Prehospital Personnel Research Articles

A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city.

Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components. The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement. Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups. This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.

Implementation of a prehospital whole blood program: Lessons learned.

Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes. Prehospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. Prehospital blood programs must be thoughtfully planned, have multiple safeguards, ensure adequate training and credentialing processes, and be responsible stewards of blood resources. According to the 2022 best practices model by Yazer etal, the four key pillars of a successful prehospital program include the following: (1) the rationale for the use and a description of blood products that can be transfused in the prehospital setting, (2) storage of blood products outside the hospital blood bank and how to move them to the patient in the prehospital setting, (3) prehospital transfusion criteria and administration personnel, and (4) documentation of prehospital transfusion and handover to the hospital team. This concepts paper describes our operational experience using these four pillars to make Maryland's inaugural prehospital ground-based low-titer O-positive whole blood program successful. These lessons learned may inform other EMS systems as they establish prehospital blood programs to help improve outcomes and enhance mass casualty response.

Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research.

Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.

Evaluating the effectiveness of the pre‑hospital trauma life support (PHTLS) program for the management of trauma patients in the pre-hospital emergency based on Kirkpatrick’s evaluation model

BackgroundPre-hospital trauma life support (PHTLS) training courses have been developed and widely adopted to enhance the proficiency of pre-hospital personnel in handling trauma patients. The objective of this study was to assess the effectiveness of the educational program for managing trauma patients in the pre-hospital emergency setting, utilizing Kirkpatrick’s educational evaluation model.MethodsThis is an observational approach, consisting of four sub-studies. The PHTLS course was conducted over a 2-day period, encompassing both theoretical and practical components. For this study, we selected pre-hospital personnel from three emergency aid stations using a convenient sampling method. These personnel underwent their first-ever PHTLS course training, and we subsequently analyzed the effectiveness of the training program using Kirkpatrick’s four levels of evaluation: satisfaction, learning, behavior, and results.ResultsThe study conducted on Kirkpatrick’s first-level analysis revealed that participants expressed a high level of satisfaction with the quality of all aspects of the course. Moving on to the second and third levels, namely learning and behavior, significant improvements were observed in the average scores of various skills that were examined both immediately after the course and 2 months later (P < 0.05). However, when it comes to the fourth level and the impact of the course on indicators such as mortality rate and permanent disability, no significant changes were observed even after an average of 3 months since the course was introduced.ConclusionThe implementation of PHTLS has been linked to the enhancement of participants’ skills in treating trauma patients, leading to the application of acquired knowledge in real-life scenarios and a positive change in participants’ behavior. The evaluation of PHTLS courses in Iran, as in other countries, highlights the need for specialized training in pre-hospital trauma care. To ensure the continued effectiveness of the PHTLS course, it is advisable for managers and policymakers to encourage regular participation of PHTLS employees in the program.

The talk debrief experience: Intervention in prehospital personnel care during the Covid-19 pandemic.

This study focused on the TALK Debrief Experience in the prehospital personnel (n = 1521) of a western Spanish healthcare region during the COVID-19 Pandemic. The study aimed to apply the TALK clinical debriefing intervention to out-of-hospital clinical staff during pandemics; identify their emotions, thoughts, coping strategies, and solution proposals; determine their demands for improving well-being and coping ability; and disseminate valuable knowledge for addressing trauma in similar situations. The study employed a qualitative methodology within a participatory action research (PAR) framework, conducting group discussions (n = 375) and employing the TALK clinical debriefing method as the guiding framework for the sessions. The discussion group meetings were facilitated by psychologists (n = 67) who had received training in this intervention technique. Various emotions were identified during the sessions, including fear of contagion, lack of control and security, work-related stress, and ethical dilemmas. Proposed solutions and coping strategies addressed increased security measures, promotion of social distancing, stress and anxiety management, and clarity in procedures and provision of protective equipment. The study also highlighted additional demands such as the need for clear information, psychological support, and changes in work practices like reducing strenuous shifts. In conclusion, despite study limitations, such as the lack of long-term follow-up, it emphasized the importance of comprehensively addressing well-being and working conditions during health crises.

