Prehospital Care Professionals Research Articles

Sequels of the COVID-19 pandemic on prehospital care professionals

As the COVID-19 pandemic and associated measures continue to have an impact on global populations, Guillaume Alinier explores the effects on the wellbeing of frontline prehospital care professionals and what can be done to support them to continue providing high-calibre care and growing as a profession

Hazardous material and chemical, biological, radiological, and nuclear incident readiness among prehospital care professionals in the State of Qatar

ABSTRACT This study aimed to determine whether the Hamad Medical Corporation Ambulance Service (HMCAS) personnel fulfil the pre-hospital readiness requirements for hazardous material and chemical, biological, radiological, and nuclear (HazMat-CBRN) incidents. This cross-sectional study performed an online assessment of non-specialist paramedics’ behaviour and knowledge about HazMat-CBRN incident management, followed by a ‘HazMat-CBRN incident management’ course with pre-and post-activity assessments. The validity and reliability of the knowledge assessment questions were also tested. The pre-and-post course assessement responses revealed certain deficiencies in staff knowledge. The multiple linear regression and paired groups t-test demonstrated that this was rectified after the training intervention. The results indicate that the implemented course helped HMCAS staff acquire a satisfactory level of knowledge to ensure their readiness for safe and effective responses to potential HazMat-CBRN incidents in Qatar.

Measures for the prevention of COVID-19 transmission for prehospital care workers

Objective: to identify measures to prevent transmission of COVID-19 for prehospital care health care workers. Methods: integrative review using LILACS and BDENF databases via the Virtual Health Library, CINAHL, MEDLINE/PubMed, Web of Science, EMBASE, Cochrane Library, and SCOPUS. Results: eight publications were included that presented recommendations regarding the use of safety equipment by healthcare professionals and ambulance drivers and measures to prevent the risk of infection during invasive airborne procedures in suspected or contaminated COVID-19 patients. Conclusion: the preventive measures directed to prehospital care professionals were proper use of personal protective equipment and changes in the management of suspected/contaminated patients by COVID-19 and in invasive procedures or transportation of these patients. In addition, it is essential the cleaning and disinfection of the ambulances and their equipment.

Barriers to ethical decision-making for pre-hospital care professionals.

Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision. The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel. In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach. Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality. The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes. Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients' moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them.

Medical Response to the Tianjin Explosions: Lessons Learned.

On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned. This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals. A total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied. The risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411-414).

Biological Risks In The Professionals Of Mobile Pre-Hospital Care

Introduction: Pre-hospital care professionals face situations in which they are very vulnerable to occupational risks of the biological type, due to direct and constant contact with patients in numerous adverse situations.
 Objective: To analyze the biological risks inherents to the nursing team of the Mobile Emergency Care Service (MECS) in Patos-PB.
 Method: The study was an exploratory, descriptive type, with a quantitative data approach. The research population was composed of all the nurses and nursing technicians employed in the MECS, Regional of Patos-PB who were available to participate in the research. Data were analyzed with SPSS software (version 21). Descriptive statistics of relative and absolute frequencies, central tendency (mean and median) and dispersion (standard deviation and minimum and maximum values) were used. Considering the small sample size, we adopted non-parametric inferential tests of Mann Whitney and Pearson's Chi-square test or Fisher's exact test, accepting as statistically significant that p <0.05.
 Results: The sample consisted of 45 professionals of the nursing team, with the majority (88.9%) being female and a prevalent age range from 27 to 33 years, a workload of 36 hours per week, with less than one year of performance in the service; 95.6% use the complete uniform; 97.8% make use of masks, and only 24.4% confirm wearing protective glasses; 31.1% perform reoccurrence of needles already contaminated, and 24.4% already suffered some type of accident with a sharp device. Only 24.4% said they had undergone some training on the part of the company. Conclusion: It was evidenced that the occurrence of the accidents is directly related to the exhaustion of the professionals and their lack of experience in the area, besides the lack of training offered by the service. It can be noted that the company lacks in the area of employee protection, since they do not offer a professional training course, so there is no investment in continuing health education.

