Medical Responders Research Articles

Authentic leadership & PsyCap’s role in tackling, events that impact well-being and environmental sustainability

There is a growing level of awareness among organizational leaders, that stress-induced mental health challenges are on the rise globally. High stress levels are often attributed to a spectrum of causes, from natural and human-made crises to the rapid pace of technological advancements and societal shifts. The number of causes necessitates an examination of not just the cumulative effect of these event constellations, but also their complex interactions, which may amplify stress in ways that are not yet fully understood. These dynamics appear to be contributing to a worrying trend of increased mental illness, anxiety, and depression, notably among professionals on the front lines of these societal changes, like medical practitioners and first responders. For example, there were more fire fighters who committed suicide last year in the US versus those who lost their lives protecting others. Additionally, these professionals are directly exposed to the increasing cases of mental illness, anxiety, and depression among the public, an exposure that further amplifies their own stress levels. Some of the factors contributing to these high levels of stress include natural disasters and human-caused events, as well as some of the most transformative discoveries and innovations in human history. We begin this paper, by examining how a constellation of consequential events are shaping our global society’s well-being, e.g., the COVID 19 pandemic, AI innovation and Climate Change. Next, we examine evidence-based interventions that may offer potential avenues for addressing these high levels of stress. For instance, development interventions focused on authentic leadership that can enhance leader and follower’s psychological capital or PsyCap, resulting in lowering levels of stress, especially when operating in work roles that have higher level of daily stress. These positive forms of leadership help to address the numerous challenges that individudals, organizations and communities face today and well into the future. A clear emphasis in our work is also placed on examining how positive forms of leadership and organizational behavior, can impact two very different, but critically important outcomes, including the individual and collective mental health and well-being in organizations, communities and societies. Consequently, the overall goal here is to recognize the problems we face across a broad range of first responder professions, while offering specific solutions to address those problems.

Exploring medical first responders’ perceptions of mass casualty incident scenario training: a qualitative study on learning conditions and recommendations for improvement

ObjectiveDespite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct...

Combinations of First Responder and Drone Delivery to Achieve 5-Minute AED Deployment in OHCA

BackgroundDefibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier. ObjectivesThe authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA. MethodsUsing Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival. ResultsHistorical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service. ConclusionsDeployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.

Use of Self-Efficacy Scale in Mass Casualty Incidents During Drill Exercises

IntroductionMedical First Responders (MFRs) in the emergency department SUMMA 112 are tasked with handling the initial management of Mass Casualty Incidents (MCI) and building response capabilities. Training plays a crucial role in preparing these responders for effective disaster management. Yet, evaluating the impact of such training poses challenges since true competency can only be proven amid a major event. As a substitute gauge for training effectiveness, self-efficacy has been suggested.ObjectiveThe purpose of this study is to employ a pre- and post-test assessment of changes in perceived self-efficacy among MFRs following an intervention focused on the initial management of MCI. It also aimed to evaluate a self-efficacy instrument for its validity and reliability in this type of training.MethodIn this study, we used a pretest (time 1 = T1) – post-test (time 2 = T2) design to evaluate how self-efficacy changed after a training intervention with 201 MFRs in initial MCI management. ANOVA within-subjects and between subjects analyses were used.ResultsThe findings reveal a noteworthy change in self-efficacy before and after training among the 201 participants. This suggests that the training intervention positively affected participants’ perceived capabilities to handle complex situations like MCI.ConclusionThe results allow us to recommend a training program with theory components together with practical workshops and live, large-scale simulation exercises for the training of medical first responders in MCI, as it significantly increases their perception of the level of self-efficacy for developing competencies associated with disaster response.

Safety First or Saving Lives? How Medical Responders Would Decide when Facing an Active Violent Incident. Results from an Explorative Cross-National Survey

Abstract In recent years, public authorities and rescue services have been discussing how Medical First Responders (MFRs) should behave in an Active Violent Incident (AVI) where it is necessary to weigh up self-protection and the rescuing of others. The aim of this exploratory study is to generate a preliminary picture of how European MFRs position themselves on this and related questions. With the help of a network of experts, an AVI scenario and accompanying questionnaire were developed and pretested. A refined version was then distributed among MFRs in eight European countries and Israel. We performed descriptive statistics and tested for significant differences among the participating countries. 1164 MFRs completed the survey. In the absence of police protection, a majority of respondents opted against providing immediate casualty care (56.6 %). Under certain circumstances, however, the rest decided in favour. More than 65.5 % did not fear disciplinary or legal consequences for not providing assistance immediately. Even with police protection, one in ten respondents would still not enter a “yellow zone”, one in four would leave this to Emergency Medical Services (EMS) units specifically trained for such operations. While there are very few strong contrasts between MFRs with different work experience, roles (supervisor/instructor) or additional qualifications (e.g., firefighting, military service), there are significant differences between MFRs from participating countries. Most notably, (1) only Norwegian participants identified, on average, a clear paradigm shift from “safety first” to “controlled risk taking”; (2) while 69.8 % of the Austrian cohort were unwilling to enter without being escorted by the police, among Norwegians MFRs the figure was 42.7 %; (3) the question whether “weapons” are “useful” equipment in such a scenario is particularly divisive (ranging from 14.3 % of German to 58.9 % of Israeli respondents). Although most of the questions were answered in the same way by a large majority, significant differences can be observed, especially between countries. We offer various explanations for these and discuss whether MFRs can actually remain passive given the situational normative forces inherent to an AVI.

