Service Clinicians Research Articles

EMS clinician perceptions on prehospital buprenorphine administration programs

ABSTRACT OBJECTIVES Personal attitudes amongst emergency medical services (EMS) clinicians could influence successful implementation of prehospital buprenorphine administration programs (PBAPs), yet few studies have investigated EMS clinician perceptions concerning these innovative programs. This mixed-methods study assessed EMS clinician perceptions and concerns about PBAPs. METHODS Emergency Medical Technicians (EMTs), advanced EMTs and paramedics were recruited for focus groups from Upstate South Carolina. Researchers moderated groups of 12 or fewer and field personnel were interviewed separately from EMS training officers and leadership. Participants took a survey assessing demographic, employment, and contextual information on EMS-led interventions addressing the opioid epidemic. Moderators asked participants to provide confidential responses to four open-ended questions. Thematic analysis was applied to all responses using the framework method. A codebook was modeled using deductive themes from previous literature, while inductive themes and subthemes were added through researcher consensus. Final coding of themes and subthemes was constructed independently by two researchers with disagreements resolved by a third. Descriptive statistics summarized demographic, employment, and contextual information collected from the survey. RESULTS The 107 participants were predominantly male (69.2%) and White (96.3%) with an average age of 38.4 years (SD = 11.4). Half were paramedics and 35.5% were EMTs with EMS experience ranging from 3 months to 39 years, median of 10 years. Most (70.2%) heard of buprenorphine and 28.9% received education on medication for opioid use disorder (MOUD). Describing initial reactions to an overdose, themes included overdoses as a routine part of EMS and naloxone distribution changing overdose dynamics. Themes included opioid withdrawal is not a medical emergency, buprenorphine negatively affecting EMS operations, and PBAPs requiring culture shift. Themes surrounding concerns included EMS clinician perceptions of individuals with opioid use disorder (OUD), PBAPs increasing substance misuse, and buprenorphine increasing EMS clinician liability. At the end of the session 45.8% stated they would want their EMS agency to participate in a PBAP, 44.9% would not want their agency to participate, and 8 (7.5%) did not answer. CONCLUSIONS Emergency medical services clinicians’ perceptions towards prehospital buprenorphine administration could influence adoption of PBAP protocols. Findings may inform PBAP educational initiatives which mitigate these concerns and knowledge gaps.

Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma – a position statement and resource document of NAEMSP

ABSTRACT Pediatric trauma patients have unique physiology and anatomy that impact the severity and patterns of injury. There is a need for updated, holistic guidance for Emergency Medical Services (EMS) clinicians and medical directors to optimize prehospital pediatric trauma guidelines based on evidence and best practice. This is especially pertinent to pediatric severe and inflicted trauma, where prehospital evaluation and management determine the overall quality of care and patient outcomes. This position statement addresses the prehospital evaluation and management of pediatric severe and inflicted trauma and is based on a thorough review and analysis of the current literature.

Using digital psychometric tests in an Irish Child and Adolescent Mental Health Service (CAMHS): an examination of the acceptability of Q-interactive for service users and clinicians.

Using digital psychometric tests in an Irish Child and Adolescent Mental Health Service (CAMHS): an examination of the acceptability of Q-interactive for service users and clinicians.

A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability.

Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.

Implementation of EMS Clinician Feedback Tool Encourages Patient Feedback Requests and Professional Development: A Mixed-Methods Study

