Emergency Medical Services Staff Research Articles

A mixed methods investigation of emergency communications centre triage in the Government Emergency Medical Services System, Cape Town, South Africa.

IntroductionIn order to allocate resources in an effective manner, emergency medical services (EMS) systems use dispatch-based triaging to prioritise patients by acuity. Over-triage, wherein patients are assigned a higher priority level than necessary, can serve as a safety measure. However, it places strain on EMS systems, a problem believed to be experienced by South Africa's Western Cape Government EMS system, with almost half of its calls designated at the highest priority level.To begin improving dispatch within WCG EMS, we aimed to describe the current system by identifying the most common conditions dispatched, and those most perceived to be suffering from over-triage.MethodsA multi-methods approach was taken: First, a quantitative chart review was used to analyse all calls assigned a dispatch priority by WCG EMS between December 2016 and November 2017. These descriptive data then informed qualitative focus groups to further investigate emergency medical dispatch (EMD). Three focus groups were conducted, each with a convenience sample of staff from: WCG EMS staff, call takers/dispatchers, and call centre managers. Data were reviewed and coded, after which the lead researcher aggregated coded transcripts and conducted thematic content analysis.ResultsSeventy-nine condition categories were identified from 649,544 completed patient records for the study period. Non-specific pain accounted for the greatest proportion of dispatched complaints (16.88%), followed by assault with a weapon (10.00%) and respiratory complaints (9.71%).Sixteen WCG EMS personnel took part in focus groups, highlighting challenges of the current EMD system, including time constraints, legal risks, communication, overuse of the system, and lack of training. Chest pain, collapsed/unresponsive patients, and vomiting and diarrhoea were frequently noted to be potentially over-triaged conditions. To improve this, participants suggested trainings, modifications to the electronic EMD system, additional protocols, and public education.ConclusionThis study identified where over-triage is possibly occurring in the WCG EMS dispatch system, as well as potential solutions proposed by those working within the system.

Prevalence of Workplace Violence Types against Personnel of Emergency Medical Services in Iran: A Systematic Review and Meta-Analysis

Objective: Workplace violence is one type of occupational hazards that is increasingly growing worldwide. In the health system, one of the important groups subject to workplace violence is emergency medical services (EMS) personnel, who provide emergency services for patients and casualties as the first responders. The aim of this study was to determine the prevalence of workplace violence and its different types among Iranian EMS personnel. Method : This study was conducted based on PRISMA guideline for systematic review and meta-analysis. The data were extracted from Scopus, PubMed, Web of Science, Google Scholar, SID and MagIran databases using Persian and English keywords. The search was conducted up to December 2018 without any limitation in publication year. The qualities of selected papers were assessed by STROBE checklist. I2 index was used to evaluate heterogeneity, and random effects model was used in meta-analysis. Data were analyzed using Stata14. Results: A total of 9 studies entered the meta-analysis. The total sample size was 1257 Iranian EMS personnel, with an average age of 32.21 ± 2.01 years. The prevalence of physical, verbal, and cultural workplace violence among EMS personnel was 36.39% (CI 95%:27.29-45.50, P<0.001, I2 = 90.8%), 73.13% (95% CI=68.64-77.62, P=0.013, I2 = 62.7%), and 16.51% (95% CI =3.49- 29.53, p<0.001. I2 = 94.7%), respectively. Conclusion: Considering the high prevalence of workplace violence among EMS personnel in Iran, more studies should be conducted to determine the underlying causes of EMS staff workplace violence in Iran. Training violence prevention methods as well as assigning national protective rules are highly suggested. Insufficient studies on Workplace violence among EMS personnel in Iran and high heterogeneity were the limitations of this study.

