Emergency Medical Services Professionals Research Articles

Demography of the National Emergency Medical Services Workforce: A Description of Those Providing Patient Care in the Prehospital Setting

Background The emergency medical services (EMS) workforce is a key component of healthcare in the U.S. Characteristics of active EMS professionals who are treating patients in the prehospital setting is unclear. The purpose of this study was to describe the roles and settings in which nationally certified EMS professionals are providing patient care and to evaluate similarities and differences of the demographics and practice settings of the three major certification levels. Methods We conducted a cross-sectional evaluation of all nationally certified EMS professionals in the U.S. that recertified between October 1, 2017 and March 31, 2018 and October 1, 2018 and March 31, 2019. Within the recertification application, EMS professionals completed an optional demographic profile. Those who were nationally certified, functioning as a patient care provider for at least one nonmilitary EMS organization, aged 18 to 85 years, and recertified at the EMT level or higher were included. Demographic, agency and job characteristics were assessed and descriptive statistics were calculated. Results In 2017-2018, 101,363 EMS professionals recertified and 87,471 (86%) completed the profile; in 2018-2019, 106,893 EMS professionals recertified and 92,640 (87%) completed the profile. Of the 142,751 EMS professionals who met inclusion criteria, the population was primarily male (76%) and age increased by certification level. By race/ethnicity, 85% were white, 5% were Hispanic/Latino, 5% were Black/African American, 2% were American Indian/Alaskan Native, 2% were Asian and 1% were Native Hawaiian/Pacific Islander. Paramedics had the highest proportion of associate degrees (EMT:16.0%; AEMT:16.6%; paramedic:28.5%); some college experience was common for all certification levels (EMT:34.7%; AEMT:37.2%; paramedic:31.6%). Most EMS professionals reported 3-7 years of experience, were working full-time (78%) and 28% were working for 2 or more agencies. Most were working for a fire department (48%) or private agency (21%) and providing 9-1-1 service (72%). No substantial differences were observed between the two recertification cycles. Conclusion This is the most comprehensive study evaluating the demographics of the national EMS workforce of active patient care providers. Understanding the characteristics of EMS professionals and the settings they practice in is important for educational and training initiatives, as well as protocols and policies.

Burnout and Coping Methods among Emergency Medical Services Professionals.

PurposeTo determine levels of burnout among emergency medical services (EMS) professionals and the coping strategies they use to alleviate burnout and measure the association between burnout vs sociodemographic and work-related characteristics and coping strategies of EMS professionals.MethodsThis was a cross-sectional survey study conducted among 270 active-duty EMS professionals. The Maslach Burnout Inventory (MBI) — Health Services Survey was used to assess burnout. There are three scales of burnout: depersonalization, emotional exhaustion, and personal achievement. Coping Methods Checklist (CMC) was used to assess coping strategies. Univariate descriptive statistics were used to explore sociodemographic characteristics of participants, level of burnout, and coping strategies. Primary bivariate analyses were used to determine variables significantly correlated with each of the three MBI scores. Multiple linear regression models were used to explore correlation between variables measured in the survey with each of the three MBI scales (emotional exhaustion, depersonalization, and personal accomplishment).ResultsEMS professionals perceived high levels of emotional exhaustion and depersonalization and low levels of personal achievement. The most frequently used coping strategies were talking with colleagues (87.4%), looking forward to being off duty (82.6%), and thinking about the positive benefits of work (81.1%). CMC7 (thinking about the positive benefits of work) contributed most to variations in emotional exhaustion, depersonalization, and personal achievement. Saudis had lower emotional exhaustion and depersonalization.ConclusionThis study might provide evidence to formulate comprehensive training on how EMS workers can cope with burnout.

The association of job demands and resources with burnout among emergency medical services professionals.

