Performance Of Paramedics Research Articles

The Impact of Sleep and Mental Health on the Quality of Work Among Paramedics in the Kingdom of Saudi Arabia

The emergency services sector is one of the most arduous and crucial fields wherein an individual’s life lies in the hands of emergency responders such as paramedics and police. Paramedics are crucial figures in the emergency medical services system. They deliver immediate medical care to patients who suffer from critical and life-threatening conditions, serving as a gap-filler between the accident scene and health facilities. In the Kingdom of Saudi Arabia, the health authority has been constantly striving to build a credible, professional, and trustworthy EMS system while discovering challenges faced by the service in the rapidly changing health scenario of KSA. This study employed a mixed-methods approach, combining quantitative surveys and qualitative interviews to assess the relationship between sleep patterns, mental health, and work quality among paramedics in the Kingdom of Saudi Arabia. The results of this study reveal a significant correlation between sleep quality, mental health, and the overall performance of paramedics in the Kingdom of Saudi Arabia. In conclusion, the findings of this comprehensive study emphasize and highlight the critical and significant relationship that exists between sleep quality, mental health, and overall job performance among paramedics working in the Kingdom of Saudi Arabia. This highlights an urgent need for targeted and effective interventions designed specifically to enhance their well-being and support their mental health in the demanding field of emergency services.

The Distributional Impact of Fatigue on Performance

Little is known about how people-centric factors affect the shape of service time distributions despite distributional statistics (variance or quantiles) being key drivers of system performance in many service industries. We investigate the impact of one people-centric factor—worker fatigue—on the average, variance, and quantiles of service times in paramedic operations. Our analysis uses data on the performance of 368,634 paramedic teams in the London Ambulance Service over 10 years. We measure fatigue by the number of prior jobs a paramedic crew has completed during a shift and estimate its impact on the time it takes the crew to respond to incidents and bring patients to hospitals. Using a recentered influence function regression approach with multiple fixed effects, we find that the average time to hospital increases by 5% throughout the course of an average shift. In addition, the workers become less consistent with fatigue; service time variance increases by 39% during a normal shift. Furthermore, we find that in addition to an upward shift in mean service times, both the upper and lower tails of the distribution have more weight for fatigued paramedics. These effects are driven mostly by the performance of paramedics at the scene, rather than their driving to or from the incident. The distributional effects of fatigue are only slightly mitigated by increased experience or reduced system workload. Our work demonstrates that the impact of people-centric factors can be highly nonuniform across the service time distribution. This paper was accepted by Jayashankar Swaminathan, operations management. Funding: The authors are grateful for financial research support from the Wisconsin Alumni Research Foundation at the University of Wisconsin–Madison. Supplemental Material: The data files and e-companion are available at https://doi.org/10.1287/mnsc.2023.4855 .

Quality of Work Life dan Burnout terhadap Kinerja Paramedis: Mediasi Kepuasan Kerja di Era Pandemi

The Covid-19 pandemic that hit the world and claimed millions of lives has resulted in an increase in the excessive workload on paramedics. This condition places paramedics at risk of exposure to the Covid-19 virus, as well as increases the risk of burnout syndrome or mental fatigue.The research aims to analyze the quality of work life (QWL) and burnout on the performance of paramedics with job satisfaction as a mediating variable. The research was conducted on paramedics at Grati Hospital, Pasuruan Regency, using a saturated sampling technique. Data analysis used SEM-PLS with SmartPLS 3.2.9 software. The results showed that paramedics' job satisfaction and QWL had a significant positive effect, while burnout had a significant negative effect on paramedics' performance. Meanwhile QWL proved to have a significant positive effect on paramedics' job satisfaction. The results of the indirect effect prove that paramedics' job satisfaction is able to mediate the relationship between QWL and paramedics' performance.

