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Introduction: Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords.Methods: For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021–May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate.Results: A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s)(95% confidence interval [CI] 43.7–56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7–31.0). The median difference between actual and perceived time was 18 s (interquartile range 6–30). We calculated high time distortion as having a difference greater than 30 s between actual and perceived laryngoscopy time. None of the secondary variables had statistically significant associations with high time distortion. Overall, we show that the paramedic’s perception of total laryngoscopy time is significantly underestimated even when accounting for paramedic experience and perceived airway difficulty.Conclusion: This study suggests that time distortion may lead to an unrecognized prolonged procedure time. Limitations include use of a convenience sample, small sample size, and potential uncollected confounding variables.

Alcohol harms changed significantly during COVID-19, but did not affect the population equally. Vulnerable groups including people with pre-existing mental health or suicidal behaviors may be at greater risk of alcohol-related harms, yet limited public health data are able to assess these. The present study utilised a novel, statewide surveillance system to examine ambulance attendances for alcohol intoxication over a four-year period prior to, and during the strictest lockdowns in Victoria, Australia. While there was an overall reduction in alcohol-related attendances during lockdown (n = 15,064) compared to the 2018–19 period (n = 16,989), alcohol- intoxication attendances involving mental health symptoms increased by 40 % in Melbourne (IRR: 1.40 [1.30–1.51], p < 0.001), and by 25 % in regional Victoria (IRR: 1.25 [1.07–1.44], p = 0.005).There was also a 7 % increase in alcohol-intoxication attendances with co-morbid suicidal behaviors in Melbourne (IRR: 1.07 95%CI [1.02–1.13], p = 0.006), and a 21 % increase in regional Victoria (IRR: 1.21 [1.08–1.35], p = 0.001). These findings suggest that extra services and supports for individuals with co-morbid alcohol-related harms are required to ensure their clinical care needs are being met. • Alcohol consumption and harms increase following exposure to pandemics or disasters, including lockdown restrictions during COVID-19. • People with pre-existing mental health conditions are more vulnerable to alcohol-related harms. • Emergency services including ambulance were placed under increasing strain during lockdown restrictions. • We tracked comorbid alcohol-related harms involving mental health, suicide and self-harm before and during COVID-19. • While overall alcohol attendances decreased, there were significant increases where comorbid conditions were noted. [ABSTRACT FROM AUTHOR]

Background: In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce. Methods: A realist evaluation was undertaken, consisting of three independent but inter-related research studies: In WP1, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS. WP2 involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed to understand paramedics' perceptions of their role. WP3 utilised focused observations and interviews to delve into the impact of paramedics on the primary care workforce. This comparative study collected data from sixty participants across fifteen sites in the UK, and twelve participants across three sites in a specific region in Canada, where Community Paramedicine is well established. Results: The culmination of findings from each phase led to the development of a final programme theory, comprising of 50 context-mechanism-outcome configurations (CMOCs) encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care. Conclusions: Our realist evaluation used a mixed-method approach to present empirical evidence of the role of paramedics in primary care. It offers insights into factors relating to their deployment, employment, and how they fit within the wider primary care team. Based on the evidence generated, we produced a series of practice implementation recommendations and highlighted areas for further research. [ABSTRACT FROM AUTHOR]

Background: Electronic palliative care coordination systems (EPaCCS) can provide a solution to support paramedic staff. It is important to understand what needs to be in place to maximise benefits and avoid harms when providing end-of-life care (EoLC). Aims: To review the evidence of what is currently known about the challenges of paramedics delivering high quality EoLC, and the current use of EPaCCS. Methods: Narrative review of the literature, focusing on the views and opinions of ambulance emergency staff referring to palliative and EoLC and/or current use and views of EPaCCS. Findings: The authors included five qualitative studies, addressing three themes: lack of access to patient information; proposed electronic solution; content of electronic system. Conclusion: EPaCCS can support ambulance-based emergency staff with EoLC. Research is required to identify the format that information should take within the EPaCCS and the essential content needed to inform staff decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis. Method: The MCRS is an 11-item instrument with a Likert scale of 1–6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose "psychosis" as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition "psychosis" on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach's Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items. Results: The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach's Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale's total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations. Conclusion: The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff's regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues. [ABSTRACT FROM AUTHOR]