The Relationship between Emergency Medical Services Staff Knowledge of Basic Life Support Indicators

Introduction: One of the most important steps to save patients is to perform resuscitation. The aim of this study was to investigate the knowledge and practice of emergency personnel in Tehran regarding the baseline level of resuscitation operations.&#x0D; Methods: This descriptive cross-sectional study was performed on 200 emergency personnel working in Tehran. The level of awareness questionnaire with 45 qualifications and the base of BLS indicators was prepared and collected.&#x0D; Results: According to Chi-square test, there was a significant correlation between age and practical score. Also, there was a significant relationship between the ALS courses and the acquired theoretical score.&#x0D; Conclusion: The results of the increase in awareness of this study in relation to previous studies in Iran and especially in the region show that during the last few years, the level of knowledge of medical emergencies personnel has had good improvement, while on the other hand, although there has been improvement in the performance compared with last few years.

Problem-Based versus Lecture-Based Method in Pre-hospital Trauma Life Support Training; a Pre-test Post-test Study.

Introduction: Pre-hospital trauma life support (PHTLS) training is necessary for all emergency medical services (EMS) personnel to increase their efficacy and skills. This study aimed to compare two methods of problem-based learning (PBL) and lecture-based learning (LBL) for PHTLS training courses of EMS personnel. Methods: In this pre-post-test study, 144 male EMS staff members were divided into two groups of PBL (n=72) and LBL (n=72). Both groups received four sessions of PHTLS training based on 8th edition of PHTLS guideline. The participants’ knowledge and skills were evaluated before and three months after training and the two groups were compared in this regard.  Results: The mean knowledge score (63.59±13.43 to 81.08±4.66; p<0.001) and mean skills score (58.85±19.74 to 99.07±25.02; p<0.001) of participants had significantly improved after the training courses. Both groups had similar scores before intervention, but PBL group had significantly higher scores in knowledge (p<0.001) and skills (p<0.001) after intervention. There was also a significantly higher change in knowledge (p<0.01) and skills (p<0.001) in PBL group compared to LBL group.Conclusions: PHTLS training improves EMS personnel’s knowledge and skill in managing trauma patients. PBL was more effective than LBL.

The use of screening tools in the early recognition of sepsis in the prehospital adult patient: a review of the literature

Background: Sepsis has been identified as a time critical and life-threatening condition resulting from the body's own systemic response to infection leading to multi-organ dysfunction and failure, and remains a major frontrunner in the morbidity and mortality of critically ill patients1–3. The 2016 Surviving Sepsis Campaign1 identified that similar to patients with polytrauma, stroke and acute myocardial infarction, the early identification and timeous delivery of appropriate treatment for patients with sepsis could improve patient outcomes and decrease mortality rates1,4. Prehospital sepsis screening tools could provide a systematic approach to critically ill patients in order to identify those patients with a high index of suspicion for sepsis and allow for early and aggressive management.Methods: A literature review was conducted for the period January 2011 to September 2017. A database search was conducted via the electronic databases Ovid MEDLINE (without revisions), CINAHL and The Cochrane Library. The websites ScienceDirect, Wiley Online Library, British Medical Journal (BMJ) and Google Scholar were also used in the search for literature. Full search strategies are detailed in Table 1. The selection and rejection of all articles can be reviewed in Figure 1.Results: All articles identified for full review (n = 13) were between the period January 2011 and September 2017. The three most common methodologies identified were systematic review (n = 3), prospective cohort study (n = 3) and prospective observational study (n = 3). Other methodologies included literature review (n = 1), retrospective cohort study (n = 1), retrospective analysis (n = 1), and retrospective cross-sectional study (n = 1). Through literature analysis, three main areas of interest were identified in which articles were reviewed: the early recognition of sepsis by Emergency Medical Services (EMS) staff (n = 2), the early recognition of sepsis using a prehospital sepsis screening tool by EMS (n = 6), and the impact of EMS sepsis recognition and management on patient outcomes (n = 4). A comparison summary of the various sepsis screening tools can be viewed in Table 2.Conclusion: Previous literature has described EMS transport rates of approximately 3.3 sepsis patients per 100 and approximately 40% of septic patients admitted having been transported by EMS5. Despite this relatively high prevalence, the review identified that recognition of sepsis by EMS personnel was poor. The use of various sepsis screening tools showed improved recognition by EMS but validation studies on the accuracy of these tools is required. In patients in whom a screening tool was used and early pre-notification given to receiving facilities, a decrease time to definitive management of these patients was identified. These varied findings in outcomes of septic patients transported by EMS identifies the need for further studies on EMS recognition of sepsis and the impact it has on the outcomes of these patients. A specific prehospital sepsis screening tool could possibly assist in the early recognition of sepsis. Pre-notification to receiving facilities could allow the facility to prepare for EMS arrival and continue aggressive early goal directed therapy (EGDT) as required.The author acknowledges the possibility of publication and selection bias within this review due to single author selection and only English studies being included.

