Prehospital Emergency Care最新文献

{"title":"Development and validation of an administrative claims measure of Emergency Medical Services (EMS) triage quality for mobile integrated health interventions.","authors":"Nicole Voll, Cameron Gettel, Shu-Xia Li, Li Qin, Yixin Li, Sarah Attanasio, Isabella Epshtein, Marvin Nichols, Alexis Lilly, Jacob Quinton, Susannah Bernheim, Hannah Stiles, Karthik Murugiah, N Clay Mann, Arjun Venkatesh","doi":"10.1080/10903127.2025.2535574","DOIUrl":"https://doi.org/10.1080/10903127.2025.2535574","url":null,"abstract":"<p><strong>Objectives: </strong>In general, Medicare pays for emergency ground ambulance services when a patient is transported to the nearest emergency department (ED) or other select facilities. As state and local agencies strive to provide high quality person-centered emergency care in locations outside the ED, there is a need for a reliable and valid prehospital quality measure to ensure patient safety. The Centers for Medicare and Medicaid Innovation Center's Emergency Triage, Treat and Transport (ET3) Model created a unique opportunity to develop a quality measure for ambulance organizations to measure safe and effective prehospital care. Our objective was to develop and validate the Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure.</p><p><strong>Methods: </strong>The measure was developed using 2021-2023 Medicare Part B fee-for-service administrative and claims data from 67 ambulance organizations that participated in the ET3 Model, triaging patients using predetermined clinical protocols. The measure cohort included patients that were either transported to an alternative destination (TAD), such as urgent care, or provided treatment in place (TIP). The measure outcome was met if the patient subsequently had an ED visit or died within three days of a TAD/TIP encounter, as an inverse measure, lower is better. We calculated a risk-adjusted measure score using a hierarchical generalized linear model approach, adjusting for patient-level variables and calculating model and measure performance. Finally, we assessed measure face validity and construct validity. To ensure measure reliability, some results were examined using a minimum case threshold of 20 TAD/TIP encounters by each ambulance organization.</p><p><strong>Results: </strong>Among the 22 ambulance organizations that met the minimum case volume threshold, the mean, SD measure score was 20.3 (5.3), ranging from 11.6 to 35.4. The mean (SD) reliability signal-to-noise ratio was 0.791 (0.124). Nine of 11 (82%) members of an interested party consensus group provided a positive vote of face validity. Construct validity was demonstrated by identifying an anticipated negative correlation with three relevant prehospital measures.</p><p><strong>Conclusions: </strong>The Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure is a reliable and valid measure that fills a critical gap in assessing patient safety in prehospital care in the United States.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and pay gaps in paramedic services leadership in Ontario, Canada.","authors":"Dominique Arseneau-Bruneau, Justin Mausz, Sarah Salvis, Andy Tannous, Elizabeth A Donnelly","doi":"10.1080/10903127.2025.2536222","DOIUrl":"https://doi.org/10.1080/10903127.2025.2536222","url":null,"abstract":"<p><strong>Objectives: </strong>Research suggests that women are underrepresented in healthcare leadership and often earn less than men. This may be true in the emergency medical services (EMS) as well, but research on the subject is limited and specific data in Canada are scarce. This study aimed to estimate the gender and income distributions among leadership within Ontario's paramedic services.</p><p><strong>Methods: </strong>We abstracted records for leadership positions (e.g., superintendent, commander, deputy chief, chief) from the Ontario Public Sector Salary Disclosure List. Two raters independently assessed the presumed binary gender of each individual, resolving discrepancies through consensus. Interrater agreement was measured using a kappa statistic. Chi-square tests compared the proportions of men and women at different leadership levels (entry, middle, executive). Income distributions were compared using parametric and non-parametric tests, stratified by leadership level.