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Ischemic stroke is responsible for significant morbidity and mortality in the United States and worldwide. Stroke treatment optimization requires emergency medical personnel to make rapid triage decisions concerning destination hospitals that may differ in their ability to provide highly time-sensitive pharmaceutical and surgical interventions. These decisions are particularly crucial in rural areas, where transport decisions can have a large impact on treatment times – often involving a trade-off between delay in pharmaceutical therapy or a delay in endovascular thrombectomy. In this work, we explore a Bayesian modeling framework to address this decision-making process, showing how these techniques may be used to fully account for diagnostic and therapeutic uncertainty. We demonstrate how these techniques can contextualize triage decision at a fine-grained spatial scale. We further show the application of this modeling approach in the US State of Iowa, using data from the Virtual International Stroke Trials Archive (VISTA), and describe potential next steps for improved triage. ABBREVIATION LVO: large vessel occlusion; non-LVO, non-large vessel occlusion; IVT: intravenous tissue plasminogen activator; EVT: endovascular thrombectomy; CSC: comprehensive stroke centers; PSC: primary stroke centers; DS: drip and ship; MS, mothership; EMS: Emergency Medical Service; BGLM: Bayesian Generalized Linear Model; BGAM: Bayesian Generalized Additive Model; BART: Bayesian Additive Regression Trees; VISTA: Virtual International Stroke Trials Archive; NIHSS: National Institute of Health Stroke Severity Scale; ASPECTS: Alberta Stroke Programme Early CT Score; mRS, modified Rankin score; ROCAUC: Area under the receiver operating characteristic curve; ELPD: Expected Log pointwise Predictive Density; SE: Standard Error; ICA: Internal Carotid Artery; M1: Middle Cerebral Artery segment 1; M2: Middle Cerebral Artery segment 2; TIA: Transient Ischemic Attack; Cr-I: Credible Intervals; LKW: Last Known Well [ABSTRACT FROM AUTHOR]

Occupational medicine clinicians working with firefighters should consider their beliefs about infectious disease (like COVID-19) vaccines and illness to increase their openness to becoming vaccinated. Encouraging firefighters to weigh benefits and barriers, along with their own perceived risks, may increase the likelihood that they will accept a vaccine. Objective: The aim of this study was to assess COVID-19 vaccination prevalence and explore whether health beliefs were associated with vaccination among firefighters. Methods: A cross-sectional online survey was distributed to Minnesota firefighters in March–April 2022. Survey questions included demographics, vaccination status, and beliefs about COVID-19 and vaccines. Results: Of the survey respondents (n = 974, 91% male, 89% White), 76% were fully vaccinated and 53% were boosted. Firefighters were less likely to be vaccinated if they reported more perceived barriers (OR = 0.42, P < 0.001), greater decision-making ease (OR = 0.42, P < 0.001), and greater autonomy (OR = 0.65, P = 0.04). Greater perceived benefits (OR = 2.63, P < 0.001) and social norms (OR = 2.10, P < 0.001) were associated with a greater likelihood of being vaccinated. Similar results were seen predicting booster status. Conclusions: Firefighters had similar vaccination rates as the general population, despite high exposure risks. Health beliefs are strongly related to vaccination status. [ABSTRACT FROM AUTHOR]

Background: Xylazine is in 99% of the fentanyl supply in Philadelphia, PA and is on the rise throughout the United States. Perspectives about this emerging crisis among people who use opioids (PWUO) and harm reduction workers are lacking. Methods: We conducted focus groups with PWUO and harm reduction workers in Philadelphia, PA. Discussions focused on xylazine's impact on PWUO. Transcripts were coded for thematic analysis. Results: Themes across focus groups included xylazine withdrawal, wounds, safety concerns, and overdose response implications. Participants emphasized extreme xylazine withdrawal and the difficulty of withdrawal management. Groups explored potential roles of first responders in addressing xylazine-related wounds. PWUO were receptive to receiving help, but many harm reduction workers expressed reservations about partnering with police. Discussion: Results underscore the impact of xylazine withdrawal on PWUO. Emerging information on withdrawal management should be shared among care providers to identify optimal protocols. Safety-planning with PWUO should be explored, but structural interventions are imperative. While there may be a role for first responders in delivering harm reduction interventions, it is important to recognize historical harms by first responders against PWUO. [ABSTRACT FROM AUTHOR]

Evidence-based HIV programming focused on populations at risk of HIV is critical for sustainable disease prevention. In response to the Tennessee Department of Health decision to reject federal HIV guidance, the present study examines the potential impact of Southern US states adopting policies that direct HIV prevention and testing efforts away from populations "disproportionately affected" (DA) by HIV toward populations "non-disproportionately affected" (NDA). Descriptive and projection analyses with publicly available data explored the influence of policies emphasizing NDA populations on HIV cases. Across the Southern US, DA populations (cisgender women, men who have sex with men, transgender persons, and people who inject drugs) represent the absolute majority (90%) of diagnosed HIV cases, whereas NDA populations (pregnant women, infants, first responders, and human trafficking victims) represent only a small proportion (2%) of diagnosed HIV cases. Estimated projections show avoidable HIV cases among DA populations in the Southern US alone could aggregate to over 32,000 by 2030 if prevention efforts exclusively concentrate on NDA populations, which approximates the current national annual incidence of 36,000 HIV cases. Prevention efforts aimed at DA populations compared with NDA populations could reduce new infections across the Southern US by 47% versus 1%, respectively, by 2030. Policies disregarding epidemiological data may hinder efforts to end the HIV epidemic, both regionally and nationally. [ABSTRACT FROM AUTHOR]