One year exploring Qatar's ambulance service: Views from an Emergency Medicine Fellow

Introduction: Pre-hospital care professionals work outside or in confined spaces. Issues like population demography, cultural diversity, geography, roads, and climate regularly challenge them. Some of these factors might be overlooked by the hospital-based mentality of other clinicians. Providing them an opportunity to accompany paramedics in their own environment may help them better understand the paramedics' role and scope of practice, and improve the patient handover process between these two “alienated worlds” of medical professionals. Methods: An Emergency Medicine Specialist spent 12 months within Qatar's national Ambulance Service. Regular rotations through its various departments were facilitated, including an 8-week ride along with a Rapid Response Vehicle (Delta unit) dealing with emergency calls. A daily journal was written to record the experiences and audit data was accessed to gain a deeper understanding of the Service. Results: This experience was an eye opener. Delta officers are very experienced and can provide a global perspective of the operations. Their main focus is safety from a 360-degree scene perspective, team leadership, and communication. The type of calls and circumstances provided a unique view of the scene realities. Ambulance crews were observed dealing with difficult situations, assessing patients, and initiating treatment in challenging environments. Depending on the type of emergency, Ambulance Paramedics were joined by a Critical Care Paramedic who has more advanced skills and the ability to administer a broader range of medications. Conclusion: This program has been effective at introducing a hospital-based clinician to the pre-hospital world and should be Considered to all Emergency Fellows. It highlighted the complexities of working in the community with limited resources and the importance of communication to ensure the provision of safe and effective care. Understanding the Ambulance Service staff's level of competency will also enhance the handover process and help build trust in the Paramedics.

Quality of Life Assessment of the Wandering Emergency Service Care professionals

Introduction: the situations faced by the prehospital care professionals drive to a wear in the workplace, compromising these professionals’ quality of life. Objective: evaluate the quality of life of the professionals who work in the Wandering Emergency Service Care in three northeastern cities of Brazil from physical and environmental aspects. Methods: quantitative, descriptive and transversal study, conducted at the Wandering Emergency Service Care in the cities of Caicó, Currais Novos and Santa Cruz, located in the Rio Grande do Norte State, northeastern Brazil. The data were collected from 55 professionals in October and November 2014. Results: there was a majority of professionals aged between 25 and 29 years old, male, with high school education, income between 2 and 5 minimum wages, with other employment. The evaluation of quality of life was considered positive by most professionals. Regarding the Whoqol-Bref questionnaire there was a score variation of 65.45% to 78.76%. Conclusion: It is concluded that most of the professionals who were studied judge themselves as satisfied with their health and evaluate their quality of life positively.

Intervention in situations of psychic crisis: challenges and suggestions of a prehospital care staff

A qualitative and descriptive research, aimed at knowing how the pre-hospital care professionals perceive the interventions towards people in mental crisis. The study was developed in Santa Catarina with four teams of basic life support units of the Department of Mobile Emergency Care, during April to June 2011. The Collective Subject Discourse was used as the method of analysis. Two themes emerged: Awareness of the difficulties in meeting a person in mental crisis and Suggestions in the search for a closer attention to the person in mental crisis. The difficulties mentioned were related to the lack of training and a local to forward the patients, suggesting a better training and systematization of care. We conclude that it is necessary to invest in the educational process, based on new care strategies guided by the principles of SUS and of the psychosocial paradigm, and revisit the strategy of protocols as guidelines and not as standardizing systems.

Clinical Experience and Practical Skills: Results from Mexico City's Paramedic Registry

Trauma is a leading cause of death and disability in Mexico. Unintentional injuries, along with diabetes and heart disease, contribute to > 35% of the country's total mortality. Effective and efficient prehospital care of the conditions may improve outcomes. The objective of this paper was to determine if prehospital field experience (PFE) correlated with higher passing rates among candidates for the paramedic registry in Mexico City. This was a retrospective, cohort study using data from the Voluntary Registry of Prehospital Care Professionals (VRPHP) in Mexico City. The mean value for candidate age was 30.6 years and mean value for the years of PFE was 6.8 years (CI = 9-13 years). Most of the applicants were male and almost 90% were basic emergency medical services providers. Sixty-five percent of the candidates were from private, non-profit organizations, 73% were volunteers, and 19% had obtained a university degree. More than 57% had > 5 years of PFE, but the experience level did not correlate significantly with higher passing rates for the registry evaluation (chi2 = 1.66, p = 0.43). The results differed between the two years that the examination was offered (chi2 = 32.98, df = 1, p < 0.001, gamma = 0.54), regardless of gender, education, and years of experience. Previous field experience showed no correlation with passing rates, although the correlations improved between examination periods. The results may be used to support appropriate implementation of future health policies for prehospital emergency services.