Volume 14 Issue 7

Differential rater function over time (DRIFT) during student simulations

Background The field of paramedicine continues to advance in scope. Simulation training is frequently used to teach and evaluate students. Simulation examinations are often evaluated using a standardised global rating scale (GRS) that is reliable and valid. However, differential rater function over time (DRIFT) has not been evaluated when using the GRS during simulations. Aims This study aimed to assess if DRIFT arises when applying the GRS. Methods Data were collected at six simulation evaluations. Raters were randomly assigned to evaluate several students at the same station. Each station lasted 12 minutes and there was a total of 11 stations. A model to test DRIFT scores was created and was tested against both a leniency and perceptual model. Findings Of the models explored, one that included students, the rater, and the dimensions had the greatest evidence (–3151 Bayes factors). This model was then tested against leniency (K=–9.1 dHart) and perceptual models (K=–7.1 dHart). This suggests a substantial finding against DRIFT; however, the tested models used a wide parameter so the possibility of a minor effect is not fully excluded. Conclusion DRIFT was not found; however, further studies with multiple centres and longer evaluations should be conducted.

Prehospital administration of calcium in trauma

Background Calcium depletion in haemorrhagic shock is associated with pathophysiology detrimental to survival. Aim The purpose of this systematic literature review was to determine whether paramedic administration of calcium for haemorrhagic shock could reduce trauma morbidity and mortality. Method The MEDLINE and CINAHL databases were searched for publications relevant to hypocalcaemia management in traumatic haemorrhage. Findings Fourteen peer-reviewed articles met the inclusion criteria. These examined incidence, morbidity, mortality and treatment options for hypocalcaemia associated with traumatic haemorrhage. Paramedicine can play a key role in managing hypocalcaemia early and determining the effect this has on improving patient outcomes from severe trauma. Conclusion The findings in this review link hypocalcaemia to poor yet potentially modifiable outcomes in trauma. Ambulance services should consider empiric treatment with calcium when shocked patients are expected to receive blood transfusion for traumatic haemorrhage.

Perceptions and experiences of mental health support for ambulance employees

Background Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. Aims To investigate ambulance staff perceptions and experiences of organisational mental health support. Methods A cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined staff perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time to talk at work. Findings A total of 540 ambulance staff responded. The majority reported having experienced work-related stressful life events (<em>n</em>=444; 82%). Associated psychological symptoms appeared to persist for years. Perceptions about organisational support related to support uptake. Stigma, fear and embarrassment were reported as barriers to disclosure and help-seeking. Mandatory time to talk at work would be acceptable (<em>n</em>=400; 74%). Conclusion The association between work-related stressful events and psychological symptoms underscores the need for interventions supported at an organisation level.

Prevalence, severity and preventability of prehospital patient safety incidents

The provision of safe and effective healthcare is a mainstay for all services and clinicians associated with the delivery of prehospital care; however, little is empirically known about the prevalence and impact of harm caused in the prehospital phase. This commentary critically appraises a recent systematic review which sought to identify the frequency of patient safety incidents and the harm associated with them in prehospital care.

Where I am going

After months of turmoil and uncertainty, Barry Costello contemplates stepping into his future

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