Analisis Motivasi Kerja Dan Pemberian Insentif Terhadap Kinerja Tenaga Kesehatan Dimasa Pandemi Covid-19 (Studi Kasus Di Rs Toeloengredjo Pare Kediri)

This study aims to determine the effect of work motivation, providing incentives on the performance of paramedics during the covid 19 pandemic. The research method was carried out by conducting surveys and with a quantitative approach. Data collection was done by distributing questionnaires to 75 respondents. Data analysis techniques were carried out through SPSS version 22.0 including regression analysis, coefficient of determination test, f test and hypothesis testing. The results of data analysis obtained the value of the coefficient of determination (R2) which was determined by R square of 0.502 (squaring of the correlation coefficient or R, ie 0.709 x 0.709 = 0.502) or equal to 50.2%, this value indicates that the relationship of the independent variable motivation, incentives with a performance dependent variable of 50.2%. While the rest (100% - 50.2% = 49.8%) is influenced by external variables. The results of the F test showed that the Fcount value was 36.301 with a significance level of 0.000 and for Fcount > Ftable (36.301 > 3.120) and the significance level was 0.000 <0.05. This shows that H0 is rejected and Ha is accepted, which means that the independent variable (free) namely Motivation and Incentives simultaneously or jointly has a positive and significant effect on the dependent variable (bound), namely Performance. Based on the results of hypothesis testing, it was found that the motivational variable had a significance value of 0.000 < 0.050. Meanwhile, the t-count value for motivation is 5.590, which is greater than the t-table, which is 1.993. So it can be concluded that H0 is rejected and Ha is accepted. This means that there is an influence of motivation on performance, while the incentive variable has a significance value of 0.804 > 0.050. Meanwhile, the value of t-count Incentive is 0.249, which is smaller than the t-table, which is 1.993. So it can be concluded that H0 is accepted and Ha is rejected. This means that there is no effect of incentives on performance.

The Effect of Transformational Leadership, Work Motivation, and Organizational Commitment on Job Satisfaction and Performance on Medical and Paramedical Personnel (Case Study at Public Health Center in Indonesia)

Human resources play a very important role because humans are the cogs of all company activities. Efforts to improve performance are carried out through a well-organized leadership system and motivating to increase employee morale. This study aims to determine the effect of transformational leadership, work motivation, and organizational commitment on employee performance. This study uses a survey method with a questionnaire as a data collection tool. The population in this study were all medical and paramedical personnel at the Public health center in Surabaya, Indonesia, totaling 60 people. Samples were taken as many as 60 employees with the sampling technique of Non-Probability Sampling with Saturated Sampling, where all members of the population became the sample. The data obtained through the questionnaire were then tested for validity and reliability using the product-moment correlation formula and Cronbach's alpha. Data analysis used multiple regression analysis, F test, t-test, and coefficient of determination test and was accompanied by classical assumption testing. The results showed that: (1) Individual/partial transformational leadership did not affect the performance of medical and paramedical officers at Public health center in Surabaya, Indonesia. This is evident from the results of the t-test to obtain a t-value of 1.028 with a t-table of 2.05 with a significance level of 5%. This means that transformational leadership that is carried out partially without being followed by work motivation and organizational commitment will not affect employee performance. (2) Work motivation has a positive effect on the performance of medical officers and paramedics at the Public health center in Surabaya, Indonesia. This is evident from the results of the t-test to obtain a t-value of 34.013 with a t-table of 2.05 with a significance level of 5%, then H2 is accepted. This means that the higher the employee's work motivation, the performance will increase. (3) Organizational Commitment has a positive effect on the performance of medical officers and paramedics at the Public Health Center. This is evident from the results of the t-test to obtain a t-value of 3.478 with a t-table of 2.05 with a significance level of 5%, then H3 is accepted. This means that the higher the organizational commitment of employees, the performance will increase. 05 with a significance level of 5%, then H2 is accepted. This means that the higher the employee's work motivation, the performance will increase. (3) Organizational Commitment has a positive effect on the performance of medical officers and paramedics at the s. This is evident from the results of the t-test to obtain a t-value of 3.478 with a t-table of 2.05 with a significance level of 5%, then H3 is accepted. This means that the higher the organizational commitment of employees, the performance will increase. 05 with a significance level of 5%, then H2 is accepted. This means that the higher the employee's work motivation, the performance will increase. (3) Organizational Commitment has a positive effect on the performance of medical officers and paramedics at the Public health center in Surabaya, Indonesia. This is evident from the results of the t-test to obtain a t-value of 3.478 with a t-table of 2.05 with a significance level of 5%, then H3 is accepted. This means that the higher the organizational commitment of employees, the performance will increase. then H3 is accepted. This means that the higher the organizational commitment of employees, the performance will increase. then H3 is accepted. This means that the higher the organizational commitment of employees, the performance will increase.

Reliability of prehospital diagnosis of acute cerebrovascular accident.

Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED). This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians. Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.

