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Abstract 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.

Introduction: Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations. Methods: A qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories. Results: Four categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients’ palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns. Conclusion: EMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.

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.

Abstract Background The role of paramedics has expanded significantly over the past two decades, requiring advanced skills and education to meet the demands of diverse healthcare settings. In 2021, the academic requirements for paramedics were raised to a bachelor’s degree to align with other registered professions. The limited evidence on effective paramedic practice education necessitates a novel or new examination of unique learning methods, emphasising the need to establish effective learning relationships between mentors and learners to enhance professional respect and support achieving learning outcomes. This study aimed to investigate expectations between student paramedics and their mentors, focusing on the learning dynamics within paramedic education. Methods This qualitative study used purposive sampling to recruit participants from two distinct cohorts: student paramedics from the University of Stirling and Practice Educator Mentors from the Scottish Ambulance Service. Focus groups were conducted to illuminate comprehensive insights into participants' expectations regarding practice education and their respective roles in the learning process. Codebook thematic analysis was used to assess the alignment of these expectations. Results Findings illustrate important challenges within practice placement across learning paradigms and highlight the attitudes surrounding the integration of higher education and expectations of practice placements. These challenges encompass systemic barriers, including the support provided to mentors as they assume increased responsibilities and barriers that deter qualified staff from initially undertaking this role. Conclusion The study aimed to assess expectations between practice educators and students within the paramedic profession in Scotland. The methodology effectively identified key themes from comprehensive data, marking the first primary research in this field. There are disparities in learning styles, expectation measurement, and attitudes toward higher education during practice placements, which could significantly impact the teaching and assessment processes. The findings suggest increased support for practice educators, educational programs addressing challenges of mentorship, and stronger links between higher education institutes and the Scottish Ambulance Service. Further research is needed to understand the extent of the expectation gap, how expectations evolve, and to develop strategies to address disparities.

Abstract Background In Ireland, there are currently three educational institutions (recognised institutions- RIs) providing paramedic programmes, accredited by the regulator, the Pre-Hospital Emergency Care Council (PHECC). Each RI assesses their students in-house, and in order to acquire a licence to practice, students must also pass summative assessments provided by PHECC. These assessments comprise multiple choice questions, short answer questions and skills assessments. The objective of this study was to explore the perceptions and experiences of paramedic educators of assessments used within their institution and by the regulator to provide insights that could inform the future design of paramedic assessments. Methods A qualitative study with an interpretivist approach and purposive sampling strategy was performed. Semi-structured interviews were conducted with educators from one RI, across their three sites. Data were analysed using an inductive approach to thematic analysis. Results Four major themes were identified in the data: improving assessments by enhancing authenticity, modifying the current process of assessment, aligning the PHECC and RI examinations and opportunities to use assessment as learning. Conclusions This study identifies perceived deficits and opportunities in the assessments currently used for paramedic students and ways in which these assessments could be improved. While participants were relatively content with their own RI assessments, they identified ways to improve both the RI and PHECC assessments. Modifying some of the current methods could be a useful first step. In particular, assessments used by PHECC could be improved by reflecting ‘real-world’ practice. The inclusion of additional assessment methods by PHECC, a continuous assessment process or devolvement of the entire assessment suite, to the RI/University has the potential to enhance assessments, particularly summative assessments, for paramedic students.

Abstract Background Australian paramedics must engage in continuing professional development (CPD), including self-directed learning (SDL). This study aimed to examine paramedics’ attitudes towards training and learning activities and perceptions about what could increase engagement in self-directed CPD. Methods A cross-sectional survey was conducted with New South Wales Ambulance paramedics. The 48-item survey examined learning attitudes, attitudes towards SDL and socio-demographic and professional characteristics. Results Most of the 149 participants (19% consent rate) were male (74.5%) and worked full-time (96.5%). All participants agreed that paramedics should reflect on the quality of their practice (100%) and most were committed to undertaking learning to improve their skills and capability (95.2%). However, 26.3% of participants did not feel motivated to undertake learning and 58.9% did not feel supported. Paramedics reported neutral to modestly positive attitudes towards SDL. Most participants agreed they would be more likely to engage in SDL if they had access to training equipment at their station (91%) and dedicated time during work hours (90.4%). Conclusion Paramedics are highly committed to undertaking CPD. Increased engagement may be supported by providing SDL materials at work locations and ensuring dedicated time for learning during work hours.

