Volume 13 Issue 12
A paramedic in public health
In our last segment of Paramedic Roles, Sian Cowell shares her journey towards public health after a COVID-19 infection and subsequent redeployment catapulted her in this unconventional but exciting direction
Organisational structural predictors of ambulance crashes: an analysis
Objective: This study investigated the association between three organisational structural factors—organisational type, organisation status (staffing model), and level of service—and ambulance crash rates. The null hypothesis was that there would be no difference in ambulance crash rates during response or transport between any of the three factors. Methods: A cross-sectional design with a sample drawn from the 2019 National Emergency Medical Services Information System dataset was used to examine the relationship between these systems-level factors and ambulance crashes. After applying inclusion criteria, a sample of 2207 cases was drawn and analysed using the χ2 test of association and multiple logistic regression. Results: There was a statistically significant but small association between level of service and ambulance crashes during transport, using the χ2 test of association (P<0.05). Emergency medical technician (EMT)-level services had lower crash rates and paramedic-level services had higher rates than expected. There was no statistically significant association between organisational type or organisational status and ambulance crashes during either the response or transport phase of an emergency medical service (EMS) call, using the χ2 test of association (P>0.05). Of the two logistic regression models performed, only EMT-level services had a statistically significant association with ambulance crashes during transport (P<0.05; OR 0.208 [0.050, 0.866]). Conclusion: The organisational structural factors examined in this study failed to explain most of the variance in ambulance crash rates. However, EMT-level services were associated with lower rates of ambulance crashes than paramedic level services. EMS healthcare administrators and researchers should continue to explore potentially modifiable factors to reduce the incidence of these events and promote positive social change by reducing the risk of injury to patients, EMS workers and the public at large.
Assessment and management of issues in early pregnancy
Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and alternative management strategies, including early pregnancy units, are also discussed.
Paramedic adult pain assessment: pilot study
Background: An inability to assess pain may lead to poor or incorrect treatment. However, pain is often poorly assessed in the prehospital setting. Objective: This study aimed to determine the inter-rater reliability of the Wong-Baker FACES Pain Rating Scale in the prehospital setting in Qatar with five adult standardised patients. Methods: This prospective, quantitative pilot study gathered primary data using survey questionnaires. Five members of staff played the roles of standardised adult patients presenting with differing reference levels of pain. Thirty-five paramedics assessed and recorded the pain intensity score of these five patients using the Wong-Baker FACES Pain Rating Scale. Each participant was exposed to the same five patients and the same range of facial expressions in a random order. Results: The paramedics recorded the pain score of the five patients based on their observations of their facial expressions, often unexpectedly comparing these to the FACES tool. Overall, the inter-rater reliability as determined through Fleiss' kappa indicated only a poor-to-slight agreement of the allocated pain scores against the reference standards. There was a wide grouping of the pain score levels around the reference standard; most of the allocations were 1 to 2 pain score levels away from the reference standard, although not in a normal distribution, with some of the higher reference pain levels receiving lower scores and vice versa. Sensitivity was poor to very poor throughout. Conclusion: The inter-rater reliability of the participant sample when using the Wong-Baker FACES Pain Rating Scale to determine pain levels of five standardised patients was poor because the tool was surprisingly not used appropriately by most clinicians. This could be attributed to various factors including the multinational population, language barriers, a lack of familiarisation with the Wong-Baker FACES Pain Rating Scale and other environmental factors.
Beyond STEMI: paramedics' views on how to improve their ability to interpret ECGs
Background: Internationally, the paramedic scope of practice is developing. Bypassing emergency departments in favour of direct access to primary percutaneous coronary intervention laboratories has been limited largely to cases of ST-elevation myocardial infarction and new-onset left bundle branch block, but updates to international guidelines suggest that enhancing paramedics' skills in interpreting electrocardiograms (ECGs) and widening the bypass criteria could be beneficial. Aim: The aim of the study is to explore paramedics' views on ways to improve their ECG interpretation abilities. Method: A two-arm design was used with an online questionnaire (quantitative) and one-to-one interviews (qualitative). The questionnaire results were used to inform the interview guide. Findings: One hundred and eighteen paramedics completed the survey, and 11 took part in interviews. The major themes identified from the template analysis of the interviews were ‘a profession in transition’, ‘lagging professional development’ and ‘supporting the frontline’. Self-directed learning resources before, during and after action were proposed. Conclusion: Paramedicine is evolving in Ireland and practitioners have reported undertaking self-directed learning activities. The resulting heterogeneity in skills such as ECG interpretation, and perceived barriers to education, can cause feelings of vulnerability within the profession. Supporting the frontline by introducing some Group-Orchestrated Self-Directed Learning resources could empower practitioners and contribute to the evolution of prehospital care in Ireland.
Becoming yourself
‘The thing that is really hard, and really amazing, is giving up on being perfect and beginning the work of becoming yourself’ - Anna Quindlen
Recognition and management of COVID-19 and other influenza-like illnesses: a guide for paramedics
During the pandemic last year, the incidence of influenza-like illnesses (ILIs) was significantly lower, as preventive measures aimed to reduce the spread of COVID-19, were also successful in preventing the spread of other respiratory illnesses. With relaxed COVID-19 measures and the return of social contact and mixing, a significant increase in ILIs is anticipated this winter. Common causative pathogens for ILIs include influenza viruses, parainfluenza virus, respiratory syncytial virus (RSV), rhinovirus and SARS-CoV-2. With similar characteristics and mode of transmissions, it may be difficult to distinguish between these common respiratory pathogens. Fortunately, the majority of ILIs are self-limiting and treatments for these illnesses are similar: supportive treatment to relieve symptoms while awaiting recovery. Paramedics should be aware of the warning signs of serious diseases and consider admission if they occur. Finally, good infection prevention and control measures are vital to break the chain of transmission of ILIs and protect yourselves and others from them.