Introduction: Pre-alerts from paramedics to trauma centers are important for ensuring the highest quality of trauma care. Despite this, there is a paucity of data to support best practices in trauma pre-alert notifications. Within the trauma system of Ontario, Canada, the provincial critical care transport organization, Ornge, provides pre-alerts to major trauma centers, but standardization is currently lacking. This study examined the satisfaction of trauma team leaders' (TTLs) satisfaction with current trauma pre-alerts and their preferences for logistics, content, and structure. Methods: This was a quantitative survey of TTLs at adult and pediatric trauma centers across Ontario, Canada. Recruitment was through email to trauma directors, with follow-up efforts to target low-response sites to achieve good geographical representation. The survey was completed online and contained a combination of single or multiple-choice questions, Likert scales and free text options. Results: In total, 79 TTLs from adult and pediatric lead trauma centers across Ontario responded to the survey, which took place over a 120-day period. The survey achieved good geographical representation. Given the current processes, TTLs describe moderate satisfaction with room for improvement (median score 3, IQR 3–4 on a 5-point Likert scale). Their overall preference was for timely and direct communication, with some concerns about multiple channels of communication around logistics. Most TTLs agreed on the important and less important content details found in common standardized framework tools. For structure, 28/79 TTLs strongly preferred the cognitive aid ATMIST, 13/79 preferred IMIST-AMBO, and 8/79 preferred MIST or SBAR as the most useful. Conclusions: There is room for improvement through standardizing communication and streamlined pre-alert channels. Some disagreements exist between TTLs, particularly regarding logistics. Further research should examine TTL satisfaction after implementing the change in the pre-alert notification framework, which can address localized issues through stakeholder meetings with individual TTLs. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in low- and middle-income countries, complicating 1% to 10% of deliveries. Despite improvement in prevention and management, variations in PPH definitions and measurement methods contribute to challenges in accurately assessing its incidence, with up to 90% of PPH-related deaths in high-income countries deemed avoidable through timely intervention. Oxytocin is the primary drug administered during labour or miscarriage, causing an increase in uterine muscle tone, which reduces bleeding and the risk of complications. The aim of the study was to assess the rate of oxytocin use by paramedics for out-of-hospital births in Poland and to verify adherence to WHO-recommended protocols for preventing postpartum haemorrhage in emergency prehospital settings. Methods: We conducted a cross-sectional study using data from the Polish Central System for Emergency Medical Services Missions Monitoring covering all EMS interventions nationwide from 2018 to 2023. The study included cases where oxytocin was administered during EMS interventions for pregnant women, identified through ICD-10 codes (O30–O92), with 62 verified cases meeting the inclusion criteria. Results: Over 6 years, oxytocin was administered in 62 cases when paramedics responded to emergencies involving pregnant women. The mean age of the patients to whom the oxytocin was administered was 29.48 years (SD = 6.25) and ranged from 15 to 43 years. Conclusions: Oxytocin is rarely administered by EMS teams at the prehospital stage. Oxytocin should be considered for incorporation into the set of medications that EMS teams can administer in prehospital settings. There is a need to train EMS teams in the management of pregnancy-related emergencies in accordance with the current medical guidelines. [ABSTRACT FROM AUTHOR]

Background/Objectives: In acute stroke, often-prolonged hospital transport times present an opportunity for early interventions to salvage brain tissue. Remote ischemic conditioning (RIC), where brief cycles of ischemia–reperfusion in a limb are induced to protect the brain, is a promising treatment for this setting. We assessed the usability of a novel RIC system in a simulated emergency response scenario. Methods: Paramedics were asked to use the RIC device in an emergency stroke care and ambulance transport simulation, overseen by a confederate. Feedback on device use was collected through questionnaires, including the System Usability Scale (SUS) and the NASA Task Load Index (NASA-TLX), and a semi-structured interview. Questionnaire responses were summarized using descriptive statistics; interview transcripts were analyzed thematically. Results: Nine paramedics (including the confederate) participated, with a mean of 10.0 ± 10.3 years of professional experience. Questionnaire responses indicated high device usability (mean SUS score: 85.3 ± 12.9 out of 100) and low task-related demands, effort, and frustration (mean NASA-TLX domain scores: ≤3.9 out of 20). Seven paramedics stated they would use the device in daily practice. They expressed concerns related to display screen clarity, interference with standard procedures, cable management, device fragility, and patient discomfort. Suggested improvements included adding indicators of device performance and refining the cuff design. Conclusions: While the device was considered easy to use, paramedics also identified important areas of improvement. With a small, localized study sample, our findings are primarily applicable to the refinement of the RICovery system for use in future clinical trials in the same healthcare setting. However, feedback on the importance of mitigating potential interference of newly introduced procedures with those already established, robustness of equipment, and effective paramedic–patient communication may also help inform the design of other pre-hospital interventions. [ABSTRACT FROM AUTHOR]

Objective: To determine whether (i) low back loads and/or (ii) kinematic coordination patterns differed across theoretical expert, contextual expert and novice groups when completing both generic and occupation-specific lifts. Background: Experience has been proposed as a factor that could reduce biomechanical exposures in lifting, but the literature reports mixed effects. The inconsistent relationship between experience and exposures may be partially attributable to the broad classification of experience and experimental lifting protocols not replicating the environment where experience was gained. Methods: Purposive sampling was used to recruit 72 participants including theoretical experts (formal training on lifting mechanics), contextual experts (paramedics), and novices. Participants performed 10 barbell and crate (generic) lifts, as well as backboard and stretcher (occupation-specific) lifts while whole-body kinematics and ground reaction forces were collected. Peak low back compression and anteroposterior shear loads normalized to body mass, as well as kinematic coordination patterns, were calculated as dependent variables. Results: No significant differences in low back loads were observed across expertise groups. However, significant differences were seen in kinematic coordination patterns across expertise groups in occupation-specific lifts, but not in generic lifts. Conclusion: Increasing expertise is unlikely to minimize low back loads in lifting. However, contextual expertise did influence lifting kinematics, but only when performing occupationally specific lifts. Application: Contextual expertise may help lifters adopt lifting kinematics that enhance the tolerance of their musculoskeletal system to withstand applied loads, but does not seem to reduce the applied low back loads relative to noncontextual expert groups. [ABSTRACT FROM AUTHOR]

