Emergency Medical Technicians Research Articles

집단미술치료가 외상 후 스트레스를 경험한 응급구조사의 회복탄력성과 정서 조절 곤란에 미치는 효과

The purpose of this study was to investigate the effects of group art therapy on the resilience and emotional regulation difficulties of emergency medical technicians who experienced PTSD. The subjects were 7 emergency medical technicians working at the fire station located in the city D who experienced PTSD. The program of group art therapy was conducted once a week for 90 minutes per session, from May 1st, 2023, to August 31st, 2023, with a total of 14 sessions. As research tools, we quantitatively analyzed the pre- and post-changes using resilience scales and emotion regulation difficulties scales. Additionally, we qualitatively analyzed the changes in major content for each session using the Person in the Rain (PITR) drawing tests. The results of this study were as follows. Firstly, group art therapy had a positive effect on the resilience of emergency medical technicians who experienced PTSD. Secondly, group art therapy had a positive effect on the emotion regulation difficulties of emergency medical technicians who experienced PTSD. Thirdly, in the Person in the Rain (PITR) drawing tests, changes in emotional regulation, reduction of emotional instability, the establishment of a positive self-image, and improvement of stress-coping ability appeared. These research results lead to the conclusion that group art therapy has a positive effect on the resilience and emotion regulation difficulties of emergency medical technicians who experience PTSD. This suggests its potential utility in counseling and art therapy settings for emergency medical technicians.

Out-of-Hospital Cardiac Arrest in the Elderly: Unique Considerations and Challenges – A Case Series

Introduction: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Developed countries have observed an increasing number of OHCAs in the elderly population. Emergency medical technicians (EMTs) are facing a growing number of OHCA cases in elderly patients, requiring special attention and consideration. As of 2020, the latest cardiopulmonary resuscitation (CPR) guidelines prioritize chest compressions as the initial course of action in OHCA situations. Methods: A year-long statistical analysis (2020-2021) of elderly individuals in the pre-hospital system of Hamadan province examined 10 cases of OHCA in the elderly in 2020-21 that occurred after consuming food (postprandial myocardial infarction). Results: Ten of 90 cardiac arrest cases attended by EMTs occurred in elderly individuals after eating, and despite resuscitation efforts by the EMTs, none of these cases were successful. Consequently, this complication significantly reduces the chances of successful resuscitation in these patients. Therefore, addressing the issue of aspiration in elderly individuals during resuscitation is crucial. Conclusion: Continued research, collaboration, and adaptation of resuscitation protocols will contribute to advancements in the field and enhance the life-saving potential of elderly individuals who experience cardiac arrest.

*SMARTSIM* A multicenter prospective randomized trial of 3D virtual reality versus traditional patient simulation.

Simulations are an integral part of paramedic education. Technological advancements have introduced three-dimensional virtual reality patient simulations (3DVRS), offering a low-cost, accessible alternative. This study compares the impact of 3DVRS and traditional simulation on paramedic students. Students selected from a convenience sample of 11 cohorts in 10 accredited programs distributed across the United States were allocated to 2 groups using a stratified random sampling. One group received simulations via 3DVRS, the second used traditional in-person simulation. Students were exposed to 6 scenarios over 2h from the National Association of Emergency Medical Technicians (NAEMT) Advanced Medical Life Support (AMLS) program. Altered mental status scenarios were selected a priori by the research team containing approximately 30 potential differential diagnoses. A 50-item posttest was administered using validated cognitive items provided by Fisdap. A multicenter prospective randomized trial of 174 paramedic students was undertaken from April until August of 2022. The traditional simulation group was comprised of 88 students and the 3DVRS group had 86 students. A Mann-Whitney U test (U=4064.5, n 1=88, n 2=86, p=0.396) detected no statistical difference between two distributions or median exam score (70%), the range of values and interquartile range (IQR) for both groups: TS IQR=64-75 (range, 32-82); 3DVRS IQR=64-76 (range, 34-86). No difference in exam scores using 3DVRS versus traditional simulation was detected. Paramedic programs may have an effective new option when incorporating simulation with 3DVRS, potentially reducing financial and real-estate resources required with in-person simulations. Larger studies are needed to truly evaluate the impact and usability of virtual reality on paramedic education.

