Group Of Paramedics Research Articles

Implementation of an autonomous paramedical training group to manage newborns and children with congenital heart disease in an intensive care unit permits to develop self-confidence and felt quality of care

Implementation of an autonomous paramedical training group to manage newborns and children with congenital heart disease in an intensive care unit permits to develop self-confidence and felt quality of care

Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany – a prospective observational study and comparison

BackgroundPoint-of-care ultrasound (POCUS) is steadily growing in use in prehospital emergency medicine. While currently used primarily by emergency physicians, POCUS could also be employed by paramedics to support diagnosis and decision-making. Yet to date, no paramedicine-targeted POCUS curricula exist in Germany. Furthermore, given time and resource constraints in paramedic training, it is unclear whether paramedics could feasibly learn POCUS for prehospital deployment. Hence, this study outlines the development and implementation of a comprehensive POCUS curriculum for paramedics. Through this curriculum, we investigate whether paramedics can attain proficiency in POCUS comparable to other user groups.MethodsIn this prospective observational study, we first developed a blended learning-based POCUS curriculum specifically for paramedics, focusing on basic principles, the RUSH-Protocol and ultrasound guided procedures. Participants underwent digital tests to measure their theoretical competence before (T1) and after the digital preparation phase (T2), as well as at the end of the on-site phase (T3). At time point T3, we additionally measured practical competence using healthy subjects and simulators. We compared the theoretical competence and the practical competence on a simulator with those of physicians and medical students who had also completed ultrasound training. Furthermore, we carried out self-assessment evaluations, as well as evaluations of motivation and curriculum satisfaction.ResultsThe paramedic study group comprised n = 72 participants. In the theoretical test, the group showed significant improvement between T1 and T2 (p < 0.001) and between T2 and T3 (p < 0.001). In the practical test on healthy subjects at T3, the group achieved high results (87.0% ± 5.6). In the practical test on a simulator at T3, paramedics (83.8% ± 6.6) achieved a lower result than physicians (p < 0.001), but a comparable result to medical students (p = 0.18). The results of the study group’s theoretical tests (82.9% ± 9.2) at time point T3 were comparable to that of physicians (p = 0.18) and better than that of medical students (p < 0.01). The motivation and attitude of paramedics towards the prehospital use of POCUS as well as their self-assessment significantly improved from T1 to T3 (p < 0.001). The overall assessment of the curriculum was positive (92.1 ± 8.5).ConclusionWith our tailored curriculum, German paramedics were able to develop skills in POCUS comparable to those of other POCUS learners. Integration of POCUS into paramedics’ training curricula offers opportunities and should be further studied.

Job satisfaction and social identification among paramedics in southern Poland.

Job satisfaction, based on professional and non-professional factors and individual characteristics of employees, is an important element influencing both the quality of care provided and employee turnover. The study included 137 paramedics employed in field teams and hospital emergency departments. The Job Satisfaction Scale (SSP), the Minnesota Job Satisfaction Questionnaire (MSQ), the Utrecht Work Engagement Scale (UWES), and the Three Dimensional Strength of Group Identification Scale (TSIG) were used to collect the data. The average job satisfaction score measured with SSP in the studied group of paramedics was 24.50 and the average job satisfaction score measured with MSQ was 74.16. The average value of the group identification in the study sample was 61.15. Of the three subscales, the highest scores were obtained in the affect toward the group subscale -22.44, and the lowest in the cognitive centrality subscale -18.78. The analysis showed that job satisfaction positively correlated with social identification (r = 0.43) and the ingroup ties (r = 0.43), cognitive centrality (r = 0.34) and ingroup affect (r = 0.37). The studied group of paramedics showed moderate job satisfaction (measured with SSP) and work engagement, with a simultaneous high level of job satisfaction (measured with MSQ) and social identification with the professional group. Social identification of studied paramedics varied depending on gender. Women showed higher levels of cognitive centrality, which might mean that they might have had greater need to categorize themselves as paramedics.