Preceptors´ experiences of student supervision in the emergency medical services: A qualitative interview study

BackgroundClinical placements play a central part in the education of future emergency medical services (EMS) staff and their development of clinical skills and competence. A key aspect of students' integration of theory and praxis and development into an independent clinician is a supportive mentorship with the preceptor. However, students report barriers for learning within the EMS, while the preceptors' experiences of their role have received scant attention in research. ObjectivesTo describe preceptors' experiences of student supervision in the EMS during clinical placements. DesignA descriptive qualitative design was used.Twenty specialist nurses were recruited among EMS staff from all parts of Sweden. MethodsData were collected using individual interviews and analyzed with latent qualitative content analysis. FindingsEMS preceptors develop a competence in combining caring and learning adapted to individual student needs when facing students with varying needs in an ever-changing healthcare setting. A trustful relationship between student and preceptor is fundamental when coping with a dual responsibility for student and patient needs. However, several aspects in the EMS setting hinders the preceptors' ability to support the development of the students' independence. Surrounding support structures are important if the preceptors are to feel safe and secure in their role as assessor, teacher and ambulance nurse. ConclusionsPreceptors need to develop a didactic flexibility through preceptor courses adapted to the complex premises found in the EMS. Ambulance services and universities should recognize the importance of preceptors´ colleagues, student continuity, university support and cooperation for improving quality and clarity in supervision during clinical placements.

PPE Misuse and its Effect on Infectious Disease Among EMS in Saudi Arabia

&#x0D; &#x0D; &#x0D; Emergency Medical Services (EMS) responders provide medical services in diverse, unique and dangerous environments. EMS provides care to diverse and mobile populations who are likely to contract infectious diseases. In addition to responding to the emergency situations, the EMS are also attending to the homeless, trauma victims and nursing home patients in addition to critically ill patients with diverse diseases and infections. Like most healthcare professionals, EMS responders are faced with increased exposure to infectious conditions. As a result, they are concerned with their safety and preventive measures against any infection. The aim of this study is to assess whether EMS follows the standard guidelines provided by the Saudi Red Crescent Authority (SRCA) to avoid being infected. Using the standard SRCA observational tool, EMS Red Crescent workers in various stations, EMS station 1 (17 paramedics), EMS station 2 (11 paramedics) and EMS station 3 (16 paramedics), were observed on whether they follow the provided standard Personal Protective Equipment (PPE) guidelines to avoid being infected whether by MERS or other diseases. The results indicate that most of the EMS staff did not implement the PPE standard procedure or failed to demonstrate the skills on the application of the standards. Failure to follow the safety standards and guidelines is the main cause of infections among the EMS staff (Disaster Med Public Health Preparedness. 2018). Therefore, there is need to provide comprehensive training on the standard guidelines and safety measures to prevent the occurrences of infections among the EMS workforce.&#x0D; &#x0D; &#x0D;

Factors behind moral distress among Iranian emergency medical services staff: A qualitative study into their experiences