Aim:In this study, we aimed to analyze patient transfers in and out of Bolu province of Turkey that were performed by 112 command and control centers and to contribute to the existing literature on this issue.Materials and Methods:The gender, age, social security status of the patients, distribution according to the types of transport, distribution according to the places of residence, the time of arrival of the 112 teams to the cases, the personnel accompanying the patients, the units where the cases were admitted, and the results of the cases were recorded in the forms designed by the researchers.Results:A total of 3,182 patients transferred by the 112 command and control centers in Bolu province were included in the study. Of all patients, 1287 (40.4%) were female, 1648 (51.8%) were male, and 247 (7.8%) were unspecified. The most common age range was 19-45 years. The mean arrival time was found as 7.53±5.8 minutes (minimum: 0, maximum: 90). 83% (n=2641) of the transfers were performed without a physician, and 2048 (64.4%) had at least one paramedic.Conclusion:The command and control centers being more selective about inappropriate calls will be effective in reducing the intensity of the emergency as well as preventing inappropriate ambulance use.

Abstract Introduction Despite the lack of knowledge about the SARS-CoV2 virus, the lack of personal protection gear among frontline healthcare workers, and lack of vaccines in the beginning of the pandemic, paramedic students in Norway contributed to the National response against the COVID-19 pandemic by working in test-stations, ambulance services, ambulance decontamination stations etc. Despite fear of contracting the COVID-19 reported by healthcare workers worldwide, paramedic students in Norway reported higher-than-average quality of life after four months of the COVID-19 pandemic (first pandemic wave). In this study we aimed to investigate how students reported their quality of life, study motivation and job satisfaction after one year of living with the COVID-19 pandemic. Method At two data collection point, all paramedic students enrolled at Oslo Metropolitan University were invited to participate in a digital, online, self-administered survey. The first data collection was in June 2020 (the first pandemic wave), while the second data collection was in March 2021 (the third pandemic wave). Results from both samples were analyzed independently with descriptive statistics. Differences between the groups were analyzed using an independent T-test and Mann–Whitney-U test to discover changes over time. Multiple linear regression analysis was used to estimate the difference attributable to timing (first vs. the third wave), seniority, and student gender. Results The samples consist of slightly more female students than male students. The mean age in both samples is 24.6 years. Despite the higher-than-average level of quality of life in the first pandemic wave, results show that there was a significant reduction in students’ health-related quality of life (p

Abstract Introduction Clinical reasoning is a complex cognitive and metacognitive process paramount to patient care in paramedic practice. While universally recognised as an essential component of practice, clinical reasoning has been historically difficult to assess in health care professions. Is the Script Concordance Test (SCT) an achievable and reliable option to test clinical reasoning in undergraduate paramedic students? Methods This was a single institution observational cohort study designed to use the SCT to measure clinical reasoning in paramedic students. Clinical vignettes were constructed across a range of concepts with varying shades of clinical ambiguity. A reference panel mean scores of the test were compared to that of students. Test responses were graded with the aggregate scoring method with scores awarded for both partially and fully correct responses. Results Eighty-three student paramedic participants (mean age: 21.8 (3.5) years, 54 (65%) female, 27 (33%) male and 2 (2%) non-binary) completed the SCT. The difference between the reference group mean score of 80 (5) and student mean of score of 65.6 (8.4) was statistically significant (p

Background. An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection. Objective. To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes. Methods. An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. Results. In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). Conclusion. EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.