Exploring the challenges to using telecardiology as perceived by pre-hospital emergency care personnel: a qualitative study

BackgroundToday, using the medical technology of telecardiology, as part of advanced medical services, plays an essential role in providing care to cardiac patients in life-threatening conditions who need emergency care. However, pre-hospital emergency care personnel are faced with certain challenges in using telecardiology, with adverse effects on their performance. Therefore, the present study aimed to investigate the challenges to using telecardiology as viewed by pre-hospital emergency care personnel in Southern Iran.MethodsThe present study is a qualitative work of research with a content analysis approach. Selected using purposeful sampling, 19 pre-hospital emergency care personnel were interviewed on a semi-structured, personal, in-depth basis. The qualitative data obtained were analyzed using the Graneheim and Lundman’s conventional content analysis approach (2004).ResultsBased on the qualitative data analysis, 3 themes and 8 subthemes were obtained. The three main themes included professional barriers (lack of clinical knowledge of telecardiology, lack of clinical skill in telecardiology, violation of patients’ privacy, lack of clinical guidelines on telecardiology), medical equipment and telecommunication barriers (poor reception and ineffective means of communication, low charge on the battery of tele-electrocardiogram machines), and organizational management barriers (serious lack of cardiologists available for medical counseling and lack of continual personal development of the telecardiology personnel).ConclusionSenior managers in pre-hospital emergency care services are recommended to use the results of this study to identify the influential factors in using telecardiology and take the necessary measures to eliminate the existing barriers toward making optimal use of telemedicine, thereby improving the quality of care provided for cardiac patients.

Effects of the Hazardous Area Response Team Training Program on the Knowledge and Confidence in Operational Skills of Prehospital Emergency Medical Personnel in Thailand: A Quasi-Experimental Study.

Hazardous areas are places emitting hazardous materials, terrorist- or war-related, which lead to public health risks in developed and developing countries globally. Hence, prehospital emergency medical personnel who work as frontliners should be trained. Data via pretest, posttest, and questionnaire surveys regarding the HART's knowledge of and confidence in operational skills were collected using the 5-point Likert scale. The cohort included prehospital emergency medical personnel aged >18 years. The training program comprised lectures, practicals, and examinations and included three subcourses: emergency medicine in the chemical, biological, radiation, and nuclear hazardous area (EM-CBRN) course; Thailand Tactical Emergency Medical Service (TTEMS) course; and cooperation and preparation for disaster (CPD) course. The HART's mean multiple choice question (MCQ) posttest knowledge score (12.80±3.11) was significantly higher (p<0.001) than the mean pretest knowledge score (7.74±3.71) for the EM-CBRN course. The HART's mean MCQ posttest knowledge score (24.04±2.79) was significantly higher (p<0.001) than the mean pretest knowledge score (14.34±3.92) for the TTEMS course. Further, the HART's mean MCQ posttest knowledge score (21.03±3.49) was significantly higher (p<0.001) than the mean pretest knowledge score (14.40±5.08) for the CPD course. The HART's mean confidence in operational skill score for the EM-CBRN course was significantly higher (p<0.001) after training (4.45±0.59) than before training (2.77±0.90). The HART's mean confidence in operational skill score for the TTEMS course was significantly higher (p<0.001) after training (4.55±0.59) than before training (2.78±0.98). The HART's mean confidence in operational skill score for the CPD course was significantly higher (p<0.001) after training (4.70±0.41) than before training (3.03±0.90). The HART training program significantly affected the HART's knowledge development and confidence in operational skills, particularly the frontline prehospital emergency medical personnel. Therefore, prehospital emergency medical personnel should undergo training, and learning activities must be developed to reinforce capacity and improve knowledge and confidence.

