Prehospital Emergency Care最新文献

{"title":"Implementation of a Child Maltreatment Screening Tool in the Prehospital Setting.","authors":"Makenzie Ferguson, Shelley Brukman, Kim Zaky, Bryan A Lara, Chloe Knudsen-Robbins, Carolina Amaya, Shelby K Shelton, Theodore Heyming","doi":"10.1080/10903127.2024.2440905","DOIUrl":"10.1080/10903127.2024.2440905","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847239","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":"Consensus Guideline for Care of Patients in the Prehospital and Aerospace Settings with Exposures to Hydrazine and Hydrazine Derivatives.","authors":"Joshua B Gaither, Robert French, Mary Knotts, Milton Lerman, Andrew J Harrell, Scott McIntosh, Amber D Rice, Richard Cole, Stevan Gilmore, Diane E Hindman, Christopher Edwards, HoanVu Ngoc Nguyen, Mark Truxillo, Jason West, Andy Yeoh, Todd Davis, Farshad Mazda Shirazi, Bryan Z Wilson, Jacob T Debevec, Michael Schertz, Frank G Walter","doi":"10.1080/10903127.2024.2442097","DOIUrl":"10.1080/10903127.2024.2442097","url":null,"abstract":"<p><strong>Objectives: </strong>Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time. Therefore, the aim of this project is to establish a consensus guideline for prehospital care of patients with exposures to HZ and HZ-Ds.</p><p><strong>Methods: </strong>A modified Delphi technique was used to develop clinical questions, obtain expert panel opinions, develop initial patient care recommendations, and revise the draft into a final consensus guideline. First, individuals (Emergency Medical Services (EMS) physicians and hazardous materials technicians) with experience in management of HZ and HZ-Ds identified relevant clinical questions. An expert panel was then convened to make clinical recommendations. In the first round, the panel voted on clinical care recommendations. These recommendations were drafted into a guideline that expert panel members reviewed. After review, additional unanswered questions were discussed electronically by expert panel members, and electronic votes were cast. Ultimately, patient care recommendations were condensed into a concise, consensus guideline.</p><p><strong>Results: </strong>Eight clinical questions regarding treatment of patients with HZ and HZ-D exposures were identified. These questions were reviewed by the expert panel which included 2 representatives from: aerospace medicine, military medicine, EMS medicine, paramedicine, pharmacy, and toxicology. Draft patient care recommendations generated three additional questions which were discussed electronically and voted on. These recommendations were then formatted into a guideline outlining recommendations for care prior to decontamination, during decontamination, and after decontamination.</p><p><strong>Conclusions: </strong>The consensus guideline for clinical care of patients with exposure to HZ/HZ-Ds is as follows: Prior to decontamination, use appropriate personal protective equipment, and when necessary, support ventilation using a bag-valve-mask and administer midazolam intramuscularly for seizures. After decontamination, provide supplemental oxygen; consider selective advanced airway management when indicated; administer inhaled beta-agonists for wheezing; and, for seizures unresponsive to multiple doses of benzodiazepines that occur during pre-planned, high-hazard activities, such as spacecraft recovery, consider intravenous or intraosseous pyridoxine.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822661","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":"Challenges and Perceived Impacts of Ambulance Diversions During Emergency Department Overcrowding: A Multi-Stakeholder Study.","authors":"Kailing Adriel Rao, Erin Y Q Wee, Anna Oh, Desmond Mao Ren Hao, Nausheen Doctor, Marcus E H Ong, Sungwon Yoon","doi":"10.1080/10903127.2024.2434615","DOIUrl":"10.1080/10903127.2024.2434615","url":null,"abstract":"<p><strong>Objectives: </strong>Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with key stakeholders including physicians, nurses and paramedics across two EDs and four fire stations. All interviews were audio-recorded following consent and transcribed verbatim. The transcripts were subjected to thematic analysis to identify key themes and sub-themes. Coding discrepancies were resolved through iterative discussions until no new themes were identified.</p><p><strong>Results: </strong>A total of 33 stakeholders were interviewed. The primary reasons for ambulance diversions were perceived to be resource constraints in EDs, overcrowding and bed block situations. Challenges during diversions included communication breakdowns, operational delays, lack of clarity in diversion criteria and emotional stress for both Emergency Medical Services (EMS) and hospital staff. Participants felt diversions impacted patient safety, staff morale, system efficiency and could generate inter-institutional conflict. Suggestions on improvements focused on use of alternative care pathways, improving hospital's flow issues, better information sharing, and optimizing the diversion process through strategizing the timing and duration of diversions. Reworking the hierarchical approach of dissemination of information to ground staff was also suggested.</p><p><strong>Conclusions: </strong>This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negative impacts on receiving hospitals and EMS operations. Our findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771470","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 Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model.","authors":"Adam L Gottula, Man Qi, Bennett H Lane, Christopher R Shaw, Kari Gorder, Elizabeth Powell, Kyle Danielson, Anna Ciullo, Nicholas J Johnson, Joseph E Tonna, William R Hinckley, Amy Koshoffer, Rabab Al-Araji, Jason Bartos, Justin Benoit, Cindy H Hsu","doi":"10.1080/10903127.2024.2355652","DOIUrl":"10.1080/10903127.2024.2355652","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence suggests that Extracorporeal Cardiopulmonary Resuscitation (ECPR) can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, when ECPR is indicated over 50% of potential candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the United States in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR Helicopter Emergency Medical Services (HEMS)-based system.