Shuffling toward paramedic practitioners in the United States

In the United States (U.S.), the Subcommittee on Adaptability and Innovation of the National Emergency Medical Services Advisory Council (NEMSAC) recently recommended that a clinically focused Master of Science in Paramedicine (MSP) be developed as the standard minimum academic degree to meet the educational needs of paramedic practitioners in the U.S. Despite the significance of this initiative and support within EMS agencies and amongst paramedics, the advisory has met with fierce opposition from fire agencies and associations, some employer groups and surprisingly the National Association of Emergency Medical Technicians.

Modified physiologic criteria for the field triage scheme: Efficacy of major trauma recognition in different age groups in Asia

BackgroundMajor trauma is a leading cause of unexpected death globally, with increasing age-adjusted death rates for unintentional injuries. Field triage schemes (FTSs) assist emergency medical technicians in identifying appropriate medical care facilities for patients. While full FTSs may improve sensitivity, step-by-step field triage is time-consuming. A simplified FTS (sFTS) that uses only physiological and anatomical criteria may offer a more rapid decision-making process. However, evidence for this approach is limited, and its performance in identifying all age groups requiring trauma center resources in Asia remains unclear. MethodsWe conducted a multinational retrospective cohort study involving adult trauma patients admitted to emergency departments in the included countries from 2016 to 2020. Prehospital and hospital data were reviewed from the Pan-Asia Trauma Outcomes Study database. Patients aged ≥18 years transported by emergency medical services were included. Patients lacking data regarding age, sex, physiological criteria, or injury severity scores were excluded. We examined the performance of sFTS in all age groups and fine-tuned physiological criteria to improve sFTS performance in identifying high-risk trauma patients in different age groups. ResultsThe sensitivity and specificity of the physiological and anatomical criteria for identifying major trauma (injury severity score ≥ 16) were 80.6% and 58.8%, respectively. The modified sFTS showed increased sensitivity and decreased specificity, with more pronounced changes in the young age group. Adding the shock index further increased sensitivity in both age groups. ConclusionssFTS using only physiological and anatomical criteria is suboptimal for Asian adult patients with trauma of all age groups. Adjusting the physiological criteria and adding a shock index as a triage tool can improve the sensitivity of severely injured patients, particularly in young age groups. A swift field triage process can maintain acceptable sensitivity and specificity in severely injured patients.

Quantifying the prevalence and predictors of burnout in emergency medical services personnel.

Recently, burnout has amassed considerable attention because of deleterious effects on workers and the work environment. Frequently, EMS clinicians find themselves prone to experiencing burnout, yet little is known about etiologies in this population. To estimate prevalence and predictors of burnout in EMS clinicians. This was a cross-sectional survey study of nine EMS agencies from North Carolina selected based on geography and population. Emergency medical technicians (EMTs), advanced EMTs, and paramedics were included. Emergency medical responders and air medical personnel were excluded if those positions were a primary occupational function. The Professional Quality of Life (ProQOL) Scale was used to assess burnout. Parametric and nonparametric testing was used to assess factors potentially affecting burnout. Factors significant in univariate analyses were included in a hierarchical linear regression model to determine unique predictors of burnout while controlling for confounders. The area under the curve (AUC) of the receiver operating characteristic (ROC) was used to determine model predictability. A total of 686 EMS clinicians completed the survey. Overall, 57.3% (n = 393) were likely to have burnout. Of the 328 respondents who were likely to have burnout, 254 (77.4%) and 211 (75.1%) also were identified as likely to suffer from compassion fatigue or vicarious trauma, respectively. Overall, 152 (22.2%) were likely to suffer from all three stress disorders, 118 (56.5%) of which scored high enough to potentially produce immune system dysregulation. Prior suicidal thoughts ((sr2 = 0.042, p < 0.001), attempts (sr2 = 0.025, p < 0.001) or the presence of vicarious trauma (sr2 = 0.040, p < 0.001) accounted for 4.2%, 2.5%, and 4.0% of model variance, respectively. Years of field experience (sr2 = 0.035, p < 0.001) and credential level (sr2 = 0.011, p = 0.005) accounted for 4.6% of model variance. Finally, a respondent's experience or knowledge of debriefing (sr2 = 0.008, p = 0.023); experiencing adversity in childhood in the form of familial mental illness, depression, or suicide (sr2 = 0.009, p = 0.016); or the incarceration of a family member (sr2 = 0.010, p = 0.011) accounted for a combined 2.7% of model variance. Model predictability showed an AUCROC of 81.5%. This study showed a nearly 60% prevalence of occupational burnout in the group of EMS clinicians surveyed, making burnout of considerable concern in this population. Further study is needed to address occupational factors that contribute to burnout in EMS clinicians.