ObjectiveAlthough burnout has been linked to negative workplace‐level effects, prior studies have primarily focused on individuals rather than job‐related characteristics. This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job‐related demands/resources among emergency medical services (EMS) professionals.MethodsAn electronic questionnaire was sent to all licensed, practicing EMS professionals in South Carolina. Work‐related burnout was measured using the Copenhagen Burnout Inventory. Multivariable generalized estimating equations were used to estimate odds ratios (ORs) for specific job demands and resources while adjusting for confounding variables. Composite scores were used to simultaneously assess the relationship between burnout and job‐related demands and resources.ResultsAmong 1271 EMS professionals working at 248 EMS agencies, the median agency‐level burnout was 35% (interquartile range [IQR]: 13% to 50%). Job‐related demands, including time pressure, were associated with increased burnout. Traditional job‐related resources, including pay and benefits, were associated with reduced burnout. Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout. EMS professionals facing high job demands and low job resources demonstrated nearly a 10‐fold increase in odds of burnout compared with those exposed to low demands and high resources (adjusted OR [aOR]: 9.50, 95% confidence interval [CI]: 6.39–14.10). High job resources attenuated the impact of high job demands.ConclusionThe proportion of EMS professionals experiencing burnout varied substantially across EMS agencies. Job resources, including those reflective of organizational culture, were associated with reduced burnout. Collectively, these findings suggest an opportunity to address burnout at the EMS agency level.

Approach to angry patients and anger expression styles of emergency medical services professionals

Approach to angry patients and anger expression styles of emergency medical services professionals

The Factors Affecting Job Satisfaction of Emergency Medical Services Professionals in Ankara

The Factors Affecting Job Satisfaction of Emergency Medical Services Professionals in Ankara

Mental Health in Emergency Medical Clinicians: Burnout, STS, Sleep Disorders. A Cross-Sectional Descriptive Multicentric Study

Emergency medicine specialists’ mental and physical health may be threatened if they experience burnout, sleep disorders, and secondary traumatic stress (STS). We aimed to investigate whether Emergency Medical Services (EMs) professionals’ mental and physical health status, depression, and anxiety are associated with burnout, STS, and sleep disorders. We hypothesized that burnout, STS, and the severity of sleep disorders would raise the risk of impaired mental, and physical health, depression, and anxiety in emergency medical clinicians. A cross-sectional multicentric study was conducted. In total,178 EMs specialists completed validated surveys to assess mental health complaints (Mental Health Inventory, MHI-5 screening test), physical health complaints (Ware scale), depression, and anxiety (Depression, Anxiety and Stress Scale-DASS), burnout (Maslach Burnout Inventory-general survey, MBI-GS), sleep disorders (Insomnia Severity Index, ISI), and STS (STS scale). This study aimed to analyze the influence that work-related factors can have on EMs specialists’ mental and physical health, depression, and anxiety. Specifically, mental health was predicted by exhaustion (β = 0.16), cynicism (β = 0.21), insomnia severity (β = 0.13), and STS (β = 0.35); physical health was predicted by exhaustion (β = 0.33) and insomnia severity (β = 0.18); depression was predicted by cynicism (β = 0.21) and STS (β = 0.46); and anxiety was predicted by STS (β = 0.63) and inefficacy (β = 0.20). Work-related stress symptoms such as burnout, STS, and sleep disorders were found to predict emergency medicine clinicians’ mental and physical health, as well to increase the risk of depression and anxiety. It is of most importance to develop practices to prevent such symptoms and to promote mental health and well-being among the emergency medicine personnel.

Seat belt use in the ambulance patient compartment by emergency medical services professionals is low regardless of patient presence, seating position, or patient acuity

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

Use of Mechanical Cardiopulmonary Resuscitation Devices for Out-of-Hospital Cardiac Arrest, 2010-2016