Background/Aims: Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics' involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases. Methods: This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations. Results: The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge. Conclusions: Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area. Implications for practice: When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Paramedics comprise a collective of professionals who perform crucial interventions in emergency medical scenarios and thus operate under high levels of stress. This study investigates the stress-inducing factors that paramedics face in their careers and explores the potential use of music as a coping technique for this stress. The study involved analyzing data collected from 19 paramedics in Kahramanmaraş through unstructured observation and semi-constructed interviews. The Maxqa24 qualitative data analysis program was used to interpret the data. The investigation yields findings encompassing themes such as work experiences and problems, musical tastes, and social interaction. The results indicated that paramedics experienced stress due to reasons such as inadequate staffing, insufficient education, excessive workload, extended working hours, and a lack of sufficient understanding and respect from the community. Paramedics have universally acknowledged music as an efficacious instrument for managing stress. The study highlights the significance of cultivating stress management techniques for paramedics in order to enhance their quality of life. These strategies should guarantee comprehensive support for health workers at the individual, organizational, and social levels. Their objective is to enhance the outcomes for both health workers and patients by implementing measures such as education, motivation, and appreciation. [ABSTRACT FROM AUTHOR]

Paramedics play a pivotal role in delivering emergency medical care, contributing to excellence in the prehospital environment and ensuring a seamless continuum of healthcare. Achieving this objective is subject to various factors. This review aims to explore, the relationship between paramedic personality profiles and key factors including stress, burnout and employment retention or attrition. The JBI approach was used to perform a scoping review. Key words including paramedic* , ambulance* , personalit* , retention OR attrition and burnout OR stress were inserted into the search engines OVID, CINAHL Plus, Scopus, Web of Science Core Collection, Psychology ProQuest, and Nursing ProQuest. Titles and abstracts of 226 results were screened and inclusion and exclusion criteria applied. Full texts of the remaining 18 results were screened to inform the results. Three themes emerged relevant to the objective including the correlation of neuroticism with stress and burnout, personality types and mental illness with the ability to cope during stressful situations and finally resilience and burnout with the intention to quit. Further research should be completed into specific personality characteristics, including neuroticism, perfectionism, and excitability to facilitate the development of strategies aimed at improving the health and wellbeing of paramedics and EMT workers internationally. [ABSTRACT FROM AUTHOR]

Introduction: Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at the point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive are the barriers and facilitators to the use of patient care pathways (PCPs) in NI. Methods: In this single-centre qualitative study, participants were recruited using volunteer sampling. Data were collected through 11 semi-structured interviews until data saturation was reached. Online interviews were recorded, transcribed verbatim and thematically analysed. Results: Five main themes were constructed during analysis. The participants discussed their perceptions of the barriers and facilitators to utilising PCPs in relation to risk, cultural issues, person-centred practice, inter-professional communication and operational infrastructure. Conclusion: The study provides insight into perceived barriers and facilitators to the use of PCPs, while indicating the existence of a paramedic workforce dedicated to achieving the best outcomes for people in their care. The themes identified are consistent with existing literature that calls for standardised pathways across regions. Future research should investigate the link between the NHS 111 service and ambulance demand. In order to facilitate the complex decision making involved in referrals, relevant knowledge and skills should be embedded in paramedic education. Efforts should be made to improve inter-professional communication and awareness of the paramedic scope of practice and knowledge base. An intervention designed to reassure staff who have concerns regarding clinical risk may improve referral rates. [ABSTRACT FROM AUTHOR]