Evaluation of system based psychological first aid training on the mental health proficiency of emergency medical first responders to natural disasters in China: a cluster randomised controlled trial

ObjectiveTo evaluate the effectiveness of a system based psychological first aid (PFA) training programme for emergency medical first responders in China.DesignParallel-group, assessor-blinded, cluster randomised controlled trial.Setting42 clusters of health workers...

Public health intervention amidst conflict: Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo

Research, policy, and donor interest in health systems in conflict environments has grown rapidly in recent years. The 2018-20 Ebola outbreak in Democratic Republic of the Congo is a critical case of healthcare militarization. The first-ever such outbreak in an active conflict zone, it grew notorious for violence against response teams, with attacks aggravating the spread of disease. However, while medical responders observed physical attacks, the causes of the violence remained largely unknown.Drawing on interviews and participant observation, we contribute civilian vantages of the way health intervention grew militarized, or associated with conflict. The argument builds in two core steps. A first reconstructs civilian experiences of conflict prior to Ebola to trace how the response took on a political meaning. We find that relationships linking state forces with the health response inadvertently tethered Ebola to what civilians perceived as security threats and that by repeating government statements about conflict, response teams unintentionally endorsed a version of the truth that silenced local voices. A second step addresses a central paradox: residents communicated these concerns directly, repeatedly, and via official response channels, yet healthcare teams failed to apply these insights. We locate this gap in the knowledge structures, or frames, accompanying intervention. Medical emergencies in warzones operate with dual sets of frames casting conflict players as "non-state" and public health resistance as "ignorance." Both frames intersect in ways that amplify invisibilities in each, clouding understandings of the nature of conflict and humanitarians’ role in it. We suggest this places intervention teams at heightened risk of mis-stepping on political fault lines—and not understanding why. The study advances work on community engagement by showing that instead of simply providing scientific knowledge, effective engagement requires adjusting socio-political lenses within the response. It contributes to studies on health intervention, humanitarian emergencies, and the limits of medical neutrality.

GPT AI in Virtual Patient Facilitates Communication Training of Medical First Responders: A Usability Study in Mixed Reality Simulation (Preprint)

GPT AI in Virtual Patient Facilitates Communication Training of Medical First Responders: A Usability Study in Mixed Reality Simulation (Preprint)

Rural Emergency Medical Services Clinicians’ Perceptions and Preferences in Receiving Clinical Feedback From Hospitals: A Qualitative Needs Assessment

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

Enhancing Mixed Reality Simulation Training Technology with Real-Time Performance Visualization: Mixed Methods Study with Medical First Responders (Preprint)

Enhancing Mixed Reality Simulation Training Technology with Real-Time Performance Visualization: Mixed Methods Study with Medical First Responders (Preprint)

Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study in Japan.

International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000. From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups. Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes. URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.

Medical Response to the February 6, 2023, Earthquakes in Hatay: Challenges Faced in the Deadliest Disaster in the History of Türkiye.

The Kahramanmaraş earthquakes struck the north-eastern part of Türkiye and Syria on February 6, 2023. It is well known that timely coordination and provision of emergency medical care in the field is particularly important to save lives after earthquakes. This study aimed to identify the challenges faced by medical responders on the ground. This exploratory-descriptive qualitative study was conducted in Hatay, the province most affected by the earthquakes. Data were collected through in-depth semi-structured interviews and field observations, and then analyzed using thematic analysis approach. The study was carried out with 15 first responders from the medical profession. The study revealed 9 themes of challenges faced by medical responders: providing safety and security, human resources management, meeting personal needs, recording data, communication, patient transport, burial procedures, psychological acumen, and logistical problems. Some problems were resolved after 72 h and some continued until day 7. Inadequate organization of volunteer health workers, communication breakdowns, and logistical problems are some of the main challenges. To address these issues, satellite phones and radio systems can be promoted, as well as disaster-resilient logistical planning and better coordination of volunteers.