Application of Technology in Cardiopulmonary Resuscitation, a Narrative Review

Novel medical technologies are designed to aid in cardiopulmonary resuscitation both in and out of the hospital. Out-of-hospital innovations utilize the skills of paramedics, bystanders, and other prehospital personnel, while in-hospital innovations traditionally aid in physician intervention. Our review of current literature aims to describe the benefits and limitations of six main technologic advancements with wide adoption for their practicality and functionality. The six key technologies include: extracorporeal membrane oxygenation (ECMO), real-time feedback devices, smart devices, video review, point-of-care ultrasound, and unmanned aerial vehicle (drone) automated external defibrillator (AED) delivery. The benefits and limitations of each technology were independently reviewed and expounded upon. Newer technologies like drone AED delivery, paramedic ultrasound use, and smart devices have been demonstrated to be safe and feasible, however, further studies are needed to compellingly demonstrate improved patient outcomes. In-hospital use of ECMO and ultrasound is well established by current literature to aid in cardiopulmonary resuscitation and improve patient outcomes.

Abstract 266: Texas Out of Hospital Cardiac Arrest Gender Disparities From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project

Introduction: Female out-of-hospital cardiac arrest (OHCA) victims experience differences in care and worse rates of survival compared to male victims. Gender differences in time spent by prehospital care teams on scene with patients has not been studied. Hypothesis: There are gender disparities in scene time and outcomes. Increased scene time is associated with worse outcomes for Males and Females. Methods: We performed a retrospective, cohort study of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-201. We included adult OHCAs not witnessed by prehospital personnel that included scene time data and did not result in return of spontaneous circulation in the field that were transferred to emergency departments for ongoing resuscitation. We described OHCA demographics. We evaluated the association between gender and scene time. Using multivariable logistic regression, we evaluated the association of scene time with favorable neurologic outcome, (cerebral performance category (CPC) of 1 or 2). Results: We include 11,782 encounters with OHCA not witnessed by prehospital personnel, of these 7,185 were male and 4,597 female. Female OHCAs were older than male (mean 63.7 vs 61.3, p &amp;lt; 0.01). Female patients had slightly longer scene times than males (mean 29.2 vs 27.9). Female patients were less likely to have favorable neurologic outcomes (12.5% women vs 17.3% men, p &lt; 0.01 by chi2). Adjusting for age, gender, race, initial rhythm and bystander CPR in the multivariable model, increased scene time remained associated with a lower odds of favorable neurologic outcome (OR 0.96, 95%CI 0.95-0.96). Conclusions: OHCAs with longer duration scene time were associated with a lower likelihood of favorable neurologic outcome. Female patients were likely to have longer scene time duration and worse rate of favorable neurologic outcome.

180 How prehospital emergency personnel experience and manage ethical challenges: results from a focus group study embedded in collaborative research to develop and implement clinical ethics support tailored to the organizational context of the emergency services

180 How prehospital emergency personnel experience and manage ethical challenges: results from a focus group study embedded in collaborative research to develop and implement clinical ethics support tailored to the organizational context of the emergency services

Effect of crew ratio of advanced life support-trained personnel on patients with out-of-hospital cardiac arrest: A systematic review and meta-analysis

This review aimed to investigate the effect of crew ratios of on-scene advanced life support (ALS)-trained personnel on patients with out-of-hospital cardiac arrest (OHCA). We systematically searched PubMed, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials databases from the inception date until September 30, 2022, for eligible studies. Two reviewers independently screened the studies for relevance, extracted data, and quality. We compared the effect of the ratio of on-scene ALS-trained personnel >50% to those with a ratio ≤50% among prehospital personnel on the clinical outcomes of OHCA patients. The primary outcome was survival-to-discharge and secondary outcomes were any return of spontaneous circulation (ROSC), sustained ROSC (≥2h), and favourable neurological outcome at discharge (cerebral performance category scores: 1 or 2). Pooled odds ratios (ORs) were calculated, and the certainty of evidence was assessed. From 10,864 references, we identified four non-randomised studies, including 16,475 patients. Two studies were performed in Japan and two in Taiwan. There were significant differences in survival-to-discharge (OR: 1.24, 95% confidence interval [CI]: 1.07-1.44, I2: 7%), any ROSC (OR:1.22, 95% CI: 1.04-1.43, I2: 74%) and sustained ROSC (OR: 1.39, 95% CI: 1.16-1.65, I2: 40%), but insignificant differences in favourable neurological outcome at discharge. The overall certainty of evidence was rated as very low for all outcomes. Prehospital ALS care with a ratio of on-scene ALS-trained personnel >50% could improve OHCA patient outcomes than crew ratios ≤50%. Further studies are required to reach a robust conclusion.