Introduction: UK ambulance services employ diverse models of care, resulting in 40-60% emergency department (ED) conveyance rates. Head injury conveyance rates for older adults (60 years and over) remain high (60-70%), despite most being mild. This research aimed to explore ambulance clinicians' perceptions, experiences and decision-making processes when assessing older adults with head injuries, considering the various factors influencing their clinical decisions. Methods: This study used a mixed-methods sequential explanatory design comprising an online survey and one-to-one interviews with patient-facing ambulance clinicians in the UK. The survey, distributed through nine ambulance services and via social media, gathered data about clinicians' experiences, confidence levels and perceptions when assessing older adults with head injuries. It focused on exposure frequency, confidence in assessing asymptomatic patients, perceived risks of medications and confidence in available decision tools. The subsequent interviews delved deeper into the survey responses. Results: A total of 385 participants were recruited, predominantly male paramedics (61%), with a median age of 35 years and a median of eight years of ambulance service experience. Participants reported frequent encounters with older adults with head injuries, and expressed high confidence in assessing visible injuries but lower confidence in conducting neurological examinations. Participants found NICE and JRCALC guidelines satisfactory, and reported confidence in conveying patients to the ED but less confidence in alternative referrals or discharges. The interviews revealed two overarching themes: guideline-based care and patient-centred care, with sub-themes emphasising the importance of shared decision making, collaboration with other healthcare professionals and safety-netting strategies. Conclusion: Although clinicians express confidence in using clinical guidelines for ED conveyances, they often find such guidance overly prescriptive and struggle to translate them for individual cases. There is a need for more patient-centred, holistic decision making, especially considering the unique aspects of head injuries in older adults. Challenges include fear of poor outcomes, limited feedback on patient outcomes and low confidence in making referral or discharge decisions. Specific guidelines tailored to this demographic, as well as improved support services, may aid in reducing unnecessary ED conveyances. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac arrest patients presenting with non-shockable rhythms have a low probability of survival, and epinephrine is one of the few pharmaceutical options for this group. The recommended 1.0 mg adult dose is extrapolated from early animal studies and lacks adjustment for patient weight. Although several prior studies have investigated "low-" and "high-" dose epinephrine, none have identified a benefit to either strategy. Aims: To identify an optimal weight-based epinephrine dose for return-of-spontaneous-circulation (ROSC) after a single bolus among patients with low likelihood of survival. Methods: Included were adult patients who experienced a witnessed, non-traumatic out-of-hospital cardiac arrest prior to EMS arrival. Patients with shockable presenting rhythms or receiving bystander CPR were excluded. The AUROC was used to assess the predictive value of epinephrine dose (mg/kg) for ROSC following a single bolus. From the ROC curve, the optimal threshold dosage (OTD) was determined using the Youden Index. A logistic regression model calculated the adjusted odds ratio of OTD on ROSC. Results: A total of 2,463 patients met inclusion criteria, of which 190 (7.7%) attained ROSC after the first epinephrine administration. The dosage AUROC for ROSC was 0.603 (p < 0.01). As calculated by the Youden index, the OTD was 0.013 mg/kg. Patients receiving ≥ OTD were more likely to attain ROSC after a single epinephrine bolus (OR = 2.25,p < 0.001). Conclusions: Among patients with a low likelihood of survival, the optimal dose of epinephrine for attaining ROSC with a single bolus of epinephrine was 0.013 mg/kg. These findings should inspire further investigation into optimal dosing strategies for epinephrine. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the extent to which non-physician healthcare personnel recognize life-threatening rhythms in Electrocardiography (ECG), and to identify the importance of professional experience or in-service training in recognizing life-threatening rhythms. Material and Methods: This descriptive study was designed to measure the ECG knowledge levels of healthcare personnel. It was completed with a total of 532 non-physician healthcare personnel including Paramedics, Emergency Medical Technicians (EMTs), nurses working in intensive care units, and inpatient clinics in Hatay province, Turkey. An 18-question survey form was used as the data collection tool in the research. Seven of the questions were related to participants' age, workplace, duration of employment, in-service training, etc., while eleven were related to ECG rhythms. Results: A total of 532 healthcare workers participated in the study, with the majority falling in the age range of 20-25 years (41.9%).Nurses comprised the largest group among the participants (37.4%). The majority of participants (75%) had been employed for 8 years or more, yet 66.9% had not attended any ECG courses during their employment, and 34% had received formal ECG training as part of their undergraduate or in-service education for five years or more. Among the units where participants worked, it was observed that 49.9% of the respondents were emergency department workers, where ECG applications were very frequent. Conclusion: According to the findings of the study, nurses were the group that answered the most questions, and the most frequently answered question incorrectly was about AF and ANT MI. It is suggested that ECG courses be added as compulsory subjects to the nursing and paramedic-EMT training curriculum, accompanied by laboratory and simulation practices.

Abstract Introduction Pre-alerts from paramedics to trauma centers are important for ensuring the highest quality of trauma care. Despite this, there is a paucity of data to support best practices in trauma pre-alert notifications. Within the trauma system of Ontario, Canada, the provincial critical care transport organization, Ornge, provides pre-alerts to major trauma centers, but standardization is currently lacking. This study examined the satisfaction of trauma team leaders’ (TTLs) satisfaction with current trauma pre-alerts and their preferences for logistics, content, and structure. Methods This was a quantitative survey of TTLs at adult and pediatric trauma centers across Ontario, Canada. Recruitment was through email to trauma directors, with follow-up efforts to target low-response sites to achieve good geographical representation. The survey was completed online and contained a combination of single or multiple-choice questions, Likert scales and free text options. Results In total, 79 TTLs from adult and pediatric lead trauma centers across Ontario responded to the survey, which took place over a 120-day period. The survey achieved good geographical representation. Given the current processes, TTLs describe moderate satisfaction with room for improvement (median score 3, IQR 3–4 on a 5-point Likert scale). Their overall preference was for timely and direct communication, with some concerns about multiple channels of communication around logistics. Most TTLs agreed on the important and less important content details found in common standardized framework tools. For structure, 28/79 TTLs strongly preferred the cognitive aid ATMIST, 13/79 preferred IMIST-AMBO, and 8/79 preferred MIST or SBAR as the most useful. Conclusions There is room for improvement through standardizing communication and streamlined pre-alert channels. Some disagreements exist between TTLs, particularly regarding logistics. Further research should examine TTL satisfaction after implementing the change in the pre-alert notification framework, which can address localized issues through stakeholder meetings with individual TTLs.

Abstract Introduction Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis. Method The MCRS is an 11-item instrument with a Likert scale of 1–6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose “psychosis” as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition “psychosis” on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach’s Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items. Results The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach’s Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale’s total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations. Conclusion The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff’s regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues.