Background: The unique characteristics of each emergency situation and the necessity to make prompt decisions cause emergency medical services (EMS) staff's ethical conflicts and moral distress. Objectives: This study aimed to explore EMS staff's experiences of the factors behind their moral distress. Methods: This qualitative study was conducted on 14 EMS staff using the conventional content analysis. Data were collected through unstructured and semi-structured interviews. Each interview was started using general questions about moral issues at workplace and barriers to professional practice. The five-step content analysis approach proposed by Graneheim and Lundman was used for data analysis. Results: The factors behind EMS staff's moral distress were categorized into 13 subcategories and 5 main categories. The main categories were staff's lack of knowledge and competence, inability to adhere to EMS protocols, restraints on care provision, ineffective interprofessional communications, and conflicts in value systems. The subcategories were, respectively, inadequate knowledge and experience, working with incompetent colleagues, artificial services, working in unpredictable situations, lay people's interference in care provision, resource and equipment shortages, barriers to early arrival at the scene, obligatory obedience to the system, poor interprofessional interactions, inadequate interprofessional trust, refusal of care, challenges in obtaining consent, and challenges in telling the truth. Conclusion: EMS staff experience moral distress at work due to a wide range of factors. Given the negative effects of moral distress on EMS staff's physical and mental health and the quality of their care services, strategies are needed to prevent or reduce it through managing its contributing factors.

Transition in Care from EMS Providers to Emergency Department Nurses: A Systematic Review

Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. Methods: We conducted a mixed-methods systematic review that included searches of electronic databases (DARE, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Joanna Briggs Institute EBP), gray literature databases, organization websites, querying experts in emergency medicine, and the reference lists cited in included studies. All English-language studies of any design were eligible for inclusion. Two reviewers independently screened titles/abstracts and full-texts for inclusion and methodological quality, as well as extracted data from included studies. We used narrative and thematic synthesis to integrate and explore relationships within the data. Results: In total, 8,348 studies were screened and 130 selected for full text review. The final synthesis included 20 studies. Across 15 studies of moderate-to-high methodological quality, 6 factors influenced transitions: different professional lenses, operational constraints, professional relationships, information shared between the professions, components of the transition process, and patient presentation and involvement. Three interventions were identified in 6 methodologically weak studies: (1) transition guideline (DeMIST, Identification, Mechanism/Medical complaint, Injuries/Information related to the complaint, Signs, Treatment and Trends – Allergies, Medication, Background history, Other information [IMIST-AMBO]) with training, (2) mobile web-based technology (EMS smartphone and geographic information system location data), and (3) a new clinical role (ED ambulance off-load nurse dedicated to triaging and assessing EMS patients). There were mixed findings for the effectiveness of transition guidelines and the new clinical role. Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given review findings that interdisciplinary communication and relationships can be challenging.

Management of Preventable Deaths due to Road Traffic Injuries in Prehospital Phase; a Qualitative Study.

Prehospital care plays an important role in decreasing the number of deaths due to road traffic injuries (RTIs). This study aimed to identify the challenges of preventable deaths due to RTIs in the prehospital phase based on the attitudes of stakeholders. Conventional content analysis of qualitative study was used to analyze the data. The participants were 24 RTI prevention experts from fire-fighting organization, traffic police, the Red Crescent, Emergency Medical Services staff, emergency medicine specialists, and hospital emergency nurses who were selected by means of purposive sampling. Data were collected using unstructured interviews and analyzed by means of data coding, followed by extracting sub-categories, and main categories. Six main categories were extracted as the major challenges of preventable deaths in RTIs in the prehospital phase including "poor management of the crash scene" with two subcategories of lack of rapid access to the patient and lack of scene safety, "lack of adequate rules and regulations" with two subcategories of lack of protocols and guidelines and lack of clear duties checklists, "poor management of time" with two subcategories of elongated response time at the crash scene and elongated time of victim transport, "low quality of training" with two subcategories of insufficient training of Emergency Medical Services (EMS) staff and inadequate public training, "poor communication and coordination" with two subcategories of poor communication of EMS staff and lack of uniform commandership at the crash scene, and "low quality of victim management" with two subcategories of low quality of clinical care and lack of accurate clinical assessment. The following measures are necessary to reduce preventable deaths due to RTIs in the prehospital phase: accurate clinical assessment of the victim on the scene, provision of high quality and accurate clinical care, enforcement of legal obligations and using protocols in the field of victim management, coordination of the involved organizations through identifying the duties and responsibilities of each organization, and full management of the crash scene by assigning a unique commander to each unit and creation of the highest level of safety on crash scene.

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.

Wearable Proximity Sensors for Monitoring a Mass Casualty Incident Exercise: Feasibility Study.