Background: The golden hour of trauma denotes the critical first hour after severe injury where timely medical response is crucial, although scientific support for this time frame is inconsistent. This study emphasizes optimizing trauma care by tailoring treatment to the specific injury rather than focusing solely on the speed of treatment. The aim is to document the need for improvement in prehospital trauma care, particularly by the use of blood and coagulation products. Methods: After a pilot study, a purpose-designed online questionnaire targeted at German physicians and rescue service personnel was utilized to collect their views on general trauma care and specifically on the use of blood and coagulation products in prehospital settings. It also assessed the appropriateness of nine specific blood and coagulation products via a 5-point Likert scale. The percentages for each item were calculated for both physicians (n = 110) and rescue service personnel (n = 142) separately as well as an overall score to delineate patterns of agreement or disagreement. Results: The study reached 9837 individuals, whereby 371 initially answered the questionnaire and 252 participants from Germany were finally included in the statistical analysis. The majority of both physicians (89.1%) and rescue service personnel (90.8%) agreed on the need to improve prehospital trauma care, particularly through the use of blood and coagulation products. Specifically, 60.9% of physicians and 83.8% of rescue personnel supported the prehospital administration of these products. Red blood cell concentrates and fibrinogen were notably endorsed, with 76.2% and 67.1% approval, respectively, for their potential to enhance survival in patients with significant blood loss; however, opinions varied on other blood products. Conclusion: The data demonstrated a readiness to change the trauma approach and confirmed that effective options are available. The utilization of certain products is supported by existing research, underlining the need for their practical implementation in preclinical settings. Here, the emphasis shifts from the isolated time components to the quality of care delivered in an optimized time interval. Ideally, timely and high-quality care should complement each other, leveraging all available therapeutic resources. This could lead to the development of a golden approach to trauma to optimize outcomes in trauma care. [ABSTRACT FROM AUTHOR]

Background: Ensuring patient safety is essential to prevent and minimize adverse events, and pre-hospital services play a vital role in the healthcare network, serving as the starting point for quality care. This study aimed to adapt the Emergency Medical Services Safety Attitudes Questionnaire to the Brazilian context and evaluate its psychometric properties. Methods: Beaton and colleagues' guidelines were used as a reference. Construct validity was evaluated by confirmatory factor analysis (CFA) based on the responses of 93 participants. Questions with reverse scoring were excluded in a further CFA. Results: The content validity index was 0.99, and Cronbach's alpha was 0.90. The initial CFA resulted in a Tucker–Lewis index (TLI) of 0.95 and a comparative fit index (CFI) of 0.951. After the exclusion of reverse-coded questions (Q4 and Q9), TLI increased to 0.96 and CFI to 0.97. Conclusions: The adapted instrument demonstrated good content, face, and construct validity, confirming its suitability for evaluating patient safety in prehospital services in Brazil. It can guide adjustments in care protocols, contributing to the safety and effectiveness of prehospital care while aligning with patient-centered best practices. [ABSTRACT FROM AUTHOR]

A longitudinal qualitative study was conducted to explore the experiences of church leaders (10 priests, pastors, and pastors' wives) who provided disaster spiritual/emotional care (DSEC) to the island of Puerto Rico during a period of intense and repeated crises from 2017 to 2022. Utilizing a narrative inquiry approach, 18 in-depth interviews were conducted and analyzed. Findings indicated that the participants engaged in psychological, social, and religious coping strategies to actively cope with the stress and trauma of being first responder rescuer/victims. Regional, cultural and contextual factors are considered in an effort to understand and enhance services to populations where disaster is the new normal. [ABSTRACT FROM AUTHOR]

Moral injury has emerged as an important construct for understanding the distress experienced in the aftermath of a moral violation, initially among combat veterans and increasingly among other populations, such as healthcare workers and first responders. While numerous measures have been validated to assess for exposure to potentially morally injurious events and/or sequelae, additional tools are needed to facilitate nuanced discussion of the experience of moral injury in therapeutic encounters. The Moral Injury Experience Wheel (MIEW; Fleming, 2023) is an infographic instrument that is designed to elicit precise language and help differentiate feelings in an effort to process morally perplexing circumstances. This paper describes the contents and potential clinical applications of a newly developed manual to guide the use of the MIEW. The MIEW and manual are designed to be used independently or alongside existing moral injury interventions. A case study featuring the use of the MIEW and manual demonstrates how the tools can be used in a professional healthcare setting. Recommendations for moral injury care practitioners are provided. [ABSTRACT FROM AUTHOR]

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer‐reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders. [ABSTRACT FROM AUTHOR]

Objectives: To examine changes in out‐of‐hospital cardiac arrest (OHCA) characteristics and outcomes during 2003–2022, and 12‐month outcomes for people who experienced OHCA during 1 January 2010 – 30 June 2022. Study design: Retrospective observational study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data. Setting, participants: OHCA events in Victoria not witnessed by emergency medical services personnel, 1 January 2003 – 31 December 2022. Main outcome measures: Crude and age‐standardised annual OHCA incidence rates; survival to hospital discharge. Results: Of 102 592 OHCA events included in our analysis, 67 756 were in men (66.3%). The age‐standardised incidence did not change significantly across the study period (2003: 89.1 cases, 2022: 91.2 cases per 100 000 population; for trend: P = 0.50). The proportion of OHCA cases with attempted resuscitation by emergency medical services in which bystanders attempted cardio‐pulmonary resuscitation increased from 40.3% in 2003/2004 to 72.2% in 2021/2022, and that of public access defibrillation from 0.9% to 16.1%. In the Utstein comparator group (witnessed OHCA events in which the initial cardiac rhythm was ventricular fibrillation or ventricular tachycardia, with attempted resuscitation by emergency medical services), the odds of survival to hospital discharge increased during 2003–2022 (adjusted odds ratio (aOR), 3.08; 95% confidence interval [CI], 2.22–4.27); however, the odds of survival was greater than in 2012 only in 2018 (aOR, 1.37; 95% CI, 1.04–1.80) and 2019 (aOR, 1.68; 95% CI, 1.28–2.21). The COVID‐19 pandemic was associated with reduced odds of survival (aOR, 0.63; 95% CI, 0.54–0.74). Of 3161 people who survived OHCA and participated in 12‐month follow‐up, 1218 (38.5%) reported full health according to the EQ‐5D. Conclusion: Utstein survival to hospital discharge increased threefold during 2003–2022, and the proportions of cases in which bystanders provided cardio‐pulmonary resuscitation or public access defibrillation increased. The COVID‐19 pandemic was associated with a substantial reduction in survival, and new strategies are needed to improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Public safety personnel, including first responders, are regularly exposed to physical, social, and psychological risks and occupational requirements. These risks and requirements extend beyond the employee and may also impact the families (for example, work-family conflict, compassion fatigue). Despite recent attention directed at the population's wellness, considerably less attention is directed towards the family. This review investigates how the risks and requirements associated with these occupations affect families' lives and experiences, and correspondingly, how families respond and adapt to these risks. Methods: In the current qualitative review, we sought to identify and describe the lifestyle experiences of public safety families as they navigate the occupational risks and requirements of public safety work. The inclusion criteria resulted in an analysis of 18 articles, representing only police (n = 11), paramedics (n = 7), and firefighting (n = 10) sectors. Results: We identified and described the experiences of public safety families both by occupation and familial role. Shared familial themes across occupational groups included 'Worry', 'Communication', 'Where do I turn', 'Are they okay', 'Serving alongside', and '(Over)Protective'. However, distinct themes also emerged between different occupational groups and family configurations. Themes prevalent amongst primarily children of police included: 'Worry', 'Let's Laugh Instead', '(Over)Protective', and 'I'm not the Police, my Parent is!'. Experiences differed if the family contained on serving public safety personnel or multiple. Conclusion: We identified the shared and unique occupational experiences of public safety families. This review normalizes these experiences and emphasizes the need to develop initiatives to improve the well-being of families and safety employees. [ABSTRACT FROM AUTHOR]