Abstract Background Mental health presentations account for a considerable proportion of paramedic workload; however, the decision-making involved in managing these cases is poorly understood. This study aimed to explore how paramedics perceive their clinical decision-making when managing mental health presentations. Methods A qualitative descriptive study design was employed. Overall, 73 paramedics participated in semi structured interviews, and data were analyzed from transcribed interviews in NVivo. Results Four themes emerged that reflected participants’ perceptions: the assessment process, experience, the use of documents and standard procedures, and consultation with other healthcare providers. There were conflicting perceptions about the clinical decision-making process, with perception of role having a potential impact. The dual process theory of clinical decision-making, which includes both analytical and intuitive approaches, was evident in the decision-making process. Conclusion Incorporating dual process theory into education and training, which highlights the strengths and weaknesses of analytical and intuitive decision-making, may reduce clinical errors made by cognitive bias. To further support clinical decision-making, additional education and training are warranted to promote critical thinking and clarify the scope of practice and roles when attending to mental health-related presentations.

Abstract Background The prevalence of mental and behavioural illnesses in the Australian community is increasing. Paramedics are frequently the first health responders to a mental health crisis, and their workload associated with mental health presentations is also increasing. The present study explored the experience and perspectives of undergraduate paramedic students who participated in a pilot mental health placement. Methods A pilot workplace learning opportunity was established in which students completed a portion of their community service hours in an inpatient mental health setting at Port Macquarie Base Hospital. Eight students attended and completed the placement and were administered the Clinical Placement Evaluation Questionnaire. Results Student responses to this placement experience were overwhelmingly positive. The data showed that all the students responded “Strongly Agree” or “Agree” to each of the survey items. Thematic analysis of the qualitative data yielded four central themes related to benefits, additional training and education, nursing staff, and improvements. Conclusions This pilot study suggests that mental health placements for paramedics have meaningful educational value and can impact student learning. Since this pilot study, mental health placements have been permanently included as part of the undergraduate curriculum in our institution.

INTRODUCTION: Over 70,000 cases of Proximal Femoral Fracture (PFF) occur annually in the United Kingdom (UK), primarily affecting the elderly. These injuries are associated with high morbidity and mortality, and often see inadequate pain management in the prehospital setting. The Fascia Iliaca Compartment Block (FICB), a regional anaesthesia technique, is the gold standard of care in Emergency Departments (ED). This review aims to assess the literature on paramedic-performed FICB for suspected PFF in the prehospital setting, highlighting benefits and challenges to guide future practice and policy in the ambulance sector. MATERIALS AND METHODS: A rapid scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with modifications for this project’s limitations. A systematic search of the databases CINHAL, PubMed, EMBASE, and Medline was performed. A synthesis matrix was created to extrapolate data from the included studies and allow for a coherent interpretation of results. Each included study was subject to a critical appraisal conducted using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Data was extracted from three studies and two reports which identified four key themes emerged: paramedic competency in performing FICB, patient perspectives, adverse events, and training and governance. Studies showed paramedics can competently perform FICBs in prehospital settings. Verbal pain scores were lower following an FICB compared to standard care with IV morphine, which required more supplementary morphine for break-out pain. Concern for causing harm was a consistent theme among the paramedics performing FICB, particularly in precipitating an adverse event sequela. Adverse events were more common in non-FICB groups, with only one case of local anaesthetic toxicity in the FICB group, which was correctly managed by the paramedic. CONCLUSIONS: Paramedics can competently perform FICB in the prehospital setting, showing promising results in pain relief compared to intravenous morphine. However, higher-level research is needed for confirmation. Patients generally tolerated paramedic-led FICB well, with minimal concerns. Training and governance remain significant barriers to implementing FICB in local ambulance services.

Background: Mental health presentations account for a considerable proportion of paramedic workload; however, the decision-making involved in managing these cases is poorly understood. This study aimed to explore how paramedics perceive their clinical decision-making when managing mental health presentations. Methods: A qualitative descriptive study design was employed. Overall, 73 paramedics participated in semi structured interviews, and data were analyzed from transcribed interviews in NVivo. Results: Four themes emerged that reflected participants' perceptions: the assessment process, experience, the use of documents and standard procedures, and consultation with other healthcare providers. There were conflicting perceptions about the clinical decision-making process, with perception of role having a potential impact. The dual process theory of clinical decision-making, which includes both analytical and intuitive approaches, was evident in the decision-making process. Conclusion: Incorporating dual process theory into education and training, which highlights the strengths and weaknesses of analytical and intuitive decision-making, may reduce clinical errors made by cognitive bias. To further support clinical decision-making, additional education and training are warranted to promote critical thinking and clarify the scope of practice and roles when attending to mental health-related presentations. [ABSTRACT FROM AUTHOR]

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In UK helicopter emergency medical services (HEMS), 20% of doctors and 24% of paramedics are women, yet women make up 49% of all doctors and 44% of all paramedics. One hundred and forty clinicians recruited through social media undertook an anonymous online qualitative survey exploring potential barriers and enablers, particularly for women, to following a career pathway into HEMS. Perceived barriers included: toxic, alpha, macho, boys' club HEMS cultures; bullying; discrimination; recruitment issues involving biases, fitness tests and degree of competition; HEMS communications depicting elitism and a lack of diversity; and poor work-life balance. Women feared skill fade and both women and men reported that exposure to traumatic incidents deterred them. Perceived enablers included: paid, rostered time to study and attend charity events; supportive or forgiving families; a lack of care commitments; and employers offering flexible working/contracts for less than full-time hours. This research may provide the opportunity for organisations to review diversity within their teams. A recommendations document has been produced that may help to close the gender gap within HEMS. [ABSTRACT FROM AUTHOR]

