Prehospital Staff Research Articles

Occupational stress profiles of prehospital and clinical staff in emergency medicine-a cross-sectional baseline study.

Occupational stress among emergency medical staff remains a central problem. Prior to the COVID-19 pandemic, many studies were focused on the working conditions of clinical emergency staff, but few examined the occupational stress profiles of prehospital emergency dispatchers (ED). The aim of this study is therefore to provide baseline data on the differences in occupational stress profiles between prehospital and clinical emergency medical staff. ED, emergency nurses (EN), and trauma surgeons on duty (TS) were questioned using the established and validated standardized short version of the instrument for stress-related job analysis for hospital physicians (ISAK-K). Differences between occupational groups were compared using the Mann-Whitney U test. Our data indicate significant differences in perception of stressors between professional groups (p < 0.05), with ED showing the highest psychological stress, followed by EN. Social stressors and emotional dissonance were significantly higher in ED and EN compared to TS (p < 0.05). Time pressure was identified as major stressor for ED and TS, but not for EN (p < 0.01). All professions showed moderate high levels of uncertainty and frustration (p = n.s.). Support from colleagues and supervisors was the greatest positive resource for all professional groups (p = n.s.). In accordance with current literature, our results advocate for a re-evaluation of the identified stressors, as ED, EN, and TS continue to show high levels of occupational stress. Training programs for coping with emotional dissonance and social stressors are likely to be crucial for reducing job stress among ED and EN.

Prehospital emergency nurses’ experiences of caring for patients with suspected acute myocardial infarction: an interview study

ObjectiveDespite the prevalence of emergency medical service assignments related to chest discomfort, limited research delves into nurses’ experiences of caring for such patients. This study aimed to illuminate prehospital emergency...

Prävalenz ausgewählter Erkrankungen bei prähospitalen Rettungskräften in Deutschland

Prevalence of selected diseases among pre-hospital emergency services personnel in Germany – results of the EMS Health Study 2023 Objective: The health of pre-hospital emergency medical services (EMS) staff is crucial for the provision of high-quality medical care. However, currently only limited data on the health monitoring of German EMS staff is available. The aim of the study was therefore to analyse the 12-month prevalence of selected diseases and symptoms among German EMS staff. Methods: A nationwide survey study was conducted. Questions from the GEDA2019/2020 study were used to collect information on the health status of EMS staff. Subsequently, 12-month prevalences were calculated with the corresponding 95 % confidence intervals (95 % CI). Results: In the end, 1,171 active German EMS staff (67.9 % male/31.9 % female) with a median age of 32.0 years were included in the analysis. The results indicate that excess weight and obesity are common health problems among EMS staff, with men (68.4 % [95 % CI: 64.8 %; 71.4 %]) being more affected than women (45.0 % [95 % CI: 39.9 %; 50.2 %]). The highest 12-month prevalence was calculated for lower back pain (51.8 % [95 % CI: 48.9 %; 54.7 %]), followed by pain in the cervical spine (41.9 % [95 % CI: 39.1 %; 44.8 %]), allergies (34.1 % [95 % CI: 31.4 %; 36.9 %]), hypertension (19.1 % [95 % CI: 16.9 %; 21.5 %]) and depression (16.2 % [95 % CI: 14.2 %; 18.5 %]). Compared to the German general population, the 12-month prevalence of obesity, asthma, COPD, hypertension, elevated blood lipid levels, arthritis, depression and obesity was higher for certain gender and age groups of emergency workers. Conclusion: The result of this study indicate a poor health state among German pre-hospital EMS staff and the need for preventive measures. Keywords: 12-month prevalence – emergency medical services – health – obesity – epidemiology

Population-Based Analysis of 6534 Seizure Emergency Cases from Emergency Medical Services Data.

Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3% < 18years) cases in Germany. A prehospital EMS physician was involved in 40.0% (SEPI) to 54.4% (PFS) of suspected seizure cases. Depending on the type of seizure, 70.7% (SEPI) to 80.9% (1stS) were admitted to hospital for inpatient stay of ≥ 24h. An additional 4% (PFS) to 16% (1stS) of cases needed immediate intervention at hospital. Prehospital EMS staff needed 8:24min:s (SD 7:24; n = 5004) after the emergency call to arrive at the scene of the ES and 10:58min:s (SD 27:39; n = 321) for PFS. ES and PFS cases caused estimated costs of 48.5 and 8.1million euros for Germany in 2019, respectively, not including hospital treatment-related costs. This study identified a high number of suspected seizure-related emergency casesand proportion of patients admitted to hospitals, as well as high associated costs in Germany.

Depressionen und damit assoziierte Faktoren bei Rettungskräften in Deutschland – Ergebnisse aus der EMS-Health-Studie für den Zeitraum 2020/2021

Depression and associated factors among emergency medical services staff in Germany: results from the EMS Health Study for the period 2020/2021 Background: Depression is one of the most common psychological conditions and factors such as pain and psychosocial workload can increase the risk for depression. Since there is little data available for prehospital emergence medical services (EMS) staff in Germany, the aim of the study was to identify factors associated with depression. Methods: This analysis was a nationwide cross-sectional study with prehospital EMS staff in Germany. Factors associated with depression were identified using multivariable logistic regression analysis, calculating adjusted odds ratios (AOR) and associated 95 % confidence intervals (95 % CI). Results: A total of 2,313 EMS staff were included in the analysis. The 12-month prevalence of depression was 15.6 % in women and 12.2 % in men. Significantly associated with depression were qualifications (paramedic*s: AOR: 1.99 [95 % CI: 1.10; 3.58] p = 0.022; paramedic*s: AOR: 1.69 [95 % CI: 1.08; 2.61] p = 0.021; reference: paramedics) and actual working hours (increase per hour: AOR: 1.02 [95 % CI: 1.00; 1.03] p = 0.013). Furthermore, poorer health, severe pain, allergies, and being a former smoker were also associated with a significantly higher chance of depression. In contrast, employees living in a relationship showed a lower chance of suffering from depression. Conclusion: This analysis provides evidence for factors associated with depression in prehospital EMS staff in Germany. Keywords: mental health – rescue service – workload – rescue service personnel – paramedics

Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study.

Pre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic. This phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi's approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research. A total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage. The findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.

Use of simulation models when developing and testing hospital evacuation plans: a tool for improving emergency preparedness

BackgroundIn recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden.MethodsA scientifically validated simulation system for “table top” exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals’ roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results.ResultsThe simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation.ConclusionsThis study has shown that “table top” exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.

Improving Accessibility in the Emergency Department for Patients with Disabilities: A Qualitative Study.

The emergency department (ED) is a critical service area for patients living with disabilities in the United States. Despite this, there is limited research on best practices from the patient experience regarding accommodation and accessibility for those with disabilities. In this study we investigate the ED experience from the perspective of patients living with physical and cognitive disability, as well as visual impairment and blindness, to better understand the barriers to accessibility in the ED for these populations. Twelve individuals with either physical or cognitive disabilities, visual impairments or blindness were interviewed regarding their ED experiences, particularly related to accessibility. Interviews were transcribed and coded for qualitative analysis with generation of significant themes relating to accessibility in the ED. Major themes from coded analysis were as follows: 1) inadequate communication between staff and patients with visual impairments and physical disabilities; 2) the need for electronic delivery for after-visit summaries for individuals with cognitive and visual disabilities; 3) the importance of mindful listening and patience by healthcare staff; 4) the role of increased hospital support including greeters and volunteers; and 5) comprehensive training with both prehospital and hospital staff around assistive devices and services. This study serves as an important first step toward improving the ED environment to ensure accessibility and inclusivity for patients presenting with various types of disabilities. Implementing specific training, policies, and infrastructure changes may improve the experiences and healthcare of this population.

