develop standard guidelines and promote FECSP training.

Background: Exceptional demands have been placed on paramedics and other healthcare workers (HCWs) during the COVID-19 pandemic. An overwhelming outpouring of public support has unfolded, bringing into focus the relationship between paramedics, other HCWs and society, where they are portrayed as heroes. Scholars have studied the notion of heroism to society, and characteristics of such heroic status include: the voluntary nature of a heroic act, risk of physical or social harm, willingness to accept the consequences of action, acting for the benefit of others and without the expectation of gain. While some HCWs and paramedics may reflect these characteristics, many may not. Such heroic narratives can be damaging, stifling meaningful discussion around limits to duties, failing to acknowledge the importance of reciprocity and potentially imposing demands on paramedics and HCWs to be heroic.Aim: This article prospectively presents the protocol for a metasynthesis which aims to identify, appraise and synthesise the qualitative literature in order to develop theory on heroism and paramedic practice.Methods: Evolved grounded theory methodology is followed along with the procedural guidelines of Noblit and Hare (1988) to guide the analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) have also been adopted when preparing this protocol and will be followed in the study proper. The protocol has been registered with the International Prospective Register of Systematic Reviews PROSPERO 2021, registration number CRD42021234851.Results: We do not currently have results, but PRISMA guidelines will be followed when reporting our findings.Conclusion: Current narratives on heroism and paramedic practice are important in terms of the relationship between paramedics and society. The metasynthesis prospectively reported in this article serves as the first point in our journey of making sense of and developing theory on heroism and paramedic practice.

This rapid review will be analysing whether a sex-specific discrepancy exists in the administration of analgesia for pain, in patients presenting prehospitally to an ambulance service.

Amaç: Bu çalışma web tabanlı elektrokardiyografi (EKG) simülasyonu kullanımının paramedik öğrencilerinin ritim tanılama becerisi üzerindeki etkisi belirlemek amacıyla yapıldı.Yöntem: Araştırma, 02.05.2021-01.09.2021 tarihleri arasında tek gruplu ön test-son test desenli çalışma olarak yürütüldü. Araştırmanın çalışma grubunu Türkiye’de bir üniversitenin paramedik bölümünde son sınıfta öğrenim gören öğrenciler oluşturdu. Araştırmanın verileri bireyi tanıtıcı bilgi formu ve Temel EKG Ritimlerini Tanılama Formu kullanılarak yüz yüze toplandı. Katılımcılara 8 hafta boyunca haftada 3 saat olmak üzere online EKG eğitimi verildi. Eğitimi takiben bir ay sonra katılımcılara ön test uygulandı. Ön test sonrası katılımcılar bir web tabanlı EKG simülatörünü 4 hafta süresince kullandı. Dört hafta sonunda katılımcılara son test uygulandı. Bulgular: Öğrencilerin Temel EKG Ritimlerini Tanılama Formunda yer alan tüm ritimleri doğru tanılama oranlarının web tabanlı simülatör kullanımından sonra arttığı bulundu. Öğrencilerin ön test ve son test puanları arasında anlamlı düzeyde istatistiksel fark olduğu belirlendi (t:-7.476 p, Objective: This study was conducted to determine the effect of the use of web-based electrocardiography (ECG) simulation on paramedic students' rhythm diagnostic skills.Method: The study was conducted as a single-group pretest-posttest design study between 02.05.2021-01.09.2021. The study group of the research consisted of students studying in the last year in the paramedical department of a university in Turkey. The data of the study were collected person-to-person using the information form and the Basic ECG Rhythm Diagnosis Form. Participants were provided online ECG training for 3 hours per week over the course of 8 weeks. One month after the training, the participants were pre-tested. After the pretest, the participants used a web-based ECG simulator for 4 weeks. Posttest was applied to the participants at the end of four weeks.Results: It was found that the rate of correct diagnosis of all rhythms in the Diagnosis of Basic ECG Rhythms Form of the students increased after the use of a web-based simulator. It was determined that there was a significant statistical difference between the pre-test and post-test scores of the students (t:-7.476, p

