Australian Journal of Paramedicine最新文献

{"title":"Soiled Airway Tracheal Intubation and the Effectiveness of Decontamination by United Kingdom Paramedics (Satiated2): A Randomised Controlled Manikin Study","authors":"G. McClelland, R. Pilbery, S. Hepburn","doi":"10.33151/ajp.17.783","DOIUrl":"https://doi.org/10.33151/ajp.17.783","url":null,"abstract":"Introduction Vomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed to help clinicians manage soiled airways. SATIATED2 reports the impact of SALAD training in North East Ambulance Service (NEAS) in the United Kingdom following the original SATIATED study in the Yorkshire Ambulance Service. The primary research question was: Among NEAS paramedics, does the addition of SALAD training, compared to standard training, improve the success rate of intubation for the soiled airway? Methods A randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting. The intervention comprised SALAD training and the introduction of the DuCanto catheter. Paramedic volunteers were block randomised into two groups: A01A02B01 who made two pre-training intubation attempts and one post-training attempt, and A11B11B12, who made one pre-training and two post-training attempts. The primary outcome was intubation success rate at the second attempt. The time taken to intubate was recorded as a secondary outcome. SATIATED2 was registered with ISRCTN (ISRCTN17329526) and funded internally with commercial support from SSCOR who supplied the DuCanto catheters. Results One-hundred and two paramedics (51 AAB, 51 ABB) were recruited between August and December 2019 with 99 participating (50 AAB, 49 ABB). The primary outcome was intubation success rate on the second attempt (A02 vs. B11) which were 86% without SALAD and 96% with SALAD; a non-significant improvement of 10% (95% CI: 1–21, p=0.09). The total intubation success rate pre-training (A01+A02+A11) was 75% (112/149) compared with 98% (145/148) post-training (B01+B11+B12). Conclusion NEAS paramedics demonstrated improved, but non-significant, intubation success rates in a simulated soiled airway following SALAD training.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123517695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Call-Taker Assessment of Patient Level of Consciousness: A Systematic Review","authors":"Jason Belcher, J. Finn, A. Whiteside, S. Ball","doi":"10.33151/ajp.17.741","DOIUrl":"https://doi.org/10.33151/ajp.17.741","url":null,"abstract":"Introduction When triaging an emergency phone call for ambulance assistance, one of the key areas of questions asked in internationally used triage decision support systems is around the patient's level of consciousness. A patient with a reduced level of consciousness can be indicative of a requirement for a high level of urgency of ambulance response. However, the value of this as a triage criterion is dependent on how accurately it can be determined by the call-taker. We sought to identify and summarise the results from published studies which determine the accuracy of call-taker assessment of conscious state during an emergency phone call. Methods We searched MEDLINE, EMBASE, CINAHL and Scopus databases for studies relating to concepts of emergency medical services, conscious state, triage and/or accuracy. Studies were screened and included if they dealt with emergency calls in the community, reported call-taker determination and on-scene determination of conscious state, and included sufficient data for at least one measure of diagnostic accuracy to be calculated. Results Out of 5753 articles initially identified, only two were found that matched the inclusion criteria. Both reported accuracy of a binary determination of consciousness versus unconsciousness, and found that it is common for the reported consciousness to differ from actual findings at scene. There were no studies identified that measured accuracy of determination of altered conscious states among conscious patients. Conclusion There is a notable gap in the literature regarding accuracy of determination of the patient's conscious state in an emergency call, which needs to be addressed.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125261708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Personal Resilience in Primary Care Paramedic Students, and Subsequent Skill Decay","authors":"Adam D. Vaughan, Bryce E. Stoliker, G. Anderson","doi":"10.33151/ajp.17.803","DOIUrl":"https://doi.org/10.33151/ajp.17.803","url":null,"abstract":"Introduction Paramedics are routinely exposed to traumatic incidents that include physical injuries; these events may manifest into psychosocial injury. Proactive and preventive measures have the potential to mitigate the negative impact of exposure to traumatic events. Enhancing an individual's capacity to effectively manage stressful/adverse life events through an online resilience resource (ORR) offers a promising option for paramedics. The aim of this study is to investigate the initial impact of an ORR on resilience and to explore the potential skill decay following this self-guided online resource among pre-employment