Challenges and opportunities for conducting pre-hospital trauma trials: a behavioural investigation

BackgroundTrials in pre-hospital trauma care are relatively uncommon. There are logistical and methodological challenges related to designing and delivering trials in this setting. Previous studies have assessed challenges reported in individual trials rather than across the pre-hospital trial landscape to identify over-arching factors. The aim of this study was to investigate the challenges and opportunities related to the set-up, design and conduct of pre-hospital trauma trials from across the pre-hospital trial landscape and a specific pre-hospital trauma feasibility study.MethodsSemi-structured interviews were conducted with two cohorts of participants: research personnel who had experience of pre-hospital trials, either through direct involvement in conduct or through strategic oversight of national initiatives (n = 7), and clinical staff (n = 16) involved in recruitment to a pre-hospital trauma feasibility study. Thematic analyses were used to assess the barriers and enablers of conducting pre-hospital trauma trials. Two frameworks (The Capability Opportunity Motivation—Behaviour and the Theoretical Domains Framework) were used to guide analyses.ResultsThe barriers and enablers reported were relevant to several TDF domains and COM-B components. Across both cohorts, challenges associated with opportunities were reported and included the lack of research experience amongst pre-hospital staff, team dynamics within a rotating shift schedule, and the involvement of external organisations with diverse institutional priorities and infrastructures (e.g. Air Ambulances). The infrequency of eligible cases was also reported to affect the trial design, set-up, and conduct. Other barriers reported related to clinical equipoise amongst staff and institutional pressures, which affected motivation.ConclusionsThis study has highlighted that pre-hospital trials face many context-specific but also generic challenges. Pre-hospital trauma trial teams could consider the findings to develop targeted, behaviourally focused, solutions to the challenges identified in order to enhance the set-up and conduct of trials in this setting.Trial registrationNCT04145271. Trial registration date: October 30, 2019. Note that this paper does not report results from a specific trial but does include participants who were involved in the conduct of a registered pre-hospital feasibility study.

For when you just can't talk to 'normal' people . . . Exploring the use of informal support structures by supernumerary university paramedic students: findings from a phenomenological study.

In an effort to shield them from distress, pre-hospital ambulance staff may avoid discussing traumatic workplace experiences with friends and family. As a source of informal support, however, workplace camaraderie is considered important for managing occupational stress. For supernumerary university paramedic students there is limited research concerning how such experiences are managed, and whether they may benefit from similar informal support. This is a concerning deficit when contextualised by reports of higher stress levels among students undertaking work-based learning, and among paramedics / paramedic students in general. These original findings allude to how university paramedic students who are supernumerary within the pre-hospital workplace utilise informal support mechanisms. A qualitative, interpretive approach was adopted. University paramedic students were recruited via purposive sampling. Audio-recorded face-to-face semi-structured interviews were performed and transcribed verbatim. Analysis involved initial descriptive coding and then inferential pattern coding. The identification of themes and discussion topics was facilitated by a review of the literature. Twelve participants were recruited aged from 19 to 27 years, and 58% (n = 7) were female. While most participants cited that they were able to enjoy the informal stress-relieving camaraderie of ambulance staff, there were perceptions that supernumerary status may leave them potentially isolated within the workplace. Participants may also compartmentalise their experiences away from friends and family in a manner similar to that found among ambulance staff. Informal student peer support networks were praised as a source of information and for emotional support. Self-organised online chat groups were ubiquitous as a means of keeping in touch with student peers. While undertaking pre-hospital practice placements, supernumerary university paramedic students may not have complete access to the informal support of ambulance staff, and they may feel unable to discuss stressful feelings with friends or loved ones. However, within this study, self-moderated online chat groups were used almost universally as a readily accessible means of peer support. Paramedic educators ideally need an awareness of how such groups are used to ensure that they represent a supportive and inclusive space for students. Further research into how university paramedic students utilise online chat groups for peer support may further reveal a potentially valuable informal support structure.