BackgroundOver the past several decades, naturally occurring and man-made mass casualty incidents (MCIs) have increased in frequency and number worldwide. To test the impact of such events on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardized method to collect and analyze data from mass casualty exercises is needed to assess preparedness and performance of the health care staff involved.ObjectiveIn this study, we aimed to assess the feasibility of using wearable proximity sensors to measure proximity events during an MCI simulation. In the first instance, our objective was to demonstrate how proximity sensors can collect spatial and temporal information about the interactions between medical staff and patients during an MCI exercise in a quasi-autonomous way. In addition, we assessed how the deployment of this technology could help improve future simulations by analyzing the flow of patients in the hospital.MethodsData were obtained and collected through the deployment of wearable proximity sensors during an MCI functional exercise. The scenario included 2 areas: the accident site and the Advanced Medical Post, and the exercise lasted 3 hours. A total of 238 participants were involved in the exercise and classified in categories according to their role: 14 medical doctors, 16 nurses, 134 victims, 47 Emergency Medical Services staff members, and 27 health care assistants and other hospital support staff. Each victim was assigned a score related to the severity of his/her injury. Each participant wore a proximity sensor, and in addition, 30 fixed devices were placed in the field hospital.ResultsThe contact networks show a heterogeneous distribution of the cumulative time spent in proximity by the participants. We obtained contact matrices based on the cumulative time spent in proximity between the victims and rescuers. Our results showed that the time spent in proximity by the health care teams with the victims is related to the severity of the patient’s injury. The analysis of patients’ flow showed that the presence of patients in the rooms of the hospital is consistent with the triage code and diagnosis, and no obvious bottlenecks were found.ConclusionsOur study shows the feasibility of the use of wearable sensors for tracking close contacts among individuals during an MCI simulation. It represents, to our knowledge, the first example of unsupervised data collection—ie, without the need for the involvement of observers, which could compromise the realism of the exercise—of face-to-face contacts during an MCI exercise. Moreover, by permitting detailed data collection about the simulation, such as data related to the flow of patients in the hospital, such deployment provides highly relevant input for the improvement of MCI resource allocation and management.

Students’ views on the need for hostile environment awareness training for South African emergency medical care students

Background. South Africans experience high levels of contact crime, including assault, robbery and hijacking. Emergency medical services (EMS) are frequently called to the scene of such incidents. Their presence in these potentially hostile environments increases the risk of South African (SA) paramedics and paramedic students becoming victims of crime and violence. A 2015 study showed that ~66% of SA EMS staff reported being assaulted while on duty. During a 10-month period in 2016, Western Cape Province recorded &gt;40 incidents of physical violence against their EMS personnel. Questions are being asked about how well prepared EMS staff are to operate in potentially hostile environments. Objectives. To explore emergency medical care (EMC) students’ experiences of violence and crime and their views on the need for hostile environment awareness training (HEAT) as part of their undergraduate degree programmes. Methods. A self-designed, non-validated, cross-sectional online survey questionnaire was used to document the experiences, views and opinions of 113 undergraduate EMC students from 4 SA universities. The questionnaire consisted of 24 closed-ended questions with pre-set Likert scale options focusing on documenting participants’ experiences, views and opinions regarding hostile environments and the need for HEAT. Results. A high percentage of participants (92%) indicated feeling unsafe while engaging in clinical learning shifts; 63% specified that they had personally witnessed violence against EMS crews, and 32% indicated that they had been assaulted while on duty. Unsurprisingly, 81% of the respondents felt that there is a need for inclusion of HEAT in the undergraduate curriculum. Conclusions. Participation in clinical learning shifts in the current SA prehospital EMS environment increases the risk of exposure to potentially hostile environments. Consequently, students feel unsafe and support the inclusion of HEAT as part of their undergraduate degree programmes.