</p><p><strong>Results: </strong>Our search yielded 863 individuals from 49 (out of 54) paramedic services. Interrater agreement on presumed gender was 95% (κ = 0.87, p < 0.001). After resolving discrepancies (n = 43), we achieved complete agreement for 855 individuals (98%). Among the sample, 655 (76%) were presumed to be men. Women held 23% of entry, 35% of middle, and 15% of executive leadership roles. Within the leadership pool and compared to men, women were twice as likely to hold a middle leadership role (Odds Ratio [OR] 2.00, 95% Confidence Interval [CI] 1.35-2.98, p < 0.001) but less likely to hold an executive leadership position (OR 0.54, 95% CI 0.33-0.87, p = 0.012). Median income distributions were comparable at the executive level (p = 0.327), but lower for women at the middle and entry leadership levels, earning $0.90 (p < 0.001) and $0.95 (p < 0.001) for every dollar earned by men, respectively. Gender accounted for 1.7% of the variance in total earnings.</p><p><strong>Conclusions: </strong>Our findings suggest the existence of both gender and pay gaps in leadership, the reasons for which are not immediately apparent and warrant further study.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"On the Wall\": A Descriptive Analysis of Ambulance Patient Offload Times in the United States.","authors":"Matthew R Shaw, Eric Quinn, Jack Cheng, Sabina Pilipovic, Ali Treichel, Remle P Crowe, Jeffrey L Jarvis","doi":"10.1080/10903127.2025.2535576","DOIUrl":"https://doi.org/10.1080/10903127.2025.2535576","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged Ambulance Patient Offload Times (APOT) can lead to decreased ambulance availability and delays for subsequent patients but there is no standardized definition for this interval. We aimed to describe various APOT definitions and compare prolonged APOT intervals by agency characteristics in a large national dataset.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2024 ESO Research Collaborative dataset, including all 9-1-1 response transports. We calculated median APOT intervals using the difference between the \"Arrival at Hospital\" timestamp and \"Receiving Facility Signature\" (APOT 1), \"Transfer of Care\" (APOT 2), \"Incident Closed\" (APOT 3), and a \"Composite\" interval (APOT 4) using the \"Receiving Facility Signature\" timestamp where available and \"Transfer of Care\" timestamp where not available. Using the composite APOT interval, we described characteristics among agencies with >100 annual transports with ≥25% of transports with prolonged APOTs compared to agencies with <25%.</p><p><strong>Results: </strong>Of the 7,237,606 included records, calculable intervals were available for 1,691,745 for APOT 1; 5,613,315 for APOT 2; 7,235,713 for APOT 3; and 6,025,643 for APOT 4. Median and interquartile (IQR) time in minutes for APOT 1 was 10.9 (6.6, 17.5), APOT 2 was 6.6 (4.4, 13.1), APOT 3 was 19.7 (13.1, 30.6), and APOT 4 was 8.7 (4.4, 15.3). Among agencies with ≥100 annual transports (2,020), 3.3% (67) had ≥25% transports with a prolonged APOT of more than 30 minutes. These agencies were more urban (79.1% vs 58.9%) and had a higher median annual 9-1-1 call volume of 2,772 (IQR:1,145, 5,978) compared to agencies where <25% of transports had a prolonged APOT (1,817 (IQR:719, 4,473)).</p><p><strong>Conclusions: </strong>Overall, median APOT intervals were short, independent of the definition. A small number of EMS agencies experienced prolonged offload times for at least 1-in-4 transports, indicating that though not widespread nationally, APOT challenges are prevalent in a subset of EMS systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Diagnosis of Acute ST-Elevation Myocardial Infarction in a Patient with Situs Inversus Totalis.","authors":"Victoria Gordon, Jason Jones, Brad Ward, Casey Patrick","doi":"10.1080/10903127.2025.2506183","DOIUrl":"10.1080/10903127.2025.2506183","url":null,"abstract":"<p><p>We report a case of a 50-year-old male who presented to emergency medical services (EMS) with acute chest pain, pallor, and diaphoresis. A prehospital diagnosis of ST-elevation myocardial infarction (STEMI) was made following electrocardiogram (ECG) lead reversal by the paramedics secondary to a reported history of situs inversus totalis, a congenital condition with complete reversal or mirroring of the thoraco-abdominal visceral organs. Paramedics initiated a STEMI alert to the emergency department (ED) from the scene, and the patient underwent emergent cardiac catheterization following transport to the hospital. A stent was placed in the left coronary artery, and the patient's symptoms resolved. He was discharged on hospital day three with no complications. This case highlights the need for prehospital clinicians to recognize and adapt when encountering rare conditions like dextrocardia and situs inversus.