Prehospital Emergency Care最新文献

{"title":"Alfentanil for Pain Relief in a Swedish Emergency Medical Service - An Eleven-Year Follow-up on Safety and Effect.","authors":"Pär Wennberg, Amir Pakpour, Anders Broström, Kåre Karlsson, Carl Magnusson","doi":"10.1080/10903127.2024.2363509","DOIUrl":"10.1080/10903127.2024.2363509","url":null,"abstract":"<p><strong>Objectives: </strong>Pain is a common symptom in prehospital emergency care and pain treatment in this context can be challenging. While previous research has assessed the use of morphine and other synthetic opioids for pain management in this setting, the evaluation of alfentanil is limited. The objective of this study was to evaluate the safety and effect of intravenous alfentanil when administered by ambulance nurses in prehospital emergency care.</p><p><strong>Methods: </strong>This retrospective observational study consecutively included patients suffering from pain, treated with alfentanil in a Swedish EMS service from September 2011 to 31 September 2022. Data regarding occurrence of adverse events (AE), serious adverse events (SAE) - were used for safety evaluation and pain scores with a visual analogue scale (VAS) before and after treatment were used for evaluation of pain treatment. These data were extracted from the electronic patients' medical records database for analysis. Univariate logistic regression analysis was used to identify significant predictors of AE following injection of alfentanil by nurses in prehospital emergency care.</p><p><strong>Results: </strong>During the evaluation period 17,796 patients received pain relief with alfentanil. Adverse events affected 2.5% of the patients, while serious adverse events were identified in 25 cases (0.01%). Out of the 5970 patients with a complete VAS score for pain, the median VAS score was 8 (IQR 3) before treatment and 4 (IQR 3) after treatment. The mean reduction in pain measured by VAS was -4.1 ± 2.6 from the time before, to the evaluation after alfentanil administration. The administration frequency increased during the first year up to a steady level during the later part of the evaluation period.</p><p><strong>Conclusions: </strong>This study proposes that alfentanil represents a safe and efficacious alternative for addressing urgent pain relief within the prehospital emergency context. Alfentanil demonstrates efficacy in alleviating pain across various conditions, with a relatively low risk of adverse events or serious adverse events when administered cautiously.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"188-193"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238039","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":"Assessing Efficiency in a Static-Based 9-1-1 Ambulance Service: An Analysis of Operational Performance Metrics.","authors":"Luke E Kayser, Devin E Spolsdoff, J Priyanka Vakkalanka, Talon J Hoefer, Curtis A Walker, Peter K Georgakakos","doi":"10.1080/10903127.2024.2360672","DOIUrl":"10.1080/10903127.2024.2360672","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to evaluate performance indicators to assist a static-based 9-1-1 agency in defining its response efficiency.</p><p><strong>Methods: </strong>Initial assessment of three metrics-unit hour utilization (UHU), fractile response intervals, and level 0 frequency (occurrence when no ambulances are available to respond)-suggested the agency's response over its four coverage zones was inefficient, so an operational change was implemented: an ambulance was relocated from one service area to another to improve the overall response productivity. A 2-year retrospective analysis was performed to determine the impact ambulance relocation had on the three targeted measurements.</p><p><strong>Results: </strong>The operational change resulted in a statistically significant change in unit hour utilization, a non-significant increase in fractile response intervals, and a statistically significant reduction in level 0 frequency from pre- to post-operational change times.</p><p><strong>Conclusions: </strong>These findings suggest a way to evaluate the efficiency of static-based ambulance deployment and potentially identify strategies for redeployment.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"177-181"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141161390","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":"A Guided Comparative Analysis of Fatigue Frameworks in Australasian Ambulance Services.","authors":"Matthew J Ferris, Alexander P Wolkow, Kelly-Ann Bowles, Aislinn Lalor","doi":"10.1080/10903127.2024.2381055","DOIUrl":"10.1080/10903127.2024.2381055","url":null,"abstract":"<p><strong>Objective: </strong>Paramedics work in a complex, unpredictable environment, subject to many external stressors including critically unwell patients, dangerous driving conditions, and prolonged shift work. Paramedic fatigue from these and other occupational demands is well documented. Ambulance services attempt to safeguard paramedics from fatigue using internal policies or procedures - a type of Fatigue Risk Management Systems (FRMSs). This study reviews ambulance service fatigue frameworks to understand the current situation in fatigue management in paramedicine, and to identify fatigue monitoring tools, strategies, and other components of these frameworks that are designed to protect personnel.