Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Introduction: One of the six guiding principles of the EMS Agenda 2050 is to foster a socially equitable care delivery system. A specific recommendation within this principle is that "local EMS leadership, educators and clinicians [should] reflect the diversity of their communities." Research has shown that women comprise a minority of emergency medicine services (EMS) field clinicians. In academic settings, women are represented at lower rates among experienced EMS faculty than within Emergency Medicine clinicians or faculty at large. ⋯ Thematic evaluation of the qualitative responses showed that respondents felt there were fewer barriers to mentorship and professional advancement opportunities in local work versus national engagement. Conclusions: In a survey evaluating representation of female professionals in EMS, participants reported on their career representations, and experiences of gender-based inequity within their EMS career settings. Several opportunities exist to improve diversity, equity, and inclusion for women in EMS based on our findings.
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Introduction: Compassion fatigue (CF) is defined as the acute or gradual loss of benevolence that occurs after exposure to critical incident stress. Colloquially referred to as the "cost of caring," CF can affect an individual's future response to stressful situations and is unhealthy for caregivers. Objective: To identify the prevalence and predictors of CF in EMS professionals. ⋯ Additionally, those with concomitant traumatic stress syndromes, such as vicarious trauma and burnout, were 4.61 and 3.35 times more likely to have CF, respectively. Conclusions: CF is a considerable concern for EMS professionals and there are several modifiable factors that may reduce the prevalence of this cumulative stress syndrome. Additional research should focus on causal factors and mitigation strategies, as well as the individual and agency impact of CF on the prehospital work environment.
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Objective: Recent evolution of the EMS system has resulted in an increased role for specially trained advanced clinicians (physicians, physician assistants, and registered nurses) in out-of-hospital field response. Despite this expansion into the out-of-hospital environment there is a lack of data regarding the actual clinical roles and activity of these clinicians in the United States. We seek to describe the clinical roles of advanced clinicians in the field through description of skills used during both 9-1-1 field responses and interfacility transports in the state of Pennsylvania. ⋯ Patient demographics for each clinician type were similar. Conclusions: Our findings indicate advanced clinicians provide care at the ALS and specialty care levels in similar patient populations with little difference in the roles between clinician types in the out-of-hospital environment. Our data demonstrate successful integration of advanced clinicians into the out-of-hospital environment in Pennsylvania and provide a framework for future planning and expansion of these roles and responsibilities.
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Objective: Shift work is an established risk factor for poor health yet is necessary for paramedics to provide continuous care to the public. It is unknown how early into a career shift work may begin to impact health. This study sought to identify changes in cardiometabolic health, diet, aerobic capacity, physical activity and health-related quality of life (HRQoL) in graduate paramedics during the first 12-months of their career. ⋯ Conclusions: Dietary patterns, HRQoL, cardiometabolic health, aerobic capacity and physical activity levels did not change meaningfully in the first year of practice. Some dietary behaviors and physical activity levels could be improved and may mitigate health effects of exposure to shift work. Long-term follow-up of this group may aid in developing programs to enhance health for paramedics and other health workers.
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Randomized Controlled Trial
Comparison of four methods of paramedic continuing education in the management of pediatric emergencies.
Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. ⋯ Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments.