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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]

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]

Research has shown paramedics form rapid intuitive impressions on first, meeting a patient and these impressions subsequently affected their clinical reasoning. We report an experiment where theory-based interventions are developed with the goal of reducing reliance on intuitive reasoning by paramedics and paramedic students in simulated patients. Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2 × 2 fully between participants experiment. They saw a written clinical vignette designed to be representative of Acute Coronary Syndrome (ACS) in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. There were no differences in the proportion of participants choosing ACS across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs, 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42) This is the first study attempting to experimentally examine clinical reasoning in paramedics using a theory-based intervention. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning appears robust to manipulation. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest often occurs at home, requiring paramedics to interact with family members and bystanders during resuscitation and inform them should the patient die. This study explores how paramedics navigate interactions and the changing needs of the patient and the bereaved. Phenomenological methodology inspired individual, semi-structured interviews. Data was then coded using reflexive thematic analysis. Ten individual interviews with working paramedics with an average of 7.2 years of experience were analysed and resulted in four overarching themes. These themes encompassed communication goals and factors affecting their implementation. Four themes emerged: maximising patient outcome, minimising psychological trauma for significant others, paramedic engagement and communicating across cultures. Communication goals shift from maximising patient outcome to minimising psychological trauma for significant others during the resuscitation. Implementation of those goals is affected by paramedic engagement and communicating across cultures. Paramedics used communication techniques based on personal and professional experiences, attempting to navigate limited resources, factors affecting paramedic engagement and a perceived lack of education and support in matters of grief and death. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making. A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified. There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs. [ABSTRACT FROM AUTHOR]

Intravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embraced by non-physicians, with point of care ultrasound (POCUS) devices more affordable, portable, and suited to the out of hospital environment. To explore the utility of ICP-performed USGPIVA for patients who are predicted to be difficult according to a difficult intravenous access scoring tool. This was a prospective observational pilot study of ICPs who used the adult difficult intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using a contemporary POCUS device. For the 32 patients enroled, the overall success rate was 50% of which 87% were successful on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved with A-DIVA-predicted difficulty. ICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for paramedics to predict difficult cannulation. Future research should focus on increasing exposure, training time and enhancing feedback to paramedics performing USGPIVA. [ABSTRACT FROM AUTHOR]

Over the past 60 years since its inception, the Anglo-American Paramedic System has continued to grow and evolve. While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a paucity of research that explores and identifies sub-models of paramedicine within the Anglo-American Paramedic System. This article describes a conceptual framework that sets a roadmap for defining and comparing two newly identified sub-models of the Anglo-American Paramedic System. A conceptual framework for the exploration of these novel sub-models was developed on the basis of the work completed by Donabedian as well as Turncock and Handler. These two sub-models worked to develop a model for quality assessment and performance measurement in the public health system. The conceptual framework consists of six components that are strongly related to each other: system design, macro context, mission and purpose, structure, service delivery models and quality outcome measures. While this framework relates specifically to two novel paramedic systems known as the Professionally Autonomous an Directive paramedic systems, it can be used to measure any integrated health model. The conceptual framework described in this paper provides a stepwise roadmap for the definition and comparison of the newly identified paramedic systems to better inform future research that defines and compares paramedic system design and performance. [ABSTRACT FROM AUTHOR]

Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. We searched Pubmed, Embase, CINAHL, and Scopus databases for peer-reviewed MIH-CP literature from January 1, 2000, to July 24, 2021. We included all full-text English studies whose program met the National Associations of Emergency Medical Technicians definition, reported ED visits, and had an MIH-CP related intervention and outcome. We established risk ratios for each included study through interpreting the reported data. We performed a random-effects and cumulative meta-analysis of ED visit data, tests of heterogeneity, and a moderator analysis to assess for factors influencing the magnitude of observed effect. We identified 16 studies that reported ED visit data and included 12 in our meta-analysis. All studies were observational; 3 used matched controls, 6 pre-post controls, and 3 without controls. 7 studies' intervention were diversion/triage while 5 studies intervened with health education/home primary care services. Pooled risk ratio for our data set was 0.56 (95% confidence interval 0.42–0.74). Cumulative meta-analysis revealed that as of 2018 MIH-CP programs began to show consistent reductions in ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis showed reduced heterogeneity for matched-control studies. Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity. [ABSTRACT FROM AUTHOR]

• Community college students tend to be more diverse compared to 4-year colleges. • Pathways and stacking credentials can alleviate barriers to nursing education. • Creative pathways can promote diversity and inclusivity in the nursing workforce. To meet local nursing workforce needs, increase diversity in nursing, and promote education and economic development for low-income students, the nursing department at Columbus State Community College has developed various educational pathways for registered nurses, practical nurses, paramedics, military medics, and nurse aides. In this article, a variety of educational pathways toward nursing and further education are described that nursing faculty may use to develop strategies to promote enrollment and diversity. Information on demographics, barriers, and outcomes is provided. [ABSTRACT FROM AUTHOR]

The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall. The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised. One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres. The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended. [ABSTRACT FROM AUTHOR]

• The number of EMS-related complaints compared to the number of EMS missions was very low. • Non-conveyance plays a vital role for the filing complaints. • Listening to patients and treating them with respect is likely to reduce the number of complaints even further. Patient safety has become a central research theme in emergency medical services (EMS). The population age structure is changing in high-income countries, potentially causing increases in the need for EMS. As the number of EMS missions is growing, the safety of non-conveyance has become the topic of wide discussion. Managing adverse events is part of quality management and safety improvement. This study aimed to examine the incidence, reasons, and process of complaints related to EMS. A retrospective mixed methods study was conducted on EMS-related complaints that were evaluated by Regional State Administrative Agency during 2013–2019. The data was classified according to conveyance and authority's decision, and finally analysed thematically. The data included 73 complaints, 39 of which were included in the study. There were more complaints related to non-conveyance than conveyance. The authority provided administrative guidance in approximately half of the cases in both groups. One of the most common event types in both groups was related to ethical competence and conduct. The number of complaints was very low. A considerable portion of the complaints related to paramedics' behavior and patient treatment. Respecting and actively listening to patients may further decrease these complaints. No administrative caveats to paramedics were observed in our data. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