</p><p><strong>Methods: </strong>This study involved a qualitative document thematic content analysis. All eleven statutory ambulance services across Australia, New Zealand, and Papua New Guinea, represented by the Council of Ambulance Authorities, were contacted and invited to participate. Fatigue frameworks were collated and entered into NVivo where data extraction occurred through three a priori areas (fatigue, fatigue mitigation tools & fatigue management).</p><p><strong>Results: </strong>Nine of the eleven ambulance services provided fatigue documentation, with one declining to participate, and one did not respond to invitations. Through thematic analysis and abstraction, seven themes were identified: fatigue definition, consequences of fatigue, sources of fatigue, signs and symptoms of fatigue, fatigue-related incidents, fatigue monitoring tools, and fatigue mitigation. There was also poor alignment between provided frameworks and established FRMSs components.</p><p><strong>Conclusion: </strong>Our findings provide an initial insight into existing ambulance service fatigue frameworks across Australia, New Zealand, and Papua New Guinea. The many inconsistencies in frameworks between ambulance services highlight an opportunity to develop a more consistent, collaborative approach that follows evidence-based FRMSs guidelines.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"120-128"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760504","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":"Drone-Facilitated Real-Time Video-Guided Feedback Helps to Improve the Quality of Lay Bystander Basic Life Support. A Randomized Controlled Simulation Trial.","authors":"Calvin Lukas Kienbacher, Wolfgang Schreiber, Harald Herkner, Christoph Holzhacker, Christof C Chwojka, Katharina Tscherny, Alexander Egger, Verena Fuhrmann, Maximilian Niederer, Marco Neymayer, Larissa Bernert, Alexandra Gamsjäger, Isabella Grünbeck, Marietta B Heitger, Line Saleh, Sophie Schmidt, Stephanie Schönecker, Dilara Wirth, Kenneth A Williams, Dominik Roth","doi":"10.1080/10903127.2024.2351970","DOIUrl":"10.1080/10903127.2024.2351970","url":null,"abstract":"<p><strong>Objectives: </strong>Telephone instructions are commonly used to improve cardiopulmonary resuscitation (CPR) by lay bystanders. This usually implies an audio but no visual connection between the provider and the emergency medical telecommunicator. We aimed to investigate whether video-guided feedback via a camera drone enhances the quality of CPR.</p><p><strong>Methods: </strong>We conducted a randomized controlled simulation trial. Lay rescuers performed 8 min of CPR on an objective feedback manikin. Participants were randomized to receive telephone instructions with (intervention group) or without (control group) a drone providing a visual connection with the telecommunicator after a 2-min run-in phase. Performed work (total compression depth minus total lean depth) was the primary outcome. Secondary outcomes were the proportion of effective chest compressions, average compression depth, subjective physical strain measured every 2 min, and dexterity in the nine-hole peg test after the scenario. Outcomes were compared using the <i>t</i>- and Mann Whitney-<i>U</i> tests. A two-sided <i>p</i>-value of <0.05 was considered significant.</p><p><strong>Results: </strong>We included 27 individuals (14 (52%) female, mean age 41 ± 14 years). Performed work was greater in the intervention than in the control group (41.3 ± 7.0 vs. 33.9 ± 10.9 m; absolute difference 7.5, 95% CI 1.4 to 14.8; <i>p</i> = 0.046), with higher average compression depth (49 ± 7 vs. 40 ± 13 mm; <i>p</i> = 0.041), and higher proportions of adequate chest compressions (43 (IQR 14-60) vs. 3 (0-29) %; <i>p</i> = 0.041). We did not find any significant differences regarding the remaining secondary outcomes.</p><p><strong>Conclusion: </strong>Video-guided feedback via drones might be a helpful tool to enhance the quality of telephone-assisted CPR in lay bystanders.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"46-52"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081033","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 Treatment of Atrial Fibrillation: Infusion Pump for Bolus and Infusion?","authors":"Michael Berkenbush, Nicholas Sherman, Nikhil Jain, Peter Cosmi","doi":"10.1080/10903127.2024.2349745","DOIUrl":"10.1080/10903127.2024.2349745","url":null,"abstract":"<p><strong>Objective: </strong>The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED.</p><p><strong>Methods: </strong>We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally.</p><p><strong>Results: </strong>The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, <i>p</i> = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, <i>p</i> = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, <i>p</i> = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"85-88"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860522","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":"Geospatial Analysis for Prehospital Extracorporeal Cardiopulmonary Resuscitation in Houston, Texas.","authors":"Ryan Huebinger, Jocelyn V Hunyadi, Kehe Zhang, Aditya C Shekhar, Cici X Bauer, Carrie Bakunas, John Waller-Delarosa, Kevin Schulz, David Persse, Richard Witkov","doi":"10.1080/10903127.2024.2386000","DOIUrl":"10.1080/10903127.2024.2386000","url":null,"abstract":"<p><strong>Objectives: </strong>Extracorporeal cardiopulmonary resuscitation (eCPR) is a promising treatment that could improve survival for refractory out-of-hospital (OHCA) patients. Healthcare systems may choose to start eCPR in the prehospital setting to optimize time to eCPR initiation and decrease low-flow time. We used geospatial modeling to evaluate different eCPR catchment strategies for a forthcoming prehospital eCPR program in Houston, Texas.