Prehospital Care Providers Research Articles

Impact of COVID-19 on Sleep, Anxiety, and Depression Among Medical Call Center Staff: Insights from a January 2021 Study.

BACKGROUND The COVID-19 outbreak emerged as a dual threat, effecting both the physical and mental well-being of healthcare staff. This study aimed to evaluate sleep quality using the Pittsburgh Sleep Quality Index (PSQI), levels of anxiety and depression using the Hospital Anxiety Depression Scale (HADS), and the significant influencing factors during COVID-19 pandemic in 284 workers in a medical call center in January 2021. MATERIAL AND METHODS Out of 443 pre-hospital care providers, 284 consented to participate. Data collection was done using an introductory information form, the PSQI for sleep quality, and the HADS for anxiety (HADS-A) and depression (HADS-D). Surveys were hosted on an online survey website and distributed via WhatsApp, with completed forms retrieved from the website. RESULTS Male sex (P=0.0001) and extended working hours in current workplace (P=0.017) were associated with higher HADS-A scores. Health problems, increased need for mental support, and poor job satisfaction correlated with lower HADS-D scores (P=0.025, P=0.005, P=0.0001, respectively) and higher PSQI scores (P=0.008, P=0.009, P=0.008, respectively). A moderately significant positive correlation was found between overall sleep quality and HADS-A (P=0.001, r=0.538) and HADS-D scores (P=0.001, r=0.493). CONCLUSIONS The pandemic significantly impacted the mental health and sleep quality of frontline healthcare personnel, necessitating the identification and mitigation of adverse psychosocial factors. Implementing and evaluating psychoeducational programs and establishing multidisciplinary mental health teams can provide for essential support and counseling, promoting the well-being of healthcare staff and ensuring effective emergency care.

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia.

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

Predictive modelling of transport decisions and resources optimisation in pre-hospital setting using machine learning techniques.

The global evolution of pre-hospital care systems faces dynamic challenges, particularly in multinational settings. Machine learning (ML) techniques enable the exploration of deeply embedded data patterns for improved patient care and resource optimisation. This study's objective was to accurately predict cases that necessitated transportation versus those that did not, using ML techniques, thereby facilitating efficient resource allocation. ML algorithms were utilised to predict patient transport decisions in a Middle Eastern national pre-hospital emergency medical care provider. A comprehensive dataset comprising 93,712 emergency calls from the 999-call centre was analysed using R programming language. Demographic and clinical variables were incorporated to enhance predictive accuracy. Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Adaptive Boosting (AdaBoost) algorithms were trained and validated. All the trained algorithm models, particularly XGBoost (Accuracy = 83.1%), correctly predicted patients' transportation decisions. Further, they indicated statistically significant patterns that could be leveraged for targeted resource deployment. Moreover, the specificity rates were high; 97.96% in RF and 95.39% in XGBoost, minimising the incidence of incorrectly identified "Transported" cases (False Positive). The study identified the transformative potential of ML algorithms in enhancing the quality of pre-hospital care in Qatar. The high predictive accuracy of the employed models suggested actionable avenues for day and time-specific resource planning and patient triaging, thereby having potential to contribute to pre-hospital quality, safety, and value improvement. These findings pave the way for more nuanced, data-driven quality improvement interventions with significant implications for future operational strategies.

Anaphylaxis: first clinical presentation, subsequent referral practise, and suspected elicitor—an observational study

Anaphylaxis is an allergic manifestation characterised by rapid onset and progression. Rapid treatment may be challenging in patients with atypical symptoms or no previous history of anaphylaxis. This study aimed to describe the clinical prehospital presentation of first-time anaphylactic patients. To help target educational initiatives, we sought to identify which groups of medical professionals are most likely to encounter first-time anaphylactic patients and investigated the referral pattern for suspected anaphylactic patients for specialised treatment. A retrospective register-based study from the Region of Southern Denmark. Patients referred to the Allergy Centre, Odense University Hospital, from 2019 to 2021 were included. The medical records were manually reviewed for first contact with the emergency departments or the emergency medical service. 444 patients with suspected anaphylaxis were referred. 226 patients had grade 3–5 systemic allergic reactions as classified by the World Allergy Organisation; 90% had cutaneous symptoms, 63% symptoms from the central nervous system, 42% gastrointestinal symptoms, 40% cardiovascular symptoms, 36% had upper-airway symptoms, and 36% had lower-airway symptoms. Patients treated prehospitally had a significantly more severe degree of anaphylaxis than patients only treated within the hospital. More than half of the patients with suspected anaphylaxis were referred to the Allergy Centre from the emergency departments. Patients with allergies progressing to severe anaphylaxis most often are treated prehospitally before transport to emergency departments. From the emergency departments, they are referred to the allergy centre. Education concerning the immediate treatment of severe anaphylaxis should primarily be targeted towards prehospital care providers.