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/10903127.2025.2527014","DOIUrl":"https://doi.org/10.1080/10903127.2025.2527014","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vital Sign Assessment in EMS Non-Transports: A National Analysis.","authors":"Alyssa Green, Sheree Murphy, Michael Redlener, Marshall Washick, Daniel Garner, Lance Corey, Maria Beerman-Foat, Maia Dorsett","doi":"10.1080/10903127.2025.2534997","DOIUrl":"https://doi.org/10.1080/10903127.2025.2534997","url":null,"abstract":"<p><strong>Objectives: </strong>To describe national performance on complete vital sign assessment during emergency medical services (EMS) encounters resulting in non-transport, stratified by patient, agency, and incident characteristics.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2023 National EMS Information System (NEMSIS) Public Release Research Dataset. Adult (≥18 years) patients from 9-1-1 incidents resulting in non-transport were included, excluding cases with cardiac arrest prior to EMS arrival. A complete vital sign set was defined as heart rate, respiratory rate, pulse oximetry, systolic blood pressure, and level of consciousness. Descriptive statistics and univariable logistic regression were used to evaluate performance across demographic, agency, and incident-level variables.</p><p><strong>Results: </strong>Among 5,983,628 eligible non-transport incidents, only 54.6% (n = 3,267,407) had a complete set of vital signs documented, while 9.8% (n = 586,968) had no documented vitals. Assessment and documentation of individual vital signs ranged from 70.9% (SpO₂) to 86.0% (heart rate). Agency-level performance varied widely, with Advanced Life Support units achieving 57.3% complete assessments compared to 44.7% for Basic Life Support and 26.8% for Emergency Medical Responder units. Vital sign assessment varied with scene time, significantly improving when scene time exceeded 15 minutes. Vital sign completeness was highest for dispatches related to chest pain and breathing problems and lowest for behavioral issues and motor vehicle collisions. Falls in patients aged 60 years and older represented a large subset of incomplete assessments, accounting for 15.1% of all non-transport incidents with incomplete vital signs and 18.2% of patients with no vital signs.</p><p><strong>Conclusions: </strong>Nearly half of EMS non-transport incidents lack complete vital sign assessment, and 10% have no vitals recorded. Given the critical role of vital signs in evaluating a patient's clinical condition and patient safety, these findings highlight substantial variability in EMS performance and a need for targeted quality improvement-particularly in high-risk populations such as older adults following falls.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medical services responses to 9-1-1 calls triggered by personal emergency response systems.","authors":"Lori L Boland, Diana Jin, Jonathan M Flynn, Marc W LeVoir, Joey L Duren, Ashish R Panchal","doi":"10.1080/10903127.2025.2534985","DOIUrl":"https://doi.org/10.1080/10903127.2025.2534985","url":null,"abstract":"<p><strong>Objectives: </strong>Many elderly adults utilize wearable personal emergency response systems (PERS) to support independent living while ensuring prompt assistance in an emergency. Activation of emergency medical services (EMS) is integral to the PERS model, but the impact of PERS activation on the utilization of EMS is not well described. We examined EMS responses to 9-1-1 calls related to PERS activations in a large EMS system over a ten-year period and evaluated the appropriateness of lights and siren (L&S) response.</p><p><strong>Methods: </strong>This retrospective analysis included 9-1-1 responses to PERS activations by a single agency between January 1, 2013, and December 31, 2022. Descriptive statistics were used to summarize the chief complaint assigned by the emergency medical dispatcher (EMD), response mode, and transport mode. Logistic regression was used to assess the association between EMD-assigned final chief complaint and L&S patient transport. Duration of L&S response (minutes) was computed as the interval between time unit dispatched and either unit arrival (patient contact), or unit cancellation (no patient contact).</p><p><strong>Results: </strong>Activations related to PERS (n = 18,660) comprised 2.5% of all 9-1-1 calls involving adult patients. Lights and siren were used in 96% of PERS responses, and patient contact, patient transport, and L&S transport occurred in 36%, 25%, and 1.4%, respectively. Patients evaluated by EMS were most often female (72%) and ages 85+ (39%). Dispatcher modification of the chief complaint from PERS alarm to a more clinically specific complaint code was univariately associated with an increased odds of L&S transport (OR = 2.85, CI = 2.10-3.87). Between 2013 and 2022, responses to PERS activations accounted for 1,734 hours of L&S use, of which 1,087 hours (63%) were attributable to calls cancelled prior to patient contact.