Background: Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives: Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods: The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results: The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions: Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting. [ABSTRACT FROM AUTHOR]

Background: First responders are at high risk for adverse mental health outcomes following trauma exposure during disaster response. This mixed methods study aimed to quantify psychological impacts and explore personal experiences among first responders after the Bahanaga train accident that killed 294 passengers in the month of June 2023. Methods: For qualitative data, in-depth interviews (IDIs) were conducted, and quantitative data was collected using the PTSD checklist for DSM-5 (PCL-5), generalized anxiety disorder scale (GAD-7), and patient health questionnaire (PHQ-9) for symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety. The study was conducted over one month during July 2023. Results: Among 225 responders, alarming rates of symptoms of probable PTSD (10.2%), anxiety (11.6%), and depression (24.9%) were noted. Those with no prior exposure to disasters and those with no formal training in disaster response scored higher in measures for PTSD. IDIs were conducted with 22 first responders, including various stakeholders. Qualitative analysis identified themes of preoccupation with witnessing trauma, feeling overwhelmed, scary and terrible emotions, avoidance, guilt, hypervigilance, intrusive memories, emotional numbing, unmet needs for mental health support, worsening physical health, re-emergence of past traumas, compounding impact of graphic images in the media, certain positive impact, including increased empathy, resilience and finding purpose, and the beneficial role of peer support. Conclusion: Significant psychological impacts are noted with elevated rates of probable PTSD, anxiety, and depressive symptoms among first responders one month after the Bahanaga train tragedy. These results underscore the vulnerability of first responders to mental health challenges following disaster response in India. [ABSTRACT FROM AUTHOR]

Decision making in nuclear emergency response involves significant uncertainty, time pressure, and high stakes. The stress and ambiguity can result in the use of heuristic decision making strategies, which may sometimes result in poor decision outcomes. As complex information systems are often used in emergency operations, this research aims at examining linkages between design choices in computer displays and cognitive biases. This paper reports a literature review covering a set of themes that include framing effects, facilitating balanced perspectives of information, automation transparency, and the role of meta-information in conveying significance. The review provides evidence from the literature showing the importance of display design in mitigating the emergence of cognitive biases in decision making tasks. The review resulted in 11 guidelines for the design of computer displays in safety-critical applications, and directions are provided for future research. A theme that connects many of these guidelines is that providing the big picture can mitigate many types of biases, which often should encompass self-reflection and calibration of appropriate confidence levels. It can be concluded that over time, the potential for biasing users can be interwoven within computer displays if debiasing is not taken into consideration early in the design process. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders. Methods: A Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement. Results: The committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities' capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport. Conclusion: This paper describes a comprehensive performance improvement initiative in LAC-EMSA's 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs. [ABSTRACT FROM AUTHOR]

Background & Objectives: The pre-hospital emergency medical service (EMS), serving as the first line of care and treatment for patients and injured individuals, holds paramount importance in the healthcare system. Identifying the challenges and problems facing this system is crucial for its improvement. This study aimed to elucidate the challenges affecting the delivery of quality services from the perspective of pre-hospital EMS personnel in southern Iran. Materials & Methods: This qualitative descriptive study investigated the views of prehospital EMS personnel (N=23) selected through purposive sampling. Data were collected via semi-structured in-depth interviews and analyzed using conventional content analysis methods as described by Graneheim and Lundman. Results: The analysis revealed three main themes: organizational challenges (encompassing lack of human resources, equipment shortages, and structural-administrative issues), human resources challenges (including individual characteristics of personnel and staff dissatisfaction), and cultural-social challenges (comprising cultural barriers and environmental-social obstacles). These themes were further divided into seven subthemes. Conclusion: Organizational, human resources, and socio-cultural challenges emerged as the most significant factors affecting the delivery of quality services in Iran's prehospital EMS system. Policy-makers and administrators can leverage these findings to develop strategies aimed at addressing the challenges impacting the delivery of quality pre-hospital emergency services. [ABSTRACT FROM AUTHOR]

Prehospital emergency healthcare employees are frequently faced with ethical problems. Moral intelligence, which is seen as a rising value in the field of health, is very important for prehospital emergency health employees to choose the best and right action ethically. This study aims to evaluate the moral intelligence of prehospital emergency healthcare employees and to determine whether moral intelligence parameters differ according to various socio-demographic characteristics. This study was conducted with 261 emergency medical personnel working in the ambulance service between November 2021 and February 2022. Participants showed high sensitivity to equality, empathy, moral intelligence, justice, tolerance, self-control, and kindness in the delivery of healthcare services. There were no significant differences between the groups in the scale dimensions in terms of gender, educational level, working hours, working systems, income level and having children. Single/widowed/divorced/separated participants had significantly higher levels of empathy (p=0.004), justice (p=0.039) and self-control (p=0.009) than married participants. The self-control levels of paramedics were found to be higher than those of health officers/nurses/midwives/others (p=0.015). The high sensitivity of employees towards moral intelligence parameters can play an effective role in solving both ethical issues and problems related to other moral intelligence parameters in the field of prehospital healthcare. [ABSTRACT FROM AUTHOR]