paramedic trainees. Methods Through a repeated measures design, 227 primary care paramedics from British Columbia, Canada completed a baseline resilience assessment and ORR. A subset of participants completed follow-up resilience assessments at 3 to 6 month or 9-month intervals. Results Between the baseline and 3-month follow-up tests, results indicate that self-report resilience scores showed a slight improvement. However, as time increased to 6 or 9 months, a statistically significant decrease in resilience scores in comparison to the baseline was observed. Conclusion This study presents evidence to suggest that an educational tool such as an online self-paced training program for building resilience may be an effective strategy for improving short-term personal resilience among primary care paramedic students. Given the gradual skill decay associated with an ORR, we can highlight the temporal limits of resilience training. Developing additional resilience training programs to be delivered throughout students’ pre-employment education may help reduce skill decay.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"46 39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122233172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Einthoven and Precordial Lead Accuracy of Smartwatch-Acquired Electrocardiographs: A Review of the Literature","authors":"M. Wilkinson-Stokes","doi":"10.33151/ajp.17.816","DOIUrl":"https://doi.org/10.33151/ajp.17.816","url":null,"abstract":"Introduction This review aims to summarise the literature regarding the ability of commercial smartwatch products to produce an electrocardiograph of diagnostic quality for interpreting Einthoven and precordial leads. Methods PubMed, Embase, MEDLINE Complete, Web of Science, and Scopus were systematically searched. Articles were screened by a sole investigator against the inclusion criteria – first by title, then abstract, then full text. The reference lists of included articles were also screened. The inclusion criteria were: discussion of smartwatch-acquired tracing of Einthoven or precordial lead accuracy, and demonstrating sufficient rigor when undergoing critical appraisal using the Joanna Briggs Institute evaluation tools. A synopsis of results was provided in a summary of information table. Results Twelve articles were identified for inclusion, nine of which had physician (cardiology or emergency specialty) evaluation of tracings, one of which had statistical comparison of wave duration and amplitude, and two of which were expert commentary. Only evaluations of Apple Watch products were discovered during the literature search. All leads in all studies were considered suitable for interpretation, with no clinically significant differences. Four studies found that 100% of patients were able to accurately use a smartwatch as an electrocardiogram after a brief tutorial. Conclusion The current early evidence, based largely on visual evaluations by cardiologists during the previous year, suggests that electrocardiograph abnormality recorded by this technology is sufficiently precise to be presumed accurate until proven otherwise.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115647317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Paramedicine through Multiple Stakeholder Lenses Using a Modified Soft Systems Methodology","authors":"Angela C Martin, P. O'Meara","doi":"10.33151/ajp.17.793","DOIUrl":"https://doi.org/10.33151/ajp.17.793","url":null,"abstract":"Introduction Community paramedicine (CP) is an emerging model of care which expands paramedic scopes of practice to collaboratively support primary healthcare delivery in underserviced and disadvantaged communities. CP is a patient-centred holistic approach focussed on improving health outcomes, with success heavily reliant on integrative partnerships. This research aimed to identify key stakeholder perspectives about the value of CP in rural Australia. Methods A workshop was conducted using a modified soft system methodology (SSM) that asked participants to consider the value of CP from the perspective of five key stakeholder groups. The 50 participants consisted of paramedics and volunteer ambulance officers, paramedic service executives, paramedic educators, Medicare Local representatives and a general practitioner. Participants were randomly allocated to five stakeholder groups: paramedic profession; Minister for Health and Ageing; consumers, chief executive and executive management team of an ambulance service; and healthcare professionals. The application of SSM placed the five groups into three broad categories of stakeholders: customers, actors, and owners. ‘Customers’ in this context are patients, families and carers. ‘Actors’ are paramedics and volunteer ambulance officers, and ambulance service executives. The ‘owners’ are the Office of the Minister and those with the power to facilitate or block initiatives. Participants were allocated 15 minutes to brainstorm the question: “What can a community paramedic do for you to improve rural health provision?” Group views were verbally shared with all workshop participants