Paramedics' continued exposure to occupational stressors can have a detrimental effect on their psychological well-being. Resilience can provide for better coping. Understanding individual differences provides explanations why some individuals thrive while others are more at risk. To explore the effect of Personality according to the Big-Five, Ways of Thinking and Occupational Preference according to Holland's RIASEC Model, on resilience. Using a quantitative cross-sectional design, The Big-Five Inventory, Ways of Thinking, Brief RIASEC Marker Scales and Connor Davidson CD-RISC were administered. Standard Multiple Regression showed that resilience is more likely to be seen in those who score high in Conscientiousness and low in Neuroticism. Modelling also showed that resilience is more likely to be seen in those who score high in Surgency (β = 0.364, p =.001) followed by the Freethinker (β = 0.312, p =.001), Scientific (β = 0.112, p =.027) and Controlled (β = 0.105, p =.040) ways of thinking. Although the RIASEC model was not a strong predictor of resilience, the Social (β = 0.252, p =.001) and Investigative (β = 0.153, p =.020) factors were highlighted as contributing towards a paramedic's resilience. The paramedicine students that participated in this study report higher levels of some of the personality traits inherently protective in facilitating resilience. [ABSTRACT FROM AUTHOR]

• Motor vehicle crashes are the leading cause of occupational death in paramedics. • 24 studies examining ambulance crashes were reviewed. • Crash/injury risks and characteristics (factors) were mapped using a systems thinking framework. • The most commonly identified factors were intersection location, emergency use of the ambulance and non-use of restraints. • There is a need to understand crash factors that go beyond the driver and the immediate environment. Motor vehicle crashes account for the largest proportion of workplace fatalities among paramedics in developed countries. Systems thinking is one approach that is popular when seeking to understand and manage complex road safety issues; however, it has not been applied to ambulance crashes. A systematic literature review was conducted to examine factors associated with motor vehicle crashes involving ambulances, and the extent to which systems thinking has been applied in this area. Crash factors were categorised using the Accident Mapping technique (AcciMap) (based on six hierarchical levels ranging from government to the road environment) and then synthesised according to whether they were crash/injury crash risk factors or characteristics. Of the 24 included studies, most only reported factors associated with the driver and their immediate environment (n = 23). The most commonly identified factors were intersection location, emergency use of the ambulance (lights and sirens operational) and non-use of restraints (all associated with increased risk of crash or injury crash). Two-thirds of studies were at risk of bias. Given the prominence of lower-level factors associated with road users, vehicles, and the road environment, it is concluded that systems thinking approaches would be beneficial to understand ambulance crashes, particularly for higher level system factors. Further research is recommended to i) examine the potential contribution of factors and their interactions that go beyond the driver and their immediate environment and ii) validate the current findings based on the low number of studies and their lack of methodological rigour in examining driver, vehicle and environmental factors. The development of a crash data collection and reporting system in line with system thinking principles is recommended as a first step to support the identification and systemic analysis of contributory factors across the entire sociotechnical system. [ABSTRACT FROM AUTHOR]

Pain is an exceedingly common complaint in the pre-hospital setting. Despite advancements in organizational protocols and guidelines, many emergency medical services (EMS) systems still fail to provide optimal pain management. This scoping review thus aimed to map the body of qualitative literature pertaining to factors influencing pre-hospital analgesia administration and practice in order to clarify concepts and understanding as well as to identify any knowledge gaps. The review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Five databases were searched from inception till October 26, 2021, namely MEDLINE, EMBASE, CINAHL, The Cochrane Library, and Scopus. The search strategy was developed in consultation with a medical information specialist. A total of 5848 records were screened by abstract and title by four independent researchers. 199 records were included for full text review. From these, 15 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Included studies found that practitioner, patient, and environmental factors influenced the administration and practice of pre-hospital analgesia. Key barriers included the difficulty in assessing pain, poor inter-professional relationship, knowledge deficits, stress and anxiety, and miscellaneous factors, such as concerns over drug-seeking behaviours. Some possible solutions were proposed, and pre-hospital EMS systems and healthcare institutions could consider bridging some of these gaps. There was a notable paucity of Asian studies, and a variety of EMS settings with different protocols and workflows were examined, hence systemic factors including guidelines and legislations cannot and should not be generalized across every healthcare system. The factors influencing pre-hospital analgesia administration and practice remain incompletely understood. Existing tools and practice guidelines were also inadequate. This scoping review provided an overarching perspective of the extant literature, highlighting some of the significant barriers, enablers, and areas for further research. [ABSTRACT FROM AUTHOR]

Violence in emergency departments poses a threaten to both medical personnel and patients. We investigated the risk factors for high burnout status and the association between the impact of violence and burnout status of paramedics in emergency departments. We included paramedics of emergency departments in Korea. We conducted a survey on the emotional, physical, and social responses to violence using an assault response questionnaire. Additionally, we evaluated burnout status using the Maslach Burnout Inventory. This study included 141 participants (57 females), with a mean age of 25.9 years. The burnout status was positively correlated with physical, emotional, and social responses, and the overall impact of violence (r = 0.576, 0.559, 0.446, and 0.590, respectively). Female sex, specialized centers, and emergency departments with <20 beds were associated with a high burnout status (adjusted odds ratio [95% confidence interval] = 13.11 [3.33–51.60], 35.34 [2.19–572.45], and 9.27 [1.75–53.56], respectively). Increased burnout was associated with emotional and physical responses to violence (B = 0.200 and 0.353, respectively). Paramedics of emergency departments were directly affected by violence. Violence was also related to burnout status. Efforts to prevent violence and detect predictive responses signaling an increase in burnout are required, followed by necessary active interventions. [ABSTRACT FROM AUTHOR]