A Quality Improvement Initiative to Increase Confirmation of Prehospital Endotracheal Tube Placement at Emergency Department Transfer of Care

Objectives Rates of prehospital unplanned extubation (UE) range from 0 to 25% and are the result of many factors, including patient movement. Transfer of care of intubated patients to the emergency department (ED) involves significant patient movement and represents a high-risk event for UE. Frequent confirmation of endotracheal tube (ETT) placement is imperative for early recognition of UE and to minimize patient harm. Methods Local Practice—Our baseline rate of verbal ETT position confirmation with a member of the ED team during ED transfer of care was 74%. Our goal was to increase this practice to >90% in six months. This project was completed in partnership with Toronto Paramedic Services. Prehospital electronic patient care records (ePCRs) were reviewed weekly to determine the proportion of intubated patients who had ETT placement confirmed in the ED at transfer of care. Interventions—Pre- and post-project paramedic focus groups were conducted to identify potential drivers, change ideas, and project feedback. Three staggered interventions were introduced over five months: (1) memorandums to paramedics, ED chiefs and respiratory therapy leads, (2) individualized paramedic feedback e-mails, and (3) ePCR changes and closing rules. Results The pre-project focus group identified several potential drivers, such as physical barriers, interprofessional relationships, and communication. ETT confirmation remained ≥90% for the last eight weeks and interventions resulted in special cause variation. Median cases without verbal confirmation between paramedics and ED staff reduced from 5/week (IQR 2.5, 6.5) to 1/week (IQR 0, 2). UE was identified in 0.6% (2/340) of patients with ETT confirmation. The post-project focus group noted improvements in perceived accountability, interprofessional relationships, and satisfaction with interventions. Conclusion Through a series of interventions, we improved the rate of ETT confirmation during ED transfer of care. Although rates of UE were low, improvement in ETT confirmation may lead to faster recognition of UE when it does occur thereby mitigating complications. The observed improvement was sustained after interventions ended.

IJCM_59A: Knowledge and Practice regarding Biomedical Waste Management (BMW) among Paramedical Staff and Group IV Workers in tertiary care hospitals of Mangalore

Background: Planning the waste management of all waste generated in healthcare facilities is a crucial task to reduce the hazards and risks to individuals and the community. Objectives: To assess the knowledge and practices regarding bio-medical waste management among paramedical staff and Group IV workers. Methods: In this cross-sectional study, 210 paramedical staff working at hospitals affiliated with Kasturba Medical College, Mangalore were assessed regarding their knowledge and practices regarding BMW. Institutional Ethics Committee permission was obtained before the commencement of the study. Data was analysed using IBM SPSS for Windows version 25.0, Armonk, New York, 25.0. Results: Among the total participants, there were 127 nurses, 6 lab technicians and 77 Group IV workers. 98.1% of healthcare providers were aware that their hospital has a waste management plan. 87.6% of healthcare providers follow hospital policies every time while disposing of waste. 92% of healthcare providers are aware of diseases transmitted by biomedical waste. The majority of the participants preferred using all five protective measures - gloves, goggles, masks, boots, and gowns while dealing with biomedical waste. Conclusion: The majority of the paramedical staff in our study were aware of the BMW management practices.

Modified streptavidin–biotin based lateral flow test strip for rapid detection of SARS-CoV-2 S1 antigen in saliva samples

Compared to other infectious diseases, for which LFT development can take years, SARS-CoV-2 antigen LFTS were developed and deployed within months. LFTS for antigen detection were adopted on an unprecedented scale during the COVID-19 pandemic, but many of them lack the sensitivity especially for samples with low viral load. In our previous work, we developed an enhanced signal strip for detection of SARS CoV-2 SI antigens in saliva. Here we introduce some modification to improve the sensitivity, and specificity, and to lower the cost of the strip, by using biotin streptavidin (BS) system. In the modified BS strip, gold-streptavidin and biotinylated Nanobodies (Nbs) against S1 antigen were externally mixed with the tested samples (saliva or nasopharyngeal swab) before their application on the sample pad of the test strip containing angiotensin converting enzyme (ACE-2), as the capturing probe. The study included 320 individuals, with 180 being positively confirmed by RT-PCR and 140 confirmed negative, as well as, 45 health care workers, who were responsible for screening and handling of surgical cases in General Surgery Department and COVID clinic of TBRI. Our results proved that modified BS strip improved the overall sensitivity and specificity of S1antigen detection in saliva samples (95.21% and 99.29% respectively) compared to our previously developed enhanced LFTS (91.66% and 98.57% respectively). Also, the sensitivity of cases with Ct ≤ 30, Ct ≤\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le$$\\end{document} 35, and Ct ≤\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le$$\\end{document} 40 using the modified BS strip showed higher values (98.54%, 95.38%, and 88.89% respectively), compared to the corresponding results of our previously developed enhanced LFTS (95.86%, 92.31%, and 82.22% respectively). There were no cross-reactions with either Middle East respiratory syndrome corona virus MERS-CoV or SARS-CoV antigens. Furthermore, we found that the lower viral detection limit (LVD) of BS strip was obviously lower than our previous LVD limit of the enhanced LFTS (0.2 × 104 copies/ml vs. 0.4 × 104 copies/ml, respectively). Our developed BS strip showed that saliva samples gave better results than nasopharyngeal swabs of the same patients. The fact of using smaller amounts of Nbs, and ACE2, as well as the dispensing off of conjugate pad when applying BS strip modifications, justified the expected reduction in the costs of the strip. The implementation of BS strips on saliva samples of 45 health co-workers, who were tested 4 and 6 days after exposure to infection, showed an increase in the sensitivity, starting from the 4th day and reaching its highest level on the 6th day in both high risk and paramedic groups (90.9%, and 80.0%, respectively). This study provides evidence that employment of the modified BS system could increase the sensitivity of the strips, lower their cost, and render them an effective screening tool for early detection of the virus in saliva of suspected Covid-19 patients.

