Professional Paramedics Research Articles

The Use of Virtual Reality in Training Paramedics for a Mass Casualty Incident

This paper presents the design of a virtual reality learning module inspired by the exercises of healthcare professionals and its limitations as a result of action research carried out by the authors’ collective. The module is implemented on a car crash scenario as a emergency event. Virtual reality training is presented here as an important supplement to traditional paramedic training with the potential to reduce costs and make paramedic training more effective as part of their refresher training for their job roles. Real-time training and its limitations are described, especially regarding patient triage, this aspect being considered as one of the key aspects in the context of virtual reality. Furthermore, the results of a questionnaire survey among the mannequins and interviews with the trainees are presented, while the virtual reality environment of the module was designed to be intuitive for each student with the possibility of self-service without major demands on the logistical organization of the staff for the updating training. The authors relied on an expert group of multi-disciplinary experts for development. The outcome of the action research and the data collected by it is a fully prepared module for teaching selected skills in reflection of the situational context of a traffic accident with mass casualties. In the context of the presented module, measurements are being prepared to compare selected variables between real training and virtual reality training with the same scenario on student paramedics and professional paramedics.

Developing A Mobile Immersive Reality Framework For Enhanced Simulation Training: MESH360


 
 
 This paper reports on the second iteration prototype design stage of an immersive reality (XR) enhanced simulation project in critical healthcare higher education. While there is no doubt of the positive impact on the development of a variety of clinical skills through the use of XR in health education, a literature review indicates that the level of engagement with learning theory and the wider literature to inform the design of these learning environments is limited. The authors propose that XR can be employed within the learning environment to introduce critical elements of patient and practitioner risk and stress through environmental and socio-cultural influences without putting either students, educators, practitioners or patients at real risk, but create a safe learning environment that more authentically simulates these risk elements. The MESH360 project involves a collaborative transdisciplinary team of educational researchers, designers, practitioners, and working professionals in the design of mobile XR to enhance student and professional paramedic training to prepare practitioners for the environmental stressors and critical care decisions involved in high risk situations. Using Design Based Research (DBR), the project explores the impact of mobile XR enhanced simulation for novice and professional paramedics.
 
 

Incorporating real-time citizen responder information to augment EMS logistics operations: A simulation study

Minimizing response time is the key to live-saving missions of emergency medical services (EMS). As an alternative to professional paramedics, citizen responders (CRs), medically trained volunteers in the community, can use their training to help others in their neighborhood or workplace, by rendering emergency responses. Empowered by connected technologies, CRs can be promptly notified by an EMS request upon its arrival, and they may provide time-sensitive (and often life-saving) response before an ambulance arrives. Currently, many EMS agencies, though employing CRs for certain emergency situations, do not necessarily intelligently leverage real-time information of CRs (e.g., position and response propensity) when making decisions on EMS logistic operations (e.g., ambulance dispatch). As a result, opportunities arise for better coordination between CRs and ambulances. In this paper, we investigate the decision problem of dispatching ambulances for priority-differentiated emergencies. We adapt a locally optimal dispatch procedure with incorporation of real-time CR information, which is intended to balance improved response for the current emergency request via dispatching CRs and response preparedness for future requests. We evaluate the adapted dispatch procedure via a discrete event simulation and compare our procedure against the procedure without incorporating CR information and a commonly used dispatch strategy in practice. We perform a sensitivity analysis with respect to the spatial distribution and response propensity levels of CRs. The results suggest that our procedure could lead to substantial and reliable system improvement.

Assessment of the psychological qualities of a paramedic’s personality

The purpose of the study is to identify professionally significant psychological qualities of a paramedic ‘s personality. Results. The presence of synchronous changes in indicators for each characteristic of the paramedic’s personality, both male and female, was revealed; the most pronounced psychological qualities of the personality of professional paramedics were: developed visual-imaginative thinking, caution and prudence, suspicion; the most pronounced psychological qualities of the personality of medical students were the same qualities as those of professional paramedics with the inclusion of markedly pronounced conservatism. Conclusion. When comparing the psychograms of professional paramedics and medical students, psychological characteristics that are subject to correction were identified: emotional instability, dominance, suspicion and relaxation.

