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Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review
An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs.
This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies.
The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.
Journal Article
First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic
Background
Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19.
Methods
To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe.
Results
We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission.
Conclusions
European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.
Journal Article
Emergency First Responders and Professional Wellbeing: A Qualitative Systematic Review
Emergency first responders (EFRs) such as police officers, firefighters, paramedics and logistics personnel often suffer high turnover due to work-related stress, high workloads, fatigue, and declining professional wellbeing. As attempts to counter this through resilience programmes tend to have limited success, there is a need for further research into how organisational policies could change to improve EFRs’ professional wellbeing. Aim: To identify the factors that may contribute to or affect EFRs’ professional wellbeing. Methods: A systematic literature review has been carried out. Three databases (Science Direct, ProQuest, and PubMed) were searched using keywords developed based on the PICo (population, interest, and context) framework. A total of 984 articles were extracted. These were then critically appraised for the quality of the evidence presented, leading to a total of five being ultimately included for review. Results: Thematic analysis revealed that although EFRs may be exposed daily to traumatic events, factors that contribute to a decline in professional wellbeing emerge from within the organisational environment, rather than from the event itself. Conclusion: The study concludes that organisational and team relations factors significantly impact EFRs ability to cope with stress. As such, organisational policy should evolve to emphasise team relations over resilience programmes.
Journal Article
Gold rush pups!
When Chase, Rubble, and the rest of Nickelodeon's PAW patrol strike gold in Adventure Bay, will Mayor Humdinger and the mischievous kittens from Foggy Bottom let them keep it? Includes textured pages featuring sparkling glitter.
Book
An ecosystem approach to the evaluation and impact analysis of heterogeneous preventive and/or early interventions projects for veterans and first responders in seven countries
Cumulative exposure to critical incidents and life-threatening events leads to significant risk for Veterans and First Responders (VFRs) developing mental ill health and disorders. Philanthropic organisations, Movember and Distinguished Gentleman's Ride, funded 15 organisations to conduct early intervention Projects across seven countries. The Projects aim to improve the mental health and wellbeing of VFRs, their families/significant others. This paper describes the novel external evaluation and impact analysis methods to identify effective Projects having positive impact on VFRs and their families, provide return on investment and the overall Grant Program.
We take an ecosystem real-world approach, which recognises the context and aims to manage the complexities involved, uses a complexity and systems perspective, multi-step mixed methods and approaches. The evaluation is from three perspectives of: Projects; Project comparisons; Grant program. Embedded in the evaluation design are methods, knowledge sharing and organisational learning activities for all stakeholders. Data is collected by the Projects and evaluation team on input, throughputs, and output indicators. Analysis tools include Global Impact Analytics Framework, multi-layered statistical analysis, performance evaluation using an efficient decision support approach, Project and Grant program social return on investment, visual linking and data connection platform and assessment of gendered lens approaches.
The complexity and heterogeneity of Projects implemented in the real world continues to present significant evaluation challenges and limitations for project leads, stakeholders, researchers and evaluators. Our ecosystem approach and novel evaluation methodology will reduce the uncertainty around real world implementation, provide key learnings for project stakeholders and more broadly implementation researchers.
•Implementation evaluation presents significant challenges for researchers.•Mental ill-health real world prevention project evaluation needs mixed approaches.•Uncertainty reduces with an impact analysis framework for implementation research.•An ecosystem approach manages project comparisons, heterogeneity and complexities.
Journal Article
Desolation Mountain : a novel
\"Cork O'Connor and his son Stephen work together to uncover the truth behind the tragic plane crash of a senator on Desolation Mountain and the mysterious disappearances of several first responders\"-- Provided by publisher.
Book
Interplay between Safety Climate and Emotional Exhaustion: Effects on First Responders’ Safety Behavior and Wellbeing Over Time
Various job demands continuously threaten Emergency Medical Service (EMS) first responders’ safety and wellbeing. Drawing on Job Demands–Resources Theory, the present study examines the effects of the organizational context—safety climate—and the psychological context—emotional exhaustion—on safety behaviors and wellbeing over time. We tested our hypotheses in a longitudinal study of 208 EMS first responders nested within 45 stations from three fire departments in US metropolitan areas over 6 months during the beginning of the COVID-19 pandemic. Multilevel modeling showed that the relationship between safety climate and safety compliance behaviors can be attenuated when EMS first responders experience high emotional exhaustion. Emotional exhaustion was also negatively associated with morale while safety climate was positively associated with morale. Additionally, EMS first responders experienced increased depression when their emotional exhaustion levels were high. Higher safety climate was associated with decreased depression when emotional exhaustion was within a low-to-medium range. Higher safety climate was also associated with lower absolute levels of depression across the entire range of emotional exhaustion. These findings suggest that promoting safety climate and mitigating emotional exhaustion can augment EMS first responders’ safety behaviors and wellbeing.]
Journal Article