Purpose: In the Covid pandemic, especially paramedics and paramedic students took part in the front stages, and their vital riskd increased by being exposed to high levels of contamination in this process. The risk they are in can affect the stress they experience and their behavior of coping with stress. The stress they experience may even lead to change of profession. The study was conducted to understand the perceived stress and coping behaviors of paramedic students and paramedics. Methods: An online survey of participants was conducted between July-December 2020 (n=390). Data was collected personal information form, Coping Response Inventory and Perceived Stress Scale were used. Descriptive statistics were used to statistical analysis. Findings: It is understood that they did not change their perspective on the profession after COVID. There is significant difference between the income levels and gender of the participants and the averages of both scales. There were a low level and significant relationship between the perceived stress and stress coping levels of the participants. Conclusions and Recommendations: The findings show that participants who do not intend to quit their profession generally have high perceived stress and low levels of coping with stress. Determining and supporting the perceived stress and coping levels of healthcare workers during the COVID period can affect their motivation to quit and work., Amaç: COVID pandemisinde özellikle paramedikler ve paramedik adayları ön safhalarda görev aldılar ve bu süreçte yüksek düzeyde kontaminasyona maruz kalarak hayati riskleri arttı. İçinde bulundukları risk yaşadıkları stresi ve stresle başa çıkma davranışlarını etkileyebilir. Araştırma, paramediklerin ve paramedik adaylarının algıladıkları stresi ve stresle başa çıkma davranışlarını belirlemek amacıyla yapılmıştır. Yöntem: Temmuz-Aralık 2020 (n=390) tarihleri arasında online anket uygulandı. Veri toplamada kişisel bilgi formu, Stresle Başa Çıkma Ölçeği ve Algılanan Stres Ölçeği kullanıldı. İstatiksel analizler için tanımlayıcı analizler kullanıldı. Bulgular: COVID sonrası mesleğe bakış açılarını değiştirmedikleri belirlenmiştir. Katılımcıların gelir düzeyleri ve cinsiyetleri ile her iki ölçeğin ortalamaları arasında önemli fark vardır. Katılımcıların algılanan stres ve stresle başa çıkma düzeyleri arasında düşük düzeyde ve anlamlı bir ilişki vardır. Sonuç ve Öneriler: Mesleğini bırakma niyetinde olmayan katılımcıların genel olarak algılanan stresinin yüksek ve stresle başa çıkma düzeylerinin düşük olduğu saptanmıştır. COVID döneminde sağlık çalışanlarının algıladıkları stresi ve stresle başa çıkma seviyelerini belirlemek ve desteklemek işi bırakma ve çalışma motivasyonlarını etkileyebilir.

This is a scoping review that will examine literature on disparities in EMS care delivery experienced by patients identifying as members of underrepresented racial, ethnic, gender, and/or sexual orientation groups in the United States.

The intention of this study is to identify the existing research on interprofessional telephone consultations carried out by paramedics and primary care physicians in the out-of-hospital setting, what this research shows and what gaps exist in the literature. The study will be conducted using the Joanna Briggs Institute (JBI) scoping review guidelines.

The objective of this scoping review is to explore the available literature in relation to the paramedicine, or emergency medical services (EMS), response in terms of role and scope to falls among older adults in the remote or rural settings.

This scoping review is conducted to review current literature covering out‐of‐hospital emergency medical services’ responses to COVID-19 to explore areas for improvement and research needs that should be considered for future OHEMS preparedness and response.

This project will be a scoping review related to workplace violence against paramedic personnel

This project describes the development, implementation, and evaluation of a novel, specialized pre-hospital COVID-19 High-Risk Response Team in Peel region, Ontario, Canada

A review to chart what work has already been undertaken within the field of pre-hospital emergency care in the UK.

We will conduct a scoping review of Irish pre-hospital research, using established scoping review methodology, and supplementing our database searches with hand-searching of identified sources within Ireland and consultation with researchers identified through the literature review and our existing professional networks.

