Prehospital Emergency Care Providers Research Articles

The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study

IntroductionGlobally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). MethodsA qualitative exploratory design, underpinned by Van Manen’s (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. ResultsTwo primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. ConclusionThe study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.

Impact of workplace violence towards public service emergency care providers on access to emergency medical care in Gauteng Province, South Africa


 
 
 Background. Workplace violence is a global concern that threatens access to equal and efficient healthcare in developing countries. Objective. To discuss the impact of workplace violence towards Gauteng Province-based public service emergency care providers on access to emergency medical care within Gauteng communities.
 Methods. This study was based on a larger non-experimental, convergent parallel mixed-methods study guided by an interpretive framework founded on pragmatism. Evidence on workplace violence towards Gauteng-based public service prehospital emergency care providers was collected from the general population of Gauteng, sampled using multistage cluster sampling, public service emergency care providers, sampled using two-stage cluster sampling and purposively sampled managers of Gauteng Emergency Medical Services as well as South African Police Services. Surveys were used to gather information from the general population, focus group discussions were conducted with prehospital emergency care providers and semi-structured interviews were conducted to engage managers. Both quantitative and qualitative data were collected concurrently, and findings were triangulated. Parallel mixed-methods analysis that involved separate analysis of the quantitative and qualitative data was used to analyse the data.
 Results. A total of 413 survey questionnaires comprising of 196 web-based and 218 paper-based responses were included in the quantitative subphase of the study. The majority (66.1%; n=273) of participants resided in townships, 24.5% (n=101) in the city, 3.6% (n=15) in informal settlements, 2.9% (n=12) in school accommodation or school residences and only 2.9% (n=12) in flats, complexes, rural areas, security estates, smallholdings or suburbs. These are the participants who met the inclusion criteria, and specifically who were non-members of medical schemes and resided in communities where public service emergency care providers mostly render their services. For the qualitative subphase, two subthemes emerged during the interviews of managers supporting access to emergency medical care in Gauteng. The themes were ‘limited access to emergency medical care’ and ‘delayed response time’. At the same time a theme ‘leaving a violent scene’ emerged from the prehospital emergency care providers’ focus group discussions.
 Conclusion. The study revealed that workplace violence towards public service prehospital emergency care providers has a negative impact on access to emergency medical care among low- to middle-income communities in Gauteng who depend on state-funded healthcare.
 
 

Impact of workplace violence towards public service emergency care providers on access to emergency medical care in Gauteng Province, South Africa


 
 
 Background. Workplace violence is a global concern that threatens access to equal and efficient healthcare in developing countries. Objective. To discuss the impact of workplace violence towards Gauteng Province-based public service emergency care providers on access to emergency medical care within Gauteng communities.
 Methods. This study was based on a larger non-experimental, convergent parallel mixed-methods study guided by an interpretive framework founded on pragmatism. Evidence on workplace violence towards Gauteng-based public service prehospital emergency care providers was collected from the general population of Gauteng, sampled using multistage cluster sampling, public service emergency care providers, sampled using two-stage cluster sampling and purposively sampled managers of Gauteng Emergency Medical Services as well as South African Police Services. Surveys were used to gather information from the general population, focus group discussions were conducted with prehospital emergency care providers and semi-structured interviews were conducted to engage managers. Both quantitative and qualitative data were collected concurrently, and findings were triangulated. Parallel mixed-methods analysis that involved separate analysis of the quantitative and qualitative data was used to analyse the data.
 Results. A total of 413 survey questionnaires comprising of 196 web-based and 218 paper-based responses were included in the quantitative subphase of the study. The majority (66.1%; n=273) of participants resided in townships, 24.5% (n=101) in the city, 3.6% (n=15) in informal settlements, 2.9% (n=12) in school accommodation or school residences and only 2.9% (n=12) in flats, complexes, rural areas, security estates, smallholdings or suburbs. These are the participants who met the inclusion criteria, and specifically who were non-members of medical schemes and resided in communities where public service emergency care providers mostly render their services. For the qualitative subphase, two subthemes emerged during the interviews of managers supporting access to emergency medical care in Gauteng. The themes were ‘limited access to emergency medical care’ and ‘delayed response time’. At the same time a theme ‘leaving a violent scene’ emerged from the prehospital emergency care providers’ focus group discussions.
 Conclusion. The study revealed that workplace violence towards public service prehospital emergency care providers has a negative impact on access to emergency medical care among low- to middle-income communities in Gauteng who depend on state-funded healthcare.
 