and video recorded for analysis. Results The ‘customers’ asked about CP from patient, family and carer perspectives, and were highly engaged with questions about how, when and where CP could operate. The paramedic and volunteer ambulance officer group of ‘actors’ battled to move beyond their emergency response mindset to articulate a clear CP vision. The executive management team responded from a strategic and risk management perspective focussing on patient safety and corporate image. They identified the need to form stakeholder partnerships. The ‘owners’ representing the Office of the Minister focussed on the holistic and wellness benefits of CP. The health professional group anticipated the CP role could provide collaborative care and support doctors. Conclusions The findings suggest many participants had a limited understanding of CP, which creates a barrier for implementation. Key benefits identified included a reduction in financial and physical burdens on the rural healthcare sector and improved outcomes for consumers. Active participation of stakeholders in the process of introducing CP programs, where people are comfortable questioning current practices and encouraged to explore new concepts and innovations, would enable a shared understanding of program aims and expectations. For paramedic services to expand servic","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114375396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cpr Quality among Paramedics and ambulance officers: A Cross-Sectional Simulation Study","authors":"Milena Talikowska, S. Ball, D. Rose, P. Bailey, D. Brink, K. Stewart, M. Doyle, Lauren Davids, J. Finn","doi":"10.33151/ajp.17.842","DOIUrl":"https://doi.org/10.33151/ajp.17.842","url":null,"abstract":"Introduction High quality cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest, yet CPR quality is often suboptimal, even among trained rescuers. St John Western Australia sought to gather anonymous baseline data on CPR performance by paramedics and ambulance officers in a simulation setting. Methods In a cross-sectional study, participants performed 2 minutes of CPR on a manikin. CPR quality was recorded and compared to recommended standards. Comparisons were also made between women and men. Results The final cohort comprised 1320 participants; 56% paramedics, 20% transport officers and 18% volunteer emergency medical technicians and emergency medical assistants. More than half achieved an overall score of 90% or greater. The median compression score was 96% (IQR 83–99%) while the median ventilation score was 94% (76–99%). Participants achieved the recommended chest compression fraction of ≥60% in 98% of cases. More than half of participants had 99% or more of their compressions reach a depth of ≥50 mm. Two-thirds (68%) recorded a mean compression rate in the range 100–120 compressions per minute. Although there were significant differences in the percentage of compressions deep enough (p<0.01) and the 2-minute mean compression depth (p<0.01) between men and women, the effect size was small. However, men were less likely than women to fully release pressure on the chest after compressions (p<0.01). Conclusion This study provides useful baseline data about CPR quality in a manikin model. Participants achieved relatively high scores for most CPR quality metrics and complied with CPR guidelines in the majority of cases.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126043101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Australasian College of Paramedic Practitioners. A Specialist College for Paramedics with Primary Healthcare Skills","authors":"G. Reaburn","doi":"10.33151/ajp.17.833","DOIUrl":"https://doi.org/10.33151/ajp.17.833","url":null,"abstract":"This commentary presents the aims of The Australasian College of Paramedic Practitioners (ACPP) and its function and purpose for Australasian paramedics.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123704571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress Response in Swedish Ambulance Personnel during Priority-1 Alarms","authors":"Kåre J. Karlsson, Patrik Niemelä, A. Jonsson, C. Törnhage","doi":"10.33151/ajp.17.776","DOIUrl":"https://doi.org/10.33151/ajp.17.776","url":null,"abstract":"Introduction Ambulance personnel consider themselves as being healthy, but studies show they often suffer from stress-related illnesses. However, research on the causes of these stress-related illnesses is limited. This study aimed to examine the stress response of Swedish of ambulance personnel during priority-1 alarms. Methods During 90 priority-1 alarms salivary cortisol concentrations were measured at alarm and after end of alarm, and heart rates measured every 15 seconds. Thirteen men and six women participated in the study. A questionnaire with background data was collected. Non-parametric statistical tests were used. Results Elevated heart rate (median +34.7%) was associated with the actual priority-1 alarm, and during the alarm for women. Median salivary cortisol concentrations at alarm and after end of alarm (14.0 and 14.2 nmol/L respectively) showed