Emergency Medical Responses at US Immigration and Customs Enforcement Detention Centers in California

Knowledge of medical care in US Immigration and Customs Enforcement (ICE) detention centers is limited. Reviews show high rates of preventable deaths while in detention due to substandard medical care within detention centers. To describe characteristics of medical emergencies at ICE detention centers in California. This cross-sectional study analyzed emergency medical services (EMS)-reported medical emergencies activated through 911 from January 1, 2018, to December 31, 2022, at 3 of the 5 ICE detention centers in California: Adelanto ICE Processing Center, Imperial Regional Detention Facility, and Otay Mesa Detention Center. Medical services requiring 911 activation. Data included the number of EMS-reported medical emergencies; ICE-reported medical emergencies; patient age and sex; and medical data in the EMS report, including primary symptom, EMS provider (emergency medical technician or paramedic) impression, vital signs, and interventions performed, using descriptive statistics. In this analysis of 3 detention centers with a mean daily census of 775 (range, 504-1001) individuals per center, there was a median of 68 (IQR, 10-88) EMS-reported emergencies per center per year for a total of 1224 emergencies. The EMS-reported emergencies involved 881 males (72%) and 338 females (28%) with a median age of 39.0 (IQR 30.0-49.0) years. The ratios of female-to-male EMS-reported emergencies were 0.51 (95% CI, 0.31-0.87) at Adelanto, 0.86 (95% CI, 0.31-2.43) at Imperial, and 1.60 (95% CI, 1.40-1.83) at Otay Mesa. Pregnancy-related emergencies accounted for 12.4% (42 of 338) of emergencies in females. A total of 357 individuals (29.2%) had at least 1 abnormal vital sign during their EMS encounter. Psychiatric emergencies comprised 48 EMS responses (3.9%), despite higher rates of ICE-reported psychiatric-related complaints. The median number of monthly EMS-reported emergencies across all 3 centers was 3 (IQR, 0-9) vs 4 ICE-reported emergencies (IQR, 1-15). In this study of medical emergencies at 3 of 5 ICE detention facilities in California, there were discrepancies in EMS vs ICE reported emergencies. The data suggested that vulnerable populations, such as pregnant women, had an increased number of medical emergencies, while individuals with psychiatric emergencies accounted for fewer reported emergencies. Based on these findings, emergency medical care provision in ICE detention centers requires increased transparency to ensure appropriate delivery of care.

Exploring Emergency Medical Technicians (EMTs) Challenges in Providing Pre-Hospital Care During COVID-19 Pandemic: A Qualitative Study

Background: Emergency Medical Technicians (EMTs) face many challenges and problems as the front line of dealing with epidemics including COVID-19. Therefore, the present study was aimed at exploring the challenges of EMTs in providing pre-hospital care during the COVID-19 pandemic. Methods: This qualitative research was conventional content analysis conducted between November and December 2021. The participants were 15 emergency medical technicians working in the emergency center 115 in Shahroud selected by purposeful sampling method. Data were collected through semi-structured in-depth interviews at the location of the participants. Then, the codes, subcategories and categories were extracted by inductive process. Results: Challenges among EMTs in providing pre-hospital care during the COVID-19 pandemic were categorized under four themes including (1) work factors (high work pressure, non-cooperation of patients, difficulty working with protective equipment) (2) unprepared organization (lack of coordination between medical centers, (3) threatened health (psychological disorders, physical problems) and (4) restless social (challenges with family members, social isolation). Conclusion: Health care managers, authorities and policy makers should use effective strategies to prevent and reduce the challenges of EMS workers in order to minimize their negative effects on EMTs and improve the quality of services provided.

Athletic Trainer and Emergency Medical Technician or Paramedic Opinions of Each Other's Understanding of Essential Emergent Football Injury Situation Tasks.

Improving the role understanding between essential emergency healthcare providers may improve teamwork and efficacy. This study asked licensed athletic trainers (ATs) and emergency medical technicians (EMTs) or paramedics for their opinions of the others' understanding of essential tasks in an emergent football injury situation. The hypothesis was that groups would have differing opinions. An electronic survey was emailed to 160 licensed EMTs or paramedics and 45 licensed ATs. All participants were full-time employees with ≥1 year experience at their current position. In addition to demographic questions (age, sex, experience), respondents completed 11, 5-point Likert-scale type questions (end range: "strongly agree" or "strongly disagree") regarding their opinion of the other profession's understanding of essential tasks in an emergent football injury situation. Participants also answered questions about the amount of control of the injury situation they assumed upon scene arrival and how frequently they partnered with the other profession when covering a game. An α level of P ≤ 0.05 was selected to indicate statistical significance. Thirty-four EMTs or paramedics (21% return) and 12 ATs (26.7% return) responded. Group demographics did not differ with the exception of the EMT or paramedic group having more men ( P = 0.006). Emergency medical technicians/paramedics perceived that ATs better understood facemask removal timing ( P = 0.002), facemask removal technique ( P = 0.04), and extremity splinting ( P = 0.02). Athletic trainers perceived that EMTs/paramedics better understood proper airway management ( P < 0.001) and cardiopulmonary resuscitation ( P < 0.001). EMT/paramedics more strongly perceived control of the injury situation upon scene arrival than ATs ( P = 0.005). As AT experience increased, they more strongly agreed that they frequently partnered with EMTs/paramedics ( r = 0.84, P < 0.001); however, an insignificant relationship was observed for EMTs/paramedics. Opinions differed about the other profession's understanding of essential tasks. More experienced ATs partnered more strongly with EMTs/paramedics. Both professional groups would benefit from collaborative workshops or seminars to improve the teamwork needed to optimize an emergent football injury situation. The development and implementation of practices such as these may also improve teamwork and patient-center healthcare at mass participant sporting events such as marathons, triathlons, and road cycling events.

Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods

IntroductionThe unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment.MethodsSequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively.ResultsThe study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: “the overall impact of the stress crisis on technicians,” “missing links in the communication network in incident management,” "professional shortcomings in pre-hospital care,” and “the complex and multifaceted context of stressful pre-hospital emergencies.” Additionally, the study's theme was centered around “surveying the experiences of EMTs in stressful environments.”ConclusionAs the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.

In Case You Haven't Heard…

Overdose prevention centers allow people to use drugs that they bring in, and rescue them from overdoses if needed. But a new approach allows people to use drugs in their home, but on a phone call with someone who will listen to see if they need help. The approach was detailed in the radio program “This American Life” in September (https://www.thisamericanlife.org/809/the‐call) and was featured at the AMERSA conference by speaker Stephen Murray, who is a harm reduction program manager at Boston Medical Center, a former drug user and now a harm reduction expert and emergency medical technician (EMT). (ADAW tried to reach him this week but did not hear back by press time. In this approach, the drug user is told to leave the door unlocked so that emergency medical services (EMS) can get in if necessary. The caller administers the drug while online. The rescue agent (like Murray) talks them through the use, and if the agent hears any sign of an overdose, they call EMS, who comes in with naloxone and oxygen to rescue the user. The approach is another perspective on the “never use alone” concept. How EMS feels about it, and whether there are enough EMTs to answer this need, is unclear.

Effect of stachys lavandulifolia on occupational stress in emergency medical technicians.

