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Sizing Up the Accreditation DEBATE By Melissa A. Bentley BS, NREMT-P, Antonio R. Fernandez MS, NREMT-P, & Greg Gibson, PhD, PRC, NREMT-B Asssessing knowledge of and barriers to national paramedic [...]

CroweRP, BentleyMA, LevineR. The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1–s6.

AbstractObjectivesThe purpose of this paper is to describe factors important for the recruitment and retention of Emergency Medical Technician (EMT)-Basics and EMT-Paramedics new to the Emergency Medical Services (EMS) field (defined as two years or less of EMS employment) through an analysis of 10 years of Longitudinal EMT Attributes and Demographic Study (LEADS) data.MethodsData were obtained from 10 years of LEADS surveys (1999-2008). Individuals new to the profession were identified through responses to a survey item. Their responses were analyzed using weights reflecting each individual’s probability of selection. Means, proportions, and 95% confidence intervals (CIs) were determined and used to identify statistically significant differences.ResultsThere were few changes in the demographic characteristics of new EMT-Basics and Paramedics across survey years. New EMT-Basics tended to be older and less likely to have a college degree than new EMT-Paramedics. More new EMT-Basics than EMT-Paramedics worked in rural areas and small towns and reported that they were working as a volunteer. There were differences between new EMT-Basics and EMT-Paramedics in several of the reasons for entering the profession and in facets of job satisfaction.ConclusionsThe findings provide guidance for recruiters, educators, employers, and governmental EMS policy organizations and will provide better insight into how to attract and retain new entrants to the field.ChapmanSA, CroweRP, BentleyMA. Recruitment and retention of new Emergency Medical Technician (EMT)-Basics and Paramedics. Prehosp Disaster Med. 2016;31(Suppl. 1):s70–s86.

AbstractObjectivesThe objectives of this study were to assess longitudinal and cross-sectional changes in Emergency Medical Technician (EMT)-Basics and Paramedics: (1) demographics, (2) employment characteristics, and (3) initial Emergency Medical Services (EMS) education.MethodsThese data were collected between 1999 and 2008 employing survey techniques aimed at collecting valid data. A random, stratified sample was utilized to allow results to be generalizable to the nationally certified EMS population. Survey weights that were adjusted for each stratum’s response were estimated. Weighted percentages, averages for continuous variables, and 95% confidence intervals (CIs) were calculated. Significant changes over time were noted when the CIs did not overlap.ResultsIn all 10 years of data collection, the proportion of EMT-Paramedics who were male was greater than the proportion of EMT-Basics who were male. A substantial proportion of respondents performed EMS services for more than one agency: between 39.8% and 43.5% of EMT-Paramedics and 18.4% and 22.4% of EMT-Basic respondents reported this. The most common type of employer for both EMT-Basics and EMT-Paramedics was fire-based organizations. About one-third of EMT-Basics (32.3%-40.1%) and almost one-half of EMT-Paramedics (43.1%-45.3%) reported that these organizations were their main EMS employer. Rural areas (<25,000 residents) were the most common practice settings for EMT-Basics (52.1%-63.7%), while more EMT-Paramedics worked in urban settings (65.2%-77.7%).ConclusionsThis analysis serves as a useful baseline to measure future changes in the EMS profession. This study described the demographic and work-life characteristics of a cohort of nationally certified EMT-Basics and Paramedics over a 10-year period. This analysis also summarized initial EMS education changes over time.BentleyMA, ShobenA, LevineR. The demographics and education of Emergency Medical Services (EMS) professionals: a national longitudinal investigation. Prehosp Disaster Med. 2016;31(Suppl. 1):s18–s29.

AbstractObjectivesThe objectives were to assess changes in (1) health and physical fitness, (2) the prevalence of selected health problems, (3) risk behaviors, (4) ambulance safety issues, and (5) the preparedness of Emergency Medical Services (EMS) professionals. In addition, the incidence of patient-initiated violence directed toward EMS personnel and associated factors were assessed.MethodsData were obtained from a sample of nationally certified EMS professionals via annual questionnaires between 1999 and 2008. Stratification was based upon national certification level, self-reported race, and experience level. Weighted percentages, averages for continuous variables, and 95% confidence intervals (CIs) were calculated. Significant changes over time were noted by lack of CI overlap.ResultsThe proportion reporting “excellent” health declined significantly from 1999 (38.5%) to 2008 (32.2%). High rates of sleeping problems (20%-27%), back problems (20%-24%), and hearing problems (7%-10%) were reported as having occurred in the past year. These rates remained constant over time. As a result of sleepiness, 8.0% of nationally certified EMS professionals reported difficulty in driving an emergency vehicle for short distances and 17.5% reported difficulty in driving long distances. The proportion of daily tobacco smokers significantly declined from over one-third (35.3%) to about one-fifth (20.3%). The proportion of providers who had ever been involved in an ambulance crash increased slightly from 2004 (14.5%) to 2008 (15.8%). In 2000, the majority of EMS professionals reported that they and/or their partner had been assaulted by a patient. Finally, there was a significant decrease in the amount of training time devoted to the recognition of biological, chemical, and nuclear (BCN) threats, use of personal protective equipment (PPE), and treatment and management of patients exposed to BCN from an average from 8.4 hours in 2003 to 6.2 hours in 2008.ConclusionsThe overall health and physical fitness of EMS professionals as well as their health problems, risk behaviors, ambulance safety, and patient-initiated violence in the prehospital emergency setting are areas of concern for the nation’s emergency medical system. The prevalence of these problems and overall health and physical fitness has shown little or no improvement from 1999 to 2008.BentleyMA, LevineR. A national assessment of the health and safety of Emergency Medical Services professionals. Prehosp Disaster Med. 2016;31(Suppl. 1):s96–s104.