Background: Emergency Medical Services (EMS) provide patients with out-of-hospital care, but not all patients are transported to the hospital. Non-transport represents an often undefined yet potentially significant risk for poor clinical outcomes. Few North American studies have quantified this risk.Objective: The objectives of this study were to determine the prevalence of non-transport and 48-h adverse event (composite of relapse responses that resulted in transport or death) and to identify characteristics associated with either outcome.Methods: An analysis of pooled cross-sectional, population-based administrative data from the provincial EMS electronic charting system in 2014 was conducted. Determination of non-transport was based on recorded call outcome. The data were searched by patient identifiers to determine the 48-h adverse event rate. Paramedic-documented patient, operational, and environmental characteristics were included in the logistic regression models.Results: Of 74,293 emergency responses, 14,072 (18.9%) were non-transport and, of those, 798 (5.6%) resulted in a 48-h adverse event. The characteristics statistically significantly and independently associated with non-transport and 48-h adverse event were younger age (odds ratio [OR] 1.72; 99.9% confidence interval [CI] 1.46-2.02), nonspecific paramedic clinical impression (OR 5; 99.9% CI 4.48-5.57), more than 7 comorbidities (OR 0.47; 99.9% CI 0.42-0.53), and incident location (jail) (OR 2.88; 99.9% CI 2.22-3.74).Conclusions: This study provides an estimate of prevalence of non-transports and 48-h adverse event in a provincial mixed rural-urban EMS system. The results of this study describe the scope of non-transport and present several characteristics associated with non-transport. Future study should examine the appropriateness of EMS responses and methods to mitigate risk of adverse event after non-transport. [ABSTRACT FROM AUTHOR]

There is growing concern for the health and wellbeing of paramedic students who are required to undertake work integrated learning (WIL) in the ambulance setting to become a registered paramedic. Paramedic culture, barriers to help seeking, and difficulty in accessing peer support is limiting their ability to express emotions and cope with workplace stress. This study aimed to examine whether participation in a peer social support group, using the CARES skills framework, changed paramedic students' emotional expression and emotion-focused coping. A convenience sample of seventy-eight participants were recruited from a paramedic program at a single regional university in Australia. Due to small participant numbers third year students were assigned to the intervention group (n = 44) and second year students were assigned to the control group (n = 34). The intervention group received training on how to undertake a peer social support group using the skills embedded in the CARES framework and were encouraged to meet every two weeks over a twelve-week period. All participants completed online surveys consisting of the DASS-21 stress subscale, General Help Seeking Questionnaire, Emotional Approach Coping Scale, Emotional Expressivity Scale and Multidimensional Scale of Perceived Social Support in week 1 and in week 12. Findings suggest that peer social support participation significantly increased emotional expression and emotion-focused coping when compared to the control group. Furthermore, this intervention significantly reduced participants' reliance upon help seeking without a significant increase in external social support. This is the first known study to investigate the role of peer social support amongst paramedic students, and the findings provide new information on how to help individuals cope with the stressors of working in the ambulance setting. Future studies should investigate whether the positive effects of peer social support are consistent over time and focus on minimising sampling issues. [ABSTRACT FROM AUTHOR]

Work integrated learning (WIL) in the ambulance setting is an essential part of the paramedic curriculum. However, qualified ambulance personnel are reported to experience higher suicide rates and mental stress disorders due to high pressure work environments, and there is growing concern for the wellbeing of students entering this setting. The aim of this integrative review was to explore how studies have reported paramedic students' experience of stress whilst undertaking WIL. Five studies met the inclusion criteria and were evaluated for quality according to validated tools from the Critical Appraisal Skills Program, then ranked on the level of evidence used. Data was summarised in a comprehensive research paper matrix, and findings were categorised into levels and sources of stress. Levels of stress were measured by the percentage of paramedic students who developed post-traumatic stress disorder. The primary sources of stress were experiencing death and fear of making clinical mistakes. Students also identified emotional expression as a negative attribute. Future research should prioritise identifying the levels and sources of stress students face in each year of their academic program when undertaking WIL to provide a direction for preparatory activities that may mitigate the negative effects of stress. [ABSTRACT FROM AUTHOR]

To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30–0.80] and 0.14 [95%CI 0.07–0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01–0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies. [ABSTRACT FROM AUTHOR]

• The Sukkah Drill is a novel way to train mass casualty incident command skills. • Skills exercised are similar to those practiced in a large, expensive Field Drill. • Although simple design, the Sukkah Drill retains psychological fidelity. • Simplicity and affordability mean it can be recreated by nearly anyone, anywhere. • The Sukkah Drill therefore makes incident command training more accessible to all. First responders classically train to manage Mass Casualty Incidents (MCIs) by practicing incident command skills during Field Drills which mimic real-world conditions but are also costly and logistically complex to conduct. We therefore present the Sukkah Drill (named for its similarity to the hut used on the holiday of Sukkot) as an alternative, low-cost and simple innovative teaching method for MCI management. This study compares the Field and Sukkah Drills to better understand the advantages and disadvantages of this new training method. We compared the physical design features of the Sukkah and Field Drills qualitatively. A checklist of fourteen procedural actions was used to evaluate incident commanders during six Field Drills and seven Sukkah Drills, and the rates of performance of each action compared quantitively. Despite differences in design, thirteen of fourteen procedural actions were performed at similar rates across both Sukkah and Field Drills. The Sukkah Drill provides a comparable simulation experience to the Field Drill. Its simplicity and affordability may make it especially useful for lower-resource organizations. [ABSTRACT FROM AUTHOR]