</p><p><strong>Conclusions: </strong>A significant proportion of PERS responses in this system are cancelled prior to patient contact or involve low acuity patients, and L&S patient transport is rare. Dispatcher determination of the specific nature of the problem increases the likelihood of the need for L&S transport after PERS activations. These findings provide a strong rationale for EMS systems transitioning away from the use of L&S response to PERS calls in the absence of definitive situational information.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-Rater Reliability and Acceptability of a Clinical Prediction Rule for Opioid-Associated Out-of-Hospital Cardiac Arrest.","authors":"David G Dillon, Colleen Kellison, Juan Carlos C Montoy, Joanna Sokol, Ralph C Wang, Robert M Rodriguez","doi":"10.1080/10903127.2025.2523986","DOIUrl":"10.1080/10903127.2025.2523986","url":null,"abstract":"<p><strong>Objectives: </strong>One-in-six cases of atraumatic out-of-hospital cardiac arrest (OHCA) in North America are thought to be precipitated by opioid overdose, but many of these cases are not obvious and there is no gold standard used by emergency medical service (EMS) personnel to identify opioid-associated (OA)-OHCA. The NAloxone Cardiac ARrest Decision Instrument (NACARDI) was developed and validated to identify potential OA-OHCA, however it has not yet been used in the field. We sought to prospectively assess the inter-rater reliability and acceptability of NACARDI in real-world OHCA.</p><p><strong>Methods: </strong>Emergency medical service clinicians evaluated the NACARDI criteria during acute resuscitations of patients with OHCA in San Francisco between September 2022-February 2024. The NACARDI rule utilized in this study consisted of two criteria: patient age <60 years and unwitnessed cardiac arrest. Clinicians completed a short survey that included free-text questions, multiple choice question, and Likert-type scales rating NACARDI's ease of use, describing when during the resuscitation they were able to assess NACARDI, and identifying potential barriers. In cases where two clinicians completed NARCADI assessments for a single OHCA case, we calculated a kappa coefficient of agreement.</p><p><strong>Results: </strong>Emergency medical service clinicians evaluated 149 cases of OHCA and completed 198 surveys - 100 (67.1%) cases had one survey response and 49 (32.9%) had survey responses from two EMS personnel. Clinicians were able to ascertain NACARDI criteria \"prior to or during the first cardiac rhythm check\" in 80.3% of cases. NACARDI was reported as \"easy to use\" by 83.3% of respondents. The overall Kappa coefficient for NACARDI was 0.73 (95%CI 0.51-0.95). The three most common reasons why NACARDI criteria were deemed difficult to ascertain were chaotic scene, language barrier, and unreliable bystander accounts.</p><p><strong>Conclusions: </strong>There was reasonable agreement in how NACARDI was interpreted for OHCA cases and the majority of surveyed EMS clinicians found NACARDI easy to use. These findings suggest that NACARDI can be reliably and easily used by EMS clinicians during acute OHCA resuscitations to identify OA-OHCA patients, potentially informing inclusion criteria for future research studies and guiding targeted interventions for this patient population.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with EMS Clinician Preparedness to Provide Care for Patients with Limited English Proficiency.","authors":"Esmeralda Melgoza, Andra Farcas, Jonathan R Powell, Christopher B Gage, Remle Crowe, Nichole Bosson, Anjni Joiner, Ameera Haamid, Shira Schlesinger, Ashish R Panchal","doi":"10.1080/10903127.2025.2524744","DOIUrl":"10.1080/10903127.2025.2524744","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians report challenges in providing care to patients with limited English proficiency (LEP); however, associated factors are not well defined. The objective of this study was to examine EMS clinicians' self-reported preparedness to provide emergency care to patients with LEP in the prehospital setting.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey between October 10 and December 3, 2024, to assess the education and training received by nationally certified EMS clinicians on providing care to patients with LEP. We analyzed the data using univariate and bivariate analyses, including Pearson's chi-square and analysis of variance tests. We used least absolute shrinkage and selection operator to identify key predictors and logistic regression models (Odds Ratio (OR), 95% Confidence Interval (CI)) to determine associations with preparedness.