Out-of-hospital cardiac arrest is a common scenario facing prehospital emergency medical services (EMS) professionals and nearly always involves either manual or mechanical cardiopulmonary resuscitation (CPR). Mechanical CPR devices are expensive and prior clinical trials have not provided evidence of benefit for patients when compared with manual CPR. To investigate the use of mechanical CPR in the prehospital setting and determine whether patient demographic characteristics or geographical location is associated with its use. A retrospective cross-sectional study was performed using the 2010 through 2016 National Emergency Medical Services Information System data. Participants included all patients identified by EMS professionals as having out-of-hospital cardiac arrest. Use of CPR, categorized as manual or mechanical. From 2010 to 2016, 892 022 patients (38.6% female, 60.4% male, missing for 1%; mean [SD] age, 61.1 [20.5] years) with out-of-hospital cardiac arrest were identified by EMS professionals. Overall, manual CPR was used for 618 171 patients (69.3%) and mechanical CPR was used for 45 493 patients (5.1%). The risk-standardized rate of mechanical CPR use, accounting for patient demographic and geographical characteristics, rose from 1.9% in 2010 to 8.0% in 2016 (P < .001). In multivariable analyses, use of mechanical CPR devices was increasingly likely over time among patients identified with out-of-hospital cardiac arrest treated by EMS professionals, increasing from an adjusted odds ratio of 1.58 (95% CI, 1.42-1.77; P < .001) when comparing 2011 with 2010, to an adjusted odds ratio of 11.32 (95% CI, 10.22-12.54; P < .001) when comparing 2016 with 2010. In addition, several other patient demographic and geographical characteristics were associated with a higher likelihood of receiving mechanical CPR, including being 65 years or older, being male, being Hispanic, as well as receiving treatment in the Northeast Census Region, in a suburban location, or in a zip code with a median annual income greater than $20 000. Mechanical CPR device use increased more than 4-fold among patients with out-of-hospital cardiac arrest treated by EMS professionals. Given the high costs of mechanical CPR devices, better evidence is needed to determine whether these devices improve clinically meaningful outcomes for patients treated for out-of-hospital cardiac arrest by prehospital EMS professionals to justify the significant increase in their use.

Females and Minority Racial/Ethnic Groups Remain Underrepresented in Emergency Medical Services: A Ten-Year Assessment, 2008–2017

Background: Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings where time pressure and incomplete information may exacerbate the effects of implicit biases. Emergency medical services (EMS) professionals represent a critical entry point into the healthcare system for diverse populations, yet little is known regarding changes in the demographic composition of this workforce. Our primary objective was to describe the gender and racial/ethnic composition of emergency medical technicians (EMTs) and paramedics who earned initial National EMS Certification from 2008 to 2017. Secondarily, we compared demographic characteristics of the 2017 EMT and paramedic cohorts to the U.S. population. Methods: As a proxy for recent graduates likely to enter the workforce, we conducted a serial cross-sectional analysis of all EMTs and paramedics earning initial National EMS Certification from January 1, 2008 to December 31, 2017. Cuzick’s non-parametric test of trend was used to assess for changes in the gender and racial/ethnic composition of the EMS cohorts over time. For 2017, we calculated differences the gender and racial/ethnic composition of the EMT and paramedic cohorts to the U.S population, stratifying by Census region. Results: The study population included 588,337 EMTs and 105,356 paramedics. The proportion of females earning initial EMT certification rose from 28% in 2008 to 35% in 2017. Throughout the study period, less than one-fourth of newly certified paramedics were female (range: 20–23%). The proportion of EMS professionals identifying as black remained near 5% among EMTs and 3% among paramedics. The proportion of newly-certified Hispanic EMS professionals rose from 10% to 13% among EMTs and from 6% to 10% among paramedics. Compared to the U.S. population, females and racial/ethnic minorities were underrepresented among EMTs and paramedics earning initial certification and these representation differences varied across geographic regions. Conclusions: The underrepresentation of females and minority racial/ethnic groups observed during this 10-year investigation of EMTs and paramedics earning initial certification suggests that EMS workforce diversity is unlikely to undergo substantial change in the near future. The representation gaps were larger and more stable among paramedics compared to EMTs and suggest an area where concerted efforts are needed to encourage students of diverse backgrounds to pursue EMS.

Patients, Protocols, and Prosocial Behavior: Rule Breaking in Frontline Health Care

Rules are essential components of organizations, especially given their foundational role in inducing organizationally preferred behavior and reducing behavioral variability among its members. Despite the existence and prevalence of these centrally important tools, rule deviation occurs. This study proposes to understand the ways in which emergency medical service (EMS) professionals break rules for prosocial purposes—to help patients. In particular, this research seeks to understand how specific organizational and personal attributes influence rule-breaking tendencies. Results indicate that aspects of ethical climate are significantly related to prosocial rule-breaking (PSRB) tendencies, whereas empathy is not. In addition, this study finds that other characteristics, such as a conformist personality, risk taking, expertise, and experience on the job influence PSRB. These findings contribute to the literature on rule deviation and EMS practices and shed light on the complexity of decision making in frontline public services.

Prior Participation in Simulation Events Is Associated With Insimulation Team Performance Among Emergency Medical Services Professionals.