The broken bond: Exploring child-to-parent violence and its spiritual and sociodemographic potential predictors among university students in Tabriz, Iran

ObjectivesThis study investigates the prevalence and risk factors of child-to-parent violence (CPV) among university students in Tabriz. MethodsUsing a cross-sectional design, 500 first-year students from Tabriz University of Medical Sciences were surveyed with questionnaires. Data analysis was conducted using SPSS version 16. ResultsThe findings revealed a concerning prevalence of controlling and psychological violence towards both mothers (48 %) and fathers (44 %). Boys demonstrated a lower likelihood of violence against their father (aOR=0.44; 95 % CI: 0.30 to 0.64) and mother (aOR=0.41; 95 % CI: 0.28 to 0.60) compared to girls. Students in the paramedical group exhibited a 54 % and 77 % lower probability of violence against their father (aOR=0.46; 95 % CI: 0.17 to 0.65) and mother (aOR=0.33; 95 % CI: 0.25 to 0.84) respectively, compared to those in the medical group. Spiritual well-being did not show a significant association with CPV towards fathers (p = 0.379) and mothers (p = 0.186). DiscussionThese findings underscore the need for multi-pronged interventions. Equipping students with healthy communication skills, expanding mental health services, and implementing preventive programs targeting adolescents could be crucial in addressing CPV. For nursing practice this research provides a basis for developing care strategies that incorporate mental health support and communication skill enhancement.

Awareness Among Girl Healthcare Students Regarding Physiological Nature of Vaginal Discharge

BACKGROUND: Leucorrhoea also spelled leukorrhoea, as a flow of a whitish, yellow, or greenish discharge from the vagina of the female that may be normal or that may be a sign of infection. Commonly, physiological vaginal discharge is confused with being associated with some pathology. AIMS: The aim of this study was; to estimate the percentage of awareness about physiological nature of vaginal discharge in MBBS students; Paramedical students and Nursing students, to estimate the percentage of women experiencing vaginal white discharge, estimating the percentage of women/girls who consult doctors because of vaginal white discharge, advising women/ girls with pathological vaginal discharge for consultation. METHODS: The present cross sectional study was done among female students from Medical, Paramedical and Nursing branch of Chirayu Medical College and Hospital, Bhopal. Total number of 246 female students were taken into the study. They were provided with a questionnaire consisting of 30 questions, which was divided into sections of; Awareness, Evaluation, Practice and Knowledge. The answers given by the three groups were compared for studying awareness regarding physiological nature of vaginal discharge. Nature of vaginal discharge experienced by individual students was also evaluated. Comparison of Practices followed by the students in daily life was also done. Knowledge regarding vaginal discharge was studied. RESULTS: Students were scored on basis of their answer in knowledge and awareness; each correct answer awarded 1 point and incorrect answer awarded 0. Unpaired t Test for comparing the Awareness Scores shows significant inter-group variation in awareness. Medical students had significantly higher awareness about vaginal discharge as compared to the other two groups. Further, Awareness of the paramedical group was higher than the nursing group. Overall responses within each group were however homogenous, representing comparable intra-group awareness about vaginal discharge. Similar findings were seen for knowledge scoring. CONCLUSION: It was found that Awareness &amp; knowledge regarding physiological vaginal white discharge is highest in medical students followed by paramedical &amp; nursing students. Nursing students consult doctors the most, medical students consult the least. But the positive and negative attitude towards the discharge is homogeneous in all the groups. A small portion of medical students had never experienced vaginal discharge.

