Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Objective: To assess comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) used by prehospital emergency medical services (EMS) to treat patients with trauma, cardiac arrest, or medical emergencies, and how they differ based on techniques and devices, EMS personnel and patient characteristics. Data sources: We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020. Review methods: We followed Agency for Healthcare Research and Quality Effective Health Care Program Methods guidance. ⋯ Conclusions: The currently available evidence does not indicate benefits of more invasive airway approaches based on survival, neurological function, ROSC, or successful airway insertion. Strength of evidence was low or moderate; most included studies were observational. This supports the need for high-quality randomized controlled trials to advance clinical practice and EMS education and policy, and improve patient-centered outcomes.
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Background: Immunizations for emergency medical services (EMS) professionals during pandemics are an important tool to increase the safety of the workforce as well as their patients. The purpose of this study was to better understand EMS professionals' decisions to receive or decline a COVID-19 vaccine. Methods: We conducted a cross-sectional analysis of nationally certified EMS professionals (18-85 years) in April 2021. ⋯ Conclusion: Despite vaccine availability, not all EMS professionals had been vaccinated. The decision to receive a COVID-19 vaccine was associated with demographics, beliefs regarding COVID-19 and the vaccine, and medical mistrust. Efforts to increase COVID-19 vaccination rates should emphasize the safety and efficacy of vaccines.
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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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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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Introduction: The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period. ⋯ However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease. Conclusion: This large nationwide study of EMS profession has shown the trend toward DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.