</p><p><strong>Results: </strong>Of the 986 EMS clinicians who responded to the survey, 58.3% reported providing care to one or more patients with LEP over the past month. Although provision of EMS care to patients with LEP was common, only 28.8% of clinicians reported receiving initial education on delivering care to patients with LEP and 29.5% reported additional education. Among respondents, 44.3% reported access to professional interpreter services. Of these, 64.9% reported that it was easy or very easy to access services, 88.0% reported that the services were effective or very effective, but 64.9% reported using interpreter services less than 25% of the time or never. Respondents with initial (OR 1.96, 95% CI (1.46-2.63)) or additional (OR 1.54, 95% CI (1.15-2.06)) education on the provision of care for patients with LEP reported feeling more prepared when delivering care to this population, compared to clinicians who did not receive education on this topic.</p><p><strong>Conclusions: </strong>Prehospital clinicians commonly provide care to patients with LEP; however, EMS education or training on delivering care to this population is uncommon and interpreter use is rare. Clinicians felt more prepared in delivering care when provided any LEP education. Future efforts in EMS should consider incorporating LEP-related content in initial and additional education efforts and create strategies to overcome the low use of professional interpreter services.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Implementing Evidence-Based Guidance for Fatigue Risk Mitigation in the Prehospital Setting.","authors":"P Daniel Patterson, Jennifer Brailsford, Jennifer Fishe, David G L Roach, Mark A Sheffield, Rachel A Lukacz, Richard N Thomas, Molly C Appio, Sarah E Martin, Christian Martin-Gill","doi":"10.1080/10903127.2025.2527365","DOIUrl":"10.1080/10903127.2025.2527365","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this research study was to capture knowledge and awareness, beliefs and behaviors related to, and perceived barriers to adopting, implementing, and maintaining evidence-based guidance as outlined in the 2018 emergency medical services (EMS) evidence-based guidelines (EBG) for fatigue risk management (FRM) and the American Academy of Sleep Medicine/Sleep Research Society's (AASM/SRS) Guiding Principles for determining shift duration.</p><p><strong>Methods: </strong>We used a mixed methods study design with in-depth interviews based on the Theoretical Domains Framework (TDF) for behavior change. Sampling was nationwide and stratified by rural/urban status with goal enrollment of 40 EMS agency administrators (employers) and 100 frontline EMS clinicians (employees). We used deductive coding to assign participant statements to established domains and constructs of the TDF.</p><p><strong>Results: </strong>Thirty-six employer and 100 employee in-depth interviews were completed. Most employers represented a fire-based or third-service agency (64%), employed all-paid personnel (58%), and provided mostly ground-based services (92%). Most employees were paramedic, firefighter-paramedic, or firefighter emergency medical technician (EMT) certified (85%) with 3.8 median years of experience (IQR 2, 7). Most employers (61%) and employees (85%) reported no awareness of the existence of EBGs focused on fatigue. Once informed of the guidance, most employers (78%) and most employees (65%) responded that they \"<i>very much want to</i>\" or \"<i>somewhat want to</i>\" adopt some or all the guidance and recommendations. Most employers (67%) and employees (61%) reported they \"<i>very much needed to</i>\" or \"<i>somewhat needed to</i>\" adopt and implement the existing guidance. Participants identified common barriers to adoption as: lack of awareness and knowledge, a perceived misalignment of some recommendations with expectations, fear of negative emotional reactions in response to changing shift schedules, costs associated with adoption, and fear of disrupting the status quo.</p><p><strong>Conclusions: </strong>While most EMS employers and employees reported the need to adopt EBGs for fatigue mitigation, barriers identified in this study impede adoption and implementation. Overcoming these impediments should include increasing awareness of fatigue EBGs and related guidance, however, increasing awareness alone may not result in a meaningful increase in adoption and implementation. Novel strategies targeting barriers identified in this study are needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}