non-significant differences. There were individual non-identical responses to the alarms. Alarms concerning traffic accidents, fast track and children generated the highest cortisol concentrations. The stress response showed non-significant differences in age, gender or level of education. Salivary cortisol concentrations and response were lower in the afternoon shift (2pm to 8pm). Conclusion The alarm causes increased heart rate at the group level but with individual different responses. Predefined fast track schedules and traffic accidents appear to generate measurable stress. Cortisol concentration follows normal diurnal variation of cortisol regarding time point for priority-1 alarms. Time of day does not affect the heart rate","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131917818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compassion Satisfaction and Compassion Fatigue among Emergency Medical Technicians in Iran","authors":"Javad Dehghannezhad, V. Zamanzadeh, Neda Gilani, A. Rahmani, Abbas Dadashzadeh","doi":"10.33151/ajp.17.642","DOIUrl":"https://doi.org/10.33151/ajp.17.642","url":null,"abstract":"Introduction Emergency medical technicians who provide emergency care for patients in a critical condition often experience compassion satisfaction through assisting these patients. However, helping ill and injured patients can also lead to compassion fatigue. Identifying the link between compassion satisfaction and compassion fatigue is important to enhance patient care. Methods This is a descriptive correlation study. A total of 248 pre-hospital emergency personnel from pre-hospital emergency centres in East Azarbaijan, Iran, were selected by cluster sampling. Professional quality of life tools, including compassion satisfaction and compassion fatigue (occupational burnout, secondary traumatic stress) were employed. Data was modeled on Stata Statistical Software: Release 14, and the correlation between factors was investigated through Pearson and Canonical correlation analyses. Results The average scores of compassion satisfaction and compassion fatigue were moderate. Reverse relationship and mean negative correlation (r=-0.40) were obtained between the two areas. In the ‘compassion fatigue’ category, the secondary traumatic stress sub-scale had a higher focal load (0.96) in comparison to burnout (0.32). Education, workplace and workload were significantly correlated with compassion fatigue, as were marital status and workplace with compassion satisfaction. Conclusion The model indicated that compassion satisfaction correlates inversely with compassion fatigue. Workplace, workload reduction, marital status and educational promotion reduce compassion fatigue therefore to enhance pre-hospital care these factors should be taken into consideration.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121994388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Opportunities for Workplace Violence Interventions in Australian Paramedicine: A Qualitative Study","authors":"Brodie Thomas, P. O'Meara, K. Edvardsson, E. Spelten","doi":"10.33151/ajp.17.817","DOIUrl":"https://doi.org/10.33151/ajp.17.817","url":null,"abstract":"Introduction Workplace violence directed at paramedics by patients and bystanders is a persistent and pervasive issue. There is little available evidence supporting the effectiveness of current interventions in the paramedicine context. No studies have reported on potential barriers and there is little evidence supporting opportunities for more effective interventions. The objective of this study was to make an inventory of current workplace interventions and explore the barriers and opportunities for these interventions as perceived by paramedics. Methods Ten paramedics were interviewed about their experiences and insights into workplace violence. The interview data underwent thematic and narrative analysis. Results Seven interventions were highlighted, 10 barriers and 12 opportunities for current and future workplace violence interventions were discussed. The majority of the barriers related to culture in society, attitudes of staff, and lack of capacity for the ambulance service to take action following violent events. The opportunities raised included co-design of interventions, culture change for paramedics and communities, accountability for paramedics and perpetrators of violence, increased ambulance service options following violent events, and improving feedback to staff. Conclusion The findings of this study suggest that interventions are likely to be more effective and sustainable if they are evidence-based, co-designed, address all levels of healthcare, and evaluated. Important areas for future research include a focus on consequences and accountability for perpetrators and strategies for ambulance services and paramedics to participate in public health approaches to reducing violence in communities.","PeriodicalId":340334,"journal":{"name":"Australian Journal of Paramedicine","volume":"11 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127157791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}