Burnout among the paramedic profession is an increasing problem and not enough is being done to improve the current climate. It is for this reason that paramedics should individually contribute to the reduction of this issue by developing their own leadership characteristics, such as emotional intelligence, social intelligence, and stress and conflict management. Evidence suggests that these qualities and behaviours reduce the possibility of being subject to burnout symptomology. Implementing positive stress and conflict-management strategies will create a healthcare environment, which will be more enjoyable to work in. Emotional and social intelligence increase the resilience of prehospital clinicians who are subject to occupational challenges on a daily basis. Wider influences such as ambulance trusts, health services and governing bodies have implemented strategies to tackle this issue but clinicians can lead the change from the front line. [ABSTRACT FROM AUTHOR]

Objective: Out‐of‐hospital seizures demand rapid management. Midazolam plays a key role in stopping seizures. At times the first dose of midazolam proves insufficient, necessitating additional doses. Within the New South Wales Ambulance (NSWA) service, the upper limit for midazolam administration is set at 15 mg. However, the outcomes and safety of using midazolam at this maximum dosage have not been thoroughly investigated. Methods: A retrospective analysis of out of hospital electronic health records from New South Wales, Australia, over the year 2022, was conducted. The study manually reviewed cases where adult patients received the maximum dose of midazolam for seizure management by paramedics. It focused on seizure cessation success rates and the incidence of adverse effects to evaluate the clinical implications of high‐dose midazolam administration. Results: Of 818 790 individual attendances by NSWA clinicians, a total of 11 392 (1.4%) adults had seizures noted, of which midazolam was administered in 2565 (22.5%). An algorithm shows that in 2352 (91.7%) instances the midazolam was associated with the apparent termination of seizures. Analysis revealed that 176 (1.5%) proportion of all adult's seizure patients required the maximum dose of midazolam for seizure control. These higher doses successfully terminate seizures in about half of the instances. AEs following the maximum dose of midazolam included hypoxia in 26.7% of patients and respiratory depression in 9.7%, indicating significant side effects at higher dosages. Conclusion: In New South Wales, Australia, administering the maximum dose of midazolam to seizure patients is rare but proves effective in approximately half of the refractory seizure cases. Therefore, assessing the potential for additional doses of midazolam or the use of a second‐line agent is advisable. [ABSTRACT FROM AUTHOR]

Background: Since the COVID-19 pandemic and the introduction of the National Partnership Agreement: Right Care, Right Person in the UK, paramedics spend about 1.8 million hours per year managing people with mental health issues. The UK health service needs to address the urgent training requirements for paramedics to provide mental healthcare in emergency care provision. Aims: To identify and examine current research on how paramedics manage people with mental health issues. Methods: A scoping review was carried out using the five stages of Arksey and O'Malley's framework. A research question—'How do paramedics manage patients with mental health issues?'—was developed, databases searched, studies identified and data charted, summarised and reported. Findings: Fifteen papers were included, and five themes identified: perceptions and expectations; call triage and inter-service collaboration; communication skills; lack of education and training; and assessment and evidence-based interventions. Conclusions: There is global evidence of the deficiencies in paramedic education around mental health presentation and a need for evidence-based education and interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of mental and behavioural illnesses in the Australian community is increasing. Paramedics are frequently the first health responders to a mental health crisis, and their workload associated with mental health presentations is also increasing. The present study explored the experience and perspectives of undergraduate paramedic students who participated in a pilot mental health placement. Methods: A pilot workplace learning opportunity was established in which students completed a portion of their community service hours in an inpatient mental health setting at Port Macquarie Base Hospital. Eight students attended and completed the placement and were administered the Clinical Placement Evaluation Questionnaire. Results: Student responses to this placement experience were overwhelmingly positive. The data showed that all the students responded "Strongly Agree" or "Agree" to each of the survey items. Thematic analysis of the qualitative data yielded four central themes related to benefits, additional training and education, nursing staff, and improvements. Conclusions: This pilot study suggests that mental health placements for paramedics have meaningful educational value and can impact student learning. Since this pilot study, mental health placements have been permanently included as part of the undergraduate curriculum in our institution. [ABSTRACT FROM AUTHOR]

Background/Objectives: The stress levels in emergency services are enormous. The resulting stress can range from psychological irritation to burnout. This study examines the importance of resilience in the German EMS and its significance for the risk of irritation and burnout among EMS personnel. Methods: A quantitative cross-sectional online survey was conducted among 285 EMS personnel in Germany. Resilience was measured by the RS-13 Scale, irritation by the Irritation Scale (IS), and burnout by the Maslach Burnout Inventory (MBI). Sociodemographic and job-related data were also collected. A classification into resilient groups was used to compare stress levels. Results: More than one-third (39%) of the participants had a low level of resilience. EMS personnel with high levels of resilience had significantly lower scores on the cognitive and emotional irritation dimensions, as well as on the burnout dimensions of emotional exhaustion and cynicism. Conclusions: Resilience plays an important role in the safety culture of emergency services. The results support the hypothesis that high levels of resilience lead to less stress and help people cope better with stress. Almost two-fifths of the participants had lower resilience, underscoring the need for safe communication and targeted measures to strengthen resilience. Regular training, a supportive work environment, and promoting team cohesion and social support can improve emergency responders' mental health and job performance. Future research should develop specific intervention strategies and evaluate their effectiveness to ensure the long-term health of emergency responders and improve the quality of emergency care. [ABSTRACT FROM AUTHOR]