</p><p><strong>Methods: </strong>We studied OHCAs treated by the Houston Fire Department from 2013 to 2021. We included OHCA patients aged 18-65 years old with an initial shockable rhythm that did not have prehospital return of spontaneous circulation (ROSC). Based on the geolocation that each OHCA occurred, we used geospatial modeling to identify eCPR candidates using four mapping strategies based on distance/drive time from the eCPR center: 1) 15-minute drive time, 20-minute drive time, 10-mile drive distance, and 15-mile drive distance.</p><p><strong>Results: </strong>Of 18,501 OHCAs during the study period, 881 met the eCPR inclusion criteria. Compared to non-eCPR candidates, eCPR candidates were younger (median age 52.3 years vs 62.7 years, <i>p</i> < 0.01) and had a higher proportion of males (76.6% v 59.8%, <i>p</i> < 0.01). Of eCPR candidate OHCAs, OHCAs occurred more frequently during the weekdays and the daytime, with 5:00 PM being the most common time. Using geospatial modeling and based on drive time, 219 OHCAs (24.9% of 881) were within a 15-minute drive, and 454 (51.5%) were within a 20-minute drive. Using drive distance, 383 eCPR candidates (43.5%) were within 10 miles, and 703 (79.8%) were within 15 miles.</p><p><strong>Conclusions: </strong>Using geospatial modeling, we demonstrated a process to estimate potential eCPR patient volumes for a geographic region. Geospatial modeling represents a viable strategy for healthcare systems to delineate eCPR catchment areas.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"146-153"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081285","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":"Factors Influencing Analgesic Use During Transport of Intubated Pediatric Patients.","authors":"Alexandre Deragon, Grant Scollay, Nick Barrowman, Lamia Hayawi, Russell MacDonald, Candice McGahern, Maala Bhatt, Fuad Alnaji","doi":"10.1080/10903127.2024.2437813","DOIUrl":"10.1080/10903127.2024.2437813","url":null,"abstract":"<p><strong>Objectives: </strong>Critically ill children undergo painful procedures during resuscitation and stabilization before and during interfacility transport. The literature supporting pain management in this unique environment focuses predominantly on isolated traumatic injuries. Timely administration of analgesia can improve patient well-being by attenuating stress responses and reducing severe adverse events. To determine the prevalence of analgesia administration among pediatric patients undergoing mechanical ventilation during transport and to identify associated factors.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using electronic patient records from a large critical care transport system in North America, between 2014 and 2018. We included sequential pediatric patients who were intubated and mechanically ventilated. We examined analgesia administration (with opioids or ketamine) administered by paramedics. Adverse events were examined in relation to analgesia administration. Multivariable logistic regression identified factors associated with in-transport analgesia administration.</p><p><strong>Results: </strong>Of 903 patients (median age 9.1 years), 770 (85.3%) received analgesia during transport, with 83.3% receiving opioids or ketamine. Patients without opiate or ketamine analgesia during transport experienced higher rates of hypotension (38.4% vs. 26.9%) and hypoxemia (29.1% vs. 22.1%). Factors significantly associated with opiate or ketamine use included the reason for transport, transport duration, paralytic use, and pre-transport opiate or ketamine administration. Patients with comorbidities were less likely to receive analgesia during transport.</p><p><strong>Conclusions: </strong>This study's findings highlight the need for improved pain evaluation in caring for mechanically ventilated pediatric patients during transport. Factors such as transport, duration, the reason for transport, pre-transport opiate or ketamine administration, and paralytics increase the likelihood of analgesia administration. At the same time, the presence of comorbidities decreases the likelihood. The study underscores the importance of improved documentation of pain to inform analgesic choices and administration with the ultimate goal of reducing adverse events.