Paramedicine最新文献

{"title":"The paramedic experience of return to clinical practice: A reflexive thematic analysis","authors":"Jessica Odgers, Andrew Rochecouste, Brett Williams","doi":"10.1177/27536386241251429","DOIUrl":"https://doi.org/10.1177/27536386241251429","url":null,"abstract":"The Australian paramedic workforce has significantly expanded and evolved in the past few decades. Professionalisation, increasing demand and evolving clinical practice have contributed to pressure on paramedics to meet community expectations of service delivery. Returning to clinical practice after an absence presents a substantial challenge for paramedics who will need to navigate this transitional phase while readjusting to the fast-paced environment of pre-hospital care. This study aims to explore and understand the experience of paramedics returning to clinical practice. Methods: Paramedics were invited to discuss their experiences returning to clinical practice in ambulance services within Australia. A qualitative reflexive thematic analysis was conducted utilising an inductive approach, underpinned by the theoretical framework of the organisational support theory. An experiential orientation was supported by a critical realist ontology, which intersected and overlapped with epistemological contextualism. Results: Three major themes were identified: (1) perceived organisational support, (2) the reality of flexible work, and (3) clinician identity. Theme one was further broken down into three sub-themes relating to structure, work engagement, and clinical support. Conclusions: Our findings provide insight into the lived experiences of paramedics returning to clinical practice. These experiences and challenges should inform the application of organisational policy and resource allocation to better support returning paramedics in the future. Strategies should include enhanced leadership capability, flexible work, robust clinical education, and structured programmes with in-built flexibility to reintegrate staff with an emphasis on communication and support.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"3 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141042457","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":"ACP International Conference 2023 - Research Abstracts","authors":"","doi":"10.1177/27536386241236280","DOIUrl":"https://doi.org/10.1177/27536386241236280","url":null,"abstract":"","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"86 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711225","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":"Portrayals of a profession: Reflecting on media depictions of paramedics","authors":"Tania Johnston, Cheryl Cameron, A. Batt","doi":"10.1177/27536386241244786","DOIUrl":"https://doi.org/10.1177/27536386241244786","url":null,"abstract":"","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"15 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741499","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":"Invited commentary – A research agenda for paramedicine","authors":"B. Am","doi":"10.1177/27536386241242814","DOIUrl":"https://doi.org/10.1177/27536386241242814","url":null,"abstract":"","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"25 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375564","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":"Epidemiology of acute stroke presentations to an emergency ambulance service","authors":"W. Loudon, E. Bosley, A. Wong, V. Tippett","doi":"10.1177/27536386241233306","DOIUrl":"https://doi.org/10.1177/27536386241233306","url":null,"abstract":"Stroke is a devastating condition with significant societal and personal costs. Attempts to improve outcomes have increasingly focussed on improvements in prehospital care of these patients. This study aims to provide an epidemiologic profile of stroke presentations to an ambulance service. A descriptive quantitative analysis of linked administrative and clinical patient data across prehospital, hospital, and death records from a two-year period (2016–2017), was used to profile the acute stroke cohort transported by ambulance in Queensland, Australia. The epidemiologic profile of patients and sub-type of stroke is presented. There were 17,603 presentations of suspected acute stroke in Queensland during the study period amongst 2,078,140 ambulance responses. A total of 11,578 patients had a confirmed diagnosis of stroke at the time of their final discharge. Of this population 49.8% suffered an Acute Ischaemic Stroke, 12.9% had intracerebral haemorrhage, 4.5% had subarachnoid haemorrhage and 32.8% were transient ischaemic attack. Of those with acute ischaemic stroke (AIS) 9.2% were due to a large vessel occlusion. The three-month stroke related fatality rate was 10%. This study demonstrated a lower annual presentation rate of stroke, to an emergency ambulance service, than would be expected based on population studies while the overall mortality rate amongst this population was higher. The reasons for these differences warrant further investigation.