Prior evidence has supported the use of high-fidelity simulation in initial emergency medical services (EMS) education, but there is a dearth of research on whether EMS professionals can also benefit from it. We sought to examine simulation use and years of practice as predictors of insimulation team performance among EMS professionals. The hypothesis is that both the prior participation in simulation events and the accumulated years of practice will predict insimulation performance. This cross-sectional study was conducted as part of a simulation-based EMS competition. Paramedic and physician teams were tested. Participants' years of EMS and healthcare practice and their prior participation in simulation events were assessed with a survey and correlated with performance in the competition. Participants were 120 EMS professionals from 51 teams, which was 75% of all competitors. They had in average 8.03 years of healthcare practice and 5.71 years of EMS practice and had previously participated in 4.34 simulation events. The prior participation in simulation events correlated significantly with EMS insimulation performance at the team level (r = 0.40-0.59). In contrast, neither the years of healthcare practice nor the years of EMS practice significantly predicted insimulation team performance. Furthermore, there was no interaction of simulation use and years of practice. The benefits of simulation use are not limited to initial EMS education but spread also to experienced professionals. Even individuals who have been working in the field for many years may benefit from high-fidelity simulation. Future research should examine whether this also translates into better clinical performance.

Measuring the levels of burnout syndrome and empathy of Spanish emergency medical service professionals

Backgroundto determine the prevalence of burnout syndrome among Spanish emergency medical service professionals and establish any possible relationships between their levels of empathy and sociodemographic and/or working conditions. Method550 professionals participated in this descriptive study by responding to the Maslach Burnout Inventory and the Basic Empathy Scale. Resultsrespondents were, on average, 40.9 years old (SD=9.03) and 63.4% were female. Their average length of service was 11.6 years (SD=8.1); 57.9% were physicians, 22.4% nurses, and 7.2% technical staff. Of the 337 who said they had children, 51% said that parenthood affected their emotional state when attending emergency situations involving children. Participants generally considered themselves to be competent (x˙=4.2; SD=0.7) and occupationally motivated (x˙=3.8; SD=1.1). More experienced participants presented fewer signs of burnout and empathy and more signs of competence (p<0.001). Occupational category appeared to significantly affect the presentation of burnout syndrome (p<0.05). Prehospital emergency medical services (PEMS) staff tended to rate their ability to perform their work and interact professionally with their patients more positively than emergency department staff. ConclusionSpanish emergency medical service staff present similar levels of burnout to other healthcare providers but have higher levels of empathy. We found no significant differences in the presentation of burnout between physicians and nurses, but compared to emergency department staff, PEMS professionals appeared to be more confident in their abilities. Educational activities are required to improve professionals’ ability to cope with their work and structural workplace interventions could help reinforce healthcare professionals’ ability to tolerate intense workloads and to maintain their sense that their work is rewarding.

Social Support Outside the Workplace, Coping Styles, and Burnout in a Cohort of EMS Providers From Minnesota.

Occupational burnout has been linked to the delivery of lower quality of care in some health care professions, including with turnover intentions and absenteeism in emergency medical services (EMS) workers. Thus, studies that identify factors associated with burnout may be integral to optimizing quality and workforce engagement among EMS professionals. A survey was conducted to assess social support outside the workplace, coping styles, and occupational burnout in a cohort of EMS providers from Minnesota. Surveys were returned by 217 providers (54% response), of which 167 had provided data on burnout, social support, and coping styles and were included in the analysis. The mean age was 41 years, 62% were male, and the prevalence of burnout was 17%. After adjustment for age and EMS tenure, the odds of burnout was higher among those characterized as socially isolated as compared with providers who were integrated socially or moderately integrated (odds ratio = 3.52; 95% confidence interval = [1.13, 10.98]). Common coping responses included planning, positive reframing, and active coping, while behavioral disengagement and denial were rarely used. Lack of social networks outside the workplace and frequent use of self-blame, food, or substance use as coping strategies were associated with burnout. Conversely, social integration and use of religion and instrumental support to cope with stressors were associated with reduced burnout.