OBJECTIVES This study examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout among emergency medical service (EMS) providers in Seoul, Korea. METHODS We conducted a cross-sectional survey of 693 EMS providers in Seoul, Korea. Participants were classified into 3 groups according to their experience of coronavirus disease 2019 (COVID-19)-related overtime work and LCCOW: (1) “did not experience,” (2) “experienced and was compensated,” and (3) “experienced and was not compensated.” Burnout was measured using the Korean version of the Copenhagen Burnout Inventory, which has 3 subdomains: personal burnout (PB), work-related burnout (WRB), and citizen-related burnout (CRB). Multiple linear regression was applied to examine whether LCCOW was associated with burnout after adjusting for potential confounders. RESULTS In total, 74.2% of participants experienced COVID-19-related overtime work, and 14.6% of those who worked overtime experienced LCCOW. COVID-19-related overtime work showed a statistically non-significant association with burnout. However, the association differed by LCCOW. Compared to the “did not experience” group, the “experienced and was not compensated” group was associated with PB (β=10.519; 95% confidence interval [CI], 3.455 to 17.584), WRB (β=10.339; 95% CI, 3.398 to 17.280), and CRB (β=12.290; 95% CI, 6.900 to 17.680), whereas no association was observed for the “experienced and was compensated” group. Furthermore, an analysis restricted to EMS providers who worked overtime due to COVID-19 showed that LCCOW was associated with PB (β=7.970; 95% CI, 1.064 to 14.876), WRB (β=7.276; 95% CI, 0.270 to 14.283), and CRB (β=10.000; 95% CI, 3.435 to 16.565). CONCLUSIONS This study suggests that LCCOW could be critical in worsening burnout among EMS providers who worked overtime due to COVID-19.

Purpose – Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days. Design/methodology/approach – This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days. Findings – This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service. Research limitations/implications – ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home. Practical implications – The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care. Originality/value – Patient feedback surveys confirm older adults want access to alternative care pathways.

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

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

Background: Endotracheal intubation is one of the basic methods for airway control during cardiopulmonary resuscitation. In the era of the prevailing pandemic of SARS-CoV-2, medical personnel may face a necessity of resuscitating aninfected patient. Objective: The objective was to compare three intubation methods for suspected/confirmed COVID-19 adult patient resuscitation performed by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGP). Material and Methods: The multicentre, single-blind, prospective, randomized, crossover simulation trial involved 32 paramedics. The participants wearing PPE AGP performed tracheal intubations with the Macintosh, Airtraq, and McGrath MAC laryngoscopes in a patient with suspected COVID-19 in two resuscitation scenarios: scenario A – without chest compressions; scenario B – with continuous chest compressions. The primary outcome was time to intubation. Results: In scenario A, the intubation time for the respective devices equalled 35 s (IQR: 29–46) vs. 44s (IQR: 35–67) vs. 49 (IQR: 34–72) (p = 0.003). The total efficacy of each intubation method was 100%; however, the efficacy of the first intubation attempt was highest for McGrath MAC (90.6%), followed by Macintosh (68.1%) and Airtraq 62.5%) (p

Objective: To assess the knowledge about hospital waste management amongst doctors, paramedic`s and general duty staff and to know various techniques of hospital waste disposal practiced at PAKMED. Study Design: Cross sectional descriptive. Place and Duration of study: Pakistan Field Hospital level II (PAKMED), United Nation Mission, Liberia (UNMIL), from May 2017 to Oct 2017. Methodology: A total of 69 participants, age ranging between 24 to 50 years of age including 14 doctors, 40 paramedics and 15 general duty staff of different departments were selected. A questionnaire consisting of 20 questions divided in two sections was used. Results: Out of 69 participants, 62 (89.85%) were males and 7(10.1%) were females. One (7.1%) of the doctors, 5 (12.5%) of paramedics and 8 (53.3%) of general duty (GD) staff was not aware of the different types of hospital waste generated in different departments. Two (14.2%) doctors, 11 (27.5%) paramedics and 8 (53.3%) general duty staff was not aware of the color coding for different types of hospital wastes. About 56 (81.1%) of the participants segregated the waste. Regarding the disposal of sharp wastes like needles, 42 (60.8%) of all participants break the needle and 21 (30.4%) use needle burner to destroy it which is the ideal method. Conclusion: Knowledge about hospital waste and its management and techniques of its disposal was appropriate among majorities of doctors, paramedics and general duty staff. However there is need for improvement in the knowledge about hospital waste management system.