 

Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers.

Background Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Identification of Elder Abuse through Out-of-Hospital Emergency Care Providers.

Elder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-ofhospital emergency care providers' experiences of identifying elder abuse. Individual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis. Although the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify. The identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.

To collar or not to collar. Views of pre-hospital emergency care providers on immobilisation without cervical collars: a focus group study.

Background:Spinal cord injury (SCI) is a rare event, with high numbers of patients unnecessarily immobilised with no potential benefit based on limited evidence from the 1950s and 1960s. Contemporary opinion now challenges the notion that traditional immobilisation prevents movement and protects the spine. Current literature suggests that these methods which include semi-rigid collars can potentially cause more movement of the spine and harm the patient. The purpose of this study was to explore the views and perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar.Methods:Focus groups were used to allow individuals to discuss and comment on a new method of immobilisation which omits the semi-rigid collar and to capture the thoughts, feelings and experiences of participants. Thematic analysis of the coded transcriptions was used to identify emerging themes.Results:Three focus groups were conducted with 15 participants in each. Participants were all exposed to patients sustaining trauma within their professional roles. Six intertwined themes emerged from the analysis: communication, conflict, education/training, empowerment, risk and the patient. Woven between these themes are the complex interactions that bring together the inter-professional relationships with other emergency services and hospital staff, the patient, the public and pre-hospital care providers.Discussion:Existing immobilisation practices are being challenged, with clinicians empowered to tailor practice to meet specific patient needs. There is limited empirical evidence to support current immobilisation practices. Contemporary literature suggests current practices may potentially cause harm. New pragmatic immobilisation practices are gradually being adopted by some pre-hospital care providers.Conclusion:This study explored the perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar for potential SCI. The consensus of the participants supports a pragmatic approach to managing potential SCI that provides safe, high-quality patient-centred care.

Emergency centre handover from the perspective of prehospital emergency care providers in Johannesburg, South Africa

PurposeThe purpose of this paper is to describe handover in the emergency centre from the perspective of prehospital emergency care providers in Johannesburg, South Africa. Reference to emergency centre handover from the prehospital perspective will have particular relevance to all deliverers of emergency centre handover.Design/methodology/approachA purposive, cross-sectional design addressed the study aim by using a purpose-designed, validated, paper-based questionnaire to collect data relating to prehospital emergency care personnel's perspectives on emergency centre handover.FindingsThere were 175 completed questionnaires collected from South African prehospital personnel within the Johannesburg area. The response rate was 175/290 or 62%. Training on handover was described as poor. There was a general appreciation of mnemonics and how well they ensured that all relevant information was handed over. However, this was countered by poor familiarity of common mnemonics. Perception of the accuracy of their own and observed prehospital handovers was generally positive. Handover length was generally perceived to be appropriate. The qualification of emergency centre personnel was perceived to impact on how handovers were received.Research limitations/implicationsThe study was limited to one geographical area and did not include all potential participants in the study area. The self-reported data collection meant that there was a risk of self-report bias. These factors may have negatively affected the generalisability of the data.Originality/valueThis paper seeks to describe perceptions related to emergency centre handover from the perspective of prehospital emergency care personnel. In doing so, it is postulated that there is the potential to use these findings to improve certain aspects of emergency centre handover.

Identification of Child and Youth Maltreatment as Experienced by Prehospital Emergency Care Providers

This mixed method study explores 200 prehospital emergency care providers’ experiences of identifying child and youth maltreatment. The data were collected in Finland in 2019–2020 using an online survey tool and analysed using SPSS statistics and inductive content analysis. Respondents had encountered signs of physical and psychosocial maltreatment, and family challenges, contexts, and economic and social problems indicative of maltreatment. It is important for the early intervention and prevention of long-term mental health problems that prehospital emergency care providers receive continuing education on the identification of child maltreatment.