Influences on paramedic prescribing: student and prescriber perspectives.

Paramedic prescribing has been permitted in legislation from 2018. In 2019 one of the first cohorts of paramedic prescribers in the country was invited to share their experiences, thoughts and perceptions around the new and evolving role of paramedic prescribing practice. To explore the opinions of student and newly qualified paramedic prescribers regarding the impact and effectiveness of paramedic independent prescribing on their clinical practice. A qualitative study was undertaken within the North East of England with a group of experienced paramedics undertaking non-medical prescribing education. A focus group and dyad interview were undertaken with a purposive sample of paramedics recruited from a higher education institution providing V300 independent and supplementary prescribing education. The focus group was undertaken with paramedics on the non-medical prescribing (NMP) programme of study. The dyad interview was undertaken with participants once qualified as prescribers, and actively prescribing. The focus group and interview were audio recorded, transcribed verbatim and subjected to thematic analysis to identify key themes. A total of n = 7 and n = 2 paramedics undertook the focus group and dyad interview, respectively. Paramedics in this sample represented a range of paramedic practice areas. Paramedic NMP students noted four key themes around role, expectations, governance and opportunities and challenges in relation to prescribing practice. The returning sample of paramedics, now practising as prescribers, noted themes of organisational and infrastructure challenges, monitoring of prescribing practice and the evolution of paramedic roles. Paramedic prescribing is rapidly expanding and evolving into new clinical areas. As such, careful consideration should be given to not only the resourcing of prescribers as individuals, but also the wider organisational and technological support and structures needed to be in place to allow paramedic prescribers to fulfil their roles and utilise their advanced practice skills.

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Pivotal role of CHWs in prevention, early detection and control of outbreaks: neglected key primary players; a call to action

Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic.

The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences. The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland. The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire. The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score). The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic.

Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program improves chest compression rate in real world out-of hospital cardiac arrest patients

BackgroundThe Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program is designed to enhance cardiopulmonary resuscitation (CPR) training by using real-time feedback manikins. Our objective was to assess the quality of CPR, such as chest compression rate, depth, and fraction, performed on out-of-hospital cardiac arrest (OHCA) patients among paramedics trained with the RQI® program vs. paramedics who were not. Methods and ResultsAdult OHCA cases from 2021 were analyzed; 353 OHCA cases were classified into one of three groups: 1) 0 RQI®-trained paramedics, 2) 1 RQI®-trained paramedic, and 3) 2–3 RQI®-trained paramedics. We reported the median of the average compression rate, depth, and fraction, as well as percent of compressions that were between 100 to 120/minute and percent of compressions that were 2.0 to 2.4 inches deep. Kruskal-Wallis Tests were used to assess differences in these metrics across the three groups of paramedics. Of 353 cases, the median of the average compression rate/minute among crews with 0, 1, and 2–3 RQI®-trained paramedics was 130, 125, and 125, respectively (p = 0.0032). Median percent of compressions between 100 to 120 compressions/minute was 10.3%, 19.7%, and 20.1% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.0010). Median of the average compression depth was 1.7 inches across all three groups (p = 0.4881). Median compression fraction was 86.4%, 84.6%, and 85.5% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.6371). ConclusionsRQI® training was associated with statistically significant improvement in chest compression rate, but not improved chest compression depth or fraction in OHCA.

Assessment of myofascial pain syndrome among married female healthcare workers: a cross sectional comparative study in a tertiary care centre

Background: Myofascial pain syndrome (MPS) is common among females between ages 20-40 years. Psychosomatic and mechanical reasons are attributed as causative factors. Female health care workers (FHW) in hospitals with rapid patient turn over are vulnerable to develop MPS. Our aim was to ascertain the prevalence of MPS in married FHW working in various departments of the hospital and its association with poor sleep and work stress. Methods: We selected married FHWs in 20-50 years age group and divided them into two groups, medical and paramedical (those involved directly and indirectly with patient care respectively). MPS was diagnosed after detailed personal interview and clinical examination. Sleep duration was divided into less than 5 hours and more than 5hours. Presence of work-related stress and other medical parameters were also recorded. Results: A total of 150 medical and 150 paramedical FHWs were included in the study. Overall prevalence of MPS among FHWs was 42%, of which, medical group was 32% and paramedical was 52%. The paramedical group showed significantly higher prevalence of MPS (p: 0.02). Sleep was less than 5 hours in 29.3% of medical FHW and 13.3% of paramedical. This difference didn’t show any association to MPS (p=0.8). 38% FHW perceived excessive work stress, 40% were paramedical and 36% were medical. This didn’t correlate with prevalence of MPS (p=0.2) among them. Conclusions: Paramedical FHW experienced more MPS than medical and it was more of mechanical type and not due to work stress or sleep deprivation.