Background: The increasing worldwide demand for ambulance transport may worsen patient prognosis due to a prolonged response time and overcrowding in the emergency department. Triage in the prehospital setting may reduce the demand for ambulance transport by advising low-acuity patients seek non-emergency medical care. In Japan, a five-level triage system that allows emergency medical services (EMS) to triage patients has been implemented since 2014. This study aimed to validate the five-level triage system.Methods: We conducted a retrospective cohort study in patients aged ≥16 years who were transported by EMS to a tertiary-care hospital in Japan from April 2018 to June 2018. We used admission to the intensive care unit (ICU) as the primary outcome. Our secondary outcome was overall admission. We conducted multivariable logistic regression analysis to determine the strength of association between triage acuity and admission (ICU and overall).Results: A total of 1261 patients were included in the analysis. The odds ratios of ICU admission were 9.62 (95% confidence interval: 5.66-16.3) in Level 1 and 2.93 (95% confidence interval: 1.60-5.38) in Level 2 compared with reference groups composed of Levels 4 and 5. Similar associations were found for triage acuity and overall admission.Conclusions: Our study validates the five-level prehospital triage system for patients transported by EMS and demonstrates an association between the triage acuity and ICU admissions. [ABSTRACT FROM AUTHOR]

Interpretations of being a paramedic are normally unspoken in the literature and easily overlooked in the busyness of everyday work. The premise of this study was to explicate historical and cultural archetypes of the paramedic from within relevant literature. A hermeneutic review was conducted to explore meanings associated with being a paramedic. This was a novel approach to exploring meanings of being and provided a rich depiction of the cultural and historical nuances inherent in paramedic work. Six paramedic archetypes were identified and related broadly to the principles of service, care and stoicism. These archetypes provided glimpses of how the paramedic is theorised both within and external to the profession, as well as gaps related to how the phenomenon of being a paramedic is experienced amid everyday practice situations. Historical archetypes of the paramedic need to be recognised by paramedics as important in shaping the inherited cultural meanings of the work they do. However, due to the limited ability of fixed archetypes to capture the dynamic meanings of being a paramedic further research is required to understand how paramedics experience their caring work as meaningful across diverse contexts. [ABSTRACT FROM AUTHOR]

Emergency preparedness is a developing specialty with a limited evidence base. Published literature primarily offers a retrospective view of experience, with few studies examining and understanding the individual lived experience of practitioners prospectively. This study explores paramedics' lived experience of emergency preparedness and applies that learning. Thirteen paramedics were recruited through purposive sampling. Face-to-face semi-structured interviews explored their individual experiences of emergency preparedness, in line with the idiographic focus of Interpretative Phenomenological Analysis. Through data analysis, the following superordinate themes were identified for further discussion: self-determination, control, and experience-based practice. Participants appeared to value their role and the unpredictable environment in which they worked. Personal resilience, an area that they suggested is not covered effectively within individual preparation, was viewed as important. The participants articulated that risk, threat, uncertainty, safety, trust, and control were important concepts within individual preparedness. These paramedics valued practice-based knowledge and education as credible and transferrable to their clinical work. Evidence from this study suggests that standard emergency preparedness, with the focus at organizational level, is not sufficient for the individual workers or for an overall effective response. Dimensions of individual preparedness are presented, with the paramedic central to the experience within a conceptual model (the DiEP model), creating a new form of emergency preparedness that reflects the individual paramedic's experience. [Display omitted] [ABSTRACT FROM AUTHOR]

During commercial flights, in-flight medical emergencies may lead the cabin crew to request assistance from qualified health care professionals among the passengers. Although a physician's function and role are well known and virtually universal globally, the role, education, and scope of practice of nurses and paramedics varies significantly. This article analyzes the possible dilemmas that medical professionals other than physicians who assist during in-flight medical emergencies may face and presents recommendations for aviation authorities. There is an identified need for universal cross-border regulations and an awareness of legal and ethical boundaries for medical responders other than physicians on board commercial international aircraft. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate prehospital and emergency department (ED) interventions and outcomes of patients who received prehospital naloxone for a suspected opioid overdose.Objectives: The primary objective was to evaluate if the individual dose, individual route, total dose, number of prehospital naloxone administrations, or occurrence of a prehospital adverse event (AE) were associated with the occurrence of AEs in the ED. Secondary objectives included a subset analysis of patients who received additional naloxone while in the ED, or were admitted to an intensive care or step-down unit (ICU).Methods: This was a retrospective, observational chart review of adult patients who received prehospital naloxone and were transported by ambulance to a suburban academic tertiary care center between 2014 and 2017. Descriptive, univariate, and multivariate statistics were used, with p < 0.05 indicating significance.Results: There were 513 patients included in the analysis, with a median age of 29 years, and median total prehospital naloxone dose of 2 mg. An increasing number of prehospital naloxone doses, an occurrence of a prehospital AE, and a route of administration other than intranasally for the first dose of prehospital naloxone were significantly associated with an increased likelihood of an ED AE. Patients who received < 2 mg of prehospital naloxone had the least likelihood of being admitted to an ICU, whereas patients who received at least 6 mg had a dramatically increased likelihood of ICU admission.Conclusions: Our results suggest that an increasing number of prehospital naloxone doses was significantly associated with an increased likelihood of an ED adverse event. [ABSTRACT FROM AUTHOR]