Objectives Emergency medical services (EMS) clinicians express dissatisfaction with the quality and quantity of clinical feedback received from hospitals, which is exacerbated by the absence of standardized feedback processes. A reported lack of regular feedback impedes their ability to learn and improve care. We evaluated a newly implemented feedback tool’s utilization and perceived impact on EMS clinicians and our health system. Methods We employed a mixed-methods study design in a single academic medical center emergency department. Quantitative data collected focused on patients’ clinical characteristics and characteristics of utilizers of the feedback tool during implementation (September 2023–July 2024). Qualitative data involved semi-structured interviews with EMS clinicians who had diverse experiences with the feedback tool and years of EMS service Semi-structured interviews applied a phenomenological framework, and were videorecorded, transcribed, and independently coded to identify key themes surrounding the utilization and impact of the implemented tool. Results Among the 381 feedback requests, 139 (36.5%) pertained to patients aged ≥65 years, while 44 (11.5 %) included patients <18 years; 343 (90%) had an Emergency Severity Index score of ≥2. Major complaints included traumatic (n = 165; 43.3%), neurologic (n = 90; 23.6%), and cardiac (n = 82; 21.5%). Emergency responder agencies included ground ambulance 227 (59.6%), air medical 90 (23.6%), public safety answering points 37 (9.7%), and fire service 27 (7.1%). The primary response method was e-mail 353 (93.7%). There was an average of 35 feedback requests per month (interquartile range: 27–59). EMS clinicians from multiple agencies with varying levels of knowledge of the feedback mechanism provided qualitative insights regarding the feedback tool, which covered several key areas: application and technological design, utilization, utility of feedback provided, barriers, comparisons to other systems, and areas for improvement. Conclusions The standardized feedback mechanism implemented for EMS clinicians showed engagement, especially among ground responders caring for high-acuity patients, highlighting its importance in patient care. The preference for email emphasizes the need for efficient communication channels. Clinicians found the system accessible and user-friendly. The feedback tool was perceived as crucial for professional development and personal growth, allowing clinicians to gain closure on patient cases and potentially improve future patient care practices.

Virtual Neonatal Resuscitation Curriculum for Emergency Medical Services (EMS) to Improve Out-of-Hospital Newborn Care

Objectives Out-of-hospital births are associated with a 2- to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS. There is a need for tailored NRP training to meet EMS clinicians’ specific needs, context, and systems. Methods This was a prospective observational study of a virtual EMS-tailored, newborn resuscitation curriculum focused on initial steps of newborn resuscitation in the out-of-hospital setting. The initial content (90-minute) was pilot tested virtually among 350 urban EMS clinicians, with favorable feedback (89% survey response rate). Based on feedback, we created a 60-minute interactive, virtual curriculum that includes NRP-based didactic and memory aids to reinforce how NRP differs from pediatric resuscitation designed specifically for EMS. The course also includes video demonstrations with pauses for hands-on self-directed skills practice. We delivered the curriculum to clinicians from 17 EMS agencies in rural Oregon. To assess neonatal resuscitation knowledge acquisition and retention, participants completed the same 10-question test before, after, and 3 months following the training. Questions were adapted from the 8th Edition NRP Textbook and NRP test questions. Results Eighty-four EMS clinicians completed the pretest, curriculum, and post-test and demonstrated improvement in immediate post-curriculum NRP knowledge (pretest mean score 5.32 ± 1.99; post-test mean score 8.61 ± 1.26; p < 0.001). Forty participants completed the 3-month follow up test and scores remained improved from baseline (3 month-follow up mean score 6.88 ± 1.83, p < 0.001). Prehospital clinicians (N = 84) thought that this EMS-tailored NRP curriculum was easy to complete (100%), valuable to their clinical practice (99%), and filled a gap in their education (98%). They felt that implementing/requiring this training is possible/doable (99%) and recommend the curriculum to other EMS agencies (99%). Conclusions A virtual EMS-tailored, NRP-based educational curriculum improved neonatal resuscitation knowledge immediately and was sustained at 3 months compared to baseline. The curriculum is feasible and acceptable to EMS clinicians.

Paramedic assessment of suspected or confirmed COVID-19 patients in the out-of-hospital environment: a scoping review protocol

Objective: The objective of this review is to develop a comprehensive collection of information about the current processes for paramedics assessing and referring suspected or confirmed COVID-19 patients in the out-of-hospital environment. Introduction: Patients with COVID-19 are frequently encountered by paramedics and ambulance service clinicians. Increased demand on ambulance services has resulted in many of these services developing alternative referral pathways to avoid unnecessary conveyance to emergency departments. There is not a strong body of literature or rigorous clinical practice guideline on this topic to support the assessment and referral decision-making for COVID-19 patients in the out-of-hospital setting. Inclusion criteria: Any suspected or confirmed COVID-19 patients in the out-of-hospital environment who are seeking care for COVID-19-related symptoms and being assessed by paramedics will be considered for inclusion. Sources from scholarly literature and gray literature, such as ambulance service clinical practice guidelines, will be included. Sources from Australia, Aotearoa New Zealand, USA, Canada, and the UK will be included. Methods: The review will be guided by the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A database search for scholarly literature will be performed, followed by a gray literature search. Databases will include MEDLINE, CINAHL, Scopus, Emcare, Embase, amber, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, and Epistemonikos. Gray literature will include clinical practice guidelines, protocols, and procedures obtained from ambulance service websites and apps. Results will be presented through figurative, tabular, and narrative synthesis methods. Review registration: Open Science Framework osf.io/yc7vq

Characterizing the Use and Potential of Social Media for Education and Advancement in Emergency Medical Services (EMS).