Use of bitemporal NACA score documentation in prehospital emergency medical services– a retrospective study

BackgroundThe assessment of illness severity in the prehospital setting is essential for guiding appropriate medical interventions. The National Advisory Committee for Aeronautics (NACA) score is a validated tool commonly used for this purpose. However, the potential benefits of using bitemporal documentation of NACA scores to capture the dynamic changes in emergency situations remain uncertain. The objective of this study was to evaluate the potential benefit of bitemporal NACA score documentation in the prehospital setting, specifically in assessing the dynamic changes of emergencies and facilitating quality improvement through enhanced documentation practices.MethodsIn this retrospective study, data from prehospital emergency patients were analyzed who received care from the physician response unit between January 1, 2018, and May 31, 2021. Patient demographics, NACA scores, indications for emergency care, and changes in NACA scores were extracted from medical records. Statistical analyses were performed to examine the associations between NACA scores, emergency categories, indications, and changes in NACA scores.ResultsThe study included 4005 patients, predominantly categorized as NACA III (33.7% at initial assessment, 41.8% at subsequent assessment) and NACA IV (31.6% at initial assessment, 22.4% at subsequent assessment). There was a significant improvement in NACA scores during the provision of prehospital care (p < 0.01). Notably, prehospital emergencies attributed to internal medical, neurological, traumatic, and paediatric causes demonstrated significant improvements in NACA scores (p < 0.01). Gender-specific differences were also observed.ConclusionOur study suggests that the bitemporal documentation of NACA scores can be advantageous in the prehospital setting and may have implications for research, practice, and policy.

Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study.

Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.

Electronic field protocols for prehospital care quality improvement in Lithuania: a randomized simulation-based study

BackgroundPrehospital emergency care is complex and influenced by various factors, leading to the need for decision-support tools. Studies suggest that cognitive aids improve provider performance and patient outcomes in clinical emergencies. Electronic cognitive aids have rarely been investigated in prehospital care. Therefore, this study aimed to evaluate the effects of the electronic field protocol (eFP) module on performance, adherence to the standard of care, and satisfaction of prehospital care providers in a simulated environment.MethodsThis randomised simulation-based study was conducted at the Lithuanian University of Health Sciences in Kaunas, Lithuania. The simulation scenarios were developed to test 12 eFPs: adult resuscitation, pediatric resuscitation, delivery and postpartum care, seizures in pregnancy, stroke, anaphylaxis, acute chest pain, acute abdominal pain, respiratory distress in children, severe trauma, severe infection and sepsis, and initial neonatal evaluation and resuscitation. Sixteen prehospital practitioners with at least 3 years of clinical experience were randomly assigned to either use the eFP module or perform without it in each of the 12 simulated scenarios. Participant scores and adherence to standardised checklists were compared between the two performance modes. Participant satisfaction was measured through a post-simulation survey.ResultsA total of 190 simulation sessions were conducted. Compared to the use of memory alone, the use of the eFP module significantly improved participants’ performance in 10 out of the 12 simulation scenarios. Adherence to the standardised checklist increased from 60 to 85% (p < 0.001). Post-simulation survey results indicate that participants found the eFP module easy to use and relevant to prehospital clinical practice.ConclusionsThe study findings suggest that the eFP module as a cognitive aid can enhance prehospital practitioners’ performance and adherence to the standard of care in simulated scenarios. These results highlight the potential of standardised eFPs as a quality improvement step in prehospital care in Lithuania.

Seeking and reaching emergency care: A cross sectional household survey across two Liberian counties.