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Background: Pain is a frequent problem faced by emergency medical services (EMS) in pre-hospital settings. This large observational study aims to assess the prevalence of sufficiently provided analgesia and to analyze the efficacy of different analgesics. Moreover, we evaluated if quality of analgesia changed with an emergency physician on scene or depended on paramedics' gender.Methods: This is a retrospective analysis of all pre-hospital medical charts from adults and adolescents treated by the municipal EMS Schutz & Rettung Zürich over a period of 4 years from 2013 to 2016. Inclusion criteria were age ≥16 years, initial GCS > 13, NACA score ≥I and ≤V, an initial numeric rating scale (NRS) ≥ I and a documented NRS at hospital admission. 20,978 out of 142,484 missions fulfilled the inclusion criteria and therefore underwent further investigation. Descriptive, univariate and multivariate analyses were applied.Results: Initial NRS on scene was on average 5.2 ± 3.0. Mean NRS reduction after treatment was 2.2 ± 2.5 leading to a NRS at hospital admission of 3.0 ± 1.9. This resulted in sufficient analgesia for 77% of included patients. Among analgesics, the highest odds ratio for sufficient analgesia was observed for ketamine (OR 4.7, 95%CI 2.2-10.4, p < 0.001) followed by fentanyl (OR 1.4, 95%CI 1.1-1.7, p = 0.004). Female paramedics provided better analgesia (OR 1.2, 95%CI 1.1-1.2; p < 0.001). Patient's sex had no influence on analgesia. In patients with a NACA score > 2, the presence of an emergency physician on scene improved the quality of analgesia significantly.Conclusions: Pre-hospital analgesia is mostly adequate, especially when done with ketamine or fentanyl. Female paramedics provided better analgesia and in selected patients, an emergency physician on scene improved quality of analgesia in critical patients. [ABSTRACT FROM AUTHOR]

Background: Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes.Methods: In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs.Results: Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes.Conclusions: Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA. [ABSTRACT FROM AUTHOR]

Aims: To explore EMS experiences of participating in a large trial of airway management during out-of-hospital cardiac arrest (AIRWAYS-2), specifically to explore: 1. Any changes in views and practice as a result of trial participation. 2. Experiences of trial training. 3. Experiences of enrolling critically unwell patients without consent. 4. Barriers and facilitators for out-of-hospital trial participation.Methods: An online questionnaire was distributed to 1523 EMS providers who participated in the trial. In-depth telephone interviews explored the responses to the online questionnaire. Quantitative data were collated and presented using simple descriptive statistics. Qualitative data collected during the online survey were analysed using content analysis. Interpretive Phenomenological Analysis was used for qualitative interview data.Results: Responses to the online questionnaire were received from 33% of the EMS providers who participated in AIRWAYS-2, and 19 providers were interviewed. EMS providers described barriers and facilitators to trial participation and changes in their views and practice. The results are presented in five distinct themes: research process; changes in airway management views and practice; engagement with research; professional identity; professional competence.Conclusions: Participation in the AIRWAYS-2 trial was enjoyable and EMS providers valued the study training and support. There was enhanced confidence in airway management as a result of taking part in the trial. EMS providers indicated existing variability in training, experience and confidence in tracheal intubation, and expressed a preference for the method of airway management to which they had been randomised. There was support for the stepwise approach to airway management, but also concern regarding the potential loss of tracheal intubation from 'standard' EMS practice. The views and practices of the EMS providers expressed in this research will usefully inform the design of future similar trials. [ABSTRACT FROM AUTHOR]

The threat of chemical, biological, radiological, and nuclear (CBRN) incidents has been a topic of increasing concern in recent years, and the need for increasing preparedness and competence among the first responder professions is widely recognized. This qualitative study explored advanced-level paramedic perspectives on competence requirements for responding to radiological/nuclear (R/N) incidents. This study utilized reflective essays (n = 26) written by advanced-level paramedics after familiarizing themselves with a fictional accidental nuclear power plant incident scenario. The material was analyzed using inductive content analysis. Three main categories were found: 1) Awareness of operating in multi-authority RN incidents, 2) Consideration of occupational safety, and 3) Competence in emergency care nursing and management during RN incidents. The results can be utilized for enhancing the competence management and training provision of Emergency Medical Services organizations. [ABSTRACT FROM AUTHOR]

• This is the first paper to apply systems thinking and associated methods to better understand paramedic occupational injury. • Systems thinking-based approaches improve contributory factor identification and the identification of interrelationships. • The factors to contribute to the occurrence of paramedic work-related injury span each level of the hierarchical model of complex sociotechnical systems. • Systems thinking-based approaches can be incorporated into current paramedic injury surveillance to enhance the effectiveness of current epidemiological injury surveillance models. Paramedic work occurs in complex, dynamic, uncontrolled, and unpredictable work environments which increase their risk of occupational injury. The complex and multi-factorial nature of paramedic occupational injury requires a holistic systems-based approach to identify and understand contributory factors of paramedic occupational injury. Systems thinking methods are useful for understanding and responding to complex issues, however these have never been applied to the surveillance of paramedic injuries. Through a narrative review of the paramedic occupational injury literature, this paper aims to establish the currently known contributors of paramedic injury, examine the extent to which a systems thinking approach has been applied in this context, and outline how these could be integrated into current paramedic injury surveillance systems. A search of Ovid Medline between the years 2004–2021. In total, 120 literature works were used to develop the systems maps and models presented in this paper. These included: a social-ecological model; an ActorMap; an AcciMap; and a PreventiMap. The findings illustrate the complexity and diversity of the factors contributing to the occurrence of paramedic injury at work. However, systems thinking-based approaches like those presented in this paper are not a substitute for the traditional epidemiological approach to injury surveillance, rather these approaches should be incorporated together to improve risk and protective factor identification, facilitating the development and implementation of targeted interventions. [ABSTRACT FROM AUTHOR]