Objective: The aim of the present study was to investigate economic burdens and the psychosocial impact of the COVID-19 outbreak on paramedic candidates in Turkey. Methods: This cross-sectional descriptive study was conducted on paramedic candidates in Turkey from January to May 2021. Students studying in the paramedic program in Turkey were included in the study. A self structured questionnaire was developed. Relatives leaving work, state support status, purchasing power for basic food needs evaluated the economic and psychosocial burden of the participants with the variables. The researchers developed a data collection tool consisting of three parts based on the current literature. The first part evaluated descriptive characteristics , the second part the economic effects of COVID-19, and the third part the psychosocial burden of COVID-19. Results: Of 1327 candidates, the average age was 20.41±2.08 years. There were 963 (72.6%) females and 364 (27.4%) males. During the pandemic, 933 (70%) and 784 (59.1%) felt responsible for grocery shopping for relatives and neighbors aged ≥65 years. Moreover, 1099 (82.8%) of the participants left their homes as rarely as possible; 784 (59.1%) were unhappy with staying at home all the time; 623 (46.9%) became more interested in religion, spirituality, and philosophy during the pandemic; 473 (35.6%) of the participants' income did not meet their expenses, and 696 (52.4%) indicated that their academic performance had deteriorated. Conclusion: The COVID-19 pandemic has affected the behaviors, lifestyles, habits, academic performance, and therefore the lives of the paramedic candidates due to additional burdens. Keywords: COVID-19, Economic Burdens, Pandemics, Paramedic.

Background: Professional ethical codes are an important part of healthcare. They are part of the professionalisation of an occupation, are used for regulation of the professions and are intended to guide ethical behaviour in healthcare. However, so far, little is known about the practical use of professional codes in healthcare, particularly in paramedicine. Objective: The aim of this scoping review was to determine what is known in the existing literature about health professionals' knowledge, awareness and use of their professional codes. Method: A scoping review was performed based on a six-stage framework as described by Levac et al. Six databases were searched: OVID Medline, EMBASE, EMCARE, CINAHL, ProQuest and Scopus, in September 2020. Google Scholar, Trove and Google using.gov and.org websites were also searched for grey literature. Two reviewers independently assessed study eligibility. Results: The search yielded 1162 results after duplicate removal. Thirty-nine studies remained after title and abstract review. Twenty-five articles were included after full-text review. Sixteen examined nursing, eight examined medicine and one examined both nursing and medicine. No studies were identified that examined paramedicine. Twenty-one studies were of a cross-sectional design and four studies were of a qualitative design. Conclusion: Most health professionals know the codes exist, but do not think they know the content. Despite valuing professional codes highly, healthcare professionals do not use them regularly in clinical practice. Further research is needed, and professional codes should be made useful for practice and consideration given to how codes can be written, communicated and implemented to increase their actualisation in healthcare. Research should also begin in paramedicine to identify clinician's knowledge and use of codes in this profession. Review registration: Open Science Framework – doi:10.17605/OSF.IO/NKBY4 Ethics Statement: This article does not contain any studies involving human participants performed by any of the authors. The review followed good scientific conduct. [ABSTRACT FROM AUTHOR]

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

Nowadays, there are more and more reports of child abuse. However, this is not due to an increase in violence against minors, but to an increase in public awareness. People have begun to report child abuse. Child Abuse Syndrome affects both physical and psychological violence. There are many risk factors. Correct diagnosis is difficult, especially for children who start walking, running and all kinds of injuries can be the result of their playing. Intelligence, accurate viewing of the child and physical examination has an important role. When discussing the child abuse syndrome, let’s not forget about Munchausen syndrome per procura. Then the child’s testimonies are invented, very often behind the story presented by the young patient there is a family member – mainlythe mother. Since September 2011, all health care workers are subject to the “Blue Card” procedure. [11,27] If child abuse has occurred in the family, or even if there is a suspicion of such abuse, an Interdisciplinary Team is established. The task of this team is to complete the Blue Card procedure and to ensure the safety of a victim of violence. A paramedic plays an important role in this procedure. In most cases it is the person who first comes into contact with a child who is a victim of abuse. The paramedic must ensure that the patient feels safe. Their task is to identify the problem, document the injuries occurring on the child’s body at the time of examination and fill in the appropriate documentation, which will be handed over to the Interdisciplinary Team. This paper presents materials explaining the epidemiology and clinical image of the child abuse syndrome. Social aspects and legal consequences of this issue are also discussed. The “Blue Card” procedure and the “Blue Bear” form are also presented. The paper explains the role of medical personnel in case of violence against children.

