Response times—and survival—in OHCA increase
Over the past 30 years in Sweden, the ambulance response time in out-of-hospital cardiac arrest (OHCA) has doubled—yet counter-intuitively, the chances of surviving an OHCA have also substantially increased.
A study team accessed data from the Swedish Registry of Cardiopulmonary Resuscitation (CPR) to determine the effect of ambulance response time on 30-day survival after OHCA. Over 20 000 cases of OHCA between 2008 and 2017 were included. The study used a model that was adjusted for age, sex, calendar year, and place of collapse, and analysed data for four groups of emergency medical service (EMS) response times: 0–6 minutes, 7–9 minutes, 10–15 minutes, and >15 minutes. A decrease in survival was seen with increasing EMS response time regardless of the initial heart rhythm. This remained true regardless of whether or not CPR was performed before EMS arrival for the time intervals up to 15 minutes. For those in a shockable rhythm, the adjusted survival dropped from 44 to 25% when the EMS response time increased from 0–6 minutes to 10–15 minutes.
Conclusion? Shortening EMS response times is likely to increase survival in OHCA.
The effects of EMS work on personnel wellbeing
This systematic review aimed to provide a comprehensive review of international peer-reviewed qualitative literature on the effects of EMS work on the psychological, physical, and social wellbeing of ambulance personnel. This included paramedics, officers, call-takers and volunteers.
The review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related wellbeing needs were articulated; effects of workflow and the nature of the work on wellbeing; and effects of organisational structures on psychological and physical wellbeing. A comprehensive overview of 39 articles was provided through synthesis of the literature, identifying three key themes:
Although the paper does not provide solutions, it does provide insight into the causes of mental health issues in the EMS workforce. Furthermore, it couldn't be timelier given the focus on the mental wellbeing of EMS staff and is open source, so is freely available and well worth reading.
Risk of human error in hospital trauma ad-hoc teams
System design, particularly in healthcare, is prone to mistakes by the human designer, whether it be a checklist or layout of a resuscitation area. Therefore, analyses help to identify and reduce the risk of unrecognised errors. This article focused on the identification of system threats on hospital trauma teams using unscheduled, recorded simulated training.
The use of ad-hoc simulation in an actual workplace allowed the researchers to collect and analyse team interaction, including the use of equipment and layout as well as task and organisational skills. A qualitative study design using framework analysis was used to classify key themes found in the filmed simulations. There were 12 simulations with over 800 safety threats found, 23 categories considered as critical threats, resulting in seven main themes relating to a high risk of error: physical workspace, mental model formation, equipment, unclear accountability, demands exceeding individuals’ capacity, infection control and task-specific issues.
In relation to paramedic practice, this study highlights similar issues and threats to the management of an OHCA. A key take-home point is that in ad-hoc teams managing severely injured patients, there is a high risk of errors, even with systems in place to reduce these.