The researcher will observe the written conversations, dialogue and opinion posts by paramedics working in primary care on online social spaces. These social spaces include Twitter, Facebook and Reddit. Content will be identified through searching these platforms for ‘paramedic’ and ‘primary care’. Across these three platforms, there are the options for public or private groups. Public groups on Facebook and Reddit social platforms will be ‘followed’. On Facebook, these groups are viewable by members of the platform, visitors to the group or participants within the group (Facebook, 2021a). On Reddit, subreddits are publicly available to visitors or members of the platform. Twitter offers users a public or protected profile (Twitter, 2021). Only post from public profiles will be used. On Facebook, private groups can be visible (searchable on the platform) or hidden (not searchable on the platform). Facebook Terms and Policies for Pages, Groups and Events applies to all groups on Facebook, where content posted is considered public (Facebook, 2021b). Where private-visible groups are found, the moderator will be contacted for permission to join the group as a visitor for the purposes of research. All Facebook groups have the option to have group rules to outline how members engage with the group. If any group (public or private-visible) have a group rule pertaining to privacy, such as ‘what’s shared in the group should stay in the group’ then this online social space will not be observed and the researcher will exit from the group even if access has been given by a moderator. This is because members will join this group and have discussions in this community based on the premise of this rule within the group, and their privacy will be respected. Postings on Twitter will be observed during the research period, using the hashtag ‘paramedic’ to find profession-specific content, and this will be manually reviewed to determine relevance to primary care. Information will be collected anonymously (there will be no record of the username or individuals behind the post). All of these social spaces (public or private-visible groups) include a high number of members who are strangers to each other. Members will not be made aware of the research, so reactivity to the researcher is minimised, and members can engage candidly with each other. This candidness is important to understand how members discuss their daily practices and highlight issues they face in their daily life that would merit further research, which will inform the next stage of the research. This research methodology is used commonly within the Oxford Internet Institute within the University of Oxford.

Background: Emergency ambulance staff have a strong desire to receive feedback but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback. Methods: This will be an observational mixed-methods study involving a baseline survey, diary entries and a follow-up survey. The emphasis of data collection is quantitative survey data, which is supported by qualitative open-ended survey items that will be integrated using triangulation. Data analysis will involve logistic regression (baseline survey), multilevel modelling (diary entries) and content analysis (qualitative data). The baseline survey includes questions on demographics, feedback frequency and the Feedback Environment Scale (Steelman et al., 2004). Participants will be asked to complete 10 diary entries for an event where feedback is received and 5 diary entries where feedback is desired but not received. Eligible participants will be NHS ambulance staff delivering face-to-face patient care. Power calculations suggest a sample size of n=325 participants. Results & Conclusion: The findings from this study will demonstrate how feedback characteristics, person and environment variables influence reported feedback effects in the prehospital setting, and highlight missed opportunities for feedback.

This protocol outlines a planned national cross-sectional survey to understand the roles and work of paramedics in primary care within the United Kingdom.

BackgroundThe 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?MethodsData were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis.ResultsThree 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.ConclusionThis 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.

Aim:This study aimed to determine and compare the knowledge level of senior year students studying the paramedic program at Dokuz Eylül (DEU), Ege (EU) and İzmir Katip Çelebi (İKÇU) universities on frequently used drugs and interventional procedures.Materials and Methods:This descriptive study was conducted with 167 students in first and emergency aid programs of three universities with DEU, EU and İKÇU in between March 30, 2019 and December 30, 2019. Descriptive findings were presented as percentage, mean, standard deviation, and median.Results:Of the participants, 52.1% were females and the remaining 47.9% were males. The most common issues for which the paramedic students felt incompetent were drug doses (58.6%) and interventional procedure complications (60.4%). The mean total score of the knowledge level of the paramedic students on drugs and administration methods was 54.724. The total mean total score of the knowledge level of interventional procedures in paramedic students was 65.653. There was no difference in the knowledge level on drugs and administration methods in terms of the different universities (p=0.470). However, a significant difference was found in the knowledge level on interventional procedures between the students studying at different universities (p=0.002). Advanced analysis revealed that the difference was due to İKÇU students (p