Attitudes toward safety and its affecting factors in Sanandaj emergency medical services staffs, in 2017

Attitudes toward safety and its affecting factors in Sanandaj emergency medical services staffs, in 2017

Massage Therapy in Management of Occupational Stress in Emergency Medical Services Staffs: a Randomized Controlled Trial

Results of various studies indicate that emergency medical service (EMS) staff suffer from occupational stress that adversely affects their quality of life and their care quality. This study aimed at determining the effect of massage on occupational stress experienced by emergency medical service staff. Prehospital emergency medical services stations of a city in the southwest of Iran. A total of 58 members of staff of the emergency medical services, working in prehospital emergency medical services stations. In this randomized controlled trial, a total of 58 EMS staff were selected from prehospital EMS stations, according to inclusion and exclusion criteria, and then assigned in two groups (29 in massage and 29 in control group) randomly by the minimization method. The intervention group received Swedish massage, twice a week for four weeks in the morning after the end of the work shift. Each massage session lasted 20-25 minutes. Subjects in the control group received no intervention. The level of occupational stress of the two groups was measured under the same conditions before and after the intervention by using the expanded nurses' occupational stress scale (ENSS). Data were analyzed with the SPSS16 software by using the chi-squared test, paired and independent-sample t tests, one-way ANCOVA. P value < .05 was considered as the level of significance. The mean and SD of total occupational stress scores in the control group was 114.41±30.11 in pretest and reach to 112.58± 30.62 in posttest stage. Also the mean and SD of total occupational stress scores in the intervention group was 130.20±26.45 in pretest and reach to 110.41±21.75 in posttest stage. A one-way ANCOVA showed that there is a significant effect of massage on EMS staff's occupational stress level after controlling for pretest score (p = .001). The training and the application of massage therapy can serve as an effective method in reducing occupational stress in emergency medical centers.

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: a feasibility study. PROXY: post ROSC OXYgenation study

BackgroundHyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment.MethodsA prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA.The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention.ResultsOne hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90 days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients.ConclusionsIt may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research.Trial registrationISRCTN 49548506 retrospectively registered on 24.11.2016.

Needs Assessment for Simulation Training for Prehospital Providers in Botswana

In June 2012, the Botswana Ministry of Health and Wellness (MOHW; Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system in response to significant morbidity and mortality associated with prehospital emergencies. The MOHW requested external expertise to train its developing workforce. Simulation-based training was planned to equip these health care providers with clinical knowledge, procedural skills, and communication techniques. The objective of this study was to assess the educational needs of the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook review and EMS provider feedback to guide development of a novel educational curriculum. Data were abstracted from a representative sample of the Gaborone, Botswana MOHW EMS response log from 2013-2014 and were quantified into the five most common call types for both adults and children. Informal focus groups with health professionals and EMS staff, as well as surveys, were used to rank common response call types and self-perceived educational needs. Based on 1,506 calls, the most common adult response calls were for obstetric emergencies, altered mental status, gastrointestinal/abdominal pain, trauma, gynecological emergencies, and cardiovascular and respiratory distress-related emergencies. The most common pediatric response calls were for respiratory distress, gastrointestinal complaints/dehydration, trauma and musculoskeletal injuries, newborn delivery, seizures, and toxic ingestion/exposure. The EMS providers identified these same chief complaints as priorities for training using the qualitative approach. A locally relevant, simulation-based curriculum for the Botswana MOHW EMS system was developed and implemented based on these data. Trauma, respiratory distress, gastrointestinal complaints, and puerperal/perinatal emergencies were common conditions for all age groups. Other age-specific conditions were also identified as educational needs based on epidemiologic data and provider feedback. This needs assessment may be useful when designing locally relevant EMS curricula in other low-income and middle-income countries. GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM, GalapiC, ParkesPS, KumarS, LabaB. Needs assessment for simulation training for prehospital providers in Botswana. Prehosp Disaster Med. 2018;33(6):621-626.