Performance of the RACE Score for the Prehospital Identification of Large Vessel Occlusion Stroke in a Suburban/Rural EMS Service

Introduction: Emergency Medical Services (EMS) providers may identify and preferentially transport patients experiencing large vessel occlusion (LVO) stroke to appropriate treatment centers. The Rapid Arterial oCclusion Evaluation (RACE) scale was created for prehospital LVO detection, yet few studies have evaluated its function in real-world EMS settings. Our objective was to assess the prehospital performance of the RACE scale for detecting LVO stroke following implementation at a large suburban/rural agency in the United States. Methods: In this retrospective analysis, all 9-1-1 patients with an EMS provider primary or secondary impression of stroke treated by the agency between June 1, 2016 and November 1, 2017 were eligible for inclusion. Patient data were abstracted using a standardized form completed by receiving hospitals. Performance for LVO detection at each RACE cutoff value was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the RACE scale overall. A secondary analysis of RACE for patients experiencing strokes best treated at comprehensive stroke centers (LVO and intracerebral hemorrhage [ICH]) was conducted. Results: There were 440 patients with a documented RACE score and hospital outcome data included in the analysis. About half (51%, n = 220) were female and the median age was 70 years (IQR: 59–81). Last known well time was under 4.5 hours for 76% of patients (n = 261). Over half (61%, n = 269) had a hospital discharge diagnosis of stroke and 64/440 (15%) were classified as LVO. The ROC curve demonstrated adequate discrimination with a c-statistic of 0.72. Performance for identifying LVO in the prehospital setting was greatest for RACE scores ≥5 with a sensitivity of 66% and specificity of 72%, PPV of 29%, and NPV of 93%. A RACE score ≥5 for both LVO and ICH demonstrated sensitivity: 63%, specificity: 77%, PPV: 47% and NPV: 86%. Conclusion: The RACE scale demonstrated acceptable discrimination, yet the sensitivity and positive predictive value were lower in this cohort of EMS professionals in the United States than in the original validation study conducted in Spain. Further work is needed to determine the optimal prehospital screening tool for identification of LVO.

Development and Validation of a Prediction Model for Prehospital Triage of Trauma Patients

Prehospital trauma triage protocols are used worldwide to get the right patient to the right hospital and thereby improve the chance of survival and avert lifelong disabilities. The American College of Surgeons Committee on Trauma set target levels for undertriage rates of less than 5%. None of the existing triage protocols has been able to achieve this target in isolation. To develop and validate a new prehospital trauma triage protocol to improve current triage rates. In this multicenter cohort study, all patients with trauma who were 16 years and older and transported to a trauma center in 2 different regions of the Netherlands were included in the analysis. Data were collected from January 1, 2012, through June 30, 2014, in the Central Netherlands region for the design data cohort and from January 1 through December 31, 2015, in the Brabant region for the validation cohort. Data were analyzed from May 3, 2017, through July 19, 2018. A new prediction model was developed in the Central Netherlands region based on prehospital predictors associated with severe injury. Severe injury was defined as an Injury Severity Score greater than 15. A full-model strategy with penalized maximum likelihood estimation was used to construct a model with 8 predictors that were chosen based on clinical reasoning. Accuracy of the developed prediction model was assessed in terms of discrimination and calibration. The model was externally validated in the Brabant region. Using data from 4950 patients with trauma from the Central Netherlands region for the design data set (58.3% male; mean [SD] age, 47 [21] years) and 6859 patients for the validation Brabant region (52.2% male; mean [SD] age, 51 [22] years), the following 8 significant predictors were selected for the prediction model: age; systolic blood pressure; Glasgow Coma Scale score; mechanism criteria; penetrating injury to the head, thorax, or abdomen; signs and/or symptoms of head or neck injury; expected injury in the Abbreviated Injury Scale thorax region; and expected injury in 2 or more Abbreviated Injury Scale regions. The prediction model showed a C statistic of 0.823 (95% CI, 0.813-0.832) and good calibration. The cutoff point with a minimum specificity of 50.0% (95% CI, 49.3%-50.7%) led to a sensitivity of 88.8% (95% CI, 87.5%-90.0%). External validation showed a C statistic of 0.831 (95% CI, 0.814-0.848) and adequate calibration. The new prehospital trauma triage prediction model may lower undertriage rates to approximately 10% with an overtriage rate of 50%. The next step should be to implement this prediction model with the use of a mobile app for emergency medical services professionals.