• Paramedics are active technology users and also potential innovators and developers. • Lack of training and inadequate support hinder paramedics' technical involvement. • The national patient information system is vital for patient safety and workflow. • 5G technology can boost diagnosis accuracy and improve communication between devices. The work environment of paramedics is rapidly becoming more technology-oriented, and new innovations are constantly being introduced. The aim of this study was to determine the roles Finnish advanced level paramedics identify for themselves within technological development processes in their experience and what kinds of technological development in pre-hospital emergency care are needed. This qualitative study utilised essay material written by experienced advanced level paramedics (n = 20), which was analysed using inductive content analysis. The paramedics identified direct and indirect roles and clear obstacles. The roles were related to expertise, their own professional skills, supporting development and implementation. The obstacles to participation in technological developed were perceived as the employer's unwillingness to involve grassroots level paramedics, lack of training or expertise, and overall unrecognised role. Technological development was seen to be needed regarding information and communication technology, treatment tools, and equipment. Further, nationally homogenous technological development that supports the quality and safety of nursing work and the integration of digitalization into education were also seen as needed. Paramedics can be innovative and active technology developers with extensive expertise in the technology of their field. Employers and technology developers should be encouraged to enable user-oriented product development and to involve paramedics in development work. [ABSTRACT FROM AUTHOR]

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

• Seat belt use by EMS varied depending on seating location and patient condition. • Ambulance front compartment seat belt use was consistently high. • Seat belts use was rarer in the patient compartment when treating critical patients. • Organizational policies requiring seat belts increased the odds of consistent use. Background : Inconsistent use of seat belts in an ambulance may increase the risk of injury for emergency medical services (EMS) professionals and their patients. Our objectives were to: (1) describe the prevalence of seat belt usage based on patient acuity and seat location, and (2) assess the association between EMS-related characteristics and consistent use of a seat belt. Methods : We administered a cross-sectional electronic questionnaire to a random sample of 20,000 nationally-certified EMS professionals, measuring seat belt use in each seating location of an ambulance during transport of stable, critical, or no patients. We included practicing, non-military, emergency medical technicians or higher who reported working in ambulances. We used multivariable logistic regression models to estimate the odds of consistent (≥50% of the time) use of seat belts for the rear-facing jump seat and right-sided crew bench during transport of stable and critical patients. Results : A total of 1431 respondents were included in the analysis. Patient compartment seat belt use varied with the highest use in forward-facing seats when no patient was being transported (59.8%) and lowest use in the left-side "CPR" seat with a critical patient (9.4%). Only 40.2% of respondents reported an agency policy regarding seat belt use while riding in the patient compartment. In all multivariable logistic regression models, advanced life support level certification and fewer years of experience were associated with decreased odds of consistent seat belt use. An agency seat belt policy was strongly associated with increased odds of seat belt use in the patient compartment. Conclusions : Seat belt use was low and varied by seating location and patient acuity in the patient compartment of an ambulance. Practical Applications : EMS organizations should consider primary prevention approaches of provider education, improved ambulance designs, enactment and enforcement of policies to improve seat belt compliance and provider safety. [ABSTRACT FROM AUTHOR]

New Zealand (NZ) has an ethnically diverse population. International studies have demonstrated significant differences in health equity by ethnicity; however, there is limited evidence in the context of out-of-hospital cardiac arrest in NZ. We investigated whether heath disparities in incidence and outcome of out-of-hospital cardiac arrest exist between NZ ethnic groups. A retrospective observational study was conducted using NZ cardiac arrest registry data for a 2-year period. Ethnic cohorts investigated were the indigenous Māori population, Pacific Peoples and European/Others. Incidence rates, population characteristics and outcomes (Return of Spontaneous Circulation sustained to hospital handover and thirty-day survival) were compared. Age-adjusted incidence rates per 100,000 person-years were higher in Māori (144.4) and Pacific Peoples (113.5) compared to European/Others (93.8). Return of spontaneous circulation sustained to hospital handover was significantly lower in Māori (adjusted OR 0.74, 95% CI 0.64–0.87, p < 0.001). Survival to thirty-days was lower for both Māori (adjusted OR 0.61, 95% CI 0.48–0.78, p < 0.001) and Pacific Peoples (adjusted OR 0.52, 95% CI 0.37–0.72, p < 0.001). A higher proportion of events occurred in all age groups below 65 years old in Māori and Pacific Peoples (p < 0.001), and a higher proportion of events occurred among women in Māori and Pacific Peoples (p < 0.001). There are significant differences in health equity by ethnicity. Both Māori and Pacific Peoples have higher incidence of out-of-hospital cardiac arrest and at a younger age. Māori and Pacific Peoples have lower rates of survival to thirty-days. Our results provide impetus for targeted health strategies for at-risk ethnic populations. [ABSTRACT FROM AUTHOR]

The use of crystal methamphetamine is a growing problem in Australia. Methamphetamine users can suffer adverse physical health effects, psychotic symptoms and methamphetamine-related aggressive behaviour. The increasing use and related harms of crystal methamphetamine is presenting serious problems for frontline emergency responders. A population-based retrospective analysis was undertaken of data collected by Ambulance Victoria describing crystal methamphetaminerelated events attended by ambulance across Victoria over six financial years from 2011/12 to 2016/17. Methamphetamine-related events attended by Victoria Ambulance paramedics significantly increased from 2011/12 to 2016/17, particularly in regional Victoria. The most frequent age group requiring ambulance attendance is 25–39 years. The proportion of events requiring police coattendance significantly increased, as did transportation to emergency department/hospital. The substantial increases in methamphetamine-related events attended by ambulance indicate the need for increased resources and support for paramedics, particularly in regional/rural areas. The large increase among young people aged 15–24 years indicates a need for policy action on prevention, harm reduction and expanded treatment services to reduce health problems and methamphetamine-related harms. [ABSTRACT FROM AUTHOR]