Twelve-month prevalence of injury due to an occupational accident in pre-hospital Emergency Medical Services staff: Data from the EMS Health Study

Background: Pre-hospital emergency medical services (EMS) staff are at a high risk of occupational injuries. Therefore, this analysis aimed to calculate the 12-month prevalence of injuries due to occupational accidents and identify the associated factors in German pre-hospital EMS staff. Methods: We analyzed data from a cross-sectional survey to calculate the 12-month prevalence and the 95% confidence interval (95% CI) of an injury due to an occupational accident. In addition, the variables associated with these injuries were identified by multivariable logistics regression analysis and by calculating adjusted odds ratios (AORs) with 95% CI using JASP software. Results: A total of 2,307 study participants were included in the analysis. The 12-month prevalence of an injury due to an occupational accident was 15.61% (95% CI: 14.15%; 17.15%). The presence of lower back pain or chronic back pain (AOR: 1.65 [95% CI: 1.24; 2,20]; p ≤ 0.001), allergies other than allergic asthma (AOR: 1.42 [95% CI: 1.09; 1.86]; p = 0.009), and osteoarthritis (AOR: 1.85 [95% CI: 1.03; 3.32]; p = 0.039) in the previous 12 months, which are associated with an injury due to an occupational accident, were statistically significant. In addition, participants who were working in rural areas indicated lower odds compared to those working in metropolitan areas (AOR: 0.62 [95% CI: 0.43; 0.90]; p ≤ 0.001). Conclusion: This analysis indicates a high 12-month prevalence and mainly health-related factors associated with injuries due to occupational accidents being statistically significant in the participating German pre-hospital EMS staff.

Resources for Improving Pediatric Readiness and Quality of Care in Rural Communities and Emergency Departments.

To share the process and products of an 8-year, federally funded grant from the Health Resources and Services Administration Emergency Medical Services for Children program to increase pediatric emergency readiness and quality of care provided in rural communities located within 2 underserved local emergency medical services agencies (LEMSAs) in Northern California. In 2 multicounty LEMSAs with 24 receiving hospital emergency departments, we conducted focus groups and interviews with patients and parents, first responders, receiving hospital personnel, and other community stakeholders. From this, we (a regional, urban children's hospital) provided a variety of resources for improving the regionalization and quality of pediatric emergency care provided by prehospital providers and healthcare staff at receiving hospitals in these rural LEMSAs. From this project, we provided resources that included regularly scheduled pediatric-specific training and education programs, pediatric-specific quality improvement initiatives, expansion of telemedicine services, and cultural competency training. We also enhanced community engagement and investment in pediatric readiness. The resources we provided from our regional, urban children's hospital to 2 rural LEMSAs facilitated improvements in a regionalized system of care for critically ill and injured children. Our shared resources framework can be adapted by other regional children's hospitals to increase readiness and quality of pediatric emergency care in rural and underserved communities and LEMSAs.

Traumatic Brain Injuries: A Cross-Sectional Study of Traumatic Brain Injuries at a Tertiary Care Trauma Center in the Punjab, Pakistan.

Traumatic brain injuries (TBIs) are 1 of the most common reasons for young adult death and disability. This study sought to provide novel data for TBIs in Southern Punjab, as well as to identify any areas of service improvement to reduce the acute and long-term burden of this condition. A survey in English was created, which was then circulated to members of the emergency and neurosurgical department for a 3-wk period. A total of 450 patients (379 male [84.2%] and 71 female [15.2%]) were included as TBI admissions or attendances with a mean age of 28.9 y. Of the total, 420 people (93.2%) had experienced a TBI following a road traffic incident (RTI), with 78.7% (n = 354) of TBIs involving motorbike users who were not wearing helmets. A total of 226 (50.1%) patients arrived by car to the hospital, and 201 (44.7%) arrived by means of provincial government-funded emergency ambulance services. TBIs in Southern Punjab mostly affect younger males involved in RTIs while riding motorbikes. Recommendations to reduce the acute and long-term burden of TBIs in this region include formal training of all hospital and prehospital staff in the management of acute trauma cases according to international guidelines and operating provincial government emergency ambulance services in a wider geographic area.