Background: This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. Methods: This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. Results: We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 +/- 0.79. The PCPs who experienced health problems (1.85 +/- 0.69), suffered from mental problems and received psychotherapy and medication (2.57 +/- 0.57), encountered COVID-19 patients (1.58 +/- 0.8), provided care for COVID-19 patients (1.59 +/- 0.79), and took polymerase chain reaction (PCR) tests (1.68 +/- 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 +/- 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). Conclusions: The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period. (c) 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Patients with COVID-19 who require aerosol-generating medical procedures (such as endotracheal intubation) are challenging for paramedic services. Although potentially lifesaving for patients, aerosolizing procedures carry an increased risk of infection for paramedics, owing to the resource limitations and complexities of the pre-hospital setting. In this paper, we describe the development, implementation, and evaluation of a novel pre-hospital COVID-19 High-Risk Response Team (HRRT) in Peel Region in Ontario, Canada. The mandate of the HRRT was to attend calls for patients likely to require aerosolizing procedures, with the twofold goal of mitigating against COVID-19 infections in the service while continuing to provide skilled resuscitative care to patients. Modelled after in-hospital ‘protected code blue’ teams, operationalizing the HRRT required several significant changes to standard paramedic practice, including the use of a three-person crew configuration, dedicated safety officer, call–response checklists, multiple redundant safety procedures, and enhanced personal protective equipment. Less than three weeks after the mandate was given, the HRRT was operational for a 12-week period during the first wave of COVID-19 in Ontario. HRRT members attended ~70% of calls requiring high risk procedures and were associated with improved quality of care indicators. No paramedics in the service contracted COVID-19 during the program.

PurposeThe study aimed to (1) determine on what bases paramedics in this context have defined themselves as feeling safe or at risk while serving on the front lines and (2) develop recommendations to support paramedics in their critical public health emergency response role.Design/methodology/approachThis qualitative study consisted of 21 semi-structured interviews with primary care paramedics (PCPs), advanced care paramedics (ACPs) and critical care paramedics (CCPs) with first-hand experience responding to the COVID-19 pandemic in Ontario. Qualitative research is best suited to the research objectives of gaining detailed and nuanced understandings of paramedics' experiences during this public health emergency, and identifying in paramedics' accounts what changes to policy and practice might strengthen their sense of safety in future infectious disease outbreaks (Bowling, 2002; Chafe, 2017). Data collection occurred over the course of 3.5 months, from June 2020 until September 2020.FindingsParticipants described several factors that heightened their feeling exposed to risk particular to working on the front lines of the COVID-19 public health response. These factors include stress connected to personal protective equipment (PPE) and equipment access, risks of infection to self and family, communications and feelings of being systematically under-considered. Recommendations from this research include, but are not limited to, ensuring a more equitable distribution of protective equipment to paramedics across unevenly funded services, and recognizing paramedics face unique and additional stressors in public health emergencies.Research limitations/implicationsA key limitation of this study was the relatively small sample, with 50% of potential participants deciding not to engage in an interview. The authors suspect this is likely a result of timing, as this was conducting during significant periods of the COVID-19 pandemic in Ontario. The study identifies and begins to shed light on the way in which feelings of compromised safety and specific stressors in a public health emergency context connect to one another and potentially increase risks of burnout for this healthcare provider group. This study's documentation of paramedics feeling uncertainty about their own and their family's safety, combined with feeling occupational pressure, decisional pressure within constrained frameworks of care delivery, a lack of autonomy and a lack of consideration within their healthcare system in general and within its pandemic response in particular, is important in and of itself. These stressors can have serious implications for the ability of paramedics to sustain their integral role in public health emergency response.Practical implicationsA series of pandemic-specific and generalizable recommendations emerged from this research and in collaboration with community-based medical leadership. (1) Consult paramedics on effectiveness of screening questions and equipment. Be sure to illicit and respond to paramedic feedback in a timely manner. (2) Implement operational changes during pandemics in the form of donning and doffing stations, disposable gowns, decontamination teams at hospitals, infectious disease paramedic (IDP) truck, anti-fog sprays for goggles, and safe and controlled areas for eating and taking breaks. (3) Develop an emergency pandemic plan that is resourced and maintained as part of EMS strategic planning. Involve EMS in decisions related to health system emergency planning and sustainability of EMS practice. (4) Establish equitable distribution of resources, such as ensuring PPE is distributed equitably and applying pandemic pay equally to all essential workers. (5) Validate and respect EMS, as they are essential workers. Recognize the expertise of paramedics and community healthcare providers. Finally, an overarching recommendation at the core of this research is the consideration for paramedic knowledge as expertise given their role as critical front line healthcare specialists and the protection of this crucial human resource as it relates to their resilience and mental wellbeing.Social implicationsEvidence-based awareness and improved understanding of paramedic stress during the pandemic is a first step to developing strategies to reduce that stress. This is essential in ensuring access to this essential service during emergencies and the safety of the communities they serve.Originality/valueFindings from this study can inform development of supports to sustain paramedic wellbeing during public health emergencies, during the ongoing pandemic, in Ontario and beyond.