</p><p><strong>Methods: </strong>We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. Emergency Medical Services (EMS) response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial. The combined model was used to estimate the total ECPR eligibility in each system.</p><p><strong>Results: </strong>The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical criteria, 24,661 (3.4%) ECPR-indicated OHCA were identified. When considering overall ECPR eligibility within 45 min from OHCA to initiation, only 11.76% of OHCA where ECPR was indicated were eligible in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%).</p><p><strong>Conclusions: </strong>The study demonstrates a two-fold increase in ECPR eligibility for a prehospital ECPR ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based ECPR system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"53-61"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917014","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":"Development of a Computable Phenotype for Prehospital Pediatric Asthma Encounters.","authors":"Ira Harmon, Jennifer Brailsford, Isabel Sanchez-Cano, Jennifer Fishe","doi":"10.1080/10903127.2024.2352583","DOIUrl":"10.1080/10903127.2024.2352583","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma exacerbations are a common cause of pediatric Emergency Medical Services (EMS) encounters. Accordingly, prehospital management of pediatric asthma exacerbations has been designated an EMS research priority. However, accurate identification of pediatric asthma exacerbations from the prehospital record is nuanced and difficult due to the heterogeneity of asthma symptoms, especially in children. Therefore, this study's objective was to develop a prehospital-specific pediatric asthma computable phenotype (CP) that could accurately identify prehospital encounters for pediatric asthma exacerbations.</p><p><strong>Methods: </strong>This is a retrospective observational study of patient encounters for ages 2-18 years from the ESO Data Collaborative between 2018 and 2021. We modified two existing rule-based pediatric asthma CPs and created three new CPs (one rule-based and two machine learning-based). Two pediatric emergency medicine physicians independently reviewed encounters to assign labels of asthma exacerbation or not. Taking that labeled encounter data, a 50/50 train/test split was used to create training and test sets from the labeled data. A 90/10 split was used to create a small validation set from the training set. We used specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and macro F₁ to compare performance across all CP models.</p><p><strong>Results: </strong>After applying the inclusion and exclusion criteria, 24,283 patient encounters remained. The machine-learning models exhibited the best performance for the identification of pediatric asthma exacerbations. A multi-layer perceptron-based model had the best performance in all metrics, with an F₁ score of 0.95, specificity of 1.00, sensitivity of 0.91, negative predictive value of 0.98, and positive predictive value of 1.00.</p><p><strong>Conclusion: </strong>We modified existing and developed new pediatric asthma CPs to retrospectively identify prehospital pediatric asthma exacerbation encounters. We found that machine learning-based models greatly outperformed rule-based models. Given the high performance of the machine-learning models, the development and application of machine learning-based CPs for other conditions and diseases could help accelerate EMS research and ultimately enhance clinical care by accurately identifying patients with conditions of interest.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"10-21"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877073","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":"Feasibility and Safety of Oral Risperidone to Treat Prehospital Agitation.","authors":"Nicholas S Simpson, Alexander M Schin, Michael C Perlmutter, Alec J Bunting, Gregg A Jones, Holly M Drone, Florian Merkle, Timothy M Kummer, Brian E Driver, Jon B Cole, Aaron E Robinson","doi":"10.1080/10903127.2024.2361133","DOIUrl":"10.1080/10903127.2024.2361133","url":null,"abstract":"<p><strong>Objective: </strong>Agitation is a common prehospital problem and frequently presents without a clear etiology. Given the dynamic environment of the prehospital setting, there has historically been a varied approach to treating agitation with a heavy reliance on parenteral medications. Newer best practice guidelines recommend the incorporation of oral medications to treat patients experiencing agitation. Therefore, we evaluated the use of oral risperidone in a single system after a change in protocol occurred.</p><p><strong>Methods: </strong>This was conducted as a retrospective chart review of an urban/suburban Emergency Medical Services system over the period of 8 months. The first day this medication was implemented throughout the service was included. Charts were included for selection if they included risperidone oral dissolving tablet (ODT) as a charted medication. The primary outcome was administration of additional medications to treat agitation. Exploratory outcome measures included acceptance of medication, documented injury to paramedics, documented injuries to patients, scene times, and adverse events that could possibly be linked to the medication.