Social media has significantly impacted how healthcare professionals access health education, news, and communication. However, Emergency Medical Services (EMS) clinicians' professional use of social media remains unclear. Our objective was to characterize current EMS social media use and explore the potential for future professional use. This was a cross-sectional survey of nationally-certified EMS clinicians. Data were collected from November to December 2018. Respondents were surveyed regarding demographics, social media use, and use of and preferences for accessing EMS-specific social media content. Descriptive statistics were calculated. A total of 3,087 participants responded to the survey. Of these, 2,705 respondents met the inclusion criteria. The majority of the sample were male (68%, n=1,838), non-Hispanic White (85%, n=2,200), with a mean (SD) age of 37 (±13.1) years. More than half (57%, n=1,531) were certified as EMTs and worked full-time (61%, n=1,387) in urban settings (60%, n=1,630). The most commonly used social media platforms included Facebook™ (80%, n=2,175) and Instagram™ (48%, n=1,285), with 66% (n=1,600) of respondents checking social media platforms several times per day. The most common professional uses of social media were for education (64%) and news (65%). Respondents reported interest in using social media for EMS resources, including education (83%, n=1,989), news/events (60%, n=1,439), products/innovations (57%, n=1,352), and networking/job opportunities (54%, n=1,285). Many EMS clinicians reported their EMS agency had a social media policy (63%), but 15% reported they were not allowed to use social media for professional activities. EMS clinicians access social media frequently and express interest in its use for professional resources. However, many EMS do not currently use social media for professional activities. Considering EMS clinicians' interest in social media for professional reasons and the growing use of social media across numerous professional fields, EMS agencies and organizations should consider broadening outreach to clinicians through social media.

Advancing a machine learning-based decision support tool for pre-hospital assessment of dyspnoea by emergency medical service clinicians: a retrospective observational study

BackgroundIn Sweden with about 10 million inhabitants, there are about one million primary ambulance missions every year. Among them, around 10% are assessed by Emergency Medical Service (EMS) clinicians with the primary symptom of dyspnoea. The risk of death among these patients has been reported to be remarkably high, at 11,1% and 13,2%. The aim was to develop a Machine Learning (ML) model to provide support in assessing patients in pre-hospital settings and to compare them with established triage tools.MethodsThis was a retrospective observational study including 6,354 patients who called the Swedish emergency telephone number (112) between January and December 2017. Patients presenting with the main symptom of dyspnoea were included which were recruited from two EMS organisations in Göteborg and Södra Älvsborg. Serious Adverse Event (SAE) was used as outcome, defined as any of the following:1) death within 30 days after call for an ambulance, 2) a final diagnosis defined as time-sensitive, 3) admitted to intensive care unit, or 4) readmission within 72 h and admitted to hospital receiving a final time-sensitive diagnosis. Logistic regression, LASSO logistic regression and gradient boosting were compared to the Rapid Emergency Triage and Treatment System for Adults (RETTS-A) and National Early Warning Score2 (NEWS2) with respect to discrimination and calibration of predictions. Eighty percent (80%) of the data was used for model development and 20% for model validation.ResultsAll ML models showed better performance than RETTS-A and NEWS2 with respect to all evaluated performance metrics. The gradient boosting algorithm had the overall best performance, with excellent calibration of the predictions, and consistently showed higher sensitivity to detect SAE than the other methods. The ROC AUC on test data increased from 0.73 (95% CI 0.70–0.76) with RETTS-A to 0.81 (95% CI 0.78–0.84) using gradient boosting.ConclusionsAmong 6,354 ambulance missions caused by patients suffering from dyspnoea, an ML method using gradient boosting demonstrated excellent performance for predicting SAE, with substantial improvement over the more established methods RETTS-A and NEWS2.