Doctors', nurses' and clinical associates' understanding of emergency care practitioners.

BackgroundHealthcare professionals’ understanding of the knowledge, skills and training of their counterparts from other disciplines cultivates appreciation and respect within the workplace. This, in turn, results in better teamwork and improved patient care. Emergency departments are places where emergency care practitioners (ECPs) engage with doctors, nurses and clinical associates. Whilst the importance of inter-professional communication and teamwork between in-hospital professionals and pre-hospital emergency care providers is acknowledged, no literature could be found describing exactly how much these in-hospital professionals understand about the training and capabilities of their ECP colleagues.AimThe aim of this study was to assess the level of understanding that prospective doctors, nurses and clinical associates have regarding the training and capabilities of ECPs.SettingThe research was conducted in Johannesburg, South Africa, at two universities.MethodsSeventy-seven participants completed a purpose-designed questionnaire assessing their understanding regarding the education and clinical capabilities of ECPs.ResultsIn total, 64% of participants demonstrated a poor understanding of the level of education and clinical capabilities of ECPs. The remaining 36% showed only moderate levels of understanding.ConclusionMedical, nursing and clinical associate graduates have a generally poor understanding of the education and clinical capabilities of their ECP colleagues who practise predominantly in the pre-hospital environment. This lack of understanding can become a barrier to effective communication between ECPs and in-hospital staff during patient handover in emergency departments.ContributionThis research highlights a lack of understanding about the role and function of South African ECPs as pre-hospital emergency care providers and the need for more effective inter-professional education.

Prehospital care providers' understanding of responsibilities during a behavioural emergency.

BackgroundPrehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting.AimTo investigate prehospital emergency care providers’ understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies.SettingThe research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa.MethodsA grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care – basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach.ResultsA total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced.ConclusionParticipants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.

The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness

BackgroundManagement of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). CUE is associated with a high mortality and a wide variety of pathologies that require differential therapies. A suspected diagnosis issued by pre-hospital emergency care providers often drives the first approach to these patients. We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE.MethodsConsecutive ED patients presenting with CUE were prospectively enrolled. We obtained the suspected diagnoses or working hypotheses from standardized reports given by prehospital emergency care providers, both paramedics and emergency physicians. Suspected and final diagnoses were classified into I) acute primary brain lesions, II) primary brain pathologies without acute lesions and III) pathologies that affected the brain secondarily. We compared suspected and final diagnosis with percent agreement and Cohen’s Kappa including sub-group analyses for paramedics and physicians. Furthermore, we tested the value of suspected and final diagnoses as predictors for mortality with binary logistic regression models.ResultsOverall, suspected and final diagnoses matched in 62% of 835 enrolled patients. Cohen’s Kappa showed a value of κ = .415 (95% CI .361–.469, p < .005). There was no relevant difference in diagnostic accuracy between paramedics and physicians. Suspected diagnoses did not significantly interact with in-hospital mortality (e.g., suspected class I: OR .982, 95% CI .518–1.836) while final diagnoses interacted strongly (e.g., final class I: OR 5.425, 95% CI 3.409–8.633).ConclusionIn cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers’ qualifications. It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.

The accuracy of Bloemfontein-based Emergency Medical Services providers in recognising sepsis