AbstractObjectiveThe objective of this paper was to compare demographics, employment variables, satisfaction, and motivation for entering the field of Emergency Medical Services (EMS) between members of under-represented races/ethnicities and members of the majority group.MethodsA cohort of nationally certified EMS professionals was followed for 10 years through annual surveys; however, race/ethnicity was only available for 9 years (2000-2008). Descriptive statistics and 95% confidence intervals (CIs) were calculated and significance was determined by lack of CI overlap.ResultsFrom 2000 through 2008, the range of proportions of nationally certified EMS professionals by race/ethnicity was as follows: whites: 83.5%-86.0%, Hispanics: 4.2%-5.9%, and African-Americans: 2.5%-4.6%. There were no significant changes in the proportion of minority EMS professionals over the study period. Hispanics and African-Americans combined increased slightly from 6.7% of the population in 2000 to 9.9% in 2008. Likewise, the proportion of all under-represented races/ethnicities increased slightly from 2000 (14.0%) to 2008 (16.5%). Females were under-represented in all years. Nationally certified African-Americans were significantly more likely to be certified at the Emergency Medical Technician (EMT)-Basic level (compared with the EMT-Paramedic level) than whites in all but one survey year. The proportion of Hispanics registered at the EMT-Basic level was significantly higher than whites in three survey years. Accordingly, a larger proportion of whites were nationally registered at the EMT-Paramedic level than both African-Americans and Hispanics. A significantly larger proportion of African-Americans reported working in urban communities (population >25,000) compared with whites for nine of the 10 survey years. Similarly, a significantly larger proportion of Hispanics worked in urban communities compared with whites in 2002 and from 2005 to 2008. For satisfaction measures, there were no consistent differences between races/ethnicities. Among factors for entering EMS, the proportion of whites who reported having a friend or family member in the field was significantly higher than African-Americans in all years and significantly higher than Hispanics in four of the nine years.ConclusionThe ethnic/racial diversity of the population of nationally certified EMS professionals is not representative of the population served and has not improved over the 2000-2008 period. Similar to other health care professions, Hispanics and African-Americans are under-represented in EMS compared with the US population. This study serves as a baseline to examine under-represented populations in EMS.CroweRP, LevineR, EggerichsJJ, BentleyMA. A longitudinal description of Emergency Medical Services professionals by race/ethnicity. Prehosp Disaster Med. 2016;31(Suppl. 1):s30–s69.

Idiopathic thrombotic thrombocytopenic purpura (TTP) is a rare, clinically-diagnosed disorder characterized by widespread intravascular platelet thrombosis. The pathophysiology involves acquired deficiency of ADAMTS13 (A disintegrin and metalloprotease with thrombospondin type 1 repeats), the enzyme responsible for cleavage of high molecular weight vonWillebrand factor multimers. Disease mortality is high, though prompt treatment with plasma exchange is generally effective. A readily available and highly reliable method of identifying ADAMTS13-deficient patients for appropriate plasma exchange is therefore of interest.Our initial study (Bentley et al, Transfusion 2010;50:1654–1664) involved the assessment of multiple clinical and laboratory variables in patients with clinically-suspected TTP for whom ADAMTS13 assay was performed. Five variables were found to be of significant predictive power. This enabled the development of a point-based scoring system to efficiently determine the likelihood of TTP and response to plasma exchange in a given patient. (seeTable 1). This current study involved a separate validation cohort of patients with clinically-suspected TTP who underwent ADAMTS13 testing within two large health care systems in Utah between 2009 and 2011. The previously derived score was applied to this cohort and its performance was analyzed. Additionally, the original and validation cohorts were combined to revisit the predictive power of individual variables, derive more parsimonious models, and refine diagnostic scores.A total of 96 patients comprised the validation population. The percentage of TTP diagnoses in this group (10%) was identical to that in the initial cohort. Using an ADAMTS13 activity of <10% of normal, our original score correctly predicted or excluded TTP in all but one patient when data for all variables was available. The mis-predicted patient was a “false positive;” or, in other words, our score predicted TTP, when in fact this patient's ADAMTS13 activity was not low, and the ultimate diagnosis was HUS. On closer review, this patient was a child whose creatininevalue, though within the normal range for an adult, was indicative of significant renal insufficiency in a pediatric patient. Our score did not inappropriately exclude the diagnosis of TTP in any patient with ADAMTS13 <10% of normal. However, in cases with one or more predictive variables missing, it performed less well.In combined analysis, four of the five originally derived predictive variables remained highly significant: platelets (p=0.004), reticulocytes (p=0.009), d-dimer (p=0.027), and creatinine (p=0.005); the fifth, indirect bilirubin, was not statistically significant as a single variable (p=0.128). However, in creating a parsimonious model using only two variables, the most predictive power comes from platelet counts and indirect bilirubin. ROC analysis of individual, combined, and parsimonious models was performed (Figure 1).This work confirms the predictive power of a simple point-based score to exclude TTP in appropriately selected patients. It may enable clinicians to begin plasma exchange, or to pursue an alternative cause of thrombotic microangiopathyand subsequently to begin prompt and appropriate treatment.No relevant conflicts of interest to declare.

Focuses on the primary care solutions of infant gut problems. Incidence of diarrhoea in children in Great Britain; Results of toddler diarrhoea; Description of gastro-oespphageal reflux. INSET: Case study.