Background: First responders (i.e. police and ambulance staff) have increasingly become part of the mental health care system, often being the first port of call for those experiencing a crisis. Despite their frequent involvement in supporting those with mental health problems, there is evidence that mental health stigma is high amongst first responders. Aims: The aim of the present study was to evaluate a brief training video aimed at reducing mental health stigma amongst first responders. Methods: First responders watched a training video based on the cognitive behavioural model of mental health stigma, and involved contributions from people with lived experience, and first responders. Measures of mental health stigma were collected before and after viewing the training. Results: The training video produced small but significant improvements in mental health stigma, and these effects did not differ between police and ambulance staff. We were unable to determine what psychological constructs mediated this change in stigma. The feedback on the training video was generally positive, but also indicated some key areas for future development. Conclusions: The present study provides encouraging evidence that levels of mental health stigma can be improved using a resource-light training intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine the co-occurrence of alcohol misuse and posttraumatic stress disorder (PTSD) and potential sources of coping (e.g., spirituality/religion) and clinically relevant variables among first responders (e.g., firefighters, law enforcement corrections officers, paramedics). Method: We assessed rates of independent and co-occurring alcohol misuse and PTSD among a national online sample of 320 first responders as well as the prevalence and salience of S/R, guilt, shame, moral injury, aspects of S/R, and treatment interest. Results: In our sample, 46.88% (n = 150) met criteria for comorbid alcohol misuse and probable PTSD and individuals with these comorbid conditions reported significantly greater negative religious coping, moral injury, and shame than all other diagnostic groups (i.e., independent alcohol misuse, independent PTSD, and neither). Correlations also revealed significant relationships between alcohol misuse and PTSD symptomatology with positive and negative religious coping, moral injury, shame, guilt, interest in treatment, and interest in spiritually integrated treatment. Conclusions: Findings highlight the high rates of independent and co-occurring alcohol misuse and PTSD among first responders as well as the salience of S/R in this population. [ABSTRACT FROM AUTHOR]

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD =.5.66) (F(1, 360) = 5.32, p =.02, partial η2 =.015). We found that TEs had a direct effect on EDM, β = −.16, Z = −3.74, p <.001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, β =.02, Z = 3.10, p =.002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed. [ABSTRACT FROM AUTHOR]

In 2020, the COVID-19 pandemic thrust the world's population into a crisis. Social workers and other professionals working with youth have been front-line witnesses to the accentuated negative impact of this public health emergency on youth and their families as well as to the creative adaptive strategies of youth and their families. Purpose: Because youth workers are often the first to identify and respond to the needs and desires of children and youth, it is critical to better understand the ways in which youth workers adapted, coped, and intervened within the context of this global health, social, and economic crisis. Youth workers play a central role in the lives of children and youth. Their perspective is key to recognizing both practice innovation and organizational impediments. Method: 31 youth workers in mental health, housing, primary care, and child protection participated in focus groups discussing the impact of the pandemic during waves 1 and 2 on the youth and families they work with and, consequently, on their own practice. Results: include two central domains that organize findings around adapting professional practice to crisis situations: (1) the first-person experience of working with youth during the pandemic; (2) the changing needs and risks faced by youth and their families. Discussion: These domains include discussions around participant emotions and feelings of isolation, helplessness, and fear as well as adaptability. The article concludes with recommendations to support youth workers and adapt organizational structures to help protect youth from increased risk and vulnerability during a pandemic or other crises. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate the opinions and perspectives of The Novel Integrated Toolkit for Enhanced Prehospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) end-users and tool developers regarding Key Performance Indicators (KPIs) and benchmarks that assess the prehospital response to Mass Casualty Incidents (MCIs) enhanced by the NIT-MR. Methods: A qualitative study employing focus group discussions was conducted to collect opinions and perspectives of end-users and tool developers regarding KPIs and benchmarks in MCI response using the NIT-MR. The criteria considered for the selection and distribution of participants within the groups was the nature of their involvement within the NIGHTINGALE project and their familiarity with the tools to be discussed. Results: Thirty-one participants from different countries were included. Four themes emerged during data analysis which are: definition/explanation is the personal understanding of participants of the term KPI, process of KPI development and relationship with User Requirements is the decision process for assigning KPIs to user requirements, benchmarking is the mental process of associating a benchmark to a KPI or for developing a benchmark, and technical/medical gap is the gap of understanding between each sides' fields. Conclusion: This study emphasized the need for a structured approach to using KPIs and bridging the gap between technological and medical worlds, taking the NIGHTINGALE project, funded by the European Union, which aims to develop a technological toolkit for first responders in mass casualty incidents as an example. These insights are crucial for enhancing disaster response. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to offer a comprehensive synthesis of the existing Key performance indicators (KPIs) used in the evaluation of the pre-Hospital response to disasters and mass casualty incidents (MCIs). Methods: At the end of December 2022 a scoping review has been performed on PubMed, Scopus, Embase, and Medline to identify articles describing the use of KPIs to assess the performance of first responders during the prehospital phase of an MCI (real or simulated). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, fourteen articles were included in the analysis. Results: Eleven articles applied indicators in exercises and/or simulations. Two articles proposed new KPIs, and one used KPIs for developing a model for benchmarking pre-Hospital response. All articles analyzed quantitative indicators of time, whereas two studied indicators of structure, of process, and of outcome as well. Conclusion: The findings from this review emphasize the need for employing common terminology and using uniformed data collection tools, if obtaining standardized evaluation method is the goal to be achieved. [ABSTRACT FROM AUTHOR]