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771629","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 Trauma Compendium: Vasopressors in Trauma - a Position Statement and Resource Document of NAEMSP.","authors":"Ross E Orpet, Whitney J Barrett, Kevin A Kaucher, Christopher B Colwell, John W Lyng","doi":"10.1080/10903127.2024.2437656","DOIUrl":"https://doi.org/10.1080/10903127.2024.2437656","url":null,"abstract":"<p><p>Acutely injured trauma patients may develop shock from several potential mechanisms, including hypovolemic shock from hemorrhage, neurogenic shock from traumatic brain injury (TBI) or spinal cord injury, obstructive shock from tension pneumothorax or pericardial tamponade, or a mix of several of these mechanisms. Regardless of the cause, restoration of adequate perfusion is of critical importance to reduce the morbidity and mortality of trauma patients with shock. Multiple interventions including hemorrhage control, volume resuscitation with intravenous fluids or blood products, and pleural decompression procedures are used to address some of these issues and are discussed elsewhere in the trauma compendium. The prehospital use of vasopressors to augment organ perfusion pressures seems theoretically appealing for settings where trauma patients have hemorrhagic shock that is refractory to volume resuscitation strategies alone, where blood products are not available, in cases of hypoperfusion caused by neurogenic shock, or to address mean arterial pressure (MAP) goals in severe spinal cord injury. The National Association of Emergency Medical Services Physicians (NAEMSP) reviewed the available evidence surrounding the prehospital use of vasopressors in shock related to trauma to develop the following recommendations as supported by the evidence summarized in the subsequent resource document.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855118","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":"A Prehospital Quality Improvement Framework to Reduce Mortality and Other Harms Associated with Opioid Use Disorder.","authors":"Melody Glenn, Remle Crowe, Maia Dorsett, Mike Taigman, Andrew A Herring, Mary Mercer, Anjni Joiner, Arjun Venkatesh, Corey Davis, Kathryn Hawk, H Gene Hern, Gerard Carroll, José G Cabañas, Gail D'Onofrio, Elizabeth A Samuels","doi":"10.1080/10903127.2024.2428671","DOIUrl":"10.1080/10903127.2024.2428671","url":null,"abstract":"<p><strong>Objectives: </strong>In response to the escalating overdose crisis there is an urgent need for innovative strategies to reduce overdose death. Emergency Medical Services (EMS) is uniquely poised to reduce mortality and other harms associated with opioid use through prevention, harm reduction, and treatment, yet there is a paucity of nationally recognized best practices or quality measures to guide prehospital quality improvement (QI) efforts related to opioid use disorder (OUD).</p><p><strong>Methods: </strong>A multidisciplinary team of subject matter experts in addiction medicine, EMS, public health, and QI was convened to develop recommendations for a model QI framework for prehospital OUD prevention, harm reduction, and treatment based on the Model for Improvement framework.</p><p><strong>Results: </strong>This article introduces a comprehensive EMS QI framework, aimed at not only addressing acute opioid-related emergencies but also fostering long-term strategies to mitigate mortality and other adverse outcomes among individuals with OUD.</p><p><strong>Conclusions: </strong>Grounded in evidence-based practices and informed by collaborative expertise, this framework represents a pivotal step toward enhancing the effectiveness and responsiveness of EMS in combating the multifaceted challenges posed by OUD.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822639","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":"Factors Associated With Emergency Medical Clinicians Leaving EMS.","authors":"Christopher B Gage, Christine B Cooke, Jonathan R Powell, Jacob C Kamholz, Jordan D Kurth, Shea van den Bergh, Ashish R Panchal","doi":"10.1080/10903127.2024.2436047","DOIUrl":"10.1080/10903127.2024.2436047","url":null,"abstract":"<p><strong>Objectives: </strong>Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics' likelihood of leaving EMS.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of nationally registered civilian EMTs and paramedics ages 18-85 from October 2021 to April 2022. After recertifying their National EMS certification, respondents were invited to complete a survey regarding their primary role, additional jobs, and the likelihood of leaving EMS in the next 12 months. If likely to leave, reasons for leaving were collected and evaluated for the top reasons. Multivariable logistic regression modeling (OR, 95% CI) was used to describe the odds of being likely to leave in 12 months, adjusted for age, agency type, education level, primary role, and job satisfaction.</p><p><strong>Results: </strong>A total of 29,671 (response rate-25.9%) EMTs and paramedics were included in the analysis, with 7.1% and 7.9%, respectively, reporting they were likely to leave EMS in 12 months. The EMTs likely to leave were younger (median age 32 vs. 37) and had fewer years with main EMS job (median 3 vs. 4) than paramedics. A lower proportion of EMTs were male (68.8% vs. 78.6%) and non-Hispanic White (79.8% vs. 87.6%). The EMTs were less likely full-time (65.6% vs. 87.5%) and held fewer EMS jobs (23.4% vs. 32.3%). The EMTs and paramedics reported stress as the most significant reason for leaving (27.9% and 38.8%, respectively), followed by COVID-19 (12.9% and 19.3%) and education (18.3% and 6.4%). Those dissatisfied had significantly higher odds of leaving (11.91 and 13.46, respectively). The EMTs and paramedics in hospitals (OR = 2.32, OR = 2.37), private (OR = 2.72, OR = 2.38), and government non-fire (OR = 2.22, OR = 1.98) agencies were likelier to leave than fire agencies.</p><p><strong>Conclusion: </strong>Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771626","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}