Background: Prehospital detection and triage of stroke patients mostly rely on the use of large vessel occlusion prediction scales to decrease onsite time. These quick but simplified scores, though useful, prevent prehospital providers from detecting posterior strokes and isolated symptoms such as limb ataxia or hemianopia. Case report: In the present case, an ambulance was dispatched to a 46-year-old man known for ophthalmic migraines and high blood pressure, who presented isolated visual symptoms different from those associated with his usual migraine attacks. Although the assessment advocated by the prehospital guideline was negative for stroke, the paramedic who assessed the patient was one of the few trained in the National Institutes of Health Stroke Scale assessment. Based on this assessment, the paramedic activated the fast-track stroke alarm and an ischemic stroke in the right temporal lobe was finally confirmed by magnetic resonance imaging. Discussion and conclusions: Current prehospital practice enables paramedics to detect anterior strokes but often limits the detection of posterior events or more subtle symptoms. Failure to identify such strokes delay or even forestall the initiation of thrombolytic therapy, thereby worsening patient outcomes. We therefore advocate a two-step prehospital approach: first, to avoid unnecessary delays, the prehospital stroke assessment should be carried out using a fast large vessel occlusion prediction scale; then, if this assessment is negative but potential stroke symptoms are present, a full National Institutes of Health Stroke Scale assessment could be performed to detect neurological deficits overlooked by the fast stroke scale. [ABSTRACT FROM AUTHOR]

Background: Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels. Aim: To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia. Design: Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken. Setting/participants: Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine. Results: Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework. Conclusion: This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice. [ABSTRACT FROM AUTHOR]

Objective: Following recent changes to the German Narcotics Act, this article examines prehospital analgesia by paramedics using piritramide vs. nalbuphine + paracetamol. Material and methods: Prehospital analgesia administered by paramedics from the Fulda (piritramide) and Gütersloh (nalbuphine + paracetamol) emergency services was compared regarding pain intensity at the beginning and end of the mission, measured using the numeric rating scale (NRS). Additionally, an analysis of the resulting complications was carried out. Results: In this study 2429 administrations of analgesia were evaluated (nalbuphine + paracetamol: 1635, 67.3%, initial NRS: 8.0 ± 1.4, end of NRS: 3.7 ± 2.0; piritramide: 794, 32.7%, initial NRS: 8.5 ± 1.1, end of NRS: 4.5 ± 1.6). Factors influencing NRS change were initial NRS (regression coefficient, RC: 0.7075, 95% confidence interval, CI: 0.6503–0.7647, p < 0.001), treatment with nalbuphine + paracetamol (RC: 0.6048, 95% CI: 0.4396–0.7700, p < 0.001). Treatment with nalbuphine + paracetamol (n = 796 (48.7%)) compared to piritramide (n = 190 (23.9%)) increased the odds of achieving NRS < 4 (odds ratio, OR: 2.712, 95% CI: 2.227–3.303, p < 0.001). Complications occurred in n = 44 (5.5%) with piritramide and in n = 35 (2.1%) with nalbuphine + paracetamol. Risk factors for complications were analgesia with piritramide (OR: 2.699, 95% CI: 1.693–4.301, p < 0.001), female sex (OR: 2.372, 95% CI: 1.396–4.029, p = 0.0014), and age (OR: 1.013, 95% CI: 1.002–1.025, p = 0.0232). Conclusion: Compared with piritramide, prehospital analgesia with nalbuphine + paracetamol has favorable effects in terms of analgesic efficacy and complication rates and should therefore be considered in future recommendations for paramedics. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Health History is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Over 70,000 cases of Proximal Femoral Fracture (PFF) occur annually in the United Kingdom (UK), primarily affecting the elderly. These injuries are associated with high morbidity and mortality, and often see inadequate pain management in the prehospital setting. The Fascia Iliaca Compartment Block (FICB), a regional anaesthesia technique, is the gold standard of care in Emergency Departments (ED). This review aims to assess the literature on paramedic-performed FICB for suspected PFF in the prehospital setting, highlighting benefits and challenges to guide future practice and policy in the ambulance sector. MATERIALS AND METHODS: A rapid scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with modifications for this project's limitations. A systematic search of the databases CINHAL, PubMed, EMBASE, and Medline was performed. A synthesis matrix was created to extrapolate data from the included studies and allow for a coherent interpretation of results. Each included study was subject to a critical appraisal conducted using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Data was extracted from three studies and two reports which identified four key themes emerged: paramedic competency in performing FICB, patient perspectives, adverse events, and training and governance. Studies showed paramedics can competently perform FICBs in prehospital settings. Verbal pain scores were lower following an FICB compared to standard care with IV morphine, which required more supplementary morphine for break-out pain. Concern for causing harm was a consistent theme among the paramedics performing FICB, particularly in precipitating an adverse event sequela. Adverse events were more common in non-FICB groups, with only one case of local anaesthetic toxicity in the FICB group, which was correctly managed by the paramedic. CONCLUSIONS: Paramedics can competently perform FICB in the prehospital setting, showing promising results in pain relief compared to intravenous morphine. However, higher-level research is needed for confirmation. Patients generally tolerated paramedic-led FICB well, with minimal concerns. Training and governance remain significant barriers to implementing FICB in local ambulance services. [ABSTRACT FROM AUTHOR]