Abstract TP310: Barriers Experienced by Emergency Medical Service Providers When Responding, Assessing, and Transporting Stroke Patients in a Rural State: Findings from Mission: Lifeline North Dakota

Introduction: In predominantly rural states, effective and efficient response of Emergency Medical Services (EMS) to stroke cases is often delayed by geographically large, sparsely populated service areas and limited access to healthcare professionals and services. North Dakota is a rural state with 36 of 53 counties designated as Frontier (less than six persons per square mile) and a total population estimated at 755,393. Purpose: To identify barriers experienced by EMS professionals in North Dakota when responding to, assessing, providing care, and transporting potential stroke patients. Methods: EMS providers were recruited to participate in in-person focus groups. Four focus groups were performed (n=24) using a semi-structured interview guide. Sessions were digitally recorded and field notes with abridged transcripts were analyzed for recurrent themes using content analysis. Results: Participants were 37.5% male, 91.7% non-Hispanic White and included unpaid EMS volunteers (29.0%). Several common themes were identified, including: 1) importance of public awareness for timely recognition of stroke symptoms and the importance of calling 9-1-1 at early onset of symptoms; 2) frequent receipt of inaccurate/insufficient information from Dispatch; 3) difficulties notifying accepting hospitals due to loss of cell service in rural areas; 4) perceptions that accepting hospital staff due not trust EMS clinical assessments; 5) technical barriers and time restraints experienced when providing written and verbal patient reports to hospitals; and 6) lack of formal feedback from hospitals to EMS agencies regarding stroke patients transported by EMS agencies. Conclusions: EMS providers in North Dakota experience several challenges inhibiting their ability to provide timely pre-hospital care to stroke patients. Although several barriers were identified, most are modifiable and can be remedied with enhanced education and training focused on improving effectiveness and efficiency of EMS communications with dispatch and hospitals.

How to improve communication using technology in emergency medical services? A case study from Finland

The field of emergency medical services (EMS) is a challenging environment for ensuring fluent information exchange between stakeholders because several different kinds of organizations are involved in EMS missions. Solutions for information and communication technology can vary significantly depending on the organization. This study aims to identify current communication bottlenecks between EMS professionals, understand the technological challenges behind them, and describe technologies that can improve EMS communication in the future.&#x0D; Information for the study about current EMS processes, technologies, and technology needs was collected from EMS professionals during three workshops, five personal interviews, and one email questionnaire. All surveyed health care professionals were working in the county of Northern Ostrobothnia. Information about proposed technologies for EMS was obtained from literature and interviews with five technology companies.&#x0D; The principal problem in EMS communication is scattered health data. This leads to a lack of common situational awareness for professionals and incomplete medical histories for patients. The reasons behind those problems are different information systems which do not communicate with each other and the lack of a common electronic patient care record (ePCR) for use by stakeholders. Personal health measurements, sensors, telemedicine, and artificial intelligence will create opportunities for further improving the flow of communication in EMS, provided those tools can be integrated into decision-making systems.

Characteristics of patients treated for severe hypoglycaemia in emergency care settings – Analysis of routinely collected data

ObjectiveSevere hypoglycaemic events (SHE) commonly require emergency care. This study investigates the presentation of patients with SHE to a single Swiss emergency service, including pre-hospital care with emergency medical services (EMS) and emergency department (ED) presentations. MethodRetrospective analysis of routinely collected data by the EMS and ED during 2014. All adult patients with diabetes type 1 or type 2 with SHE were included in the analysis. Results43 SHE were recorded in 38 patients with diabetes. Mean age of all patients was 65 years (SD ± 17.51), 54% (n = 23) were men, 55.8% (n = 24) were living in a relationship, and 54.8% (n = 23) were diagnosed with type 2 diabetes. Of the 43 episodes, 65% (n = 28) of the presentations used EMS and were then taken to the ED, 28% (n = 12) involved contact with the EMS only, and 7% (n = 3) were seen by the ED but did not use EMS. Patients seen by the EMS only (n = 12) were younger compared to those admitted to ED (n = 28); Md 54 years vs Md 72 years; U = 98; p = .039. The same age difference was similar between patients in the ED setting discharged home (n = 11) and with in-patients (n = 20); Md 61 years vs. Md 79 years; U = 51; p = .013. ConclusionsPeople most likely to suffer a SHE were men, those living with a partner, over 65 years old, and living with type 2 diabetes. Younger patients treated by EMS at home tended to remain at home, in contrast to the older patients who were admitted to hospital. This was also true for the ED where older people in particular became in-patients after such an event. Elderly care specialist brief interventions conveyed by EMS and ED healthcare professionals might be of value to prevent further SHE. Validating these findings in multiple emergency settings is warranted to support the delivery of targeted interventions.