Background: Sepsis is considered a severe life-threatening medical emergency and globally carries a high mortality. Research suggests early recognition of sepsis can lead to early initiation of treatment and effective communication of this condition to the receiving facility by pre-hospital emergency care (PEC) providers. Depending on system operations, this has been shown to improve patient outcomes. However, sepsis often presents non-specifically, and in the absence of validated pre-hospital sepsis screening tools, less than half of sepsis patients seen by PEC providers are recognised. This study aimed to determine the accuracy with which Bloemfontein-based PEC providers recognise sepsis in a series of patient vignettes. Methods: A series of seven case vignettes were presented to a convenient sample of advanced life support (ALS) and intermediate life support (ILS) PEC providers. The PEC providers were asked to review each vignette and indicate whether the patient described had sepsis or not. The vignettes consisted of a clinical case description with signs and symptoms of patients presenting with or without sepsis, and images were shown where relevant. Elements of the Robson Prehospital Severe Sepsis Screening (RPSS) tool were used to populate the sepsis vignettes. Results: A total of 27 ILS and ALS PEC providers in the Bloemfontein area partook in the research study. Thus, a total of 189 vignettes were evaluated for sepsis. PEC providers, both ILS and ALS, recognised sepsis with a sensitivity of 69.63% and a specificity of 37.04% (PPV 73.44%, NPV 32.79%), indicating an accuracy of 60.32%. Although all participants mentioned some motivations for their answers, none of the participants gave specific cut-off value ranges at which point they would suspect sepsis. Conclusion: This vignette-based study found that PEC providers can recognise sepsis with modest accuracy, echoing previous work on this topic. In addition, the study provides a platform for similar studies, which, in turn, could aid in the development of a validated, pre-hospital sepsis screening tool.

Penetrating Injury from Interpersonal Violence and Related Haemorrhagic Shock Resuscitation Practices in An Urban South African Emergency Medical Service

Introduction Physical injury is a major cause of premature death and/or disability worldwide. South African mortality statistics indicate approximately half of all injury-related deaths were intentional, often from sharp-force injuries. Injury surveillance data for victims of penetrating injury is scarce in low- to middle-income countries with a reliance on mortality data. The aim was to provide an epidemiological description of penetrating injury and the related haemorrhagic shock resuscitation practice in a South African emergency medical service. Methods A prospective, observational, descriptive study was conducted in urban Cape Town. ‘R’ statistical computing was used. Emergency care providers voluntarily documented parameters for mechanism of injury, vital signs, intravenous fluid resuscitation and demographic information for patients with penetrating injury. Results Of 2884 (N) penetrating trauma cases, 143 (n) cases were sampled from providers. The chest (35.7%) and upper-limbs (31.5%) were the most common anatomy for penetrating injuries. The estimated mean crystalloid fluid volume administered for penetrating abdominal and chest injuries was 1010.6 mL and 925.3 mL respectively. A statistically significant association was observed between fluid administration and clinical indications such as systolic and diastolic blood pressure, heart rate, capillary refill time, level of consciousness estimation from the scene of the incident to the hospital after intravenous fluid administration. Most emergency medical service call outs (56%) were likely to occur between 20:00 and 02:00. Conclusion The intravenous fluid management by pre-hospital emergency care providers for patients with penetrating traumatic injuries, do not cohere with hypotensive resuscitative recommendations. Future research must include clinical practice guideline implementation efficacy and pre-hospital surveillance mechanisms. This study informs hospital clinician expectations for penetrating trauma care by pre-hospital providers.

Medication storage in Emergency Medical Services: Temperature ranges from a South African sample

Background: Pre-hospital emergency care providers working in emergency medical services (EMS) are licenced to administer medication to the acutely ill and injured. In South Africa, there are significant seasonal variations in temperature, sometimes far exceeding the recommended medication storage temperature. The aim of this study was to determine the summer temperature ranges inside select emergency vehicles and storage facilities in four provinces in South Africa. Methods: A prospective, observational study was conducted in four (Cape Town, Western Cape; Johannesburg, Gauteng; Durban, KwaZulu-Natal; Potchefstroom, North West) provinces during the summer (February – March) months of 2019. A continuous temperature monitoring device was placed in the medication storage room, the response vehicle drug bags, and an ambulance at a single private EMS base in each of the provinces. Temperature data were recorded in fifteen-minute intervals. The data were extracted after six weeks and subjected to descriptive analysis. Data were also analysed in six-hourly strata to account for daily temperature variations. Results: A total of 36 002 temperature readings were recorded during the study period. The mean (range) temperature across the four bases was 25.4°C (13.1–56.8) for ambulances, 25.7°C (13.3–49.1) for primary response vehicles, and 24.4°C (17.3–33.9) for medication storage facilities. The highest mean (range) temperatures, of 33.7°C (20.4–47.9), were recorded in a Johannesburg-based primary response vehicle between 12h00 and 18h00. Conclusion: Current medication storing and transporting practices not maintain temperatures according to the recommended storage conditions. Further investigation should address the implication of temperature fluctuations on medication degradation, and a sustainable, cost-effective solution should be developed to store medication in the pre-hospital setting.