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. Qualitative essay material was collected from a group of experienced advanced-level paramedics (n = 41). The material was analysed with inductive content analysis. 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. 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. [Abstract copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.]

Background Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it. Methods We conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie. Results There were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt, Conclusion Specialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.

Background The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it. Aim The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel. Method This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman’s conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. Results Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected. Conclusion If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, “hostility” will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.

Introduction This study explores the career intentions of undergraduate university paramedic students. Other like studies have been completed before paramedicine registration, and this is the first career intentions study to focus on the Queensland perspective. Methods Second year Queensland University of Technology (QUT) undergraduate paramedic students (n=182) were invited to participate. Ethics approval was gained and consent to participate was implied by the completion of a mixed methods questionnaire developed from the extant literature. Data were coded and analysed using Stata 15.1 and NVIVO 12. Results The response rate was 47.3% (n=86). Findings indicated 82.35% of participants intend to pursue paramedic employment after graduating. Queensland Ambulance Service is the preferred choice of employer (78.05%), however 67.07% intended to apply to multiple services for employment, 62.2% are considering private industry employment and 59.76% are contemplating overseas work. Intended paramedicine career length revealed 39.5% of participants plan to work for 20 years or more, 29% for 6–10 years and 18.4% for 11–15 years. Qualitative findings suggest students are concerned about employment opportunities, dislocation from support networks, and feeling unprepared to work in other paramedic jurisdictions. Furthermore, the employer's reputation, culture, internship program and career development opportunities impact on employment decisions. Conclusion The paramedic landscape in Australia appears to be changing. Although the majority of participants intend to work for jurisdictional ambulance services, students are exploring a range of employment opportunities. Understanding the career intentions of undergraduate paramedic students is essential for universities when preparing students for the transition to a globally evolving profession.

Posttraumatic stress disorder (PTSD) is reported to be more prevalent in ambulance clinicians than the general population. Given the high frequency of exposure to high stress and traumatic situations over the course of an ambulance clinician’s career, the current study examined the prevalence of posttraumatic stress (PTS) symptoms and the severity of distress related to these symptoms in this population. A total of 508 ambulance clinicians, including paramedics and technicians, completed the Life Events Checklist- Five and the Impact of Events Scale—Revised. Severity of distress associated with PTS symptoms was determined by using commonly used clinical cut-off scores. Nearly 50% of ambulance clinicians reported distress arising from symptoms of PTS of severity sufficient to be of clinical concern. Over 23% reported severe levels of distress. Results indicate concerning levels of distress relating to PTS within the ambulance service. Anchoring PTS to an index event and measuring duration of symptoms relative to that event is likely not accounting for the complex interaction of previous and further exposures on presentation. This may mask the extent of the impact of trauma exposure in populations with recurrent exposure to distressing situations.