Background: In times of demographic change and an immense shortage of qualified personnel in emergency medical services, telemedicine could offer more efficient solutions for better care. Given the community-based nature of emergency services, local communities play an important role. This study explored the expectations of healthcare professionals and volunteers for telemedicine tools in prehospital emergency medicine. Methods: This mixed-methods study was conducted in the rural region of Burgenland in Austria with stakeholders of the local emergency medical service in two focus groups (13 participants) and 99 quantitative questionnaires. Results: Combining quantitative and qualitative data, we found that a majority of respondents (almost 80%) already experienced basic telemedicine and consider it valuable. In particular, there is a strong expectation for diagnostic support and inquiries related to potential hospitalization. Findings from two focus groups emphasized the importance of cultivating an improved learning culture, developing a specific mindset, and refining soft skills. The optimal telemedicine solution includes a knowledgeable and experienced tele-emergency physician coupled with user-friendly technology. Conclusion: To be clear about the expectations of stakeholders, it is essential to involve all stakeholders right from the beginning. The solution should prioritize the integration of existing structures and be seamlessly incorporated into an evolving learning culture, while also fostering the necessary mindsets alongside educational aspects. [ABSTRACT FROM AUTHOR]

Burnout and stress-related issues are significant concerns among medical personnel involved in emergency situations due to the high demands of their work. A cross-sectional descriptive and comparative study was conducted on 266 prehospital emergency personnel across five Romanian counties, comprising 41 physicians, 74 nurses, and 151 paramedics. Data were collected through an online form, including demographic and professional characteristics, and five validated scales. This study revealed moderate (49.3%) to high (25.9%) burnout rates, with 35% showing signs of work addiction. Despite these challenges, the personnel demonstrated high levels of stress-related growth (61.2%), strong self-discipline (74.1%), and low to moderate responsive distress (100%). Physicians exhibited higher work addiction and job satisfaction, whereas paramedics faced higher burnout, self-discipline, and distress levels. Nurses showed lower burnout and self-discipline levels. These findings highlight the prevalence of burnout and work addiction among emergency medical personnel, while also underscoring the presence of protective factors like higher self-discipline, good level of stress-related growth, and low to moderate responsive distress. The distinct differences in experiences among physicians, nurses, and paramedics emphasize the need for tailored strategies to address these issues within each group. [ABSTRACT FROM AUTHOR]

This study aims to describe the civilian experience and perceptions of the patient coordination and management at the interface of the New York City (NYC) civilian and the military health systems during a large-scale public health emergency. A qualitative study design was implemented with interviews conducted using a basic descriptive approach. Purposive sampling was used to recruit participants with experience working during the first wave of COVID-19 in NYC. Inclusion criteria were civilians who worked at the Javits Center, the USNS Comfort, or NYC hospitals, who interfaced with patient transfer and military personnel during the city-wide medical response to COVID-19. Semi-structured video interviews were conducted between July 20, 2021 and March 11, 2022. Civilian responders working in the clinical and transfer operations of patients to military facilities in NYC during March and April of 2020 described initial confusion, as well as logistical (patient selection, transfer logistics, patient tracking), communication, and leadership challenges. While the military deployment was felt to be necessary to address the surge capacity in hospitals, the lack of clarity about military medical resources and frameworks for response resulted in confusion about what was being offered by the military deployment. This was balanced by the positive impression of working with military members and the resources that they brought to the response more generally. The need for future trainings and exercises were highlighted. Initial challenges with civilian-military roles and responsibilities, regional needs assessment, patient selection, and logistics were ultimately resolved through adaptation of civilian and military leadership. Improvements in patient tracking, medical records, and standard hospital admission and discharge functions for patients in military alternative care facilities were identified as areas for improvement. Civilian government, health care, and military leaders should consider these ideas when planning for future military deployments in support of a domestic medical response. [ABSTRACT FROM AUTHOR]

The term 'zero responder' was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident, who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of the zero responder and to explore how they can be better integrated into the emergency response. Current definitions of the zero responder in a medical setting were found through a literature search of several databases and online libraries using defined search terms. Additionally, a manual search of citations in included articles was performed to yield more results. In total, 16 papers defining the zero responder were included. These definitions were evaluated, and a revised definition was suggested to clarify the role in a medical setting relating to mass casualty incidents. The role of the zero responder can be facilitated through authority recognition and adequate equipment provision. Familiarisation with the term and role of zero responders among ambulance services is essential for effective collaboration. Further research and clarity on the integration of these two groups is necessary to facilitate effective and safe working between them. [ABSTRACT FROM AUTHOR]

Introduction: Mass casualty incidents (MCI) are unforeseeable and complex events that occur worldwide, therefore enhancing the training that medical first responders (MFRs) receive is fundamental to strengthening disaster preparedness and response. In recent years, extended reality (XR) technology has been introduced as a new approach and promising teaching technique for disaster medicine education. Objective: To assess the effectiveness of XR simulation as a tool to train MFRs in MCIs, and to explore the perception and experience of participants to these new forms of training. Design: Systematic review. Methods: This systematic review was conducted in accordance with the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA) statement. Four databases were searched (MEDLINE, EMBASE, CINAHL and LILACs) using a comprehensive search strategy to identify relevant articles, and MetaQAT was used as a study quality assessment tool. Data from included studies was not pooled for meta-analysis due to heterogeneity. Extracted data was synthesised in a narrative, semi-quantitative manner. Results: A total of 18 studies were included from 8 different countries. Studies encompassed a variety of participants (e.g., nurses, paramedics, physicians), interventions (virtual, mixed and augmented reality), comparators (comparison between two groups and single groups with pre-post evaluation), and outcomes (effectiveness and MFR perception). The synthesis of data indicated that XR was an effective tool for prehospital MCI training by means of improved triage accuracy, triage time, treatment accuracy, performance correctness and/or knowledge acquired. These XR systems were well perceived by MFRs, who expressed their interest and satisfaction towards this learning experience and emphasized its usefulness and relevance. Conclusion: This research supports the usefulness and significance of XR technology that allows users to enhance their skills and confidence when facing forthcoming disasters. The findings summarize recommendations and suggestions for the implementation, upgrade and/or assessment of this novel and valuable teaching method. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The dynamicity and mobility of the population in a mass gathering setting pose a challenge to traditional disease surveillance methods and strain the local health services. Velankanni is one of the most sacred Christian pilgrimage places located in Nagapattinam, Tamil Nadu, India. We participated in the Velankanni festival to describe the public health preparedness, surveillance, and response activities carried out during the festival. Methods: This was a cross-sectional study. We reviewed the national and international guidelines and published literature and discussed with the key stakeholders. We developed a checklist to observe public health preparedness activities. We facilitated the staff and monitored the activities by the implementers. We established the syndromic surveillance in the designated locations of the event and used tracker software to capture the data. Emergency medical teams were formed with trained health personnel to respond to medical emergencies. Results: The team monitored all the public health activities. There are 59 primary care public health facilities and nine ambulatory Mobile Medical Units, with 160 medical officers available at the site. Of the 16,169 persons who attended the medical camps, 9863 (61%) were males and 8408 (52%) were aged 15–44. Acute diarrheal disease was the most frequent of the reported syndromes, followed by injuries, acute febrile illness, and animal bites. Conclusions: There was no outbreak of any disease either identified or reported. Our findings suggest that risk assessments should be used, and establishing an Incident Command Center is vital for executing command and control mechanisms during mass gatherings. [ABSTRACT FROM AUTHOR]