MESH360

Paramedics deal with a variety of emergency situations, ranging from natural disasters to road traffic accidents. Higher education providers need to critically explore how to best prepare student paramedics for high risk, unforeseen events that require critical awareness and diagnostic problem-solving capabilities. Hi-fidelity mannequin based simulation is a widely adopted and proven technique for clinical training and critical care response education (Kaufman, 2010). However, traditional mannequin based simulation in isolation limits a meaningful learning context and authentic real-world assessment influences.
 The MESH360 project involves a collaborative transdisciplinary team of designers and educational researchers, in the design of XR to enhance student and professional paramedic training to prepare practitioners for the environmental stressors and critical care decisions involved in high-risk situations. 
 This presentation explores the third iteration prototype design stage of an immersive reality (XR) enhanced simulation project in critical healthcare higher education. To promote student engagement through innovative learning tasks, XR was employed to introduce critical elements of patient and practitioner risk and stress by creating a learning environment that more authentically simulates these elements. 
 Design Based Research (DBR) provided a structure within a four-phase iterative framework (McKenney & Reeves, 2012) when designing the XR learning environment (Cochrane et al., 2017). Using DBR, the project explored the impact of mobile XR enhanced simulation for novice and professional paramedics. This project explored the development and implementation with an enhanced simulation scenario involving a virtual helicopter ride and an immersive simulated patient rescue.
 The project used mixed methods to triangulate qualitative and quantitative data within the design. We measured participant stress by recording heart rate (HR) followed by subjective qualitative participant responses and feedback (Pre and post participant surveys, and post focus group). The thematic analysis showed a positive and enthusiastic experience by the students. Whilst some thought there was room for increased helicopter fidelity, all students believed that XR provided a more authentic experience. This presentation will demonstrate the methods and user reaction of this prototype study.
 This is the third iteration prototyping a DBR project that explores the development of an immersive reality framework for enhanced critical care simulation for educating paramedics within an authentic learning environment. A learning solution was implemented into an educational setting offering context to real-world learning within an engaging authentic environment. The next stages of the research will iteratively evaluate and refine prototype immersive reality learning environments, comparing the impact upon both novice and expert paramedics. This will inform the next phase of the DBR project that will focus upon the development of design principles for a transferable design framework.
 References 
 Cochrane, T., Cook, S., Aiello, S., Christie, D., Sinfield, D., Steagall, M., & Aguayo, C. (2017). A DBR Framework for Designing Mobile Virtual Reality Learning Environments. Australasian Journal of Educational Technology (AJET), 33(6), 54-68. doi: https://doi.org/10.14742/ajet.3613
 Kaufman, D. (2010). Simulation in Health Professional Education. In D. Kaufman & L. Sauvé (Eds.), Educational Gameplay and Simulation Environments: Case Studies and Lessons Learned (pp. 51-67). Hershey, PA, USA: IGI Global.
 McKenney, S., & Reeves, T. (2012). Conducting educational design research. London: Routledge.

Factors Associated with Psychiatric Morbidity, Post-Traumatic Stress Disorder and Post-Traumatic Growth in Paramedic First Responders: The Role of Core Beliefs

Introduction Paramedics are routinely exposed to traumatic events. This study describes the rates of post-traumatic stress disorder (PTSD), psychiatric morbidity and levels of post-traumatic growth (PTG) in New Zealand first responder paramedics, exploring a mix of demographic, professional, crewing status and exposure risk factors associated with these outcomes and their associations with core belief disruptions. Methods A cross-sectional study recruited paramedics (N=579) working in a first responder role. Univariate and multivariate logistic and linear regressions were conducted to identify predictors of PTSD, non-specific psychiatric morbidity and PTG in trauma-exposed participants. Results Two-thirds (66.3%) reported significant psychiatric morbidity, with volunteer paramedics being significantly less at risk when compared with professional paramedics (OR=0.52; 95% CI: 0.31-0.87; p<0.01). Probable PTSD was reported by 14.6% of participants. Older age reduced the odds of this (OR=0.94; 95% CI: 0.92-0.98; p<0.01) while experiencing greater disruptions in core beliefs increased the odds (OR=2.75; 95% CI: 2.00-3.77; p<0.01). Being female (t=4.70; p<0.01) and experiencing greater core belief disruption (t=7.54; p<0.01) (adjusted R 2 =0.27) independently contributed to PTG. Conclusion Although PTSD rates were typical of first responders generally, psychiatric morbidity rates were high and may be more prevalent in professional staff. Contextual and methodological factors may have influenced these outcomes. Core belief disruptions predict both negative and positive emotional states, suggesting their important role in workplace interventions.

Coping styles and dispositional optimism as predictors of post-traumatic stress disorder (PTSD) symptoms intensity in paramedics.

The aim of the study was to determine the relationship between the severity of post-traumatic stress disorder (PTSD) symptoms and such predictors as coping style and dispositional optimism in the group of professional paramedics. The study was conducted in a group of 440 paramedics employed by various units of the Polish Emergency Medical Service in five voivodships. Finally, research data obtained from 159 people were analyzed. The mean age of the respondents was 34.14 (SD = 8.67), mean work experience - 9.22 years (SD = 7.67). The majority of participants were male (N = 139, 87.4%), which reflects the gender balance observed in this particular professional group. Intensity of PTSD symptoms was assessed using the Impact of Event Scale - Revised (IES-R). Dispositional optimism was evaluated by means of the Life Orientation Test - Revised (LOT-R) and coping styles were measured with the use of the multi-faceted Coping Orientations to Problems Expected (COPE) inventory. On the basis of the conducted studies, it can be concluded that PTSD concerns 28% of the participants. Hierarchical regression analysis revealed that general risk of PTSD symptoms occurrence is caused by preferred coping style, namely the emotion-focused coping style (positive predictor). Furthermore, two-factor interaction regression analysis showed that dispositional optimism can play a role as a mediator of the relationship between PTSD general index and the emotion-focused coping style. Paramedics are more prone to develop PTSD symptoms than general population. This indicates the need for preventive steps to be taken in the professional group of paramedics taking into consideration their coping styles and level of dispositional optimism.

Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study

BackgroundTriage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed.MethodsA dummy based trial on primary MCI triage with yearly follow-up after initial training using the ASAV algorithm (Amberg-Schwandorf Algorithm for Primary Triage) was undertaken. Triage was assessed concerning accuracy, sensitivity, specificity, over-triage, under-triage, time requirement, and a comprehensive performance measure. A subgroup analysis of professional paramedics was made.ResultsNine hundred ninety triage procedures performed by 51 providers were analyzed. At 1 year after initial training, triage accuracy and overall performance dropped significantly. Professional paramedic’s rate of correctly assigned triage categories deteriorated from 84 to 71%, and the overall performance score decreased from 95 to 90 points (maximum = 100). The observed decline in triage performance at 1 year after education made it necessary to conduct re-training. A brief didactic lecture of 45 min duration increased accuracy to 88% and the overall performance measure to 97.ConclusionsTo improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.

Pre-hospital assessment with ultrasound in emergencies: implementation in the field.

Point-of-care ultrasound (US) is a proven diagnostic imaging tool in the emergency department (ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients. We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest. Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making (89%, 95%CI 67%-99%). Paramedics accurately recorded 17 cases of cardiac activity (100%, 95%CI 84%-100%) and 2 cases of cardiac standstill (100%, 95%CI 22%-100%). Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.

Comparative quality analysis of hands-off time in simulated basic and advanced life support following European Resuscitation Council 2000 and 2005 guidelines

AimTo compare hands-off time (HOT) in simulated advanced life support (ALS) following European Resuscitation Council (ERC) 2005 guidelines and ERC 2000 and to provide quantitative data on workflow.Subjects and MethodsObservations...

Effects of organization leadership behavior on learning ethics: A study of professional paramedics

A review of the methods of ethics instruction reveals that demonstrated ethical behavior by leadership, although not central-most to introducing an organization’s newcomers to a normative approach to ethical decision making and behavior, is ubiquitous and highly placed in contemporary ethics pedagogy. Similarly, a review of ethics assessment tools finds that nearly all probe perceptions by group members of the ethical behavior of those who provide group supervision and leadership.This article asks if ethical behavior by senior Emergency Medical Service (EMS) leaders is of sufficient strength to convey to newcomers (in this case, newly hired fire department paramedics) the ethics of that organization. This research was conducted in an urban fire academy and compared, using a standardized assessment tool, an ethics culture survey of academy instructors, and then a class of paramedics both before and after their academy experience. The authors find that EMS newcomers do not absorb ethics osmotically and that EMS leaders must anticipate that instruction in ethics is necessary to ensure that moral actions taken by newcomers will be those desired by the organization.

A qualitative analysis of the central values of professional paramedics.

Biomedical ethics decisions are often made after reflection, deliberation, and after a process of communication, reveal the values and interests of the patient or the patient's family. However, acute and rapid changes in the patient, the very public view of the care provided, and a need for rapid decision making by paramedics in a prehospital setting make protracted deliberation and reflection a practical impossibility. As paramedics provide care for patients, they regularly make value-laden choices that affect the type of care, how care is provided, and to whom care is provided. These choices transcend the technical judgment and professional skills necessary for provision of emergency care in prehospital settings. This article identifies, describes, and organizes a number of central values of professional paramedics and discusses how values may be considered by paramedics when resolving conflicting values.

Quality of chest compressions during 10 min of single-rescuer basic life support with different compression: ventilation ratios in a manikin model

Good quality basic life support (BLS) improves outcome during cardiac arrest. As fatigue may reduce BLS performance over time we wanted to examine the quality of chest compressions in a single-rescuer scenario during prolonged BLS with different compression:ventilation ratios (C:V ratios). Professional paramedics were asked to perform single-rescuer BLS with C:V ratios of 15:2, 30:2 and 50:2 for 10 min each in random order. A Laerdal Medical Resusci Anne Simulator with PC Skillreporting System was used for BLS quality analysis. Total number of chest compressions, compression depth and compression rate were measured and the differences between the C:V ratios were analysed with repeated measures ANOVA. For analysis of fatigue, chest compression variables for each 2-min period were analysed and compared with the first 2-min period using repeated measures ANOVA. Altogether 50 paramedics completed the study. The mean number of chest compressions increased significantly from 604 to 770 and 862 with C:V ratios of 15:2, 30:2 and 50:2, respectively. Chest compression rate was significantly higher with C:V ratio of 15:2 compared to 30:2 and 50:2 but was above 100 per minute for all three ratios. However, the mean chest compression depth did not change significantly between the different C:V ratios. The number of chest compressions did not change significantly with time for any of the three C:V ratios. Compression depth did decline after the first 2-min period for 30:2 and 50:2 as did compression rate for all three ratios. However all were above the guideline limits for the entire test period. Increasing the C:V ratio increases the number of chest compressions during 10 min of BLS. Compression depth and compression rate were within guideline recommendations for all three ratios. We found no decline in chest compression quality below guideline recommendations during 10 min of BLS with any of the three different C:V ratios.