Awareness, Knowledge, and Attitude towards Body Donation among Medical and Paramedical Students

Background: Cadavers are the mainstay of learning anatomy by dissection. Due to insufficient awareness of body donation, most of the medical institutions are facing a shortage of cadavers. Health-care professionals should have knowledge about the complete process of body donation, so that they can become motivators of organ and body donation. The present study was conducted to determine and compare the awareness, knowledge, and attitude regarding body donation among medical and paramedical students. Methodology: A cross-sectional and comparative study was conducted among 182 medical and 119 paramedical students through a pretested semistructured questionnaire via a Google form. The Chi-square test was used for the estimation of the P value. Results: 96.7% of medical students and 93.2% of paramedical students had heard about the concept of body donation. 31.8%medical and 49.5% of paramedical students (P &lt; 0.00001) knew that body donation and eye donation can be done simultaneously. The cadavers available are not adequate was felt by 45% of medical and 42.8% of paramedical groups. 90.1% of medical and 86.5% of paramedical students opined for the inclusion of a chapter on body donation. The virtual anatomy table cannot be a substitute for body donation was perceived by 78% of medical and 15.1% of paramedical students (P &lt; 000001). 34.6% of medical students and 56.3% of paramedical students have shown their willingness to donate their whole body and eyes. Conclusion: Although medical and paramedical students have heard about the concept of body donation, their awareness, knowledge, and attitude need to be improved.

‘I Certainly Wasn't as Patient-Centred’

Abstract This article explores how a group of paramedics were cross-trained as community health workers (CHWs) in Indiana. Cross-training paramedics as CHWs provided a foundation to better understand the social issues that occur outside of the hospital and clinic, thereby enabling further empathy among paramedics and seeking means to connect patients to other health and social services agencies. I detail how earning a certification as a CHW shifted the mindset of the paramedics and their approach toward caregiving. Ultimately, I argue how cross-training healthcare professionals can further expand the general awareness of CHWs and possible opportunities for employment. However, steps must be taken to ensure that reducing the CHW model to a cross-training opportunity will not minimise the impacts of hiring a full-time CHW.

Psycho-social working conditions of nursing, medical and paramedic staff in a hospital emergency department

Background: A hospital Emergency Department (ED) is a working place in which numerous working conditions evoke various organisational and operational stressors affecting medical staff working there. Aim of the study: Analysing the psycho-social working environment in nursing, paramedic and medical staff in a specific hospital ED and, in particular, examining 1) work requirements, 2) levels of control, 3) psycho-physical wellbeing and 4) changes expected by the staff. Material and methods: The research was conducted among 69 employees of ED (nursing, paramedic and medical staff) in the University Clinical Hospital in Opole. A standardized Psychosocial Working Conditions Questionnaire (PWCQ) was applied. Results: The average score were as follows: at the demands scale 94.99 points, at the control scale 59.26 pts, at the social support scale 48.94 pts, at the social support scale 48.94 pts, at desirable changes scale 75.32 pts. The length of service in the job correlated negatively with the support received at workplace (r= - 0.308, p=0.01). The necessity for changes at workplace was stronger in the residents of villages and towns below 100 000 residents (p=0.007). The material status of the respondents had a statistically significant correlation (p&lt;0.05) with the answers collected in each PWCQ questionnaire subscale. The support received at workplace was significantly higher in the groups of paramedics (51.11±8.48) and doctors (52.95±13.66) than in nurses (44.39±10.26), p=0.005. Conclusions: Due to numerous stressors present at EDs and psycho-social working conditions, employers ought to make some effort to modify them.

Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): study findings.

One-fifth of emergency department presentations by ambulance are due to acute-on-chronic breathlessness. We explored the feasibility of an evaluation-phase, cluster randomised controlled trial (cRCT) of the effectiveness and cost-effectiveness of a paramedic-administered, non-pharmacological breathlessness intervention for people with acute-on-chronic breathlessness at ambulance call-out (BREATHE) regarding breathlessness intensity and conveyance to hospital. This mixed-methods, feasibility cRCT (ISRCTN80330546) randomised paramedics to usual care or intervention plus usual care. Retrospective patient consent to use call-out data (primary end-point) and prospective patient/carer consent for follow-up was sought. Potential primary outcomes included breathlessness intensity (numerical rating scale) and conveyance. Follow-up included: interviews with patients/carers and questionnaires at 14 days, 1 and 6 months; paramedic focus groups and surveys. Recruitment was during COVID-19, with high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; nine withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients, not meeting recruitment target (n=36); eight patients and three carers were followed-up. Data quality was good but insufficient for future sample size estimation. The intervention did not extend call-out time, was delivered with fidelity and was acceptable to patients, carers and paramedics. There were no repeat call-outs within 48 h. All trained paramedics strongly recommended BREATHE as a highly relevant, simple intervention. Patient recruitment to target was not feasible during the pandemic. Training and intervention were acceptable and delivered with fidelity. Results include valuable information on recruitment, consent, attrition and data collection that will inform the design and delivery of a definitive trial.

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

BackgroundParamedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes. ObjectiveThe aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley’s model for SA, can improve overall SA during emergency calls. MethodsA prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores. ResultsThe overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011. ConclusionsA targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.

Awareness of COVID-19 Infection and its Safety Protocols among Health Care Workers in Pakistan: A Cross Sectional Study on Knowledge, Attitude and Practice (KAP)

Objective: To draw a comparative analysis of the levels of awareness of COVID-19 pandemic and its protective measures amongst health care workers (HCWs). Materials and Methods: This cross sectional study on Knowledge, Attitude and Practice (KAP) was conducted at PNS Hafeez hospital in Islamabad from 1st August 2020 to 30th September 2020. 156 professionals in the hospital including doctors and paramedics, who directly or indirectly came in contact with or managed COVID-19 patients, were included in the study with their consent and were provided with a questionnaire of 22 questions which comprised of answers of ‘yes’, ‘no’ or ‘I don’t know’. All participants were divided into two groups; the doctors were assigned Group 1 while the paramedics Group 2. Their answers were studied and overall KAP and comparison was analyzed using SPSS, v 22; IBM Corporation, Armonk, NY. The correct responses were considered ‘Poor’ (&lt;70%), ‘Good’ (70-90%) and ‘Very Good” (&gt;90%). Results: The difference in gender population between two groups was not significant. The difference in correct knowledge, attitude and practice between two groups was statistically significant. Conclusion: The attitude and practice about COVID-19 and its preventive measures was good in all professionals, though the doctors had very good (&gt;90%) attitude. The knowledge was poor (&lt;70%) in paramedics. The awareness programs are still required to continue better understanding and practice of COViD-19 especially in paramedics. Keywords: COVID-19, Corona, Knowledge, Attitude, Practice, Healthcare workers.

THE IMPACT OF WORKING CONDITIONS ON STRESS AND ITS EFFECTS IN THE GROUP OF PARAMEDICS: A SYSTEMATIC REVIEW

Purpose: This is a review to assess the working conditions that affect the stress level of paramedics and their ability to cope with stress. The profession of a paramedic is characterized by constant contact with other people and exposure to many factors, including biological (HIV, flu virus), chemical (causing allergic reactions, burns) physical (noise, low or excessive temperature), psychosocial (aggression, violence, traumatic experiences).&#x0D; Methodology: This is a Systematic review paper. The PubMed, Cochrane Library, and Google scholar search were used to analyze the problem. The following keywords were used to search for information sources: paramedic, working conditions, medical rescue, ambulance, stress, coping with stress. Articles were selected according to the impact of working conditions on stress and its consequences among the group of paramedics.&#x0D; Main Findings: The work of a rescuer is a constant action under the influence of a high level of stress and emotions, caused by an unforeseen sequence of events and time pressure. The long-term presence of negative factors is the cause of the appearance of burnout syndrome, rumination, PTSD, and somatic symptoms related to stress in the workplace. It can result in a deterioration of the quality of patient care.&#x0D; Implications of this study: The above results should be taken into account by units of the emergency medical care system. The paper indicates the occurrence of negative psychological effects of work-related stress and as a consequence the need to train the personnel in the field of stress-coping techniques and to provide emergency medical service workers with mental health monitoring and psychological care in the workplace.&#x0D; Novelty in this study: There is a lack of systematic reviews of the impact of working conditions on the mental health of workers in emergency medical care services. The paper is an attempt to assess the impact of working conditions on stress and its effects on the group of paramedics and other emergencies medical care system employees.