According to studies, occupational stress is quite prevalent among Emergency Medical Technicians (EMTs). On the other hand, it has been shown that Stachys lavandulifolia, also known as the Mountain Tea in Iran, has anxiolytic properties. Considering the current increasing trend of using remedies based on alternative medicine for stress management, the present clinical trial intended to investigate the effect of Stachys lavandulifolia on occupational stress in EMTs METHODS: The present study included 60 EMTs working in Arak, Markazi province, Iran, who were randomly divided into study and control groups. The study group was treated with tea made of Stachys lavandulifolia (2g daily) for 2 months, while the control group was treated with black tea. Moreover, the level of occupational stress in the study participants was assessed using the Hospital Stress Scale (HSS-35) before and after the intervention. Data analysis was performed using the SPSS software version 22. According to our results, the mean occupational stress score was significantly decreased in the study group after the intervention (p<0.05). Moreover, the post-intervention scores were significantly lower in the study group compared to the control group (p<0.05). However, there was no significant change in occupational stress in the control group after the intervention (p>0.05). In combination with other stress-relieving options, the tea made of Stachys lavandulifolia can be used as a complementary therapy for alleviating occupational stress in EMTs.

320 Effect of training Emergency medical technicians EMT'S, in BLS and ILS protocols using high fidelity simulator mannequins. A new project for Greek emergency medical services

320 Effect of training Emergency medical technicians EMT'S, in BLS and ILS protocols using high fidelity simulator mannequins. A new project for Greek emergency medical services

Resilience, posttraumatic growth and psychological wellbeing of paramedicine clinicians: An integrative review

Clinicians in paramedicine are exposed to stressful events at work that have potential to cause negative psychological outcomes. Posttraumatic growth (PTG), resilience and psychological wellbeing, however, are adaptive psychological states that can also occur following trauma and adversity. Synthesis of knowledge on these positive outcomes can provide insight into resources needed to support paramedicine clinicians. To examine and synthesise what is known of PTG, resilience and psychological wellbeing of paramedicine clinicians, including the experience of these phenomena and relationship between them. An integrative review of peer-reviewed empirical literature published in English from 2013 to 2022 was conducted, following Whittemore and Knafl’s method. CINAHL Complete, MEDLINE Complete, PsycINFO, Scopus and Embase databases were searched. Included articles were quality appraised, with data analysed using the constant comparison method. Thirteen articles were included, with results synthesised into four categories. Mean PTG scores were reportedly moderate, and resilience ranged from average to above average. PTG and resilience had positive and negative relationships with specific coping strategies including dysfunctional coping, active coping, planning, venting emotions, social and emotional support and mental and behavioural disengagement. PTG scores were significantly lower for clinicians with longer shift duration and paramedics compared to emergency medical technicians. Resilience scores were higher for clinicians working part-time. Wellbeing was reportedly moderate and associated with the psychosocial climate established by managers. Qualitative findings indicated that workplace culture was perceived as stoic and masculine, which served to undermine staff resilience and willingness to disclose emotions. To support PTG and resilience, organisations should work to reduce stressors in workplace culture, including management and clinical supervision style, and offer employment flexibility. Organisations can upskill clinicians’ capacity for positive adaptation to adversity with professional development targeting identified coping strategies. Future research could examine clinicians’ experiences of PTG, resilience and wellbeing, and the relationship between them.

Novel moving, handling and extraction simulation for students in a soft play area

Background: Emergency medical services often have to extricate patients from their location and take them to an ambulance. High-quality training is required to ensure patient and staff safety during moving, handling and extrication manoeuvres. This study aimed to determine student satisfaction and self-confidence regarding what they had learnt after a novel moving, handling and extrication simulation exercise in a children's soft play area. Methods: A mixed-methods cross-sectional survey was adopted, using the validated Student Satisfaction and Self-Confidence in Learning survey tool. Qualitative data were collected from an open question for additional comments. Student paramedics and student emergency medical technicians from one higher education institution completed four time-limited scenarios, each of which involved moving an immobile patient away from their environment. Descriptive statistics were determined for the participant characteristics and survey responses. Thematic analysis was performed on the qualitative data. Results: The student participants were aged 18–47 years and the majority were women. They were satisfied with both their learning and their self-confidence in what they had learnt after the simulation event, and felt their communication and teamwork skills had improved. They enjoyed the event more than classroom-based simulation. While they felt the simulation was realistic, suggestions were made to make it more so. Conclusion: Use of a children's soft play area for a moving, handling and extrication simulation provided student satisfaction and self-confidence in learning.