Trauma

The October 2023 Trauma Roundup360 looks at: Intramedullary nailing versus sliding hip screw in trochanteric fracture management: the INSITE randomized clinical trial; Five-year outcomes for patients with a displaced fracture of the distal tibia; Direct anterior versus anterolateral approach in hip joint hemiarthroplasty; Proximal humerus fractures: treat them all nonoperatively?; Tranexamic acid administration by prehospital personnel; Locked plating versus nailing for proximal tibia fractures: a multicentre randomized controlled trial; A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Financial medicine as a source of moral distress: An unrecognised pathway to moral injury in the South African EMS systems

IntroductionThe phenomenon of Financial Medicine is a wide spread practice within the South African prehospital domain, which remains poorly researched. Similarly the impact of this phenomenon is not well understood, with many healthcare providers grappling with the moral dilemmas introduced into the work systems through the effects of the practice of Financial Medicine. Persisting, repetitive moral dilemmas can lead to instances of Moral Distress and Moral Injury. The practice of Financial Medicine in the South African prehospital domain proves to introduce many moral dilemmas and subsequently can serve as a source of Moral Distress and Moral Injury. MethodsThis study used a qualitative research methodology in the form of a constructivist grounded theory design. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity. ResultsThe sub-category presented in this study stems from the development of 6 final analytical labels that were abstracted in the process of a theory construction, not presented in this article. This sub-category is nested under 1 of the final analytical labels, and comprised of 3 preliminary analytical labels and an associated code and proposition list. ConclusionUnderstanding the sources of Moral Distress and Moral Injury within the South African prehospital domain are key steps in promoting and supporting the adoption and sustainability of ethical practices. This article presents a key finding that demonstrates a link between the experience of the phenomenon of Financial Medicine and the suffering of a Moral Injury by South African prehospital personnel.

Cadaveric Prehospital Amputation: Which Reciprocating Saw Blade Offers the Most Efficient Amputation.

Field amputations are a low-frequency, high-risk procedure. Many prehospital personnel utilize the reciprocating saw. This study compares the efficiency, speed, and degree of tissue damage of different reciprocating saw blades found commercially. Amputations were performed on two human cadavers at different levels of the upper and lower extremities. Four different blades were used, each with a different teeth-per-inch (TPI) design. The amputations were timed, blade temperature was recorded, subjective operator effort was obtained, amount of splatter was evaluated, and an orthopedic physician evaluated the extent of tissue damage and operating room repair difficulty. The blade with fourteen TPI was superior in overall speed to complete the amputations at 1.07 seconds per one centimeter of tissue (SD = 0.49 seconds) and had the lowest fail rate (0/8 amputations). The three TPI, six TPI, and ten TPI blades all required a "rescue" technique and were slower. The blade with fourteen TPI caused the least amount of tissue damage and was deemed the easiest to repair. Secondary outcomes demonstrated the fourteen TPI blade had generated the least amount of heat and produced the least amount of splatter. All blades had a perceived effort of "easy" to complete the amputation. While all blades were able to achieve an amputation, the overall recommendation is use of a fourteen TPI blade. It did not require any rescue techniques, provided the most straightforward amputation to repair, had the least amount of biohazard splatter and temperature increase, and was the fastest blade overall.