Teleconsultation has become one of the most important and sometimes the only possible forms of communication between healthcare professionals (HCPs) and their patients during the COVID-19 pandemic. The perceptions and attitudes of HCPs to teleconsultations may affect the quality of the therapeutic process provided using them. Therefore, this study aimed to understand the attitudes to and perceptions of medical teleconsultation among various HCPs during the COVID-19 pandemic. We analyzed data from a dedicated questionnaire on preferences, attitudes, and opinions about teleconsultation, which was filled by 780 Polish HCPs. Most of the HCPs were doctors and nurses (69% and 19%, respectively); most of the doctors were family physicians (50.1%). During the pandemic, teleconsultation and face-to-face contact were reported as the preferred methods of providing medical services with similar frequency. Doctors and nurses displayed the most positive attitude toward teleconsultation while the paramedics and physiotherapists took the least positive view of it. The most frequently indicated ratio of the optimal number of teleconsultations to in-person visits in primary health facilities care was 20%:80%. Most HCPs appreciate the value of teleconsultation, and more than half of them are willing to continue this form of communication with the patient when necessary or desirable.

Key Points Question Does the use of an evidence-based, custom-designed, mobile app result in decreased rates of pediatric medication errors compared with conventional preparation methods in prehospital emergency care? Findings In this multicenter, simulation-based, randomized clinical trial including 150 advanced paramedics in 14 emergency medical services centers and 600 drug preparations, the proportion of medication errors committed during sequential preparation of 4 intravenous emergency drugs in prehospital settings was significantly decreased with the use of the app in absolute terms by 66.5%. Meaning Dedicated mobile apps have the potential to change practices in prehospital emergency medicine and to improve quality of care in pediatric populations by decreasing the rate of medication errors., Importance Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking. Objective To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. Design, Setting, and Participants This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). Intervention Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76). Main Outcomes and Measures The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus–based criteria. Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects. Results In total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%]; mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P, This randomized clinical trial compares the efficacy of conventional drug preparation methods with a custom-designed mobile app that assists emergency medical personnel in drug preparations during simulated out-of-hospital cardiac arrest resuscitation in children.

Objective This study sought to identify factors that influence emergency medical services (EMS) clinicians' destination decision-making for pediatric patients. We also sought EMS clinicians' opinions on potential systems improvements, such as protocol changes and the use of evidence-based transport guidelines. Methods Thirty-six in-depth phone interviews were conducted using a semi-structured format. We utilized a modified Grounded Theory approach to understand the complicated decision-making processes of EMS personnel. Memo writing was used throughout the data collection and analysis processes in order to identify emerging themes. The research team utilized hierarchical coding of interview transcripts to organize data into sub-categories for final analysis. Results EMS clinicians cited the perceived need for specialty care, the presence of a medical home, a desire for improved continuity of care, and the availability of aeromedical transport as factors that promoted transport to a pediatric specialty center. They voiced that children with emergent stabilization needs should be transported to the closest facility, however, they did not identify any specific medical conditions suitable for transport to non-specialty centers. EMS clinicians recommended improvements in pediatric-specific education, improved clarity of hospitals' pediatric capabilities, and the creation of a pediatric-specific destination decision-making tool. Conclusion This study describes specific factors that influence EMS clinicians' transport destination decision-making for pediatric patients. It also describes potential systems and educational improvements that may increase pediatric transport directly to definitive care. EMS clinicians are in support of specific designations for hospitals' pediatric capabilities and were in favor of the creation of a formal destination decision-making tool.

Background Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review. Methods A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas—countries within which the paramedic role within primary care is well established. Results Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source. Conclusions Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed.