Analysis Of Factors Affecting The Performance Paramedic At Hospital Royal Prima Medan

Paramedics as human resources run health services in hospitals. Paramedic performance is closely related to the quality of hospital services. The purpose of this study is to analyze the factors that affect the performance of paramedics at RSU Royal Prima Medan. This type of research is quantitative research with a cross-sectional design. The location of this research was conducted at RSU Royal Prima Medan. The research sample is all paramedics at RSU Royal Prima Medan as many as 112 people. The survey data were analyzed using the chi-square test and logistic regression. The results showed that there was an influence of motivation on the performance of paramedics (p= 0.000 &lt;0.05), there was an effect of ability on the performance of paramedics (p = 0.000 &lt;0.05), there was an effect of knowledge on the performance of paramedics (p = 0.000 &lt; 0.05). ), there is an effect of the work environment on the performance of paramedics (p= 0.000 &lt; 0.05), there is the effect of incentives on the performance of paramedics (p = 0.000 &lt; 0.05), there is an effect of promotion on the performance of paramedics at the Royal Prima Hospital Medan in 2021 (p= 0.000 &lt; 0.05). The variable that most dominantly influences the performance of paramedics at RSU Royal Prima Medan in 2021 is the motivation variable with a p-value of 0.016, OR = 4.182 (95% CI = 1.300-13,448). So the suggestions in this study are expected that hospitals can minimize these factors by redesigning work to reduce role ambiguity and paramedic boredom at work. there is the effect of incentives on the performance of paramedics (p = 0.000 &lt; 0.05), there is an effect of promotion on the performance of paramedics at the Royal Prima Hospital Medan in 2021 ( p = 0.000 &lt; 0.05.

Factors affects the performance of red crescent paramedics, Bisha, Saudi Arabia.

Context:Saving lives is the ultimate purpose of the Red Crescent paramedics. It is crucial to enable safe, effective, and efficient performance of paramedics globally. In Saudi Arabia, the Red Crescent faces at least over 280,000 cases every year.Aims:Therefore, this study aims to address the factors affecting the performance of the Red Crescent paramedics.Methods and Material:Descriptive qualitative study and all data processed were analyzed using thematic analysis.Settings and Design:In total, 31 paramedic staff in Bisha city were invited to participate in this descriptive qualitative study. Among them, 11 paramedics agreed to participate in an in-depth semi-structured interview.Results:The findings of the research indicated three themes. The first theme was a lack of awareness in society, with three sub-themes: types of emergency calls, the crowd that gathers at the incident location, and people interruptions. Theme 2 was the long distance and road obstacles, and other factors that affect the paramedics were the third theme.Conclusions:Policymakers and the community should obtain a clear understanding of the Red Crescent paramedic interventions to help to create policies, legislation, and guidelines suitable for the needs of paramedics.

Job Stress, Job Burnout and Performance of Paramedics during the Covid 19 Pandemic

This study aims to analyze the influence of work stress and job burnout on the performance of health workers during the Covid-19 pandemic and analyze the influence of work stress on the performance of health workers of Aisyiyah Ponorogo General Hospital mediated by job burnout during the Covid-19 pandemic. The type of data used consists of primary data, namely data obtained from the dissemination of questionnaires and secondary data obtained from the company's internal data, journals, books and scientific articles. This study used a sample of 194 respondents who are health workers. The results of this study found that: 1) work stress has a negative and significant effect on performance in health workers; 2) work stress has a positive and significant effect on burnout in health workers; and 3) work stress has a negative and significant effect on the performance of health workers through mediation of burnout variable

Awareness and Performance of Paramedics in Preventing toward Middle East Respiratory Syndrome Coronavirus Infection

The purpose of this study is to examine the knowledge of Middle East Respiratory Syndrome Coronavirus(MERS), wearing of protective equipment and the performance in preventing MERS infection amongparamedics and analyze correlations. The survey was conducted on 96 active paramedics in K city, SouthKorea. The data were analyzedusing the SPSS 21.0 programusing descriptive statistics, t-test, one-wayANOVA, Scheffe test and Pearson’s correlation coefficient.Through this analysis, it was found that higher knowledge of MERS resulted in higher scores in the actionsto prevent infection. As such, it is necessary to raise the infection control performance of paramedics byreflecting strategies for ‘preparedness’ rather than ‘response’ in the training on MERS, which must focus onknowledge and infection prevention.