The overwhelming burden of morbidity and mortality from injury and medical conditions requiring acute care are borne by low- and middle-income countries lacking accessible, quality care systems. Current evidence suggests the lack of prehospital care systems likely contributes to this disproportionate burden. As an initial step in a longitudinal, collaborative effort to strengthen the chain of survival for emergency conditions in Liberia, baseline attitudes and behaviors in accessing and utilizing emergency care were characterized. A multistage, proportional, cluster sampling frame was employed to conduct a cross-sectional, community-based survey of 800 households across rural Lofa County and the greater capital (Monrovia) metropolitan area. The primary outcome was facility-based utilization of emergency care within the 12 months prior to survey administration. 43.9% of individuals surveyed reported a visit to an emergency unit in the last year. Multivariable logistic regression revealed increased adjusted odds of facility-based emergency care utilization in households that were low-income, non-English-speaking, lacking electricity, or had a non-durable roof. Among these individuals, 23.6% had sought care from a community health worker, family/friend, clinic, pharmacy, or traditional healer prior. The majority of persons seeking care do so without ambulance services. 34.8% of all households have called a community member for a medical emergency, but 88.9% of survey respondents report no first aid training and cite barriers to rendering aid. This represents the first household survey to assess the perceptions and utilization of emergency care in Liberia. Formal pre-hospital care provision is limited and substantial barriers to emergency care access exist. First aid training and acceptance is lacking, despite frequent reliance on community-based aid during emergencies.

Practical psychosocial care for providers of pre-hospital care: a summary of the report ‘valuing staff, valuing patients’

BackgroundCaring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently.MethodFPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA).ResultsThe Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems.ConclusionThis paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.

Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes.

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.

Prehospital Care in Road Traffic Accident Cases

Abstract Background: Rapid population growth, industrialization and an increase in road vehicles, have led to a drastic increase in the number of Road Traffic Accidents (RTA).Pedestrians, motorized two wheeled vehicle (MTV) users, and cyclists are the most vulnerable road user groups in terms of injuries and fatalities resulting from road traffic crashes in India. At least one-third of potentially preventable deaths occur prior to arrival at hospital and over half occur during the hospital reception and resuscitation phase of care. Prehospital emergency care in India is only beginning to develop. Thirty per cent of emergency patients in India die before they reach a hospital. Persons who shift the victims are usually untrained members of the public. Crash victims are often taken to the nearest hospital, regardless of the hospital’s capabilities for dealing with trauma. The vast majority of ambulances are used for inter-hospital transfer, not for primary response. This highlights the need of urgent steps for establishing good pre-hospital care and trauma services at site in India. Aims and Objectives: The study attempts to know the status of provision of pre hospital care to RTA victims and to suggest measures for improving hospital and pre-hospital care to the same. Methods: The study was conducted on patients of RTI admitted at Trauma Centre of King George’s Medical University UP (KGMU), Lucknow. A semi-structured questionnaire was used gather information about the socio demographic profile of RTA victims and the status of provision of pre hospital care to them. Results: It was seen in the present study that only eight percent cases had some sort of pre-hospital care given, or some interventions done before victim was taken to the hospital. Majority of these interventions were given by the bystanders and included measures like shifting the victim from the accident site (76.5%), water splinting/fanning/water given to drink (8.8%), or wound covered with cloth (5.9%) or medications (8.8%). In 9.7 percent cases, it was not known whether any pre hospital intervention was given. Out of the total cases who died, 66.7 percent had not received any intervention before hospitalization. The proportion of mortality was 2.5 percent in cases where no interventions were given, while there was no mortality in cases where some interventions were given before hospitalization. Conclusion: It was seen that very few cases got some intervention before hospitalization and a number of cases were referred from government health facilities due to unavailability of beds, equipment or medical staff. About thirty percent interviewees were not aware of ambulance emergency number. Lower proportion of mortality was seen in cases that got intervention at a health facility within an hour.

Evaluation of the psychological distress and mental well-being of pre-hospital care providers in Saudi Arabia during COVID-19.

Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic. This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia. The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5). In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being. The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life.

Relationship Between Incontinence and Disease Severity in Patients Transported by Ambulance

Introduction:As there have been no reports concerning the relationship between incontinence and disease severity in patients in the prehospital setting, a retrospective investigation examined this relationship using data from Shimoda Fire Department.Method:Patients who were transported by Shimoda Fire Department from January 2019 to December 2021 were investigated. The following details of the subjects were collected: age, sex, contents of incontinence, season of transportation, weather, wind speed, temperature, place of collapse, scene time, classification of disease, disease severity (as judged by a physician at a receiving hospital) and mortality rate at the initial treatment. The subjects were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups.Results:There were 499 cases with incontinence and 8,241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the Incontinence (+) group were significantly greater in comparison to the Incontinence (-) group, while the average temperature in the Incontinence (+) group was significantly lower than that in the Incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions.Conclusion:This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Prehospital Nursing Volunteer’s Personality Traits: A Motivational Perspective