Investigation of the Effect of Virtual Stress Management Training on the General Health of Pre-hospital Emergency Personnel: A Semi-experimental Study during the COVID-19 Pandemic

Background and Objective: It is necessary to carry out urgent interventions to improve the general health of pre-hospital emergency personnel. The present study aimed to investigate the effect of virtual stress management training on the general health of pre-hospital emergency personnel. Materials and Methods: In this semi-experimental study conducted in 2022 in Jiroft City, Iran, 160 pre-hospital emergency personnel were randomly selected and divided into two intervention and control groups by simple random allocation (lottery). The educational content of stress management was held for eight sessions of 45 minutes (two sessions per week) for the intervention group virtually and online via the Adobe Connect application. The General Health Questionnaire (GHQ) was completed in two stages, before the intervention and one month after the completion of the intervention, in both groups. Using SPSS software (version 20), descriptive statistics (mean and standard deviation) and inferential statistics (ANCOVA) were used for data analysis. Results: The post-test results indicated a significant difference between the two groups in the overall score of general health (46.13±15.10 in the control group versus 34.50±12.63 in the intervention group). Moreover, after the intervention, the overall score of general health and its subscales decreased significantly only in the intervention group (P&lt;0.001). Conclusion: The implementation of the stress management virtual training program helps to improve the general health of pre-hospital emergency personnel. Therefore, it is recommended to be used as an effective method for empowering human resources.

Development of a prediction model for emergency medical service witnessed traumatic out-of-hospital cardiac arrest: A multicenter cohort study

To develop a prediction model for emergency medical technicians (EMTs) to identify trauma patients at high risk of deterioration to emergency medical service (EMS)-witnessed traumatic cardiac arrest (TCA) on the scene or en route. We developed a prediction model using the classical cross-validation method from the Pan-Asia Trauma Outcomes Study (PATOS) database from 1 January 2015 to 31 December 2020. Eligible patients aged ≥18 years were transported to the hospital by the EMS. The primary outcome (EMS-witnessed TCA) was defined based on changes in vital signs measured on the scene or en route. We included variables that were immediately measurable as potential predictors when EMTs arrived. An integer point value system was built using multivariable logistic regression. The area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow (HL) test were used to examine discrimination and calibration in the derivation and validation cohorts. In total, 74,844 patients were eligible for database review. The model comprised five prehospital predictors: age <40 years, systolic blood pressure <100mmHg, respiration rate >20/minute, pulse oximetry <94%, and levels of consciousness to pain or unresponsiveness. The AUROC in the derivation and validation cohorts was 0.767 and 0.782, respectively. The HL test revealed good calibration of the model (p=0.906). We established a prediction model using variables from the PATOS database and measured them immediately after EMS personnel arrived to predict EMS-witnessed TCA. The model allows prehospital medical personnel to focus on high-risk patients and promptly administer optimal treatment.

Ethical considerations in the prehospital treatment of out-of-hospital cardiac arrest: A multi-centre, qualitative study.

Prehospital emergency physicians have to navigate complex decision-making in out-of-hospital cardiac arrest (OHCA) treatment that includes ethical considerations. This study explores Danish prehospital physicians' experiences of ethical issues influencing their decision-making during OHCA. We conducted a multisite ethnographic study. Through convenience sampling, we included 17 individual interviews with prehospital physicians and performed 22 structured observations on the actions of the prehospital personnel during OHCAs. We collected data during more than 800 observation hours in the Danish prehospital setting between December 2019 and April 2022. Data were analysed with thematic analysis. All physicians experienced ethical considerations that influenced their decision-making in a complex interrelated process. We identified three overarching themes in the ethical considerations: Expectations towards patient prognosis and expectations from relatives, bystanders, and colleagues involved in the cardiac arrest; the values and beliefs of the physician and values and beliefs of others involved in the cardiac arrest treatment; and dilemmas encountered in decision-making such as conflicting values. This extensive qualitative study provides an in-depth look at aspects of ethical considerations in decision-making in prehospital resuscitation and found aspects of ethical decision-making that could be harmful to both physicians and patients, such as difficulties in handling advance directives and potential unequal outcomes of the decision-making. The results call for multifaceted interventions on a wider societal level with a focus on advance care planning, education of patients and relatives, and interventions towards prehospital clinicians for a better understanding and awareness of ethical aspects of decision-making.

Investigation and Analysis on Occupational Exposure Causes and Mental Status of Infectious Diseases in Pre-Hospital Emergency Medical Personnel.