THE EFFECT OF ORGANIZATIONAL CITIZENSHIP BEHAVIOR (OCB) ON THE INCREASING SPIRIT OF PARAMEDIC WORK OF COMMUNITY HEALTH CENTER IN EAST OKU DISTRICT

Morale of a person will be influenced by the level of job satisfaction they have. When an employee feels satisfied with the work being done, the employee will work optimally in completing his job, even doing some things that may be outside his job. The problem faced by community health center paramedics in East OKU district is how the Organization Citizenship Behavior plays an important role in the morale of public health center paramedics in East OKU district, while this research is to determine the important role of Organization Citizenship Behavior on the performance of Paramedics. Community health center in East OKU Regency. The hypothesis proposed is that there is a strong influence between Organization Citizenship Behavior on the performance of public health center paramedics in East OKU Regency.From the calculation results obtained r = 0.689. After being consulted with conservative standards to determine whether the relationship is close or not, it turns out that it lies in the distance between 0.600 - 0.799. It can be concluded that the influence of Organization Citizenship Behavior on improving the performance of community health center paramedics in East OKU Regency is having a strong influence. Then to answer the hypothesis test that was previously proposed to have a relationship or not, then tested with the hypothesis test and obtained t count = 2.69. While the value of t table at the 95% confidence level for (n - 2) = 1,860. Then it can be seen that the value of t count 2.74 is greater than the value of t table, namely = 1.860, thus means (Ha) can be accepted and (Ho) is rejected. This means that the hypothesis proposed is acceptable, namely the influence of the Organization Citizenship Behavior on increasing the morale of Puskesmas Paramedics in East OKU Regency is very strong

Sensitivity stratification concept and hierarchical multi-objective optimisation for an ambulance with hydraulically interconnected suspension and stretcher-human body model

In this paper, a hierarchical optimization strategy for an ambulance with a supine human body model is proposed to improve suspension performance, where the ride comfort of both patients and paramedics and the road holding of the ambulance vehicle are particularly focused. An ambulance model integrating a hydraulically interconnected suspension system and a stretcher-human body model is developed first. This integrated model considers the interaction between stretcher and human body and provides a platform to directly evaluate ride comfort of patients. The sensitivity stratification concept is defined and the sensitivity levels of each design variable are determined according to sensitivity ratios. Then, design variables and optimization objectives are divided into two pairs and optimized in sequence, which not only comprehensively considers the overall performance of patients and paramedics, but also reduces the number of objectives in each optimization process. At last, the optimum solution of proposed hierarchical strategy is obtained and compared with general monolayer optimization strategy. The simulation results show that the hierarchical strategy is highly competitive and outperforms the monolayer optimization strategy, being able to provide not only a better solution and convergence but also has good computational efficiency.

Examining the effects of stress on the driving abilities of paramedic students

Background: Research has suggested that stress may have a negative effect on paramedics' clinical performance. Stress has also been demonstrated to negatively affect the driving abilities of the general population, increasing the number of driving errors. However, no studies have explored stress and its potential impact on the non-clinical performance of paramedics, particularly their driving abilities. Methods: Paramedic students underwent emergency driving assessment in a driving simulator before and after exposure to a stressful medical scenario. The number and type of errors were documented before and after through the use of both driving simulator software and observation by two members of the research team. The NASA Task Load Index (TLX) was used to record self-reported stress levels. Results: Thirty-six students participated in the study. Following exposure to a stressful medical scenario, paramedic students had no rise in overall error rate, but demonstrated increases in three critical driving errors: namely, failure to wear a seat belt (three baseline versus 10 after stress); failing to stop for red lights or stop signs (seven versus 35); and losing control of the vehicle (two versus 11). Self-reported stress levels also increased after the clinical scenario, particularly in the area of mental (cognitive) demand. Conclusion: Paramedics are routinely exposed to acute stress in their everyday work, and this stress could affect their non-clinical performance. The critical errors committed by participants in the present study closely matched those considered to be contributory factors in many ambulance collisions. These results illustrate the need for further research into the effects of stress on non-clinical performance in general, and highlight the potential need to consider additional driver training and stress management education to mitigate the frequency and severity of driving errors among paramedics.