Implementation of a Child Maltreatment Screening Tool in the Prehospital Setting

Objectives Emergency medical services (EMS) clinicians are in a unique position to screen for child maltreatment as they are often the first point of contact with the health care system and they may encounter children in their home environment. However, EMS training regarding the signs of child maltreatment is lacking. Although several child maltreatment screening tools have been developed for the primary care and emergency department (ED) settings, there appears to be no published literature describing or evaluating a prehospital screening aid. The objective of this study was to develop, implement, and examine the effectiveness and acceptability of a prehospital child maltreatment screening tool. Methods We completed a mixed methods qualitative and quantitative study, with data collection spanning June 2021–June 2022. We developed a child maltreatment screening tool “Shield” for the prehospital setting by adapting Pittsburgh Child Abuse Screening Tool (P-CAST), a screening tool developed at the University of Pittsburgh for use in the ED. Shield was integrated into the EMS electronic patient care report (ePCR) for three participating fire agencies. Data, including demographics, ED evaluation, and outcomes, were collected for patients who underwent Shield evaluation. The EMS clinicians completed self-assessment surveys and participated in focus groups to provide feedback on their experience using Shield. Results Participating EMS agencies evaluated 1,054 eligible patients (children <15 years old) during the study period, June 2021–June 2022. Of these, Shield screenings were initiated on 948 patients and completed on 753. Among all patients for whom a Shield evaluation was started, 32 (3.4%) screened positive for findings and/or histories concerning for possible maltreatment. Of these, 20 patients were transported to the primary study institution; in the ED 10 patients underwent additional child maltreatment evaluation. Pre-implementation surveys suggested a majority (77.2%) of EMS clinicians desired a child abuse screening tool integrated into the ePCR and post-implementation focus group data demonstrated EMS clinicians found Shield to be well integrated into their ePCR. Conclusions Shield screens were initiated on nearly 90% of pediatric patients evaluated by EMS during the study period, suggesting that this tool has the potential to help standardize child maltreatment screening in the prehospital setting.

"When you're in pain you do go into your shell" A community-based pain management programme co-designed with Māori whānau to address inequities to pain management - A qualitative case study.

Chronic or persistent non-cancer pain disproportionately affects Māori - the Indigenous population of Aotearoa New Zealand (NZ) and their whānau (extended family). In a previous study with a Māori community service provider - Tū Kotahi Māori Asthma and Research Trust - Tū Kotahi, identified a need for a Kaupapa Māori (by Māori, for Māori) pain management programme (PMP) with embedded principles of Whānau Ora (care focusing on the wellbeing of the individual and their significant others as a collective). Using a qualitative case-study design, the main aims were to describe (1) the implementation of a community-based, whānau-focused PMP; (2) the participant experiences of the programme. This is community-based participatory action research guided by a Māori-centred research approach. Based on our previous co-design study with Tū Kotahi, a 6-week PMP (July - August 2021) was implemented at Kokiri Marae (community meeting place). Eight whānau living with persistent pain participated in the 6 sessions led by our Māori community partner and a pain management physiotherapist including a dedicated session on Rongoā Māori (Māori traditional treatment). Supporting resources were co-developed with our community partner, pain service clinicians, a Māori Health literacy expert, and a Māori illustrator. On completion, whānau reported enhanced confidence towards managing pain with "more tools to manage". The role of meaningful relationships, co-design, use of metaphors, and inclusion of traditional treatments - Rongoā were key aspects for the successful implementation. This initiative provides an exemplar for community and mainstream pain service partnership to address inequities in accessing pain management services for Māori. PERSPECTIVE: This study explains the key cultural processes of implementing a community-based pain management programme for Māori with persistent pain in Aotearoa New Zealand. The principles from our engagement could be applicable globally to engage with Indigenous and culturally and linguistically diverse communities with persistent pain to address longstanding health inequities.

Change in self-construal: a repertory grid technique study of women admitted to a Mother and Baby Unit.