Background There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance. Subject and methods The study was undertaken in the Riyadh region of Saudi Arabia. Potential participants were currently employed by Saudi Red Crescent EMS as either a technician, paramedic or an EMS station manager, and had a minimum of five years experience with the EMS. Semi-structured interviews were undertaken between October 2019 and July 2020 with first respondents to a call for participants, and continued until data saturation was reached. All interviews were conducted in Arabic and transcribed verbatim. The Arabic transcript was shared with each participant, and they were asked to confirm their agreement with the transcription. The transcribed interviews were then translated into English; the English versions were shared with bi-lingual participants for validation, while independent certification of the translations were performed for data from participants not fluent in English. A thematic analysis methodological approach was used to examine the data. Results The final sample involved 20 participants (10 rural, 10 urban) from Saudi Red Crescent EMS. Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing. Conclusion The findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, three changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes.Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS.Results: Of the 31 patients, the mean difference (prehospital mNIHSS—hospital mNIHSS) was 2.4, 95% limits of agreement (−5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26–0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38–0.82), respectively.Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.

Introduction Endobronchial intubation is a known complication of endotracheal intubation with significant associated morbidity and a reported incidence of up to 15%. In the out-of-hospital setting, paramedics must rely on bedside techniques to confirm appropriate endotracheal tube (ETT) depth. The present real-world practices of paramedics have not been described in this regard. Methods A multi-point survey was distributed to paramedics within the state of Pennsylvania. Participants were scored on the basis of their use of techniques to confirm ETT depth with the highest sensitivity to exclude endobronchial intubation. Results Four-hundred nine (409) responses from 111 emergency medical services (EMS) agencies were recorded. Participants were found to evaluate endotracheal tube depth via auscultation of bilateral breath sounds (91.7% of participants), visualization of the endotracheal tube as it advances 1-2 cm beyond the vocal cords (82.9%), observation of symmetrical chest rise (80.0%), and by securing the ETT at 21 and 23 cm at the incisors for women and men (18.6%). Experienced paramedics were more likely to use the 21/23 cm rule (p=0.039). Participants did not employ the cumulative use of these techniques (p < 0.001) as per a method that has been previously described to exclude endobronchial intubation with 100% sensitivity. Conclusion These data suggest that paramedics are not presently employing the most sensitive techniques to exclude endobronchial intubation. An educational initiative and protocol update may be beneficial.

The patient safety climate is a key element of quality in healthcare. It should be a priority in the healthcare systems of all countries in the world. The goal of patient safety programs is to prevent errors and reduce the potential harm to patients when using healthcare services. A safety climate is also necessary to ensure a safe working environment for healthcare professionals. The attitudes of healthcare workers toward patient safety in various aspects of work, organization and functioning of the ward are important elements of the organization’s safety culture. The aim of this study was to determine the perception of the patient safety climate by healthcare workers during the COVID-19 pandemic. Methods: The study was conducted in five European countries. The Safety Attitude Questionnaire (SAQ) short version was used for the study. A total of 1061 healthcare workers: physicians, nurses and paramedics, participated in this study. Results: All groups received the highest mean results on the stress recognition subscale (SR): nurses 98.77, paramedics 96.39 and physician 98.28. Nurses and physicians evaluated work conditions (WC) to be the lowest (47.19 and 44.99), while paramedics evaluated perceptions of management (PM) as the worst (46.44). Paramedics achieved statistically significantly lower scores compared to nurses and physicians in job satisfaction (JS), stress recognition (SR) and perception of management (PM) (p < 0.0001). Paramedics compared to nurses and physicians rank better in working conditions (WC) in relation to patient safety (16.21%). Most often, persons of lower seniority scored higher in all subscales (p = 0.001). In Poland, Spain, France, Turkey, and Greece, healthcare workers scored highest in stress recognition (SR). In Poland, Spain, France, and Turkey, they assessed working conditions (WC) as the worst, while in Greece, the perception of management (PM) had the lowest result. Conclusion: Participant perceptions about the patient safety climate were not at a particularly satisfactory level, and there is still a need for the development of patient safety culture in healthcare in Europe. Overall, positive working conditions, good management and effective teamwork can contribute to improving employees’ attitudes toward patient safety. This study was carried out during the COVID-19 pandemic and should be repeated after its completion, and comparative studies will allow for a more precise determination of the safety climate in the assessment of employees.

Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation.