An Assessment of General Health and Related Factors in Yazd's 115 Emergency Personnel in Covid-19 Pandemic

Background: Professional emergency workers are exposed to different risk factors which are related to their jobs. The pressure work load can cause complications such as physical symptoms, psychological and behavioral dimension of general health of the paramedic staff. This study examined the General Health status and related factors of Yazd's pre-hospital employees in COVID-19 pandemic. Methods: In this cross-sectional study with descriptive-analytical approach, among operational staff working in emergency centers, 200 eligible participants included with census sampling method. Goldberg general health questionnaire, a Likert-like scale was used to collect data. Results: The data showed that, 26% of the Emergency operational staff had low general health, and the majority 50.5% of them patients had moderate and 23.5% of subjects had good mental health .Statistical analysis showed that the social dysfunction had an impact on reducing mental health with highest (18%) and depression with lowest effect (5%) .The relationship between social dysfunction and type of employment was significant (p value = 0.025). Tukey Test showed that a significant difference between the official and contract employees (p value = 0.023) as well as a significant difference between the contract employees (p value = 0.016). Conclusion: Occupational stressor can have adverse effects on the clinical performance of pre-hospital staff and their mental health. Accurate knowledge of workplace stressors and occupational stressors to protect the health professional which can help this group of worker.

The Feedback Form and Its Role in Improving the Quality of Trauma Care.

Background: One of the tasks of a level I trauma center is quality improvement of level II and level III regional hospitals and emergency medical services by means of continuous education and learning processes. One of the tools for this, which provides constant monitoring of the quality of treatment, is feedback. The purpose of the study was to evaluate the effect of feedback on the quality of trauma care. Methods: Retrospective cohort study comprising two periods of time, 2012–2013 and 2017–2018. The study group included physicians and pre-hospital staff who treated patients prior to referral to the level I center. Upon arrival when the trauma teams identified issues requiring improvement, they were asked to fill in feedback forms. Data on patients treated in the trauma shock room for whom feedback forms were filled out were also extracted. Results: A total of 662 feedback forms were completed, showing a significant improvement (p ˂ 0.0001). The majority of the medical personnel who received the most negative feedback were the pre-hospital staff. A significant increase was revealed in the number of feedbacks with reference to mismanagement of backboard spinal fixation, of the pre-hospital staff, in 2012–2013 compared to 2017–2018 (p < 0.001). Improvement in reducing the time of treatment in the field was also revealed, from 15.2 ± 8.3 min in 2012–2013 to 13.4 ± 7.9 min in 2017–2018. Conclusion: The findings show that feedback improves the treatment of injured patients. Furthermore, constantly monitoring the quality of treatment provided by the trauma team is vital for improvement.

The prevalence of diseases in German emergency medical services staff: A survey study

For the general German population, the GEDA study is the main health monitoring study. Since nothing comparable is existing regarding the health of emergency medical services (EMS) staff, the aim of the present study was to estimate the 12-months prevalence of socially relevant diseases and symptoms among German pre-hospital EMS staff. This was a nationwide survey study. For retrieval of information on the health status of participating EMS staff items from the GEDA2014/2015 study were used. Afterwards, 12-months prevalence or proportions and corresponding 95% confidence intervals (95% CI) were calculated. Overall, 2,313 German pre-hospital EMS staff (42.6% female/57.2% male) with a median age of 25.0 (min. 18.0; max. 63.0) years were included into the final analysis. Obesity based on BMI was present in 25.9% (95% CI: 23.5%; 28.4%) of male compared to 15.7% (95% CI: 13.5%; 18.1%) of female study participants. Highest 12-months prevalence in the full study sample were calculated for lower back pain (41.1% [95%: 39.1%; 43.2%]), cervical pain (32.9% [95% CI: 30.9%; 34.8%]), allergies (32.6% [95% CI: 30.7%; 34.6%], depression (13.7% [95% CI: 12.4%; 15.2%]), and hypertension (11.5% [95% CI: 10.3%; 12.9%]). The 12-months prevalence in specific age-/gender-groups were higher for asthma, depression, hypertension, increased blood lipids, and osteoarthritis among study participants compared to the general German population (GEDA study) with the same age and gender (ratio ≥ 1.5). This study indicates that the prevalence of obesity, depression, hypertension, and other disorders is high among study participants and disease prevention measures for pre-hospital EMS staff are needed.