Introduction:The aim of this cross-sectional, descriptive study was to determine the personality traits and motivation of nursing volunteers and their effects on pre-hospitalization emergency care.Method:Participants were 133 pre-hospital nursing volunteers from Taiwan. This study was performed using self-administered basic demographic information, Eysenck Personality Questionnaire-Revised Short (EPQ-RS), and Volunteer Motivation Scale with Chinese Volunteers (VMS-C). The statistical analysis was performed by SPSS 23.0. The data collections were analyzed by nonparametric statistics, correlation coefficient, covariance analysis, and one-way ANOVA analysis multiple regression analysis.Results:Our findings showed that having social desirability and extraversion personality had a positive impact on the attitudes of volunteers in terms of the provision of pre-hospital care. The first identified regulation was highlighted in the motivation scale; intrinsic motivation was secondarily emphasized. Pearson correlation coefficient revealed years of service in volunteering seniority, age, gender and nursing seniority were correlated. On the contrary, the job department and six municipalities were negatively correlated. Equivalence with the other relation, participants’ attending hours per month in volunteering and gender were positively related. Inverse correlations were found in age and nursing seniority. Extraversion personality and involvement in specific municipalities were positively correlated.Conclusion:Emergency Medical Services (EMS) has been developed in Taiwan for more than 20 years and must improve the quality of EMS. These results may be used to improve the quality of the pre-hospital care system and encourage nursing staff to join the system. Nursing volunteers in pre-hospital care are a particularly valuable resource, and satisfy a pivotal role early in the process of pre-hospital care. It is recommended that we provide a good interpersonal environment to maintain the good will of the dedicated, experienced, enthusiastic volunteers in Taiwan.

Prehospital care according to the principles of Damage Control Resuscitation in the conditions of modern warfare (literature review)

Relevance. Bleeding and hemorrhagic shock are the leading cause of potentially preventable deaths in combat casualties. The concept of pre-hospital injury control Remote Damage Control Resuscitation is becoming an integral part of care in the wounded with shock in the field. The significance of prehospital care provision according to the principles of Damage Control Resuscitation is increasing in future “multidomain battlefield”.The objective is to consider the effectiveness and features of prehospital care provision according to the principles of DCR in armed conflicts of the last two decades (in Afghanistan, Iraq, Africa, the Middle East).Methodology. A search was made for scientific articles in the PubMed database and the Scientific Electronic Library (eLIBRARY.ru), published from 2017 to 2022.Results and Discussion. Prehospital care according to the principles of Damage Control Resuscitation includes temporary arrest of bleeding, infusion therapy as part of hemostatic resuscitation and permissive hypotension, adequate respiratory support, prevention and elimination of hypothermia, and prompt evacuation to the stage of surgical care. Effective means to stop bleeding in combat casualties are modern hemostatic tourniquets, pelvic bandage, hemostatic dressings with koalin and chitosan. Resuscitation endovascular balloon occlusion of the aorta is recognized as a promising method for stopping internal bleeding. The basis of hemostatic resuscitation on the battlefield is the earlier transfusion of blood or its components in combination with the introduction of tranexamic acid and calcium preparations. Group O (I) whole blood with low titer anti-A and anti-B antibodies, lyophilized plasma and fibrinogen concentrate offer logistical advantages for combat use.Conclusion. Pre-hospital care according to the principles of Damage Control Resuscitation is effective and can significantly reduce mortality among those injured in combat operations.

Acceptability of Australian prehospital care quality indicators: An explanatory sequential mixed methods study

Background Systematically developed quality indicators (QIs) facilitate the measurement and monitoring of quality of care and ultimately meaningful quality improvement. The aim of this study was to evaluate the acceptability of a predetermined suite of 84 scientifically valid prehospital care QIs from the provider perspective. Methods An explanatory sequential mixed methods study design was used. Quantitative data were obtained from 36 participants of an online survey in which they rated the acceptability of the QIs using a five-point numerical rating scale. Qualitative data were gathered by conducting semi-structured interviews with a purposive sample of nine survey participants. The successional collection of quantitative and qualitative data facilitated integrated interpretations and conclusions about the acceptability of the QIs. Results Generally, the acceptability of all QIs in the suite was rated highly. Data suggested a positive association between acceptability and other key characteristics of QIs. QIs that were seen as clear, supported by scientific evidence, practical and meaningful tended to be more acceptable than those which were not. The benefits of outcome type QIs were recognised, but participants raised concerns about their sensitivity in the measurement of prehospital quality of care. To be acceptable, QIs which included time intervals needed to be specific about time-critical interventions. Further, the high acceptability of the QIs was explained by a connection to participants’ professional values and qualities. Assessing the QIs’ acceptability from a healthcare provider perspective meant that QIs on patient satisfaction frequently received lower ratings. Conclusion The findings of this study provide evidence of the acceptability of prehospital care providers of a proposed suite of QIs. Future research should evaluate the feasibility and reliability of the QIs. There is also a need to investigate how acceptable the proposed QIs are to patients and communities.