IntroductionThis article aims to summarise and categorise the current types of frontline paramedics in Australia and New Zealand, their relative scopes of practice, their qualifications and training, and the titles used in each jurisdictional ambulance service. Methods Each of the 10 jurisdictional ambulance services were contacted and their current clinical roles discussed with a manager or senior paramedic between June and October 2020. Information was summarised in tables and text. ResultsMinimum qualifications for paramedics range from a diploma to an undergraduate degree, with graduate programs ranging from six to 18 months’ duration. Additional minimum qualifications for Extended Care Paramedics range from no minimum qualifications to a nursing degree. Additional minimum qualifications for Intensive Care Paramedics range from no minimum qualifications to a postgraduate diploma. Additional minimum qualifications for Retrievalists range from no minimum qualifications to a master degree. Helicopter emergency medical services (HEMS) teams range from primarily physician-led in four services to autonomous paramedics in five services. Armed offender paramedics exist in four services; urban search and rescue paramedics exist in five services; wilderness paramedics exist in five services; CBRNE paramedics exist in three services; mental health paramedics exist in three services. Special Operations variously refers to HEMS, USAR, CBRNE or armed offender. Critical Care variously refers to Intensive Care, HEMS in a physician-led team and autonomous HEMS. Advanced life support refers to paramedics and intensive care. Rescue Paramedic refers to road crash extrication or wilderness paramedics. Flight Paramedic refers to Paramedics or Intensive Care Paramedics, either HEMS or fixed wing. ConclusionThe jurisdictional ambulance services are heterogenous in the structure, qualifications, training and terminology for their frontline paramedic roles. Due to this lack of consistency, roles for paramedics in Australasia are currently largely incomparable between services, rendering shared titles inoperable from intranational and international perspectives.

Objectives: Overcrowding in emergency departments (EDs) is an international issue and ambulance bypass is seen as one element of the solution to a complex problem. Irish EDs are not immune to this healthcare crisis, which, together with increased off-load delays for ambulances, is one catalyst for the introduction of Treat and Referral (paramedic non-ED disposition decision). The confidence of consultants in emergency medicine in paramedics and advanced paramedics offering Treat and Referral to patients presenting with hypoglycaemia or seizure was explored. Other specific clinical presentations were also investigated for suitability for Treat and Referral and a consensus was sought on an upper age limit for such patients. Methods: Public-sector consultants in emergency medicine in Ireland at the time of the study, were invited to complete an online survey. A 62% response was received from the targeted population. Results: Confidence was expressed in advanced paramedics offering Treat and Referral to patients with hypoglycaemia or seizure by the majority (78%) of respondents. However, confidence was reduced for paramedics (53%). Six of the twelve specific clinical presentations received clear support as suitable for Treat and Referral, with the remaining receiving reducing support and ‘falls in the elderly (without injury)’ was opposed. There was no consensus on an upper age limit for patients being offered Treat and Referral. Conclusions: Support for the highest level of EMS practitioner in Ireland, advanced paramedic, to expand their scope of practice to include Treat and Referral was identified. Clinical presentations have been identified that would be conducive to a Treat and Referral clinical care pathway. A trial implementation period may be essential to build confidence in the programme before a universal roll out.

Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

Purpose This study aims to identify the relationship between alexithymia and empathy tendency in university students receiving health education. Design and methods This descriptive study was conducted with the volunteer participation of 376 students at a university located in the eastern part of Turkey between September and October 2019. Data were collected through the Sociodemographic Form, the Empathy Tendency Scale, and the Toronto Alexithymia Scale. Findings The Empathy Tendency Scale was found to be significantly higher in females, in those who lived alone, who did not experience a traumatic event when they were children, whose mother was alive, and who were not subject to violence. As to the Alexithymia Scale, mean scores were significantly higher in males, in those whose mother or father was illiterate, who had a monthly family income of less than 2000₺, who graduated from a Religious Vocational High School, and whose mother was not alive (P %3C .05). A negative, significant relationship was found between the Empathy Tendency Scale mean score and the Toronto Alexithymia Scale (P %3C .001). Practice implications A negative, significant relationship was found between empathy tendency and alexithymia. It is recommended that similar studies should be conducted in different regions as well.