Abstract Background Older adults are more likely to access the emergency department, which suffers from overcrowding and congestion, for conditions that could potentially be treated in other settings. Older adults living in long-term care centers have access to healthcare resources in their residence, and several programs have been created with the intent of treating medical conditions on-site. The aim of this study is to identify and systematically review programs and interventions at long-term care centers that aim to treat patients on-site, avoiding unscheduled transportation to the emergency department. Methods We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We will perform a comprehensive search of Embase, MEDLINE, CINAHL, ClinicalTrials.gov, PROSPERO, and the Cochrane Central Registry of Controlled Trials using a broad search strategy. Two independent reviewers will assess titles and abstracts against inclusion criteria, and we will further evaluate relevant full-text articles for inclusion. We will assess the risk of bias using the Newcastle-Ottawa scale for included non-randomized studies and the Cochrane Risk of Bias tool for randomized trials. We will present a narrative synthesis of results and complete a meta-analysis only if enough homogeneity is found. We will create funnel plots to evaluate possible reporting bias and use The Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology to assess the confidence in cumulative evidence. Discussion As pressure on the healthcare system continues to rise, many areas are looking for alternative models of care. Several programs have been put in place in long-term care centers that seek to avoid transportation to the emergency department by providing enhanced care on-site. These programs are quite variable, and, to date, there is no standardized program or model of care. Systematic review registration PROSPERO (CRD42018091636)

Abstract Background Paramedics are required to provide care to an aging population with multidimensional and complex issues. As such educators need to prepare undergraduate paramedics to recognise, assess and manage a broad range of psychosocial care and support issues beyond somatic conditions. Experiential educational interventions with older people provide realistic and contextualised experience which can improve the provision of holistic patient focused care. Methods This was a single institution controlled before-after study with parallel groups, conducted in Australia in 2017. It was designed to compare the effectiveness of an educational program related to older people (intervention), verses no intervention (control) on paramedic student attitudes, knowledge and behavior with older patients. Results A total of 124 second year paramedic students were included in this study; 60 in the intervention and 64 in the control group. Their demographics and Time 1 baseline results were homogeneous. Both groups showed improvement in communication skills with real older patients (p

Sepsis is a life-threatening dysfunction of the body that causes a host to respond incorrectly to an infection. Sepsis and septic shock are a major health issue affecting millions of people each year worldwide. Every fourth person with sepsis dies. Multi-organ trauma, acute myocardial infarction or stroke, early diagnosis and management in the first hours after the onset of sepsis improve survival rate. The Sequential Organ Failure Assessment (SOFA) scale is mainly used to assess sepsis. SOFA helps medical staff to assess the risk of morbidity and mortality due to sepsis. The basic parameters of SOFA are: assessment of the respiratory system based on partial oxygen pressure in the blood (PaO2), assessment of the nervous system based on the Glasgow Coma scale (GCS), assessment of the cardiovascular system based on the average blood pressure or after vasopressor administration (any dose), assessment of liver function based on the level of bilirubin in the blood, assessment of kidney function based on the level of creatinine in the urine, assessment of blood clotting based on the amount of thrombocytes contained in the plasma. This scale is used in hospital settings. qSOFA (Quick Sequential Organ Failure Assessment score) is a simplified version of the SOFA score as the first way to identify high-risk patients due to poor results associated with infection. qSOFA simplifies the SOFA score drastically, taking into account only three clinical criteria and introducing "any change" instead of requiring GCS ≤13. It uses three criteria, assigning one point for low blood pressure (SBP ≤100 mmHg), high respiratory rate (≥ 22 breaths per minute) or changed mentation (GCS

Capnometry is an increasingly used element of patient monitoring in emergency medicine, also in pre-hospital area. The increasing availability of compact devices for measuring the end-expiratory concentration of carbon dioxide (EtCO2) offers great opportunities to improve the quality of treatments, as well as giving rescuers feedback on the effectiveness of life-saving procedures. However, the capnometer is just another device and without the proper substantive preparation of the person who uses it, its usefulness will be negligible. Aim of this study, is to assess paramedics knowledge about capnometry and capnography. The study group consisted of 102 paramedics who are actively working in ambulance service, aged 30.5 ± 5.7 years including 7% of women and 93% of men. Results were collected with the author’s questionnaire. Most of participants (91%) confirmed that in their ambulance was available device to measure end-expiratory carbon dioxide (EtCO2). The most commonly available device was capnometry (72%), followed by the capnography (19%). Moreover, the analysis shows that the rescuers who declared participation in the training of monitoring and analysis end-expiratory value of carbon dioxide concentration in the last 12 months obtained significantly higher correct answers than the staff who did not have such training (6.5 ± 2.0 vs. 5.4 ± 1.7). However, only 35% of participants took part in such training in last year. Study shown a lack of knowledge and experience in use of devices to measure end-expiratory carbon dioxide concentration (EtCO2) by Emergency Medical Service providers.