</p><p><strong>Results: </strong>A total of 552 records were screened for inclusion. Risperidone was offered to 530 patients and accepted by 512 (96.6%). Of these 512 patients, the median age of included patients was 39 years old (IQR 29-52 years old) with a range of 18-89 years old. Rescue or additional medications for agitation were required in 9 (1.8%) cases. There were a total of 4 (0.8%) potential complications following administration of risperidone. There were no reported assaults with subsequent injuries to prehospital personnel or injuries sustained by patients reported in this study.</p><p><strong>Conclusions: </strong>Risperidone ODT was found to be a safe and effective medication to treat mild agitation in a large urban and suburban EMS system. The need for additional medications to treat agitation was rare, and there were no documented injuries to either patients or paramedics.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"182-187"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161534","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":"Mapping Prehospital Clinician Impression to Hospital-Based Diagnoses in Children Transported to the Hospital by Emergency Medical Services.","authors":"Tara Funk Corcoran, Remle Crowe, Christian Martin-Gill, Sriram Ramgopal","doi":"10.1080/10903127.2024.2370511","DOIUrl":"10.1080/10903127.2024.2370511","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) serves a critical role in the delivery of services to children with out-of-hospital emergencies. The EMS clinicians' initial field diagnoses, termed \"impressions,\" facilitate focused patient assessments, guide the application of prehospital treatment protocols, and help determine transport destination. We sought to evaluate the concordance of the EMS clinician impression to a child's hospital-based diagnosis.</p><p><strong>Methods: </strong>We retrospectively studied de-identified pediatric (<18 years old) scene runs transported to the hospital and with available linked hospital data from the 2021 ESO Data Collaborative, a multi-agency prehospital electronic health record dataset. EMS impressions and primary emergency department or admission-based diagnoses were categorized into one of twenty-one major groups in the Diagnosis Grouping System. We identified the most common hospital-based discharge diagnoses and evaluated for the agreement between EMS impression and hospital-based diagnosis using Cohen's Kappa statistic.</p><p><strong>Results: </strong>We included 35,833 pediatric transports from the scene with linked prehospital and in-hospital data (median age 11 years, interquartile range, 3-15 years; 50.9% male). The most common categories for both EMS impressions and hospital-based diagnoses were as follows respectively: trauma (26.1%; 24.6%), neurologic diseases (18.9%; 16.4%), psychiatric and behavioral diseases and substance use disorder (11.8%; 11.6%), and respiratory diseases (11.1% and 9.5%). A total of 23,224 out of 35,833 patients, or 64.8%, had concordant EMS impressions and hospital-based diagnoses. There was high agreement between common EMS impression and in-hospital diagnoses (trauma 77.3%; neurologic diseases 70.3%; respiratory diseases 64.5%; and psychiatric, behavioral disease and substance use disorder 73.9%). Hospital-based diagnoses demonstrated moderate concordance with prehospital data (Cohen's κ = 0.59).</p><p><strong>Conclusions: </strong>We found moderate concordance between EMS primary impression and hospital diagnoses. The EMS encounter is brief and without capabilities of advanced testing, but initial impressions may influence the basis of the triage assignment and interventions during the hospital-based encounter. By evaluating EMS impressions and ultimate hospital diagnoses, pediatric protocols may be streamlined, and specific training emphasized in pursuit of improving patient outcomes. Future work is needed to examine instances of discordance and evaluate the impact on patient care and outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"22-29"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446853","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":"Development and Deployment of a Pre-Planned Hospital Emergency Response Team (HERT) for EMS Augmentation: Case Report and Program Review.","authors":"Marc Cohen, Ryan DeVivo, Marianne Gausche-Hill, Shira A Schlesinger","doi":"10.1080/10903127.2024.2365333","DOIUrl":"10.1080/10903127.2024.2365333","url":null,"abstract":"<p><p>With the establishment and growth of the Emergency Medical Services (EMS) subspecialty, significant attention has been focused on clinical activities performed by EMS physicians in the out-of-hospital environment. An EMS fellowship includes special operations education to develop preparedness for responding to field situations requiring physician expertise. With only a thousand Board Certified EMS physicians in North America, EMS physicians may not be available 24 h per day to respond to field emergencies. Non-EMS physicians with minimal experience in prehospital or austere care may be called upon to respond to complex prehospital emergencies requiring advanced skills. The Los Angeles County EMS Agency implemented a policy in 1992 to establish Hospital Emergency Response Teams (HERT) as a regional resource to provide time-critical, specialized prehospital services within an EMS system. Activation of the HERT is rare, most frequently prompted by need for field amputation to enable extrication. We describe one such incident of a field intervention by HERT and detail the staffing, training, and equipment considerations within our large regional EMS system.