Background: The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable. Aim: Recommended actions for collaboration between nonclinical and clinical planning to manage a mass casualty incident in terrorist life-threatening response situations are presented. Material and methods: The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. A recommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority. Results and discussion: Competence-based interface solutions for a smooth cooperation between prehospital and hospital management in the care of patients who have become victims of a terrorist attack are to be demanded. For preliminary planning, the establishment of a local safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up a joint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, a liaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference. [ABSTRACT FROM AUTHOR]

To cross-validate bioelectrical impedance devices for the determination of body fat percentage (BF%) in firefighters. Twenty-eight structural firefighters were evaluated (female, n = 2; male, n = 26 [mean ± SD] age: 38.2 ± 8.3 years; height: 180.2 ± 7.5 cm; body mass: 86.7 ± 20.8 kg; body mass index: 25.8 ± 7.8 kg⋅m-2) using multifrequency bioelectrical impedance analysis (MFBIA) hand-to-foot device, and single- frequency BIA foot scale (F2FBIA), and a single-frequency handheld BIA device (HHBIA). Dual X-ray absorptiometry served as the criterion. Validity metrics were examined to establish each method's performance. Body fat % values produced by MFBIA (r = 0.913), F2FBIA (r = 0.695), and HHBIA (r = 0.876) were strongly associated (p < 0.001) with criterion BF% measures. However, MFBIA, F2FBIA, and HHBIA all significantly (p < 0.001) underestimated BF% when compared with the criterion measure. Constant error ranged between 4.0 and 5.5% across all BIA devices. Despite strong associations between the BIA devices included in the current study and the criterion measure, all BIA devices underestimated BF%, which resulted in an overestimation of fat-free mass. In addition, proportional bias was observed in which BF% was overestimated at lower values and underestimated at higher values. [ABSTRACT FROM AUTHOR]

The purpose of this pilot study was to evaluate the online, self-guided, interactive Traumatic Brain Injury Family Support Program (TBIFS) with caregivers of law enforcement officers, fire fighters, and veterans (SOPs, service oriented professionals) with traumatic brain injury (TBI). Participants (n = 38) were caregivers of SOPs with TBI in the United States. The participants completed an online pretest (T1) and a posttest immediately upon completion of the online TBIFS program (T2). The study used a within-subjects, nonexperimental evaluation. The main measures were: (1) knowledge of basic TBI facts; (2) self-efficacy, measured by the General Self-Efficacy Scale, and (3) hope, measured by the Herth Hope Index. Participants demonstrated significant improvements in knowledge (n = 38, p =.001, d = 1.20) and self-efficacy (n = 37, p =.006, d = 0.48) and a non-significant gain in hope (n = 38, p =.054, d = 0.32). Improvements in participant knowledge about TBI and confidence (i.e., self-efficacy) about dealing with issues related to caregiving were associated with their use of the TBIFS program. Future research should include a controlled experimental investigation with caregivers from more diverse backgrounds. [ABSTRACT FROM AUTHOR]

Anthropologists have long understood that a society's ideas about who or what is risky depend on how meaning and worth are attributed to objects, people, and processes in a given place and time. However, until recently, little consideration has been given to the ways race and other hierarchical relations of power and difference shape how risk is constructed and deployed in social life. This article explores how race and criminal status intersect to shape the perception and management of risk and vulnerability in the United States by chronicling the lived experience of one young African American man who was prevented from obtaining an emergency medical technician (EMT) license because of his felony convictions. His pursuit of the EMT license and a career in firefighting exposes how risk, as a purportedly value-neutral concept, builds on racialized ideas about threat and vulnerability and further entrenches racialized social exclusion. Whereas many have decried racism as an unfortunate by-product of actuarial practices, I argue that racism and antiblackness are among risk's core animating logics. Challenges to risk evaluations must therefore go beyond politics of deservedness, rehabilitation, and inclusion to confront the foundational premises of risk head-on. [ABSTRACT FROM AUTHOR]