Pregnancy and the postnatal period represent a time of heightened risk for women to experience mental health difficulties. Some mothers may require specialist inpatient psychiatric support made available through Mother and Baby units (MBUs). Although there is evidence of the therapeutic benefits of MBUs, many studies have utilised methodologies vulnerable to interviewer and social desirability biases. The repertory grid technique (RGT), derived from personal construct theory (PCT), has been successfully used to explore how the way in which a person thinks about and defines the self (i.e., self-construal) changes following therapeutic intervention in samples of people experiencing mental health conditions. Therefore, this study aimed to explore change in maternal self-construal following MBU admission, utilising the RGT, thereby enhancing our understanding for the therapeutic role of MBU admissions in women's mental health recoveries. Participants were recruited from two MBUs in England. RGT was undertaken with participants shortly after admission and again at discharge, allowing for comparisons between grids to assess change in how a mother viewed herself in relation to certain aspects of the self (e.g., ideal self) and other people, a concept referred to as construing in PCT. Data were analysed using principal component analysis, Slater analysis, and content analysis. There were 12 participants who completed repertory grids at admission, with eight (66.67%) participants also completing discharge grids. Most of the eight participants demonstrated improvements in overall self-esteem and self-esteem as a mother, a shift towards a more positive self-perception, and increased construed similarity between the self and positively construed others, and construing became more varied. Conversely, a few participants displayed a reduction in self-esteem, particularly in the maternal role and increased construed similarity between the self and negatively construed others, and construing became more rigid. All participants exhibited changes to construing during their MBU admission, with most participants displaying positive changes to self-esteem and self-perception and a more adaptive process of construing. Potential implications are offered for service users, families, clinicians, and stakeholders. Recommendations for future research are also provided.

Health related outcomes of patients with serious traumatic injury: Results of a longitudinal follow-up program delivered by trauma clinicians

The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program. This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point. Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54-9.21, p=0.01), anxiety and depression (OR 1.95, 95 % CI 1.09-3.48, p=0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75-13.5, p=0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points. Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge.

Peer support for borderline personality disorder: A critical review of its feasibility, acceptability, and alignment with concepts of recovery.

Many organizations have adopted peer support to increase service alignment with recovery-oriented principles. Yet, few studies have scrutinized borderline personality disorder (BPD)-specific concepts of "recovery" and "recovery-oriented practice," nor evaluated the extent to which existing peer support services (PSS) align with these concepts. We addressed these knowledge gaps in four phases: (a) a literature review to understand BPD-specific concepts of "recovery" and "recovery-oriented practice," (b) a literature review and open web search to describe the implementation, feasibility, or effectiveness of PSS for people with BPD, (c) a landscaping survey of program administrators regarding their BPD-PSS programs, and (d) a critical review of the extent to which current peer support for BPD aligns with "recovery" and "recovery-oriented practice." We identified 40 published sources that defined "recovery" or "recovery-oriented practice" as it pertains to BPD, and narratively summarize these results, nine sources that described PSS for people with BPD, and received survey responses from seven BPD-PSS program administrators. Our critical review highlighted the distinctive but overlapping concepts of "clinical recovery" versus "personal recovery" and underscored the alignment of BPD-PSS with personal recovery goals, including increased self-knowledge and -acceptance, hope, engagement in meaningful social roles and relationships, and self-determination. While peer support is experienced positively by service users, peer supporters, and clinicians, challenges include setting boundaries, minimizing dual roles, and ensuring adequate training, supervision, and personal support to reduce burnout. Peer support appears to be a feasible avenue for meeting the personal recovery goals of people with BPD; however, formal program evaluations are needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Not Just 9-1-1: The Expanded Work Environment of United States Emergency Medical Service Clinicians.

Recently, there have been annual increases in emergency medical service (EMS) demand with concurrent clinician shortages. Understanding the diverse number of EMS clinicians available for emergent roles is vital for planning and resource management. Our study aims to understand the roles and environments of US EMS clinicians. This cross-sectional study analyzed nationally certified civilian US EMS clinicians recertifying from October 2021 to April 2022, ages 18-85, with at least one EMS job. Respondents answered questions regarding their primary and secondary EMS roles, including emergent response (with/without 9-1-1), medical transport (non-emergent), clinical services, mobile integrated health (MIH), or none of the above. Next, respondents were asked about the number of jobs needed to make ends meet. All responses were combined with self-reported National Registry profile data (e.g., age, sex). Descriptive statistics were performed. The study included 33,335 EMS clinicians (response rate: 34.0%). The primary role reported was emergent response with 25,086 (75.3%), including ground ambulance and non-ambulance response. Clinical service roles were reported by 2,427 (7.3%), including settings such as the emergency department and outpatient clinics. Medical transport roles accounted for 2,346 (7.0%), including ground interfacility and critical ground care. Educators and administrators made up 1,453 (4.4%). Overall, roles varied by sex, and 48.8% of respondents reported needing more than one job to make ends meet. Our evaluation highlights various US EMS clinician roles. These findings suggest the need for continued focus and attention on EMS roles, compensation structures, and sex distributions to ensure a resilient, diverse, and adequately supported EMS workforce.