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"194-201"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262536","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":"State-Based Evaluation of the Workforce Pipeline from Paramedic Program Enrollment to Agency Affiliation.","authors":"Jonathan R Powell, Shea L van den Bergh, Adrienne Kramer, Christopher B Gage, Adam Harrell, Deborah T Akers, Ashish R Panchal","doi":"10.1080/10903127.2024.2371945","DOIUrl":"10.1080/10903127.2024.2371945","url":null,"abstract":"<p><strong>Objectives: </strong>The strength and stability of the paramedic workforce is dependent on the continual flow of EMS clinicians into the field. Workforce entry requires three distinct steps: program completion, certification attainment, and affiliation with an EMS agency. At each of these steps, future EMS clinicians may be lost to the workforce but the contribution of each is unknown. Our objective was to evaluate these inflection points using a state-based registry of EMS clinicians from their point of entry into the EMS education system to eventual EMS agency affiliation.</p><p><strong>Methods: </strong>This is a retrospective cohort evaluation of paramedic students in the Commonwealth of Virginia. We included any student who enrolled in a paramedic program in 2017 or 2018. Data were provided by the Virginia Office of Emergency Medical Services, who tracks the development of EMS clinicians from the point of entry into an educational program through their affiliation with an EMS agency upon employment. Our primary outcomes include proportions of enrolled students who complete a program, graduating students who attain national/state certification, and nationally certified EMS clinicians who affiliate with an EMS agency. Proportions were calculated at each step and compared to the overall population of students enrolled.</p><p><strong>Results: </strong>In 2017 and 2018, 775 and 603 students were enrolled in paramedic programs, respectively. Approximately a quarter of students did not complete their paramedic program (2017: 25% [192/775]; 2018: 28% [170/603]). Of those who graduated, the proportion of students not gaining certification was lower (2017: 11% [62/583]; 2018: 17% [75/433]). Of those who certified, those not affiliating was similarly low (2017: 15% [77/521]; 2018: 13% [46/358]). Evaluating the effect of each of these steps on the total entry into the workforce, nearly half of those who originally enrolled did not join the workforce through agency affiliation (2017: 43% [331/775]; 2018: 48% [291/603]).</p><p><strong>Conclusions: </strong>There are multiple areas to enhance retention of potential EMS trainees from program enrollment to EMS agency affiliation. This analysis suggests that educational attrition has a larger impact on the availability of new paramedics than certification examinations or agency affiliation decisions, though is limited to a singular state evaluation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"115-119"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493051","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":"Impact of Workplace Violence Against Emergency Medical Services (EMS).","authors":"Sarayna S McGuire, Michelle A Lampman, Olivia A Smith, Casey M Clements","doi":"10.1080/10903127.2024.2381218","DOIUrl":"10.1080/10903127.2024.2381218","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this study were to: (1) understand the personal impact of workplace violence (WPV) on staff within a large multistate emergency medical services (EMS) agency, (2) describe the impact of WPV on subsequent patient interactions, examining how experiences of violence affect the quality of care provided by EMS clinicians, (3) examine the influence of WPV on perceived workplace safety among prehospital personnel and its correlation with retention in the EMS field, and (4) solicit recommendations from staff for the prevention and mitigation of WPV in the future.</p><p><strong>Methods: </strong>We conducted virtual focus groups and individual interviews with 22 prehospital personnel using a descriptive qualitative design within a large multistate Midwest EMS agency between 4/5/2023-6/20/2023. Data were analyzed using Thematic Analysis to identify common perceptions among and across participants.</p><p><strong>Results: </strong>Major themes of personal impact; impact on patient interactions; influence of WPV on career longevity/sustainability; and relationship between EMS culture and WPV were identified. Overall, participants shared the perception that WPV is \"part of the job\", and that verbal abuse was so common that they hadn't previously considered it as violence. Participants provided several examples of WPV and described how these experiences impacted them personally (e.g., hypervigilance) and impacted their subsequent interaction with patients (e.g., quicker to use restraints, loss of empathy). Participants shared the perception that EMS is no longer valued or respected by patients or communities. Several voiced concerns for the next generation of colleagues and nearly all participants reported the need for education and training in situational awareness, de-escalation, and self-defense tactics. Participants referenced desire for more coordination and communication with law enforcement, change in culture of abuse from patients without repercussions, and improved agency mental health support and peer support/mentoring following a violent event. Despite experiences with WPV, the majority reported plans to remain in EMS.</p><p><strong>Conclusions: </strong>Emergency Medical Services personnel are commonly traumatized by violence in their work and nonphysical violence is underappreciated. Despite its impact on staff and subsequent patient interactions, most participants reported plans to remain within EMS. Multi-faceted system-focused efforts are needed to shift toward and support a zero-tolerance culture for WPV.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"129-137"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752479","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}