Out‐of‐hospital cardiac arrest (OHCA) is a global public health problem, with survival rates remaining low at around 10% or less despite widespread cardiopulmonary resuscitation (CPR) training and availability of automated external defibrillators (AEDs). This is partly due to the challenges of knowing when and where a sudden OHCA occurs and where the nearest AED is located. In response, countries around the world have begun to use network technology‐based smartphone applications. These applications are activated by emergency medical service dispatchers and alert preregistered volunteer first responders (VFRs) to nearby OHCAs using Global Positioning System localization. Accumulating evidence, although mostly from observational studies, shows their effectiveness in increasing the rate of bystander CPR, defibrillation, and patient survival. Current guidelines recommend the use of these VFR alerting systems, and the results of ongoing randomized trials are awaited for further dissemination. This article also proposed the concept of a life‐saving mobile network (LMN), which uses opportunistic network and wireless sensor network technologies to create a dynamic mesh network of potential victims, rescuers, and defibrillators. The LMN works by detecting a fatal arrhythmia with a wearable sensor device, localizing the victim and the nearest AED with nearby smartphones, and notifying VFRs through peer‐to‐peer communication. While there are challenges and limitations to implementing the LMN in society, this innovative network technology would reduce the tragedy of sudden cardiac death from OHCA. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) clinicians experience dissatisfaction with the quality and quantity of clinical feedback from hospitals. Satisfaction is further diminished by the lack of a standardized systems approach. The purpose of this study was to identify rural clinicians' perceptions and preferences regarding clinical feedback received from hospitals, the delivery mechanisms, and its impact on their relationships with health care organizations. This was a qualitative study focused on EMS clinicians involved in rural prehospital care at a single Midwestern academic medical center. Using a phenomenological framework, semi-structured interviews were conducted with medical directors, service directors, fire captains, air medical personnel, emergency medical responders, emergency medical technicians, advanced emergency medical technicians, and paramedics, all of whom were selected through purposive sampling. Interviews were recorded, transcribed, and independently coded by two trained reviewers. Twenty participants (11 frontline clinicians and 9 administrative staff members) with a wide range of clinical experience from 14 air and ground EMS agencies were interviewed. Emerging themes included: (1) the value or usefulness of feedback; (2) desired feedback system characteristics; (3) barriers to receiving feedback; (4) utilization and application of feedback; and (5) the feedback's impact on the relationship with health care organizations. Participants felt that clinical feedback from hospitals was especially important as a method of improving quality of care, though was rarely provided. Professional development was seen as a major benefit of receiving clinical feedback from hospitals. Our results suggest that consistent clinical feedback provided by hospitals was valued. Establishing a culture of providing organized feedback to practicing rural EMS clinicians is important for professional development and can strengthen the relationships between EMS clinicians and hospitals. These study findings can assist in the development and implementation of a standardized feedback instrument to benefit rural EMS clinicians, patients, and the health care system as a whole. [ABSTRACT FROM AUTHOR]

Introduction: Overcrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient's disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission. Methods: A prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients' need for hospital admission. Results: In total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7–95.9% versus 60.6%, all p < 0.001). Conclusions: Healthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score. [ABSTRACT FROM AUTHOR]

Medication errors in emergency care settings pose significant risks to patient safety, particularly due to the complexity of urgent care situations and the rapid decision-making required. A multisectoral approach, incorporating Emergency Medical Services (EMS), pharmacy, and laboratory services, is essential for minimizing medication errors in these environments. This paper discusses strategies to improve medication safety by fostering collaboration across these sectors, implementing standardized protocols, utilizing technology, and enhancing communication. The implementation of these strategies can significantly reduce medication errors, ensuring better patient outcomes and a safer emergency care environment. [ABSTRACT FROM AUTHOR]

Evidence-based practice (EBP) is crucial for improving healthcare outcomes and ensuring the delivery of high-quality care. However, the adoption of EBP among healthcare professionals remains a challenge. This review aims to investigate the barriers and facilitators to the adoption of EBP among emergency medical services specialists, anesthesia technicians, nursing technicians, health assistants, and cardiologists. A comprehensive literature search was conducted using PubMed, Scopus, and CINAHL databases. Studies that explored the barriers and facilitators to EBP adoption among the targeted healthcare professionals were included. The findings suggest that common barriers include lack of time, limited knowledge and skills, inadequate organizational support, and resistance to change. Facilitators include training and education, leadership support, access to resources, and multidisciplinary collaboration. The review highlights the need for targeted interventions to address the identified barriers and promote the adoption of EBP among these healthcare professionals. Recommendations for policy, practice, and future research are provided to support the widespread implementation of EBP in healthcare settings. [ABSTRACT FROM AUTHOR]

Introduction: Many interdisciplinary efforts are actually regarding much of the preoperative patient preparation that could bring outstanding surgical performance with fewer complications and better recovery outcomes. It is also very much a true team effort: briefed and administered by nurses, general surgeons, emergency medicine doctors, anesthetists, radiologists, pharmacy technicians, and all other health care technicians, everyone contributes towards complete evaluation, coordinated plan of action, and skills to educate patient aside from prerequisites of successful surgical program. Aim of work: To the expanded role of nursing beyond traditional bedside care, focusing on the contributions of nurses in leadership, research, and community impact. Methods: We conducted a comprehensive search in the MEDLINE database's electronic literature using the following search terms: Nursing, Leadership, Research, and Community Impact. The search was restricted to publications from 2016to 2024 in order to locate relevant content. We performed a search on Google Scholar to locate and examine academic papers that pertain to my subject matter. The selection of articles was impacted by certain criteria for inclusion. Results: The publications analyzed in this study encompassed from 2016 to 2024. The study was structured into various sections with specific headings in the discussion section. Conclusion: Changes of nursing are going beyond the bedside, and this reflects the dynamic nature of healthcare as well as the complexity of patient needs. Case in point is their work in community involvement through leadership and research-in an effort to redefine their roles as an integral part of society's health and well-being. By putting together clinical expertise with advocacy, innovation, and collaboration, nurses will ever be at the forefront of the ongoing transformation of healthcare. As the demand for comprehensive and equitable healthcare grows, so too will the importance of empowering nurses to fulfill their expanded roles. Such health systems will be capable of harnessing the potential of nursing fully to achieve better outcomes for individuals and communities alike. The profession becomes that much more inspirational and transformative, and the impact goes well beyond global health. [ABSTRACT FROM AUTHOR]

Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and communitytrained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors. [ABSTRACT FROM AUTHOR]