111 Using Video Teleconferencing for an Effective Remote Simulation Course in Transfer Medicine

Critically ill patients require transfer within and between hospitals – a necessity amplified by ITU capacity pressures during the COVID-19 pandemic. This rising demand highlighted the need for dedicated transfer teams. Alongside establishing and expanding a cross-sector transfer team, we necessarily needed to meet growing training requirements. Transfer medicine is a core competency for intensivists, anaesthetists, ITU nurses and pre-hospital staff, with simulation recommended in the respective curricula. However, COVID-related restrictions alongside demands on staff’s time, limited opportunities for face-to-face training. We overcame these challenges by developing an online simulation-based course. Teleconferencing has previously been received favourably and rated highly for educational benefit The aim of the study was to test the efficacy of and response to remote simulation-based training in transfer medicine.Before attending the online simulation, multi-disciplinary participants completed 3 hours of interactive e-learning hosted online via the platform Rise. This incorporated case-based discussions, practical assignments and filmed presentations. Simulation utilized Zoom teleconferencing to immerse participants in clinical transfers. We used high-fidelity, pre-recorded scenarios made with a mannequin simulator and high-definition video. The participants observed the simulated transfer of critically ill patients (Example screenshot of online simulated scenario with participants observingA total of 21 multi-disciplinary participants completed training: 43% doctors and 57% nurses. 100% of respondents (18) rated the course 5/5 on the Likert scale when asked ‘how much did you enjoy the course’ and 100% would recommend the course to colleagues. All rated the course extremely relevant to their practice. Average assessment scores pre- versus post-course improved by approximately 20% (74.3% to 94.4%) (Results of pre- and post-course knowledge assessmentsWe developed an effective and well-received remote simulation transfer course to deliver training to a wide-reaching audience. Participants were enthusiastic about the innovative and interactive approach, finding the online course enjoyable and relevant to their clinical practice. Results suggest the course effectively increased learning. The flexible nature of online remote provision allows for delivery at scale, to meet a rising demand. Further evaluation will establish the extent at which this training translates to performance, such as a reduction in adverse events in transfer practice.

46 ‘Born Too Soon’ Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community

Premature infants are at risk of death or neurodevelopmental impairment unless prompt effective care is delivered The aim of the study was to introduce a recurring virtual simulation workshop for WMAS on optimizing the initial care for vulnerable premature infants born unexpectedly in the community.Our local WMAS lead identified a training need through informal feedback from paramedics about the lack of training and confidence in dealing with premature births. Our workshop, designed to address this need, begins with an overview of prematurity. A simulation session follows, demonstrating basic Neonatal Life Support skills using equipment available to pre-hospital teams, focussing on thermoregulation. It concludes with a question-and-answer session. To enhance pre-hospital thermal care, we also put forward a successful business case for heated gel mattresses to be introduced across the WMAS and incorporated training for its use in the workshop.Two virtual training workshops have been delivered so far. In 2020, seven paramedics attended, and two completed the feedback and found the session valuable. After advertising, a second workshop was delivered in March 2021. Over 330 WMAS personnel registered, 219 attended and 132 gave feedback. There were representatives of various grades from 16 hubs across the region. Before the session, 12.2% of participants reported feeling somewhat confident/confident attending unplanned premature births of infants &lt;32 weeks’ gestation. Following the session, this improved to 66.7% of participants. Attendees commented on how ‘useful’, ‘fabulous’ and ‘fantastic’ they found the session. The sharp rise in interest in this virtual workshop confirms the training need whilst the positive feedback highlights the effectiveness of the virtual simulation workshop. With enhanced technical support, we will improve the learning experience of participants in the future. This project also led to the successful introduction of heated gel mattresses which are now carried on every WMAS ambulance. We expect that with increased staff training and confidence, the incidence of babies admitted with hypothermia following an unexpected birth in the community will improve with time. Our vision is to expand this project to other regions to empower pre-hospital staff to support premature infants born unexpectedly in the community and improve outcomes.