The study evaluated the performance of a cohort of healthcare professionals in image interpretation of appendicular radiographic examinations following a preliminary clinical evaluation (PCE) course. A systematic review and meta-analysis of image interpretation performance by non-medical staff was undertaken. Thirty three participants (seven radiographers, nineteen nurses, five paramedics, and two physiotherapists) completed an image based Objective Structured Examination (OSE) following a short course on PCE of appendicular radiographs. The case bank comprised 25 appendicular radiographic examinations. Prevalence of abnormal examinations approximated 52% (traumatic conditions). The OSE test scores were analysed with Alternative Free-response Receiver Operating Characteristic (AFROC) calculation of Area Under the Curve (AUC), sensitivity, specificity, and Cohen's Kappa (k) for multi-reader agreement. Professional subgroup results were compared with Analysis of Variance (ANOVA), and compared to the literature review. The participant subgroup results for radiographers were sensitivity 79.7%, specificity 92.9%, k = 72; AUC 86.5. Nurses sensitivity 76.2%, specificity 80.4%, k = 56; AUC 78.3. Paramedics sensitivity 80.3%, specificity 81.6%, k = 61; AUC 81.5. Physiotherapists sensitivity 90.4%, specificity 91.6%, k = 82; AUC 91.8. ANOVA Samples scores (f = 1.5; p = 0.23), sensitivity (f = 0.5; p = 0.65), specificity (f = 2.8; p = 0.05). The comparison of the radiographers and nurses results to the published literature were encouraging (SROC AUC 93.1 and 91.2, respectively). The paramedics and physiotherapists results could not be compared to published standards or abilities on the task due to a lack of literature available. The study results of image interpretation and commentary of appendicular radiographs in an academic environment by this multi-professional sample were to a high standard, further work is recommended on a larger sample. • The study sample recruited radiographers, nurses, paramedics and physiotherapists. • Following training non-medical staff interpret images to a high degree of agreement. • A literature meta-analysis of multi-professional image interpretation was completed. • The is a lack of professional guidance on Image Interpretation outside of radiology. [ABSTRACT FROM AUTHOR]

It is widely accepted that survival from OHCA may be improved through direct transfer of patients to hospitals with percutaneous coronary intervention (PCI) capability. However, within the New Zealand healthcare system there is limited evidence available to support this. We aimed to compare patient characteristics and outcomes following an out-of-hospital cardiac arrest between those patients transported to hospitals with or without PCI-capability within New Zealand. A retrospective cohort study was conducted using data from the St John New Zealand OHCA registry for adults treated for an out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 October 2013 and 31 October 2018. Population characteristics were investigated using a Chi-Square analysis. Binary logistic regression modelling was used to investigate outcome differences in survival at 30 days post-event according to receiving hospital PCI-capability. The study included 1750 patients who were transported to hospital following an OHCA. A significantly lower proportion of patients over 65 years (49.9%) were conveyed to hospitals with PCI-capability compared to younger aged patients (15–44 years (52.1%) and 45–64 years (59.7%) (p < 0.001). When ethnic groups were compared, Māori (32.9%) had the lowest proportion transported to PCI-capable hospitals, followed by European (55.6%) then Pacific Peoples (86.2%) (p < 0.001). A lower proportion of patients located rurally (34.7%) were transported to hospitals with PCI-capability compared to patients in an urban location (59.1%) (p < 0.001). Thirty-day survival was higher in patients transported to hospitals with PCI-capability (adjusted OR 1.285, 95%CI (1.01–1.63), p = 0.04). Patient characteristic differences indicate that inequities in healthcare may exist in New Zealand related to age, ethnic group, and rurality. Thirty-day survival was significantly increased in patients conveyed directly to a hospital with PCI-capability. [ABSTRACT FROM AUTHOR]

Around the world, many paramedics are authorised to withhold or terminate resuscitation. Research indicates this can be a challenging part of their role. Little is known about graduating paramedic student confidence, concerns and learning in this area. An online cross-sectional survey of students nearing completion of a paramedic degree in New Zealand, including piloting of a newly-developed confidence scale. Seventy-two participants reported varying exposure to termination of resuscitation and patient death. Participants felt most confident providing technical procedurally-based care and least confident with non-technical skills. Participants' greatest concerns included making 'the right call', supporting grieving family, controlling emotions and encountering conflict. Clinical exposure with supportive mentoring, clinical simulation, peer reflection and resolved personal experience with death, were considered most useful for professional development. Exposure to termination of resuscitation and management of the scene of a patient death is variable amongst graduating paramedics. Novice paramedics may benefit from opportunities to observe and rehearse non-technical skills including delivering death notification and communicating with bystanders and bereaved family. The Confidence with Resuscitation Decision-Making and Patient Death Scale has favourable psychometric properties and utility as an outcome measure for future research in this area. [ABSTRACT FROM AUTHOR]

Emergency Medical Services (EMS) are attending an increasing number of adults who fall. This study aimed to describe the incidence, patient characteristics, treatments and disposition of ambulance attended patients who fell in Western Australia (WA). An ordinal logistic regression (using STATA) was conducted in this retrospective cohort study, analysing predictors of lower compared to higher transport urgency levels. Participants were adults (≥ 18 years) who fell and required ambulance attendance in WA between 1st January 2015 – 31st December 2021. A total of 188,720 patients (female = 107,811, 57 %) were attended by ambulances after falls, (median age = 80 years [IQR 67–87]). The age-standardized incidence rate of ambulance attended falls increased from 115 cases/100,000 person-years to 161 cases/100,000 person-years between 2015 and 2021. A total of 89,140 (47 %) patients had an injury recorded by paramedics, most often lacerations or suspected fractures. The electronic patient care record showed, 50,044 (26.5 %) patients received medication and 30,954 (16.4 %) patients received other intervention, e.g., ECG. A total of 148,050 (78 %) patients were transported to hospital with the following urgency levels: 2,371 (2 %) via urgency one; 27,882 (19 %) via urgency two, 93,447 (63 %) via urgency three and 22,584 (15 %) via urgency four and five (< 1 % unknown urgency). Positive predictors of lower level transport urgency to hospital included being female and older than 65 years of age. Older, female patients had higher odds of being transported via a lower urgency, with 50 % of this cohort transported via urgency three. While 19 % of patients were attended via a Priority one, only 1 % were transported to hospital via urgency one. The incidence rate of falls requiring ambulance attendance has increased over time, increasing the demand placed on EMS annually. [ABSTRACT FROM AUTHOR]