Paramedics in the Pre-Hospital care setting are a crucial part of the "When seconds matter" team of Bahrain's First Emergency Medical Conference, 2019. The teamwork concept is emphasized within newly developed Paramedic Internship Programs in Saudi Arabia where preceptors reiterate "The Golden-Hour" phrase. Dr. Cowley coined this phrase and recognized the importance of "The Golden Hour" from his personal experiences in post-World War II and his career in the 1960s. His practices allowed him to recognize that the earlier the trauma patient reached definitive care, the greater the chances were of survival. Paramedics are a crucial part of the team by having a quick response time to the scene, treat the patient's lifethreatening injuries first, and transport the patient to the most appropriate hospital. The Paramedic's on-scene time is as vital as their patient assessment and critical thinking skills, to make an appropriate in-field diagnosis. "Not All Pre-hospital Time is Equal: Influence of Scene Time on Mortality" emphasizes that a prolonged on scene time is associated with increased mortality rates. With the advancement of medical equipment, proven clinical trials, continuing education, and paramedic protocols in place that allow paramedics to activate the nearest hospital's cath-lab, paramedics are able to make a definitive field diagnosis and transport their patient to the appropriate facility. This "golden-hour" term can be utilized not only for trauma patients but other critical patients that have a field diagnosis of a stroke or a STEMI. American Heart Association guidelines state that hospitals treating STEMI patients with emergency percutaneous coronary interventions should reliably achieve a door-to-balloon time of 90 minutes or less. Together with the collaborating of appropriate trauma hospitals, paramedic department's protocols, and advanced medical equipment, paramedics are able to transmit a 12-lead of a STEMI patient to a hospital with a cath-lab, and test for elevated troponin levels for non-STEMI patients. Additionally, paramedics can perform a FAST exam to detect internal abdominal bleeds and implement the RUSH protocol and detect symptoms of a stroke to greater the chances of survival in patients. Ultimately, from each of these pre-hospital care efforts, the goal is to improve the patient's prognosis. [SJEMed 2020; 1(1.000): 33-33]

Introduction: Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods: Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence intervals are presented as appropriate. We determined the magnitude of significant pre-post differences with Cohen’s d. We assessed scale reliability using Cronbach’s alpha and was found to be reliable with scores of 0.83 and 0.88 across pre- and post-test responses, respectively. Results: Participants exhibited a significant increase in confidence in performing procedures (p

Tactical Medicine is an evolving subspecialty involving a combination of proven pre-hospital medical care paired with operating procedures of law enforcement. From the ancient battlefield to modern medicine, tactical medicine continues to transform and is increasingly utilized by law enforcement and emergency services personnel. This article gives a basic insight into the field of tactical medicine to current utilizations in many situations around the world. The article demonstrates the adaptability of the tactical medicine for use by many different levels of law enforcement, as well as the ongoing evolution for future application. [ABSTRACT FROM AUTHOR]