Assessment of suicidal risk is one of the most challenging tasks faced by health professionals, notably in emergency care. We compared telephone suicide risk assessment at prehospital Emergency Medical Services Dispatch Center (EMS-DC), with subsequent face-to-face evaluation at Psychiatric Emergency Service (PES), using French national Risk-Urgency-Danger standards (RUD). Data were collected for all suicidal adult patients (N = 80) who were addressed by EMS-DC to PES between December 2018 and August 2019 and benefited from RUD assessment at both services. Suicidal risk was given a score of 1, 2, 3 or 4, in order of severity. Mean of the differences between the RUD score at EMS-DC and PES was −0.825 (SD = 1.19), and was found to be significant (p < 0.01). The average time between RUD assessments was 420 min (SD = 448) and was negatively correlated with the difference in the RUD score (r = −0.295, p = 0.008). Associated suicide attempt increased the odds of a decrease in the RUD score (OR = 2.989; 95% CI = 1.141–8.069; p < 0.05). Telephone evaluation of suicidal risk using RUD at EMS-DC yielded moderately higher scores than those obtained by a subsequent face-to face evaluation at PES, with this difference partially explained by the time between assessments, and by clinical and contextual factors. [ABSTRACT FROM AUTHOR]

Introduction Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published and anecdotal data suggest that many patients with TBI are inappropriately ventilated during transport, thereby increasing the risk of morbidity and mortality from secondary brain injury. Materials and Methods Enlisted Air Force personnel with prior emergency medical technician training completing a 3-week trauma course were evaluated on their ability to provide manual ventilation. Participants provided manual ventilation using either an in-situ endotracheal tube (ETT) or standard face mask on a standardized simulated patient manikin with TBI on the first and last days of the course. Manual ventilation was provided via a standard manual ventilator and a novel manual ventilator designed to limit tidal volume (VT) and respiratory rate (RR). Participants were given didactic and hands-on training on the third day of the course. Half of the participants were given simulator feedback during the hands-on training. All students provided 2 minutes of manual ventilation with each respirator. Data were collected on the breath-to-breath RR, VT, and peak airway pressures generated by the participant for each trial and were averaged for each trial. A minute ventilation (MV) was then derived from the calculated RR and VT. Results One hundred fifty-six personnel in the trauma course were evaluated in this study. Significant differences were found in the participant's performance with manual ventilation with the novel compared to the traditional ventilator. Before training, MV with the novel ventilator was less than with the traditional ventilator by 2.1 ± 0.4 L/min (P  = .0003) and 1.6 ± 0.5 L/min (P  = .0489) via ETT and face mask, respectively. This effect persisted after training with a difference between the devices of 1.8 ± 0.4 L/min (P  = .0069) via ETT. Both traditional education interventions (didactics with hands-on training) and simulator-based feedback did not make a significant difference in participant's performance in delivering MV. Conclusions The use of a novel ventilator that limits RR and VT may be useful in preventing hyperventilation in TBI patients. Didactic education and simulator-based feedback training may not have significant impact on improving ventilation practices in prehospital providers. [ABSTRACT FROM AUTHOR]

Background: Emergency medical personnel are among the people who play a major role in reducing the mortality and disability of the injured. This study determines the relationship between mental health and job satisfaction with professional ethics in emergency medical personnel. Materials and Methods: The present cross-sectional study included 126 emergency medical personnel in Hamadan City, Iran. The data were collected using a 3-part demographic information questionnaire, the 28-item general health questionnaire, the Barry Field and Ruth job satisfaction questionnaire and the Cadozier professional ethics questionnaire. The data were analyzed using Stata software, version 14. Meanwhile, the significance level was considered P<0.05. Results: Most of the participants in the study were married (53.17%), technicians (80.95%), in contractual employment (75.4%), with rotating shift type (84.92%), had a bachelor's degree (55.56%) and were not satisfied with their monthly income (76.98%). The results showed that the mean scores of mental health, professional ethics and job satisfaction were 50.9, 81.45 and 35.58, respectively. There is a direct and significant relationship between mental health and professional ethics (P=0.007, r=0.24). Additionally, there is a direct and significant relationship between professional ethics and job satisfaction (P=0.001, r=0.41). However, no significant relationship was observed between mental health and job satisfaction (P=0.24, r=0.10). Conclusion: Mental health workshops and fun facilities can improve emergency medical personnel's professional ethics and job satisfaction due to their direct relationship. [ABSTRACT FROM AUTHOR]

Highlights Pre- and post-tests, administered to 2,141 emergency first responder participants, showed an average improvement in test scores from 67% to 75%, highlighting the efficacy of the training. Interviews conducted within 3 years post-training revealed high participant satisfaction, with over 25% reporting adoption of key strategies discussed in the training by their fire/rescue service. Areas of concern were identified, including the lack of understanding related to certain hazards, such as free-flowing grain, which may put first responders at risk of secondary victimization. Purdue University’s Agricultural Safety and Health Program has provided leadership for nearly 40 years in the documentation of fatalities and injuries associated with agricultural confined spaces, especially those relating to grain storage, handling, and transport. Findings have been used to develop evidence-based resources to assist in the prevention and mitigation of these incidents, including the design of in-service training resources for emergency rescue and medical personnel responding to entrapments or engulfment in agricultural confined spaces. To enhance the efficacy and consistency of these training resources, a list of core competencies was developed with companion test questions by a panel of experts to validate the baseline understanding and knowledge gain of training participants. The test questions were pilot tested as pre- and post-tests and incorporated into a curriculum developed under a U.S. Department of Labor Susan Harwood Training Grant. The twenty-question pre- and post-tests were administered to 2,141 registered emergency first responder participants in training conducted primarily in Indiana. Participation was voluntary, providing 671 usable matched pre- and post-tests. On average, test scores improved from 67% to 75%. A question-by-question review highlighted areas of common knowledge as well as at least one topic in which the potential for confusion was increased by the instructional content. In addition, participants were interviewed within 3 years to assess the impact of the training received. Interviewees indicated a high level of satisfaction with the training, and over 25% indicated that their fire/rescue service adopted at least one of the seven key strategies discussed in the training. One key concern observed in training was the lack of understanding related to certain hazards, such as the nature of free-flowing grain, that may put first responders at risk of becoming secondary victims during rescue and extrication efforts. A need was identified for continued improvement of emergency first responder training through the incorporation of recent research findings on confined space rescue, greater attention to the prevention of secondary injuries, and more consistent instructor preparation in order to increase the probability of successful outcomes from incidents involving grain storage, handling, and transport. [ABSTRACT FROM AUTHOR]