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.

NextGen Training for Medical First Responders: Advancing Mass-Casualty Incident Preparedness through Mixed Reality Technology

Mixed reality (MR) technology has the potential to enhance the disaster preparedness of medical first responders in mass-casualty incidents through new training methods. In this manuscript, we present an MR training solution based on requirements collected from experienced medical first responders and technical experts, regular end-user feedback received through the iterative design process used to develop a prototype and feedback from two initial field trials. We discuss key features essential for an effective MR training system, including flexible scenario design, added realism through patient simulator manikins and objective performance assessment. Current technological challenges such as the responsiveness of avatars and the complexity of smart scenario control are also addressed, along with the future potential for integrating artificial intelligence. Furthermore, an advanced analytics and statistics tool that incorporates complex data integration, machine learning for data analysis and visualization techniques for performance evaluation is presented.

Comparison of kinetic changes during helicopter medical evacuations: civilian versus military flights

BackgroundHelicopter evacuation is crucial for providing medical care to casualties. Previous civilian studies have demonstrated that air transport can enhance survival rates compared with ground transport. However, there has been...

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

ObjectivesTo design, develop, deliver and assess a training initiative on haemorrhage control for emergency medical services (EMS) staff in Ukraine, in an active wartime setting.DesignUsing the Medical Research Council framework...

Medical Equipment Supply Chain Optimization and Stability Study using Deep Reinforcement Learning

Medical equipment is a critical resource during the COVID-19 pandemic. An efficient and stable supply chain of medical equipment (masks, goggles, protective coveralls, etc.) enables medical workers and first responders to effectively and safely fight against this highly contagious disease. In my research, I design and investigate two agents based on the traditional (s,Q) policy and the Deep Reinforcement Learning (DRL) algorithm and apply them respectively to optimize a two-echelon medical equipment supply chain where one distribution center and multiple retailers are involved. To my knowledge, this is the first implementation of DRL algorithm for medical supply chain optimization. I implement the DRL algorithm in Python using Ray and RLlib packages and conduct experiments using Google Colab with GPU support. To maximize the DRL algorithm’s potential, I optimize the reward function and the hyperparameters of this algorithm. By testing the agents in different environment initializations, I find that the DRL algorithm outperforms the static (s, Q) agent, which is one of the most commonly used methods in many inventory optimization systems, by returning a 17.33% greater cumulative reward on average. Additionally, the relative standard deviation of baseline (s,Q) Policy is 1.97% and that of DRL is 2.49% based on ten repeated trials. Thus, the DRL approach is not only stable but can also significantly improve the retailer’s profit. My DRL model can be further applied to more complicated multi-echelon supply chain systems and lays a solid foundation for optimizing large-scale medical supply chains [TF18].

Civilian Medical Responder Perspectives to a Federal Military Medical Deployment in New York City during the COVID-19 Pandemic

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

Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest

BackgroundThis methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures.MethodsTeams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity.We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians.ResultsWe conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC’s fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC.ConclusionsFNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care.

Mixed Reality–Exploring the Requirements of Realism in the Context of Mass Casualty Incident Training

Introduction:The occurrence of mass casualty incidents is increasing globally. Training is an essential cornerstone in achieving disaster preparedness, yet studies show that medical first responders perceive their level of readiness to face disaster incidents as inadequate. As real-world disaster training exercises can be characterized as resource-intensive in terms of cost and time, virtual training environments have been highlighted as a potential alternative to mass casualty incident training. In order to increase the preparedness of medical first responders, a deeper understanding of their requirements in the context of disaster training exercises is needed.Method:Individual, contextual interviews were conducted with a total of 26 medical first responders from four European emergency service organizations: Hellenic Rescue Team (Greece), Summa 112 (Spain), Sanitätspolizei Bern (Switzerland), and Johanniter Österreich (Austria). The interviews were analyzed using qualitative content analysis.Results:The preliminary results indicate that real-world disaster training exercises have limitations regarding realism. The participants described a need to train in an environment that accurately represents what they might face amidst a real-world incident site. This included the recreation of potential environmental dangers that had to be taken into consideration before approaching the incident site. The participants also highlighted the importance of realistic representations of injuries and reactions from the victims during training. The limited possibilities to provide a realistic training environment that corresponds to the set requirements lead to the participants feeling less prepared to face a real-world mass casualty incident.Conclusion:Medical first responders’ need for increased realism in real-world disaster training exercises deserves attention. Training solutions that could potentially increase the level of preparedness needs to be taken into consideration. How the degree of realism in Virtual or Mixed Reality based training platforms affects the perception of preparedness among medical first responders warrant further research.