The Development and Piloting of an Early Youth-Engagement (EYE) Model to Improve Engagement of Young People in First Episode Psychosis Services: A Mixed Methods Study.

Psychosis is associated with significant health and societal costs. Early intervention in psychosis services (EIP) are highly effective in promoting recovery, yet substantial proportions of young people disengage. The current study aimed to develop and evaluate a novel engagement intervention in EIP services. A qualitative investigation of facilitators and barriers to engagement in 68 first episode psychosis patients, family members and young people, and a Delphi consultation with 27 regional and national youth and psychosis service leads informed the development of the intervention. A mixed-methods feasibility-pilot study then compared engagement outcomes in 298 EIP service users in two cohorts: standard EIP versus standard EIP plus the novel early youth-engagement (EYE) intervention. A qualitative study explored intervention experiences in 22 randomly selected service users, carers and clinicians. A process evaluation explored delivery. Disengagement was 24% in the standard EIP cohort compared to 14.5% in the standard EIP plus EYE intervention cohort. A 95% Bayesian credibility interval revealed a 95% probability that the true reduction in disengagement lay somewhere between 0% and 18%. The number needed to treat was 11, 95% CI [5, 242]. Use of the EYE resources was associated with engagement. Qualitiative feedback supported effects on communication, social network engagement, service user goals, mental health and well-being outcomes. The EYE intervention was designed from a service user, young person and carer perspective. Both qualitative and quantitative data support impacts on engagement. We now need to evaluate effectiveness, cost-effectiveness and implementation in a multi-site randomised controlled trial.

Prehospital Trauma Compendium: Traumatic Pneumothorax Care – a position statement and resource document of NAEMSP

ABSTRACT Emergency Medical Services (EMS) clinicians manage patients with traumatic pneumothoraces. These may be simple pneumothoraces that are less clinically impactful, or tension pneumothoraces that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Further, there is also ambiguity regarding EMS management of open pneumothoraces. To provide evidence-based guidance on the management of traumatic pneumothoraces in the EMS setting, NAEMSP performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document. NAEMSP recommends: EMS identification of a tension pneumothorax must be guided by a combination of risk factors and physical findings, which may be augmented by diagnostic technologies. EMS clinicians should recognize the differences in the clinical presentation of a tension pneumothorax in spontaneously breathing patients and in patients receiving positive pressure ventilation. EMS clinicians should not perform pleural decompression in patients with simple pneumothoraces but should perform pleural decompression in patients with tension pneumothorax, if within the clinician’s scope of practice. When within scope of practice, EMS clinicians should use needle thoracostomy as the primary strategy for pleural decompression of tension pneumothorax in most cases. EMS clinicians should take a patient-individualized approach to performing needle thoracostomy, influenced by factors known to impact chest wall thickness and risk for iatrogenic injury. Simple thoracostomy and tube thoracostomy may be used by highly trained EMS clinicians in select clinical settings with appropriate medical oversight and quality assurance. EMS systems must investigate and adopt strategies to confirm successful pleural decompression at the time thoracostomy is performed. Pleural decompression should be performed for patients with traumatic out-of-hospital circulatory arrest (TOHCA) if there are clinical signs of tension pneumothorax or suspicion thereof due to significant thoraco-abdominal trauma. Empiric bilateral decompression, however, is not routinely indicated in the absence of such findings. EMS clinicians should not routinely perform pleural decompression of suspected or confirmed simple pneumothorax prior to air-medical transport in most situations. EMS clinicians may consider placement of a vented chest seal in spontaneously breathing patients with open pneumothoraces. In patients receiving positive pressure ventilation who have open pneumothoraces, chest seals may be harmful and are not recommended. EMS physicians play an important role in developing curricula and leading quality management programs to both ensure that EMS clinicians are properly trained in the recognition and management of tension pneumothorax and to ensure that interventions for tension pneumothorax are performed appropriately, safely, and effectively.