Mikos Marcin, Juszczyk Grzegorz, Czerw Aleksandra. Odpowiedzialność cywilna ratownika medycznego za błąd medyczny = Civil liability of a paramedic in case of a medical error. Journal of Education, Health and Sport. 2016;6(11):221-224. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.166268 http://ojs.ukw.edu.pl/index.php/johs/article/view/3988 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 22.10.2016. Revised 30.10.2016. Accepted: 11.11.2016. Odpowiedzialność cywilna ratownika medycznego za błąd medyczny Civil liability of a paramedic in case of a medical error Marcin Mikos (1), Grzegorz Juszczyk (2), Aleksandra Czerw(2) (1) Polskie Towarzystwo Prawa Medycznego (2) Warszawski Uniwersytet Medyczny, Zakład Zdrowia Publicznego Streszczenie: Ratownik medyczny podobnie jak inni profesjonaliści medyczni może zostać pociągnięty do odpowiedzialności cywilnej za zawinione postępowanie niezgodne ze stanem aktualnej wiedzy medycznej, w wyniku którego pacjent doznał szkody na zdrowiu. Ocena zgodności postępowania ratownika medycznego ze stanem aktualnej wiedzy medycznej jest przedmiotem oceny biegłych sądowych. Za powstałe szkody o charakterze majątkowym i niemajątkowym ratownik medyczny może zostać zobowiązany do wypłaty odszkodowania i zadośćuczynienia. Abstract Paramedics, similar to other medical professionals may a subject of civil liability litigation in case of at fault actions which has been inconsistent with current medical knowledge followed by a loss in health experienced by a patient. The evaluation of accordance of medical activities with current medical knowledge is performed by an expert witness. A paramedic may be obliged to pay a compensation if a financial or nonfinancial loss is proven. Słowa kluczowe: ratownik medyczny, odpowiedzialność prawna, błąd medyczny. Key words: paramedic, legal liablility, medical error.

Background: In 2008 South Africa (SA) had 1631 registered advanced life support (ALS) paramedics to provide pre-hospital advanced life support care to a population of approximately 50 million. Compared to globally accepted ratios, the number of ALS paramedics in South Africa can be considered as grossly inadequate. This current shortage may be ascribed to migration. However, the extent and nature of this migration, the factors that have contributed to them leaving the country and the existence or effectiveness of implemented strategies that attempt to manage migration of SA ALS paramedic is not known for sure. Methods: The study consisted of a two-phase mixed method descriptive survey. A subset of SA ALS paramedics made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N = 97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n = 10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were integrated to obtain an in-depth understanding of South African ALS paramedic migration. In addition, the study investigated whether strategies that attempted to manage migration of SA ALS paramedics existed, and if they did, how effective have they been. Result: Fifty-one of 97 (53%) ALS paramedics responded to the questionnaire in Phase One. Of those, 24 (47.1%) were found to be working inside South Africa, while 27 (52.9%) were working outside South Africa. Working conditions, physical security, and economic considerations were ranked as the top three major factors contributing to the decision or intended decision to migrate. Initiatives to manage the shortage of ALS paramedics in the public sector EMS do exist; however, it appears to be inadequate at its current rate of progress. Conclusion: This study suggests that ALS paramedics in SA are leaving to find work outside the country because of working conditions, physical security, and economic considerations. The current measures to manage migration appear to be ineffective, indicating that new or additional strategies to manage migration of ALS paramedics in SA may be required.

Objectives: South Africa has a lack of advanced life support (ALS) paramedics in full-time operational practice within the pre-hospital and inter-hospital fields. This is due at least in part to the departure of experienced ALS paramedics from operational practice. It is therefore important to identify and understand the factors that cause this departure in order to positively alter them. Methods: This study was a cross-sectional on-line survey conducted over 28 days. South African ALS paramedics were invited by e-mail to complete an on-line questionnaire consisting of 64 questions, including sections on demographics, reasons for leaving operational practice, current satisfaction levels and willingness to return to operations. Results: Of 318 registered ALS paramedics with valid e-mail addresses, a response rate of 52% (166) was observed. Top respondent groups were whites, critical care assistants and those operational in Gauteng. The top five reasons for leaving operational practice were related to remuneration, a lack of control of workplace dynamics, inadequate opportunities for promotion, poor organisational communication and poor benefits. The paramedics’ current, or post-operational, satisfaction levels (in earning, time, stress and career development) were higher than when operational. Sixty-five percent of respondents were willing to consider returning to operational practice if the above issues were addressed. Conclusion: Whilst the job of an ALS paramedic is difficult and demanding, it was not operational factors that appeared to cause the majority of ALS paramedics to leave operational practice, but rather organisational and career-based factors. These factors should be addressed in order to improve job satisfaction, with the objective of retaining more operational paramedics for longer.