Level of Self-Care and Patient Care Against COVID-19 Among Emergency Medical Services Personnel; a Cross-sectional Study.

Provision of pre-hospital care by emergency medical services (EMS) requires paying attention to self-care and patient care against possible infections. The present study was conducted with the aim of determining the level of self-care and patient care against COVID-19. The present correlational, descriptive, analytical study was carried out on 301 EMS personnel in Iran. Data were collected using a demographic information form and questionnaires made by the researcher on the level of self-care and patient care against COVID-19. The results showed that more than half of the participants (55%) were aged 27 to 34 years. The majority of the participants had an experience of participating in self-care (88.7%) and patient care (83.7%) training courses against COVID-19. The overall score of self-care was 55.96 ± 6.97 out of 72 and that of patient care was 26.86± 3.39 out of 32, both of which revealed a favorable level. However, in some questions, the mean score was lower than the optimal level. The lowest mean score among items related to self-care against COVID-19 was allocated to wearing protective clothing (1.77±1.19). Among items related to patient care against COVID-19, the lowest mean score was related to training the patient about hand hygine after touching contaminated equipment (2.83±1.08 out of 4). There was a positive (r=0.491) and significant correlation between self-care and patient care against COVID-19 (p=0.001) based on our findings. Although the general level of self-care and patient care against COVID-19 was favorable, due to the undesired level of some domains, it seems necessary to implement corrective planning through periodical training and monitoring the performance of the personnel.

Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance.

Retrospectively investigated this relationship using data from Shimoda Fire Department. We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups. There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions. This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Implementation of Prehospital Handover in the Emergency Department: A Proposed Novel SRCA Checklist in Saudi Arabia

Background: Maintaining effective clinical handover between prehospital services and emergency departments is crucial to recognize critical cases, guiding proper management, and determining final outcomes. Methods: This is a single-center cross-sectional study that was conducted between October 15, 2021, and July 30, 2022, in a tertiary care center in Riyadh, Saudi Arabia. A novel handover tool (SRCA checklist) was developed, and eight emergency medicine consultants checked its content validity. It contains 4 domains and 12 items and is based on previously validated tools after an extensive literature review and experts&amp;apos; opinions. The primary outcome of this study was to validate the newly developed tool aimed at assessing the quality of handover skills between prehospital medical care providers and emergency departments. The tool\&amp;apos;s reliability was examined using Cronbach\&amp;apos;s alpha method, while factor analysis with varimax rotation was used to examine the construct validity. Results: 147 handovers were captured in this study. Almost 50% of the observed handovers adhered to 7 out of 12 checklist criteria for assessing the handover quality. The chief complaint and associated symptoms were reported in 94.56% (n=139) of cases, and verbalizing of the Airway–Breathing–Circulation–Disability–Exposure (ABCDE) was seen in 75% (n=111) of cases.

The prevalence of post-traumatic stress disorder (PTSD) among emergency medical services personnel in Riyadh, Saudi Arabia

Background: Emergency medical services personnel are not aware of the significance and the prevalence of post-traumatic stress disorder (PTSD) among them and its effect on their mental well-being and the quality of patient care. Objective: The current study aimed to assess the prevalence of PTSD and its associated factors among emergency medical services personnel in Riyadh, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted including all accessible emergency medical services personnel working at five hospitals in Riyadh during the period from November to December 2022. Data were collected using the three-phase method including identification of eligible care providers, approaching using an interview-based questionnaire, and recruitment of the questionnaires that were administered to all pre-hospital care providers. Results: A total of 138 emergency personnel were included. A total of 74 (53.6%) were emergency specialists, 12 (8.7%) were emergency technicians, 39 (28.3%) were interns or physicians, and 13 (9.4%) were nurses or paramedics. The most endorsed symptoms included loss of interest in activities that the participants used to enjoy (45.7%), followed by feeling very upset when something reminded them of the stressful experience (44.2%), and trouble falling or staying asleep. A total of 42 (30.4%) participants experienced PTSD (95% CI: 23.1%-38.2%). Conclusion: The current study revealed that nearly one out of each three emergency personnel experienced symptoms coping with PTSD. The higher rate was estimated among old age and participants with higher experience years. Avoiding memories and sleep disturbance were the most reported symptoms.