Abstract First responders (FRs) respond to critical incidents as an expectation of their profession, and after years of service, exposure to trauma can accumulate and potentially lead to mental health problems, such as posttraumatic stress disorder (PTSD). A gap persists in the research regarding duty-related risk factors and prevalence of mental health problems among FRs. Guided by existing evidence and in partnerships with the state's FR community, this study assessed the mental health needs of FRs, risk factors that may contribute to these problems, and the associations therein. A convenience sample of firefighters and emergency medical technicians/paramedics (n = 220) were recruited from across Arkansas to complete an online survey. This survey incorporated brief assessment tools to measure various mental health problems, and captured other data regarding possible risk factors. Results found that 14% reported moderate-severe and severe depressive symptoms, 28% reported moderate-severe and severe anxiety symptoms, 26% reported significant symptoms of PTSD, 31% reported harmful/hazardous alcohol use and dependence, 93% reported significant sleep disturbances, and 34% indicated high risk for suicide. Significant group differences were found across measures and gender (female), shift-structure (48 h or more), department setting (rural), relationship status (non-partnered), and having a medical history of hypertension. These findings pose significant implications for mental healthcare providers, as well as other healthcare providers and FR organizations. Findings will guide future research that will address the need for changes in decision-making, funding, and policy regarding FRs' MH and MH services available to them. Highlights • First responders are at increased risk for developing mental health problems. • 1 in 4 first responders met PTSD criteria and 1 in 3 was at high risk for suicide. • Duty-related risk factors include working in a rural setting and >48 h. • Additional risk factors are female gender and relationship status (non-partnered). [ABSTRACT FROM AUTHOR]

Background The intractable problem of young novice driver road crashes, and the critical role of emergency responders in attending road crashes, is well-recognised as is the critical role of situation awareness skills (SAS, ie. an understanding of ‘what is going on’ in a specific situation). Emergency responders may be young novice drivers and young novice ambulance drivers, therefore SAS will be required for safe road use. This project explored the SA demands upon young novice ambulance drivers (‘drivers’) in Queensland, Australia. Method A synthesis of literature regarding SAS relevant to drivers was followed by a hierarchical task analysis (HTA) and a perceptual cycle model (PCM) to explicate the complex emergency ambulance driver dispatch and response system and SAS requirements. Results Inadequate SA is a likely contributor to risks for drivers, patients, and other road users. The HTA revealed a plethora of opportunities for inadequate SAS to negatively impact safety. The PCM highlighted complex environmental information modifies driver ‘world’ schema (eg., medical procedures) which in turn directs their actions (eg., attending to radio/pager) that in a cyclical manner relies upon complex environmental information, etcetera. Discussion and concluding remarks Emergency responder SA appears quite different to ‘ordinary drivers’, suggesting well-developed road-related schema are required before young novice ambulance drivers are behind the wheel in a highly-emotive, time-critical situation. Drivers are not simply ‘driving’; they are engaged in a breadth of tasks while driving (e.g., accessing dynamic case details) which, for safety, rely upon adequate SAS, therefore training programs should target SAS development. [ABSTRACT FROM AUTHOR]

Resumo Justificativa Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC ® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo‐MM e Grupo‐MV utilizaram laringoscópios Macintosh e o Grupo‐VV e Grupo‐VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo‐MM e Grupo‐VM e videolaringoscópios pelo Grupo VV e Grupo‐MV. Resultados As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV ( p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo‐VM ( p = 0,008). Conclusões A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal. Background Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC ® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group‐MM and Group‐MV used Macintosh laryngoscopes; Group‐VV and Group‐VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group‐MM and Group‐VM and videolaryngoscopes used in Group‐VV and Group‐MV. Results Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV ( p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group‐VM ( p = 0.008). Conclusions The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs. [ABSTRACT FROM AUTHOR]

Background: A significant increase in false positive ST-elevation myocardial infarction (STEMI) electrocardiogram interpretations was noted after replacement of all of the City of San Diego's 110 monitor-defibrillator units with a new brand. These concerns were brought to the manufacturer and a revised interpretive algorithm was implemented.Objectives: This study evaluated the effects of a revised interpretation algorithm to identify STEMI when used by San Diego paramedics.Methods: Data were reviewed 6 months before and 6 months after the introduction of a revised interpretation algorithm. True-positive and false-positive interpretations were identified. Factors contributing to an incorrect interpretation were assessed and patient demographics were collected.Results: A total of 372 (234 preimplementation, 138 postimplementation) cases met inclusion criteria. There was a significant reduction in false positive STEMI (150 preimplementation, 40 postimplementation; p < 0.001) after implementation. The most common factors resulting in false positive before implementation were right bundle branch block, left bundle branch block, and atrial fibrillation. The new algorithm corrected for these misinterpretations with most postimplementation false positives attributed to benign early repolarization and poor data quality. Subsequent follow-up at 10 months showed maintenance of the observed reduction in false positives.Conclusions: This study shows that introducing a revised 12-lead interpretive algorithm resulted in a significant reduction in the number of false positive STEMI electrocardiogram interpretations in a large urban emergency medical services system. Rigorous testing and standardization of new interpretative software is recommended before introduction into a clinical setting to prevent issues resulting from inappropriate cardiac catheterization laboratory activations. [ABSTRACT FROM AUTHOR]

Objective: To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel.Methods: This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented.Results: Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience. [ABSTRACT FROM AUTHOR]