Background: Nocebic communication can impair patient outcomes and increase their risk of post-traumatic stress disorder. It could therefore be legitimately regarded as a patient safety issue. Aims: This study aimed to determine whether nocebic effects (negative outcomes) induced by potentially harmful word and language choices commonly occur in clinical practice involving paramedics and other emergency responders. Methods: Five publicly available televised excerpts of prehospital care encounters were reviewed. Cases typically involved the treatment of patients who had sustained serious traumatic injuries. The incidence of words and language patterns commonly associated with nocebo effects were collected using a template to enable relevant dialogue to be tracked and recorded. Results: Emergency responders, typically paramedics and doctors in these examples, frequently employed nocebic words and poor language pattern choices even though less harmful forms of communication were available and more clinically appropriate. Conclusions: Inappropriate nocebic effect-inducing language is frequently used by emergency response personnel, potentially inflicting avoidable pain and anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Global demand for healthcare is escalating, prompting exploration of innovative strategies to augment service capacity. Independent prescribing (IP) helps to address this challenge, allowing non-medical professionals to prescribe medication. Paramedics in the UK were granted prescribing privileges in 2018, yet uptake remains low. Despite qualitative evidence indicating that paramedic prescribing is beneficial, quantitative comparisons of medication provision between prescribers and non-prescribers are lacking. Paramedics provide patients with non-emergency medication by three different routes: IP, using a patient group direction (PGD) or with prescriber support. Advanced paramedic practitioners who are not qualified as independent prescribers, rotating through ambulance and general practitioner out-of-hours services, offered an opportunity to quantitatively compare medication supply. Methods: This study compares medication supply by three advanced paramedic practitioners using PGDs with three prescribing nurses in a Welsh general practitioner out-of-hours service. A cross-sectional design was employed to retrospectively review electronic patient clinical records between 1 December 2019 and 30 November 2020, including patients presenting with one of five generalised clinical conditions (urinary, soft tissue, respiratory, abdominal pain, ear). Descriptive analysis and non-parametric tests compared medications prescribed or supplied, how patients received medication and reasons for seeking prescriber support. Results: A total of 397 patient records were analysed. Paramedics supplied medications more frequently with prescriber support (68.2%) than via PGD (27.9%). Nurses predominantly prescribed medication independently (99.3%). Medication provision was comparable when paramedics had prescriber support. Reasons for paramedic support-seeking included having no PGD available (34.1%) and PGD being excluded from use (28.4%). Conclusions: Advanced paramedic practitioner medication supply using PGDs and prescriber support was comparable to that of prescribing nurse colleagues. However, autonomy restrictions highlight the need for paramedic prescribing in services where prescriber availability is limited. Further research evaluating the efficiency and cost-effectiveness of PGD use versus IP is necessary. Additionally, the qualitative benefits of IP, such as improved patient care and satisfaction, warrant due consideration when implementing future healthcare strategies. [ABSTRACT FROM AUTHOR]

Introduction: In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates. Objective: To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA. Methods: This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC. Results: Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight. Conclusions: Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC. [ABSTRACT FROM AUTHOR]

Abstract Background Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate their decision-making. Within the United Kingdom (UK), there is little evidence on how and why paramedics make their decisions at actual OHCA events. Methods We explored the experiences of UK paramedics using individually recalled OHCA events as catalysts for discussion. Pen portraits developed from semi-structured interviews with 31 paramedics across two UK ambulance services were thematically analysed, enabling cross-participant comparisons whilst retaining depth and context. Results We identified four themes: uncertainties encountered in resuscitation guidelines, influences on decision-making, holistic perspectives, and indirect moderators. We found that paramedics experienced uncertainty at all stages of the resuscitation process. Uncertainties arose from indeterminate, ambiguous or complex information and were described as having both clinical and ethical dimensions. Whilst guidelines drove paramedics’ decisions, non-clinical personal, practical and relational factors moderated their assessments of survivability and decision-making, with attitudes to interactions between patient age, frailty and quality of life playing a substantial role. Coping strategies such as uncertainty reduction, assumption-based reasoning and weighing pros and cons were evident from interviews. Conclusions The complexity of interactions between clinical and non-clinical factors points to an element of variability in paramedics’ responses to uncertainty. Exploring UK paramedics’ uncertainties and decision-making during specific OHCA events can help acknowledge and address uncertainties in resuscitation guidelines and paramedic training, providing paramedics with the tools to manage uncertainty in a consistent and transparent way.

Abstract Background The dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics’ perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics’ opinions of the factors contributing to human errors. Method Data was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used. Results Contributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience. Conclusion Various factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics’ work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.

Abstract Background Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients’ Deaths during their missions in 2023. Methods This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith’s approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran. Results Seventeen emergency personnel with the age range of 24–60 (average = 39) years and with a history of confronting patients’ deaths during their services were interviewed. Their lived experiences of being exposed to patients’ deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes. Conclusion While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.