Situational awareness in the identification of abuse – Out-of-hospital emergency care providers’ experiences

This qualitative study describes out-of-hospital emergency care providers’ experiences and views of situational awareness (SA) in the identification of abuse, including observations that led them to suspect abuse. Nine prehospital emergency care providers and three community paramedics were interviewed based on preselected themes. The data was analyzed using inductive content analysis. According to the results, emergency care providers’ self-defined situational awareness consisted of cognitive competence (logical reasoning and detection of cause-effect relationships); emotional competence (empathy and emotional intelligence); social competence (interaction skills and assessment of family dynamics), and experiential knowledge. Indicators of abuse involved the overall situation; the client’s physical condition; the client’s mental condition; the context and circumstances, and the logic in client reports. Although situational awareness develops with work experience, it is advisable for educators to include a wide range of cognitive, emotional and social skills in the initial and continuing education of emergency care professionals. These skills can be practiced using multi-professional simulation-based education.

The evaluation of pre-hospital emergency care providers' attitudes towards refugees in Turkey

Abstract Background Health for all is one of the fundamental rights for eliminating inequalites. Within the scope of Sustainable Development Goals, health services should be provided to everyone without any discrimination regardlass of race, religion, political view, gender, economic and social status. The increase of violence in their home country caused about 3 million 666 thousand 59 people to flee to Turkey and they've been experiencing economic, social and cultural problems as well as a problem of acceptance and adaptation. We aimed to evaluate the attitudes of emergency healthcare providers towards refugees and their perception of social distance. Methods This is a methodological study conducted between January-February 2020. The study group consisted of 372 (77.5%) out of 480 healthcare professionals. Attitude towards refugees was evaluated with the Health Providers' Attitude Towards Refugees Scale (HPATRS) developed by the researchers. Questionnaire form included HPATRS and Social Distance Scale(SDS). The Cronbach's alpha value of HPATRS was 0.694. Multiple linear regression was used for multivariate analysis. Results The ages of the study group ranged between 18-60 while the mean age was 32.15 ± 7.50 and 55.1% were female. Of the study group, 50.8% scored below the mean score from HPATRS. Multivariate analysis showed that, having language difficulties, having a master's degree and above and having high social distance was related to negative attitude towards refugees. (F: 7.567 p &amp;lt; 0.001 R²: 0.195). The social distance level was found to be the most important determinant in attitude (β: 0.343). Conclusions The attitude towards refugees in emergency care providers were thought to be not positive enough to eliminate the inequalities. It was concluded that; having a master's degree and above, having more social distance and having language difficulties were risk factors for a negative attitude towards refugees. Key messages As the first responders, emergency workers’ attitudes towards refugees is an important issue to be addressed in eliminating health inequalities. Mass media campaigns should be used to reduce social distance and trainings should be planned in order to develop positive attitudes towards refugees.

Finnish and Swedish prehospital emergency care providers’ knowledge and attitudes towards pressure ulcer prevention