Learner's Stop the Bleed Outcomes Between Lay Instructor and Emergency Medical Services (EMS)-Trained Instructor Groups.

One of the most utilized Stop the Bleed courses, the "Bleeding Control Basic (BCon) course v. 1.0," requires instructors to have a specific healthcare license or pre-hospital credential (e.g., physician or paramedic) or specific emergency medical services (EMS) instructor certification and have completed the BCon provider course. This requirement provides a level of expertise in instructorsbutlimits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleedcourses, such as the American Red Cross First Aid for Severe Trauma (FAST) course, do not have this requirement. This raises questions pertaining to the learners' outcomes between those facilitated by instructors with and without healthcare licenses or credentials. Learners' outcomes for applying a tourniquet (skill), knowledge (cognitive), and Intention to Aid (attitude for behavior) were compared between those taught by lay instructors and EMS-trained (emergency medical technician or paramedic) instructors. All were trained as new instructors in the FASTprogram. For the study's primary outcome, all of the learners (n=135) properly applied a tourniquet to a simulated leg injury at the end of the training based on video evidence (skill). Learners in the EMS-trained instructor groups (n=84, mean age 25.5 years, 68% female), who were olderandhad more education, scored significantly higher on knowledge of tourniquet use on the Stop the Bleed Educational Assessment Tool (SBEAT) (mean=90.0 vs. 83.9 on a scale of 0-100, p=0.001) with a small effect size than the lay instructor group (n=51, mean age 16.6 years, 88% female).There was no statistical difference in attitude toward helping behaviors in a bleeding emergency between the two groups on the Intention to Aid (I2A) survey. Lay instructors andEMS-trained instructors performed comparably in facilitating a widely available Red Cross Stop the Bleed course. Lay experience with tourniquets should not disqualify individuals from being a Stop the Bleed instructor. Using a standard curriculum with instructor development offers a way for people with and without an EMS background to teach life-saving competencies effectively.

An Elucidation on the Challenges of Pre-hospital Emergency Technicians: A Study on Emergency Medical Technicians in Shiraz, Iran

Background: The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance. Objectives: This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022. Methods: The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data. Results: This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”. Conclusions: Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.

Sleep analysis of hospital and out-of-hospital emergency professionals

IntroductionSleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables. MethodThis is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: “Pittsburgh Sleep Quality Index“ and “Epworth Sleepiness Scale”. ResultsFour-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043). ConclusionsEmergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.

National Ambulance Services in India: A Narrative Review

Background: A strong and effective emergency referral transport network is a prerequisite for a country's assured emergency ecosystem. Ambulances have grown exponentially since the start of National Ambulance Services under the National Health Mission (NHM) a decade ago. This paper aims to understand the referral systems, strategies and the progress and undertaken by the Government of India to upgrade and strengthen the referral transport system. Methods: We conducted a narrative review and secondary data analysis on referral transportation systems from government portals. Key Interviews were held with key stakeholders’ expertise in health systems. Results: The number of ambulances increased by 57.5 % from 2012 to 2022. Hitherto, 32.2 % of Advanced life support (ALS) ambulances have been shorted against population norms. Although the accessibility of referral services has improved, there is a significant gap in delivering timely in-transit service. Conclusions: The existing referral system requires the rational deployment of well-equipped BLS &amp; ALS ambulances as per population norms with adequately trained staff or EMTs (Emergency Medical Technicians). A systematic plan for monitoring and accountability to ensure timely arrival within the “golden hour” is the need of the hour.

Ambulance clinicians' understanding of older patients' self-determination: A vignette study.

Older patients are often vulnerable and highly dependent on healthcare professionals' assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. To describe ambulance clinicians' understanding of older patients' self-determination when the patient's decision-making ability is impaired. A qualitative design with an inductive approach, guided by descriptive phenomenology. In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient's best interests. The clinicians' interpretations are based on an understanding of the patient's situation using substitute decision-making in emergency situations and conversations that reveal the patient's explicit wishes. Sometimes the clinicians collaborate to validate the patient's implicit will, while they at other times subordinate themselves to others' opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient's self-determination. The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient's unique needs based on a holistic perspective and their ability to be autonomous.