We aimed to probe into the occupational exposure causes and mental status of infectious diseases in pre-hospital emergency medical personnel. Forty medical personnel with occupational exposure to infectious diseases who participated in pre-hospital emergency work in 120 emergency center of The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China were selected as respondents from February 2018 to February 2021. The occupational exposure modes, exposure degrees, exposure sites, exposure sources and exposure causes of infectious diseases were summarized, and the mental status of emergency medical personnel after occupational exposure to infectious diseases was analyzed. In the occupational exposure modes of infectious diseases, needle stick injuries were overtly higher than mucosal pollution, hematic and humoral pollution and incised wound by glass (P<0.05). In exposure degrees, slight bleeding was notably higher than excessive bleeding, bleeding and no bleeding (P<0.05). The hand was distinctly higher than the eye in exposure sites (P<0.05). In exposure sources, hepatitis B virus was visibly higher than hepatitis C virus, HIV, syphilis, intravenous drug, hemorrhagic fever and unknown cause (P<0.05). The scores of somatic symptoms, anxiety, depression, fear, interpersonal sensitivity, hostility, compulsion and paranoia in medical personnel were clearly higher than the norm in Chinese adults after occupational exposure to infectious diseases (P<0.05), with no statistical significance in the comparison of psychotic scores. The occupational exposure risk of infectious diseases among pre-hospital emergency medical personnel is high. It is necessary to strengthen pre-job training and education and improve standardized management for protection.

Assessment of Gender Bias During Paramedic-Physician Handoffs.

Objective Gender bias against female physicians has been frequently demonstrated and associated with negative feelings toward their careers. Gender bias has also been demonstrated in prehospital clinical care. However, potential gender bias during paramedic-physician handoffs has not been studied. This study aimed to identify gender bias during interactions between prehospital personnel and emergency physicians at the time of patient handoff. Methods An observational study was conducted at an urban academic emergency department. Observers were trained to record information from paramedic-physician handoffs but were blind to the nature of the study. The primary outcome was to whom paramedics initially directed the focus of their handoff report based on physician gender, with secondary outcomes of to whom paramedics directed most of their report and whether they asked about further questions based on physician gender. Results There were 784 observed handoffs. There was no significant association between the gender of the physician and which physician received first attention (χ2{1, N = 782} = 0.9736, p = 0.3238) or majority attention (χ2{1, N = 780} = 1.9414, p = 0.1635). Paramedics were more likely to ask questions to male attendings than female attendings (χ2 {1, N = 784} = 4.4319, p = 0.0353). Conclusion We identified limited differences in communication based on gender between paramedics and physicians during emergency department patient handoffs.

The Relationship Between Organizational Justice and Job Burnout in Pre-hospital Emergency Nurses

Background: Personnel working in emergency departments are exposed to a lot of burnout due to their nature and occupational factors; therefore, it is very important to pay attention to the factors that cause and aggravate burnout. In the meantime, the existence of organizational justice is an important principle in employee efficiency that can also affect the quality of employee services. Therefore, this study was conducted to investigate the relationship between organizational justice and burnout in emergency department personnel of Tabriz hospitals in 2019. Materials and Methods: The present study is a descriptive cross-sectional correlational study that was performed on 140 pre-hospital emergency personnel in Tabriz, Iran in 2021. The sampling method was census. Data were collected using a three-part questionnaire including participants’ personal demographic information form, Niehoff and Moorman organizational justice questionnaire, and Maslach burnout inventory (MBI). For data analysis, SPSS software, version 22 was used through descriptive statistics and analytical statistics. The significance level was considered at 0.05. Results: The results showed that the level of organizational justice and job burnout of participants was in the moderate range. Also, the results of the correlation statistical test showed that there was a significant reverse relationship between organizational justice and job burnout of pre-hospital emergency personnel (P&lt;0.05). Conclusion: The findings of this study showed that organizational justice is not very desirable from the perspective of pre-hospital emergency personnel and their sense of burnout can be largely related to this situation. Therefore, based on the findings of the present study, it is suggested that managers and officials of pre-hospital medical centers and emergencies by adopting new administrative policies and creating a favorable organizational climate based on human dignity can take positive steps to improve organizational justice and reduce job burnout.