BackgroundDespite the knowledge that transportation by emergency medical services may increase the risk of pressure ulcers (PU), there is still lack of knowledge about the possibility of prehospital emergency care providers to be a part of preventing and reducing the risk of PUs. MethodsA survey was carried out during 2017 in Finland and Sweden. Validated questionnaires were used. ResultsA total of 179 (72.7%) Finnish and 188 (28.8%) Swedish prehospital emergency care providers participated in the study. The overall rate of correct answers and the mean total knowledge score was 58.8% (SD 21.8), 20/34, in the Finnish group and 70.5% (SD 15.7), 24/34, in the Swedish group (p < 0.000). The percent of the total and the mean attitude score was in the Finnish group 71.3% (SD 0.48), 37.1/52, and in the Swedish group 69.4% (SD 0.77), 36.1/52 (p < 0.813). Half of the Finnish and most of the Swedish participants felt they needed more education about PUs (Fin 50.2% & Swe: 76.0%). ConclusionsPrehospital emergency care providers don’t see themselves as responsible for PU prevention. Therefore, there is a need for increasing the level of knowledge on PU prevention and classification among prehospital emergency care providers. They could play a key role in developing methods to improve PU prevention and identifying patients in risk of developing PUs.

Pre-hospital emergency care providers’ knowledge and use of peak flow meters in the management of acute asthma in Johannesburg, South Africa

Background: Peak flow meters (PFMs) measure the speed of airflow from the lungs during a forced exhalation. Current clinical practice guidelines advocate the use of PFMs in the management of acute asthma. No literature could be found describing local prehospital emergency care providers’ use of PFMs. We aimed to investigate and describe a sample of prehospital emergency care providers’ knowledge and use of PFMs in the management of acute asthma in Johannesburg, South Africa. Method: Fifty respondents (22 basic, 16 intermediate and 12 advanced life support providers) completed a pre-piloted questionnaire consisting of closed questions with pre-set response options focusing on exploring respondents’ knowledge, understanding and use of PFMs. Results: Responses highlighted a general lack of knowledge and understanding of PFMs. None of the basic life support providers, and only 19% of intermediate life support providers, indicated they had received training on the device. PFMs do not appear to be readily available in ambulances, with only 8% of the respondents indicating they had ever used a PFM on a real patient. Conclusion: A lack of training on the device and its apparent unavailability are concerning since the peak expiratory flow rate (PEFR) measurement for asthma cases is considered best practice, and literature shows that emergency medical service (EMS) providers are commonly dispatched to asthmatic cases. Additional training and further research on the value and use of PFMs in local prehospital emergency care contexts is therefore recommended.

PEACE SUPPORT OPERATIONS IN SUB-SAHARAN AFRICA: LIVED EXPERIENCES OF EMERGENCY CARE PROVIDERS DURING EXTERNAL DEPLOYMENT

Military emergency medical care in support of mission personnel in operational areas serves as a vital element of peace support operations, as it ensures the maintenance of the human resources deployed in mission areas. Although the South African National Defence Force is facing significant financial constraints, it is becoming increasingly mobile, as South Africa continues to pledge military and diplomatic assistance in the African continent to maintain peace and stability, promote development and provide security. Consequently, when deployed abroad, military emergency care providers face unique challenges. The aim of this paper is to describe the lived experiences of Gauteng-based emergency care providers in delivering emergency medical care amid resource constraints during external deployment. The descriptions were extracted from a larger study titled “exploring lived experiences of Gauteng-based military pre-hospital emergency care providers during external deployment”. The research was conducted using a qualitative, exploratory research design and was guided by a phenomenological approach. The findings indicate that Gauteng-based military emergency care providers often did not have enough equipment or appropriate transportation to perform their duties during external deployment. As a result, they are hindered from providing quality care to ill and injured patients.

Education and clinical professional development in Penang, Malaysia

Background: This study considers the impact of the Intermediate Ambulance Care (IAC) Course on the development of pre-hospital care practice in Penang, Malaysia and considers how the course contributes to professional development. The research question asks what impact the education programme has had on a rapidly changing emergency medical service. Methods: Using a qualitative methodology—focused ethnography—data were collected from interviews, participation and observation of pre-hospital emergency care providers and medical professionals in Penang, Malaysia. Results: Four themes were identified which describe how the participants' values and beliefs contribute to the increasing professionalisation of their role in health care. Conclusion: As well as increasing paramedic knowledge, there was an observable change in participants' values and beliefs about pre-hospital care and health outcomes. This has contributed to the professional development currently being experienced in pre-hospital care in Penang, Malaysia.