Workplace Violence Against Emergency Medical Services (EMS): A Prospective 12-Month Cohort Study Evaluating Prevalence and Risk Factors Within a Large, Multistate EMS Agency

Objectives To determine the prevalence and associated risk factors of workplace violence (WPV) experienced by emergency medical services (EMS) clinicians across a large, multistate ground/air EMS agency. Methods We used a prospective cohort study design from 1 December 2022 to 30 November 2023. A checkbox was added within the electronic medical record (EMR) asking staff to indicate whether WPV occurred. Patient characteristics, encounter (run), and crew factors were abstracted. Potential risk factors for WPV were assessed using logistic regression, with the occurrence of any form of violence as the primary outcome of interest. Models were both univariable, assessing each risk factor individually, and multivariable, assessing all risk factors together to identify independent factors associated with higher risk of WPV. Multivariable model results were reported using adjusted odds ratios (aORs) and 95% confidence intervals. Results A total of 102,632 runs were included, 95.7% (n = 98,234) included checkbox documentation. There were 843 runs (0.86 per 100 runs, 95% CI 0.80–0.92) identified by EMS clinicians as WPV having occurred, including verbal abuse (n = 482), physical assault (n = 142), and both abuse and assault (n = 219). Risk factors for violence included male patient gender (aOR 1.45, 95% CI 1.24–1.70, p < 0.001), Richmond Agitation-Sedation Scale (RASS) >1 (aOR 16.97, 95% CI 13.71–21.01, p < 0.001), and 9-1-1 runs to include emergent (P1; aOR 1.75, 95% CI: 1.17–2.63, p = 0.007) and urgent (P2; aOR 1.64, 95% CI 1.08–2.50, p = 0.021) priority, compared to P3/scheduled transfer or P4/trip requests. Factors associated with lower risk for violence included older patients (aOR per 10 years = 0.95, 95% CI 0.91–0.98, p = 0.007) and run time of day between 0601–1200 h compared to 0000–0600 h (aOR 0.67, 95% CI 0.51–0.88, p = 0.004). Only 2.7% of violent runs captured through the EMR were reported through official processes. Conclusions Verbal and/or physical violence is recognized in nearly 1% of EMS runs. We recommend prioritizing WPV prevention and mitigation strategies around identified risk factors and simplifying the WPV reporting process in order to reduce staff administrative burden and encourage optimal capturing of violent events.

2024 Systematic Review of Evidence-Based Guidelines for Prehospital Care

ABSTRACT Objectives Evidence-based guidelines (EBGs) are widely recognized as valuable tools to aggregate and translate scientific knowledge into clinical care. High-quality EBGs can also serve as important components of dissemination and implementation efforts focused on educating emergency medical services (EMS) clinicians about current evidence-based prehospital clinical care practices and operations. We aimed to perform the third biennial systematic review of prehospital EBGs to identify and assess the quality of prehospital EBGs published since 2021. Methods We systematically searched Ovid Medline and EMBASE from January 1, 2021, to June 6, 2023, for publications relevant to prehospital care, based on an organized review of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised using the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool. Results We identified 33 new guidelines addressing clinical and operational topics of EMS medicine. The most addressed EMS core content areas were time-life critical conditions (n = 17, 51.5%), special clinical considerations (n = 15, 45%), and injury (n = 12, 36%). Seven (21%) guidelines included all elements of the National Academy of Medicine (NAM) criteria for high-quality guidelines, including the full reporting of a systematic review of the evidence. Guideline appraisals by the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool demonstrated modest compliance to reporting recommendations and similar overall quality compared to previously identified guidelines (mean overall domain score 67%, SD 12%), with Domain 5 (“Applicability”) scoring the lowest of the six AGREE II domains (mean score of 53%, SD 13%). Conclusions This updated systematic review identified and appraised recent guidelines addressing prehospital care and identifies important targets for education of EMS personnel. Continued opportunities exist for prehospital guideline developers to include comprehensive evidence-based reporting into guideline development to facilitate widespread implementation of high-quality EBGs in EMS systems and incorporate the best available scientific evidence into initial education and continued competency activities.

186 Emergency Medical Service Clinicians' Perceptions and Utilization of Resources for People Experiencing Homelessness

186 Emergency Medical Service Clinicians' Perceptions and Utilization of Resources for People Experiencing Homelessness