Can Altering Grip Technique and Bag Size Optimize Volume Delivered with Bag-Valve-Mask by Emergency Medical Service Providers?

Introduction: Emergency Medical Services (EMS) professionals rely on the bag-valve-mask (BVM) to provide life-saving positive-pressure ventilation in the prehospital setting. Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. A recent study has shown that the volumes typically delivered by EMS professionals with the adult BVM are often higher than recommended by lung-protective ventilation protocols. Our primary objective was to determine if a group of EMS professionals could reduce the volume delivered by adjusting the way the BVM was held. Secondary objectives included 1) if the adjusted grip allowed for volumes more consistent with lung-protection ventilation strategies and 2) comparing volumes to similar grip strategies used with a smaller BVM. Methods: A patient simulator of a head and thorax was used to record respiratory rate, tidal volume, peak pressure, and minute volume delivered by participants for 1 minute each across 6 different scenarios: 3 different grips (using the thumb and either 3 fingers, 2 fingers, or one finger) with 2 different sized BVMs (adult and pediatric). Trials were randomized by blindly selecting a paper with the scenario listed. A convenience sample of EMS providers was used based on EMS provider and research staff availability. Results: We enrolled 50 providers from a large, busy, urban hospital-based EMS agency a mean 8.60 (SD = 9.76) years of experience. Median volumes for each scenario were 836.0 mL, 834.5 mL, and 794 mL for the adult BMV (p = 0.003); and 576.0 mL, 571.5 mL, and 547.0 mL for the pediatric BVM (p < 0.001). Across all 3 grips, the pediatric BVM provided more breaths within the recommended volume range for a 70 kg patient (46.4% vs. 0.4%; p < 0.001) with only a 1.1% of breaths below the recommended tidal volume. Conclusion: The study suggests that it is possible to alter the volume provided by the BVM by altering the grip on the BVM. The tidal volumes recorded with the pediatric BVM were above recommended range in 2 of the 3 grips. The volumes of the pediatric BVM were overall more consistent with lung-protective ventilation volumes when compared to all 3 finger-grips of the adult BVM.

Workplace Incivility Among Nationally Certified EMS Professionals and Associations with Workforce-Reducing Factors and Organizational Culture

Background: Incivility, defined as negative interpersonal acts that violate workplace and social norms, has been linked to negative outcomes in healthcare settings. A minimal amount is known regarding workplace incivility among emergency medical services (EMS) professionals. Our objectives were to (1) evaluate the prevalence of incivility and factors associated with experiencing workplace incivility; (2) describe the association between incivility and workforce-reducing factors (stress, career satisfaction, turnover intentions, and workplace absences); and (3) quantify the association between incivility and the organizational culture of an EMS agency. Methods: A random sample of 38,000 nationally-certified EMS professionals received an electronic questionnaire with an EMS-adapted Workplace Incivility Scale, the Competing Values Framework organizational culture scale, and factors that may negatively impact the EMS workforce. All completed surveys from nonmilitary EMS professionals currently providing patient care at the EMT level or higher were included in these analyses. We constructed multivariable logistic regression models (OR, 95% CI) to identify factors associated with experiencing workplace incivility and to examine the associations between experiencing incivility and workforce-reducing factors. We calculated univariable odds ratios to assess the association between organizational culture type and incivility. Results: A total of 3,741 EMS professionals responded to the survey (response rate =10.3%), with 2,815 (75.2%) meeting inclusion criteria. Incivility from supervisors or coworkers was experienced at least once a week by 47.4% of respondents. Factors associated with increased odds of experiencing incivility included female sex, AEMT/paramedic certification level, increasing years of EMS experience, service types other than 9-1-1 response, and higher weekly call volumes. Exposure to regular incivility was associated with increased odds of dissatisfaction with EMS, a main EMS job or a main supervisor; moderate or higher stress levels; intent to leave one’s job and EMS in the next 12 months; and 10 or more workplace absences in the past 12 months. The organizational culture type “market” was associated with the greatest odds of incivility. Conclusions: Nearly half of respondents experienced incivility once a week or more, and incivility was associated with potential workforce-reducing factors. Further research is needed to understand how organizational climate and interpersonal behaviors in the workplace affect the EMS workforce.