Psychological Distress Model Among Iranian Pre-Hospital Personnel in Disasters: A Grounded Theory Study.

Objective: Pre-hospital personnels (PHPs) who work in disasters under extreme pressure, uncertainty, and complex situations are victims of disasters themselves, and there is a link between experiencing such incidents and mental health problems. Because most studies focus on the injured and less on the psychological issues of PHPs, the present study aimed to develop a model to provide relief for PHPs in disasters from a psychological perspective.Methods: A grounded theory methodology recommended by Corbin and Strauss (2015) was employed. PHPs (n = 24) participated in a semi-structured interview between July 2018 to May 2020.Results: In the analysis of the pre-hospital staff interviews, three main themes were extracted, namely, providing relief with struggle (complexity of incident scenes, command-organizational and occupational challenges), psychological distress (psychological regression and psychological empowerment), and consequences (resilience and job burnout). Seven categories and 22 subcategories were explored from our data via the grounded theory approachConclusions: The PHPs managed psychological distress with two approaches: psychological self-empowerment and regression, which resulted in resilience and burnout, respectively. Due to the lack of enough support, the resilience of the PHPs was short-term, turned into burnout over time, and affected the structural factors again as a cycle.

Hazardous materials and CBRN incidents: Fundamentals of pre-hospital readiness in the State of Qatar

Background: Hazardous Materials and Chemical/Biological/Radiological/Nuclear (HazMat-CBRN) incidents represent a serious threat to the population and the environment. They require a pre-hospital medical response system well equipped and supported with logistics and clinicians with appropriate knowledge and skills to prevent exposure and mitigate risks. Our aim is to determine if the Hamad Medical Corporation Ambulance Service (HMCAS) fulfils the pre-hospital readiness requirements for such incidents. Methods: This cross-sectional study was performed in HMCAS. An online survey assessed staff behaviour and knowledge in relation to HazMat-CBRN incidents. Responses were obtained on health risks and pre-hospital medical management of related threats in Qatar. Based on the results, a training module “HazMat Incident Management” was prepared with pre-/post-activity assessments. The results were explored using a multivariate linear regression and non-parametric Wilcoxon test for paired samples. Specialized Emergency Management (SEM) staff opinion about this training was assessed through an online survey. Both surveys’ validity and reliability tests were conducted. Ishikawa cause and effects diagram was built for the identification of the factors leading to a pre-hospital successful response to HazMat-CBRN incidents. Results: HMCAS has the proper logistics and plans to manage potential HazMat-CBRN incidents. The knowledge survey demonstrated that the pre-hospital medical staff information about this topic needs reinforcement. The multivariate linear regression and non-parametric Wilcoxon test demonstrated that this was obtained thanks to the implemented training module. The course satisfaction survey showed not only a big interest in this activity but also staff recommended more related topics. Earlier-RSDAT (Recognition, Safety, Decontamination, Antidot, Transport) is a tool proposed as a response acronym to build a successful risk-based response for HazMat CBRN incidents in pre-hospital setting. Conclusion: HMCAS fulfills the readiness requirements for safe and effective response to potential HazMat-CBRN incidents in Qatar. The RSDAT response matrix might help in mitigating pre-hospital response risks.