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"53 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425290","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":"Research agenda and priorities for Australian and New Zealand paramedicine: A Delphi consensus study","authors":"R. Pap, Nigel Barr, Amy Hutchison, Peter O’Meara, Paul Simpson, M. Reardon, Harry Reeves, Louise Reynolds, Michelle Thomson, Linda Ross","doi":"10.1177/27536386241231666","DOIUrl":"https://doi.org/10.1177/27536386241231666","url":null,"abstract":"Introduction: The systematic development of a research agenda is essential for coordinated, collaborative, and efficient research endeavours in any discipline. The aim of this study was to create and prioritise a stakeholder-informed, consensus-derived paramedicine research agenda for Australia and New Zealand. Methods: The study utilised a modified Delphi consensus method consisting of three phases. Phase 1, the findings of which were previously published, consisted of a survey of Australian and New Zealand paramedicine stakeholders to inform the subsequent consensus process. Phase 2 contained three Delphi rounds involving key paramedicine profession stakeholders to generate a research agenda. Panellists were asked to rate their agreement with the inclusion of each item using a 5-point Likert scale. Consensus was defined as 80% agreement signalled by ‘ Strongly Agree’ and ‘ Agree’ responses. Phase 3 involved one additional round of voting to determine the importance and thus establish priorities amongst the final list of agenda items. Results: There were 341 responses to the survey in Phase 1 and thematic analysis produced a provisional agenda consisting of 109 perceived research priorities. Sixty-three key paramedicine profession stakeholders were invited to Phases 2 and 3, of which 56 (88.9%) completed all three rounds in Phase 2, and 43 (68.3%) completed the final Phase 3. Thirty-seven items achieved consensus and were subsequently prioritised constituting the final research agenda. Panellists gave the highest priority to ‘Paramedics role in broader healthcare system’, ‘New and emerging roles in for paramedics’, ‘Patient safety’, ‘System improvement’, and ‘Clinical reasoning processes and models’. Conclusion: Using a modified Delphi consensus method and drawing from a broad range of stakeholders, a 37-item Australian and New Zealand paramedicine research agenda with item prioritisation was developed. The agenda serves to inform industry and other key stakeholders to guide their research endeavours ultimately leading to meaningful and tangible impact within the paramedicine profession.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"519 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140448243","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":"Paramedicine education: Navigating moments for transformation through research","authors":"Walter Tavares","doi":"10.1177/27536386241232670","DOIUrl":"https://doi.org/10.1177/27536386241232670","url":null,"abstract":"","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"10 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963581","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":"A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services","authors":"Belinda Flanagan, Nigel Barr, James Pearce, Kathryn Eastwood","doi":"10.1177/27536386231223761","DOIUrl":"https://doi.org/10.1177/27536386231223761","url":null,"abstract":"Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines. Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards. Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence. This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139869017","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":"A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services","authors":"Belinda Flanagan, Nigel Barr, James Pearce, Kathryn Eastwood","doi":"10.1177/27536386231223761","DOIUrl":"https://doi.org/10.1177/27536386231223761","url":null,"abstract":"Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines. Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards. Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence. This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":"66 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139809294","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":"Descriptive before-and-after study of the introduction of a ‘Leave Behind’ take-home naloxone dispensing/distribution program by the ambulance service in Western Australia","authors":"H. Tohira, Rudolph Brits, Simon Lenton, S. Agramunt, D. Brink, Curtis Naylor, Jason Belcher, S. Ball, Judith Finn","doi":"10.1177/27536386231222283","DOIUrl":"https://doi.org/10.1177/27536386231222283","url":null,"abstract":"To describe changes observed in case characteristics and patient outcomes before and after ambulance service participation in a ‘Leave Behind’ take-home naloxone (THN) dispensing/distribution program. This before-and-after study included emergency ambulance attendances for patients experiencing an opioid overdose one year before 1 October 2021 (pre-participation phase: 1 October 2020–30 September 2021) when St John Western Australia (SJWA) participated in the THN program and those one year after the date (post-participation phase: 1 October 2021–30 September 2022). There were 945 and 1240 opioid overdoses among 221,451 and 222,480 emergency ambulance attendances in the pre- and post-participation phases (0.43% vs 0.56%, p < 0.001). The number of ambulance attendances for overdose in the post-participation phase was not significantly different from that predicted based on the ambulance attendances in the pre-participation phase. No statistically significant differences in patient age, sex, and geographical location were identified between the two phases. Compared to the pre-participation phase, more patients had naloxone administered prior to ambulance arrival (10.7% vs 15.1%, p = 0.003), and more patients were discharged at the scene (21.2% vs 29.8%, p < 0.001) in the post-participation phase. No difference was found in mortality within one day (3.4% in the pre-participation phase vs 3.5% in the post-participation phase, p = 0.30). After implementation of a ‘Leave Behind’ take-home naloxone dispensing/distribution program, more patients had naloxone administered prior to ambulance arrival, and the likelihood of discharging a patient at the scene significantly increased without affecting patient survival rates.","PeriodicalId":509430,"journal":{"name":"Paramedicine","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620839","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}