Thoughts, Ethics and Actions in EMS photography

&lt;p&gt;“Photography can only represent the present. Once photographed, the subject becomes part of the past.” Berenice Abbott (July 17, 1898 – December 9, 1991). To me photography is about capturing a moment, a single moment in time, a single image. Most of us these days are amateur photographers with our camera phones. A picture tells a thousand words they say. A bride on her wedding day, a child killed by a bombing, a beautiful mountain range, a riot, boats , hurricanes...anything you take a photo of is a moment in time, a split second… then it is history.&lt;/p&gt;&lt;p&gt;So what role does photography have in Emergency Medical Services (EMS)? It's about education, history, promoting, documenting, recording. Looking back on old photographs we can see how far we have come in terms of equipment, personnel, and training. Without the photos we would have no reference point. It’s a sobering thought that the photos we take today in good faith may in fact be the warnings of tomorrow. &lt;/p&gt;&lt;p&gt;Who doesn’t love to look back at photographs when they first started in EMS? Looking to pick out who is still in the job, who has lost the most hair and maybe who has passed away. Sitting around a table, having a cup of coffee with your colleagues, talking about a call you just did, maybe a bad call, someone breaks the tension; “Time for a photo?” Most will smile and join in, some will refuse - each to their own, but a time will come when you look back on these photos remembering not only the bad call but also remembering who had your back that day.&lt;/p&gt;&lt;p&gt;Formal EMS events provide a means to mingle and connect and a chance for a photographer to capture a moment in time, the atmosphere, the faces, the colour, the pomp. But in fact, this is also recording history of the EMS staff at that moment in time.&lt;/p&gt;&lt;p&gt;Of course there is a graphic side to EMS photography. Photographers will be held to account to portray individuals and scenes with the utmost respect to the patient and their families.(1) Passers-by can be opportunistic and sometimes thoughtless at crisis scenes.(2) So we ask...is it okay to photograph a person in their last few minutes? Graphic photos taken by EMS personnel can be used as a training tool, a reference point and a visual aid when you get to the emergency department. Like a T- boned car, a bullseye impact in the windscreen… a picture tells a thousand words. But where is the line drawn…or is there a difference?&lt;/p&gt;&lt;p&gt;The National Press Photographers Association (NPPA) Code of Ethics Summary guide expresses this nicely as: “Photographic and video images can reveal great truths, expose wrongdoing and neglect, inspire hope and understanding and connect people around the globe through the language of visual understanding. Photographs can also cause great harm if they are callously intrusive or are manipulated”.(3)&lt;/p&gt;

Videographic Assessment of the Quality of EMS to ED Handoff Communication During Pediatric Resuscitations

Background: The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration.Objective: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations.Methods/Design: We conducted a retrospective review of video recordings of pediatric patients who required critical care (“resuscitation”) in the ED between January 2014 and February 2016 at a Level 1 pediatric trauma center. Handoff quality between EMS and emergency department teams was assessed for completeness, timeliness, and efficiency. Institutional review board approval was obtained.Results: Sixty-eight resuscitations were reviewed; 28% presented in cardiac arrest, requiring cardiopulmonary resuscitation (CPR). Completeness of information communicated was variable and included chief complaint (88%), prehospital interventions (81%), physical exam findings (63%), medical history (59%), age (56%), and weight (20%). Completeness of specific vital sign reporting included: respiratory rate (53%), heart rate (43%), oxygen saturation (39%), and blood pressure (31%). Timeliness of communication included median patient handoff and report times of 50 seconds [IQR 30,74] and 108 seconds [IQR 62,252], respectively. Inefficient communication occurred in 87% of handoffs, including interruptions by ED staff (51%), questions from the ED physician team leader asking for information already communicated (40%), and questions by ED physician team leader requesting information not yet communicated (65%). When comparing non-CPR to CPR cases, only timeliness of patient handoff was significantly different for those patients receiving prehospital CPR.Conclusion: Handoff communication between EMS and ED teams during pediatric resuscitation was frequently incomplete and inefficient. Future educational and quality improvement interventions could aim to improve the quality of handoff communication for this patient population.

Factors influencing the decision to convey or not to convey elderly people to the emergency department after emergency ambulance attendance: a systematic mixed studies review

BackgroundThe decision over whether to convey after emergency ambulance attendance plays a vital role in preventing avoidable admissions to a hospital’s emergency department (ED). This is especially important with the...