PENGARUH LATAR BELAKANG PENDIDIKAN, PENGALAMAN, PELATIHAN DAN HUBUNGAN ANTAR KARYAWAN TERHADAP KINERJA MANTRI PADA PT BANK RAKYAT INDONESIA (PERSERO) TBK CABANG SAMUDERA BANJARMASIN

The purpose of this study was to determine the effect of educational background, experience, training and the relationship between employees on the performance of paramedics. The research method used is a quantitative method. Data collection techniques are questionnaires, observations, and interviews. The data analysis technique used is multiple linear regression data analysis techniques using SPSS for Windows software. And as many as 86 respondents. The results of this study indicate that (1) the variables of educational background, experience, training, and relations between employees have a simultaneous effect on the performance of paramedics at PT Bank Rakyat Indonesia (Persero) Tbk, Samudera Banjarmasin Branch with a F = 4,449 and a significant value of 0.003 ,(2) variable educational background does not affect the partial value(t &lt;ttable = 1,155 &lt;1,663),the variable does not affect the partial experiences with the value(t &lt;ttable = -0009 &lt;1,663),training has no effect significantly with the value (t-calc &lt;ttable = 0.149 &lt; 1,663), while the relationship variable between employees has a partial effect with the value (t-calc &gt; ttable = 3.167 &gt; 1,663), and (3) the most dominant variable is the relationship variable between employees with t-calc = 3,167. Keywords: Background of Education, Training, Experience, Inter-employee Relations, Multiple Linear Regression

Driving me crazy: the effects of stress on the driving abilities of paramedic students

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Previous research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Paramedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= &amp;lt;0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Paramedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics.&lt;/p&gt;

(A319) Using a Computer Simulation (CS) to Improve Training and Event Management of Paramedics for Mass Casualty Incidents (MCI)

Using a Computer Simulation (CS) to improve training and event management of paramedics for Mass Casualty Incidents (MCI). Eli Jaffe, Avi Dagan, Eyal Zahavi, Einat Aviel, Bruria Adini. The Department of Emergency Medicine, Ben-Gurion University of the Negev Magen David Adom (MDA) is the national emergency organization in Israel. Over the past few decades MDA personnel have been required to deal with MCIs involving large numbers of casualties. Recently, there have been fewer terrorist related MCIs, however, there is a continuing need for to maintain the knowledge and skills of paramedics to manage MCIs.ObjectiveTo examine performance of paramedics exposed to a CS compared to a control group exposed to a traditional lecture based learning experience.MethodAn interactive CS based on the MDA standard operating procedure for managing MCIs was developed. The participants were randomly divided into two groups. Group 1 received the lecture format, and Group 2 the CS. Both groups were given a pre-test (Group 1 average score 56.3, Group 2 average score 53.1), and two post-tests. One immediately following completion of the intervention, and a second a month after completion of the course.ResultsAverage scores for the CS Group (n = 15) was significantly different on the first post-test (Group 1 average score 53.2, Group 2 average score 68.7), by 30% and on the second (Group 1 average score 71.9, Group 2 average score 80.8) by 12% compared to the Lecture Group (N = 17) (P = &lt; 0.00).ConclusionCS allow for the use of multiple media formats based on real events, and are able to replicate reality using real media material. MDA has recommended that continuing education interventions for emergency medical personnel for maintaining knowledge and skills required for the management of MCIs utilize a CS based training methods.

An assessment of paramedic performance during invasive airway management

Objective. To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management. Methods. An audit of paramedic call reports for a 12-month period from January to December 1997 was performed. Call reports that documented invasive airway management were retrieved and relevant data were extracted using a preformulated data-entry form. Results. Paramedics attempted tracheal intubation in 453 patients and were successful in 408 (90.1%); 331 of the patients were in cardiopulmonary arrest with vital signs absent (VSA), 101 had medical emergencies, and 21 had trauma-related problems. In the VSA cohort, the tracheas of 96% of the patients were intubated successfully; 80.1% on the first attempt, 10.6% on the second, 4.5% on the third, and 0.9% after more than three attempts. In the medical cohort, the tracheas of 74.3% of the patients were intubated; 60.4% on the first attempt, 11.9% on the second, and 2.9% on the third. In the trauma cohort, 71.4% of the intubations were successful; 66.6% on the first attempt, 26.6% on the second, and 6.6% on the third. There was a difference (p < 0.001) in the incidence of successful intubations comparing the VSA cohort with the medical/trauma cohorts. There was also a difference (p < 0.001) between the success rate for nasal intubations (43 of 68, 63% of patients successfully intubated) and that for oral intubation (365 of 385, 94% of patients). Conclusion. This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance. PREHOSPITAL EMERGENCY CARE 2000;4:164-167

Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study

Rapid diagnosis and transport by paramedics and efficient, effective emergency management are essential to improving care of acute stroke patients. To measure the performance of paramedics and emergency departments providing care for patients with suspected acute stroke. Two stroke centers and 4 other hospitals where most patients with acute stroke in Houston, Tex, are admitted participated. Hospital and paramedic performance data were collected prospectively on 446 patients with suspected acute stroke transported by paramedics between September 1999 and February 2000. Paramedics had a sensitivity of 66%, specificity of 98%, and overall accuracy of 72% in diagnosing stroke. For patients with suspected stroke, 58.5% arrived in the emergency department within 120 minutes of symptom onset; in confirmed cases, that percentage was 67%. Mean total transport time was 42.2 minutes and was significantly longer (P < .001) to inner-city hospitals (44 minutes) than to suburban, community-based centers (39 minutes). Door to computed tomography times were significantly (P < .001) shorter for the 2 stroke centers than the other hospitals. Overall thrombolysis treatment rate among patients with confirmed ischemic stroke was 7.4% (range, 0-19.4%); treatment rates at the 2 stroke centers were 5.9% and 19.4%. More than half of patients with suspected stroke arrive at hospitals while thrombolytic treatment is still feasible. Although the current rate for thrombolytic treatment in Houston exceeds the national rate, performance of paramedics and hospitals in treating acute stroke can be improved by increasing efficiency and standardizing medical practices.

A N A SSESSMENT OF P ARAMEDIC P ERFORMANCE D URING I NVASIVE A IRWAY M ANAGEMENT

Objective. To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management. Methods. An audit of paramedic call reports for a 12-month period from January to December 1997 was performed. Call reports that documented invasive airway management were retrieved and relevant data were extracted using a preformulated data-entry form. Results. Paramedics attempted tracheal intubation in 453 patients and were successful in 408 (90.1%); 331 of the patients were in cardiopulmonary arrest with vital signs absent (VSA), 101 had medical emergencies, and 21 had trauma-related problems. In the VSA cohort, the tracheas of 96% of the patients were intubated successfully; 80.1% on the first attempt, 10.6% on the second, 4.5% on the third, and 0.9% after more than three attempts. In the medical cohort, the tracheas of 74.3% of the patients were intubated; 60.4% on the first attempt, 11.9% on the second, and 2.9% on the third. In the trauma cohort, 71.4% of the intubations were successful; 66.6% on the first attempt, 26.6% on the second, and 6.6% on the third. There was a difference (p < 0.001) in the incidence of successful intubations comparing the VSA cohort with the medical/trauma cohorts. There was also a difference (p < 0.001) between the success rate for nasal intubations (43 of 68, 63% of patients successfully intubated) and that for oral intubation (365 of 385, 94% of patients). Conclusion. This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance.

An evaluation of ems educational programs in north carolina

Objectives. To determine whether EMS educational programs in North Carolina adequately prepare paramedics, and whether there is additional value to an associate of applied science (AAS) degree education in EMS when compared with traditional certificate training programs. Methods. Surveys were developed and distributed to EMS administrators, AAS paramedics, and certificate paramedics. The administrators were asked to rate the performance of both AAS and certificate paramedics in the areas of pre-employment evaluation, patient-care skills, and non-patient-care duties. The paramedics were asked to rate their preparation for specific responsibilities within those three categories. All of the participants were asked to describe the requirements for employment within their EMS systems, and any preferences given to AAS paramedics. Results. The administrators rated both AAS and certificate paramedics as good or excellent in all three categories. The paramedics also rated their preparation for patient care as good or excellent. The certificate paramedics rated their preparation for eight non-patient-care duties significantly lower than did the AAS paramedics. The eight areas were: 1) verbal communication, 2) reading ability, 3) leadership, 4) conflict resolution, 5) computer skills, 6) teaching skills, 7) personal health/hygiene, and 8) Occupational Safety and Health Administration (OSHA) compliance. Fewer than half of the EMS administrators reported preferences in hiring (46.2%) or promotion (39.6%) for AAS paramedics, but at least half (50.0% and 54.2%) of the AAS paramedics worked in systems offering such preferences. Conclusions. While administrators and paramedics believe the current EMS educational programs in North Carolina adequately prepare students to function as paramedics, there are identifiable areas that require additional emphasis. There appears to be additional value to an AAS education when compared with traditional certificate EMS educational programs.