Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Background: Interfacility transfers (IFTs) are an essential component of healthcare systems to allow movement of patients between facilities. It is essential to limit any delays in patients receiving the care they require at the receiving facility. The primary objective of this study was to assess whether IFT response time was reduced after implementation of an AutoLaunch protocol, in which an ambulance is dispatched to the sending facility prior to acceptance of the patient by the receiving facility. ⋯ Of the 996 AutoLaunch transfers, there were 215 incidents (21.6%) in which the IFT ambulance had to stage, and the median staging time was 10.1 minutes (IQR: 4.9, 24.2). Conclusions: Implementation of our AutoLaunch protocol resulted in a significant reduction in ambulance response time for interfacility transfers. Further studies are needed to assess whether the reduction in response time is associated with improved patient outcomes for certain conditions.
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Introduction: Becoming an EMS professional in most of the United States requires successful completion of the National Certification process. While multiple attempts are allowed, some candidates who are unsuccessful on their first cognitive examination attempt do not return despite personal investment. Objective: We describe the demographic and testing characteristics of EMT and paramedic candidates that do not return for a second examination attempt after an initial unsuccessful attempt on the National EMS Certification Cognitive Examination. ⋯ Conclusion: Many EMTs and paramedics who were unsuccessful on the National Certification Exam did not retest. Factors identified that impact the choice varied between EMTs and paramedics but included age, sex, length of initial examination, and time from course completion to that initial examination. These characteristics may present actionable items for EMS educational programs and stakeholders to support EMT and paramedic graduates at risk of not entering the workforce.
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Objective: Paramedicine in Canada has experienced significant growth in recent years, which has resulted in a misalignment between existing guiding conceptualizations and how the profession is structured and enacted in practice. As a result, well-established boundaries, directions, and priorities may be poorly aligned with existing frameworks. The objective of this study was to explore emerging and future states of paramedicine in Canada such that guiding principles could be derived. ⋯ Ten themes were identified: (1) prioritizing patients and their communities; (2) providing health care along a health and social continuum; (3) practicing within an integrated health care framework, and partnering across sectors; (4) being socially responsive; (5) enacting professional autonomy; (6) integrating the health of professionals; (7) using quality-based frameworks; (8) enacting intelligent access to and distribution of services; (9) enacting a continuous learning environment; and, (10) being evidence-informed in practice and systems. Six enablers were also identified: shift professional culture and identity, enhance knowledge, promote shared understanding of paramedicine, integrate data environments, leverage advancing technology, advance policy, regulation and legislation. Conclusions: Our results provide a conceptual framework made up of guiding principles and enablers that provide a consolidated lens to advance the paramedicine profession in Canada (and elsewhere as appropriate) while ensuring contextual and regional needs and differences can be accounted for.
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Background: Early during the COVID-19 pandemic, Emergency Medical Services (EMS) systems encountered many challenges that prompted crisis-level strategies. Maryland's statewide EMS system implemented the Viral Syndrome Pandemic Triage Protocol which contained a decision tool to help identify patients potentially safe for self-care at home. Objectives: This study assessed the effects of the Maryland Viral Syndrome Pandemic Triage Protocol and the safety of referring patients for self-care at home. ⋯ The 95% CIs of the estimated effect of Triage/No Triage protocol documented were wide and crossed the 1.0 limit but overall, all effects Odds Ratios and Adjust Odds Ratios were consistently over 1.0 with the lowest value of 1.3 and the highest value of 2.1. Conclusion: Most patients (95%) who were triaged to self-care at home with home documented decision support tool use did not require hospitalization within 24 hours following EMS encounter and this appears to be safe. Future opportunity exists to incorporate such tools into comprehensive pandemic preparedness strategies along with appropriate follow up and quality improvement mechanisms.
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Introduction: The quality of an Emergency Medical Technician (EMT) or paramedic training program is likely one factor that contributes to a candidate's success on the National Registry Cognitive Examination. However, program pass rates and their associated geographic location have not previously been evaluated. Our objective was to evaluate the performance of EMT and paramedic programs in the United States, pass rates on the National Registry Cognitive Examinations, and relationship to geography. ⋯ Graduates from larger EMT and paramedic programs have higher first and cumulative third attempt pass rates compared to graduates from smaller programs. Additionally, there is variability in program pass rates across NASEMSO regions for both certification levels. Further evaluation is necessary to better understand the variability in program performance in the United States.