Objective: This report aims to illustrate the history and current status of Japanese emergency medical services (EMS), including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.Methods: Government reports and academic papers were reviewed, along with the collective experiences of the authors. Literature searches were performed in PubMed (English) and Ichushi (Japanese), using keywords such as emergency medicine and pre-hospital care. More recent and peer-reviewed articles were given priority in the selection process.Results: The pre-hospital care system in Japan has developed as a mixture of U.S. and European systems. Other countries undergoing economic and industrial development similar to Japan may benefit from emulating the Japanese EMS model.Discussion: Currently, the Japanese system is in transition, searching for the most suitable and efficient way of providing quality pre-hospital care.Conclusion: Japan has the potential to enhance its current pre-hospital care system, but this will require greater collaboration between physicians and paramedics, increased paramedic scope of medical practice, and greater Japanese societal recognition and support of paramedics.

Żurowska-Wolak Magdalena, Wolak Bartłomiej, Mikos Marcin, Juszczyk Grzegorz, Czerw Aleksandra. Stres i wypalenie zawodowe w pracy ratowników medycznych = Stress and a burn-out syndrome at work among paramedics. Journal of Education, Health and Sport. 2015;5(7):43-50. ISSN 2391-8306. DOI 10.5281/zenodo.19112 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%287%29%3A43-50 https://pbn.nauka.gov.pl/works/575047 http://dx.doi.org/10.5281/zenodo.19112 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 21.04.2015. Revised 28.05.2015. Accepted: 24.06.2015. Stres i wypalenie zawodowe w pracy ratowników medycznych Stress and a burn-out syndrome at work among paramedics Magdalena Żurowska-Wolak (1), Bartłomiej Wolak (2), Marcin Mikos (3), Grzegorz Juszczyk (4), Aleksandra Czerw (4) 1. Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński – Collegium Medicum, Kraków 2. Krakowskie Pogotowie Ratunkowe; Kraków 3. Instytut Zdrowia Publicznego, Uniwersytet Jagielloński – Collegium Medicum, Kraków 4. Zakład Zdrowia Publicznego, Warszawski Uniwersytet Medyczny, Warszawa Adres do korespondencji: Magdalena Żurowska-Wolak tel: 503 196 836; e- mail: m_zurowska@vp.pl Streszczenie: Zawód ratownika medycznego jest jednym zawodów, w których narażenie na stres jest wysokie oraz istnieje ryzyko wystąpienia zespołu wypalenia zawodowego. Celem badania było poznanie sposobów radzenia sobie ze stresem, stosowanych przez ratowników medycznych oraz występowania wśród nich objawów wypalenia zawodowego. Najczęstszym z nich było występowanie dużego zmęczenia po pracy. Większość badanych (64%) potwierdziła wykorzystywanie konstruktywnych sposobów radzenia sobie ze stresem, jak również niekonstruktywne stosowanie używek, w szczególności kofeiny i nikotyny, których spożycie wzrastało w sytuacjach trudnych. Na podstawie badań można wnioskować, że wśród ratowników medycznych, pracujących w Krakowie i okolicach, występuje niebezpiecznie dużo objawów wypalenia zawodowego. Świadczy to o potrzebie stworzenia i realizacji przez ich pracodawców działań, obniżających poziom stresu wśród pracowników oraz zapobiegających wystąpieniu wypalenia zawodowego – jak debriefing, trenieng technik radzenia sobie ze stresem czy wspierania aktywności fizycznej. Jest to o tyle istotne, iż skutki stresu oraz wypalenia odczuwają nie tylko sami ratownicy. Skutki te są dolegliwe także dla pracodawców, którzy zatrudniają gorzej funkcjonujących pracowników oraz pacjentów, otrzymujących usługi o niższej jakości. Abstract: Paramedics are one of the professions where the risk of exposure to stress is high as well as the risk of occurrence of the burnout syndrome. The aim of the study was to analyze methods of stress reduction and symptoms of the burnout syndrome among 122 paramedics from Kraków and surrounding area. The most prevalent symptom was severe tiredness after working hours. The majority of respondents (64%) confirmed using constructive methods of stress reduction, however potentially dangerous use of alcohol, cigarettes was also observed especially in difficult situations. The results showed that in the research group the occurrence of alarming symptoms of the burnout syndrome was numerous. Therefore there is a need to define and implement appropriate activities aiming at stress reduction training – like debriefing, training on resilience or support of physical activity. It is highly important since the outcomes of burnout will affect not only paramedics themselves, but also their employers and patients. Słowa kluczowe: ratownik medyczny, stres, wypalenie zawodowe. Key words: paramedic, stress, burnout syndrome.