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PP20 Challenges and strategies in paramedic training for the RAPID2 trial of FICB for hip fractures
BackgroundThe NIHR HTA funded RAPID2 trial aims to test the safety, clinical and cost-effectiveness of paramedics providing pre-hospital fascia iliaca compartment block (FICB) pain relief for patients with suspected hip fracture. FICB is not routinely available in pre-hospital care but may improve patient outcomes through better pain relief and avoiding morphine side effects. However, training paramedics in FICB is not straightforward. RAPID2 seeks to train 160 paramedics across four sites. This poster will outline some of the strategies employed, challenges encountered, and reflections of research paramedics involved.MethodsChallenges encountered:Co-ordinating hospital and ambulance service staff availability with FICB training opportunities.Increased service demand during the training period, resulting in increased fatigue and reduced morale.Staff withdrawal due to career progression/secondment opportunities.Other commitments competing for staff time.Approaches used:Training was coordinated by RAPID2 site research paramedics and hospital PIs, employing strategies as follows.Increasing training opportunities by recruiting multiple anaesthetists to support trial training.Regular face-to-face contact from RAPID2 Research Paramedics at each site, including ‘drop in’ sessions and refresher training.Promotion of the rationale for the trial and the benefits it may bring to patient care, alongside the opportunity to enhance skill sets.Providing CPD hours and overtime payments for time spent undertaking RAPID2 training.Providing training sessions on different days and at different times to allow hospital and ambulance staff to carry out training at a time that suits them.ResultsThe trial was well received, with 150 expressions of interest gained from paramedics across sites, most of whom have begun training.ConclusionBy adapting to circumstances and employing a range of engagement and promotion strategies, paramedic engagement with training has improved. These strategies could be adopted in other trials.
Journal Article
OP7 Did west midlands ambulance service paramedics’ usage of adrenaline change after the publication of the paramedic2 results, but prior to any guideline change? A service evaluation
BackgroundThis project evaluated whether practice change occurred amongst Paramedics directly after the publication of the PARAMEDIC2 trial, regarding adrenaline administration during out-of-hospital cardiac arrest (OHCA) without a change in guidelines. When Paramedics are exposed to a seminal publication there is anecdotal concern their autonomous practice changes, based on comprehension of findings ahead of potential guideline changes, however little evidence appraises whether this really occurs.MethodsA service evaluation to determine any variation in adrenaline administration during OHCA, before and after publication of the PARAMEDIC2 trial.WMAS electronic patient record data that has been collected for use within OHCA ambulance quality indicators was used to evaluate practice variation.Proportion of adult patients receiving adrenaline, number of administrations and time to first administration from EMS arrival (or arrest if EMS witnessed) are reported.This evaluation assesses from the day after recruitment ended on 18th October 2017 until the trial results publication on 19th July 2018, and the same timeframe (273 days) post-publication.Results Proportion receiving adrenaline Pre-publication: 88.7% of 3026 casesPost-publication: 88.0% of 2682 cases Mean number of adrenaline administrations Pre-publication: 4Post-publication: 4 Mean time to adrenaline Pre-publication: 30:02 minutesPost-publication: 30:11 minutesConclusionsIn both datasets, average time to first adrenaline administration and number of administrations were found to be similar. This suggests Paramedic practice adheres to current guidelines when a highly anticipated article is published, however this may vary by intervention so further work is recommended. Limitations of retrospective observational evaluations include uncontrolled treatment variables; however randomised controlled trials cannot assess standard practice. Individuals need continued awareness for implications of changing practice following a trial publication, as patient safety could be breached whilst the wider medical community are scrutinising the trial results. This demonstrates how routine data can be used to evaluate practice and changes within it.
Journal Article
Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis
PurposeThere is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide.MethodsA systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity.ResultsIn total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity.ConclusionAmbulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.
Journal Article
Sleep and mental health in recruit paramedics: a 6-month longitudinal study
Abstract
Study Objectives
To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes.
Methods
Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up.
Results
Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms.
Conclusion
Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.
Graphical abstract
Graphical Abstract
Journal Article
Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis
Purpose
There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally.
Methods
A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data.
Results
1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8–21.6%), anxiety was 56.4% (95% CI 35,9–75%), and depression was at 34.7% (95% CI 23.4–48.1%).
Conclusion
This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.
Journal Article
Perception Towards the COVID-19 Vaccine Among the Paramedical Staffs
NOABSTRACTBroad access to efficacious immunizations is important for mitigating the COVID-19 pandemie. Healthcare personnel, particularly paramedical workers, may be more susceptible to infection during the covid pandemic due to a variety of causes. The purpose of this research is to assess paramedical staff members' opinions on the COVID-19 vaccine.A research study was conducted on paramedical personnel at A B Shetty Memorial Institute of Dental Sciences in Mangalore, India, using an online survey and SPSS 21 for data analysis. The survey included questions about vaccination knowledge, type, and dosage based on literature and international recommendations.The average age of the 61 participants in the research was 45.23 ± 9.66 years, with 43 females and 18 men. While all research participants knew that the COVID-19 vaccine is accessible in India, only 59% were aware of the range of vaccines that are developed and produced in India. Of those surveyed, 42.6% felt comfortable taking the COVID-19 vaccination made in the nation. Participants assessed their likelihood of contracting the illness even after immunization as high (24.6%) and low (39.3%). Of those who have received COVID-19 immunization, 55.7% believe that adverse effects might occur.The World Health Organisation (WHO) is lowering infection rates and developing a COVID-19 vaccine. Paramedical Staff who worked in the hospital are more vulnerable because of patient interaction and insufficient training on infection prevention.
Journal Article
EP07 Exploring barriers and facilitators to paramedic engagement in prehospital research
BackgroundParamedic engagement is crucial for the success of prehospital research studies. The Head injury evaluatiOn and aMbulancE Diagnosis (HOME) study aims to examine the feasibility of a diagnostic-test accuracy study to assess using the Canadian CT Head Rule in the prehospital setting to improve prehospital triage. However, significant recruitment challenges led to undertaking this qualitative study, aiming to identify barriers and facilitators to paramedic research engagement.MethodsA qualitative study was conducted using semi-structured interviews with 13 paramedics with varying experience, both participants and non-participants in the HOME study, to understand their perspectives. Interviews were recorded, transcribed, and analysed using an accepted thematic analysis approach, with data saturation guiding sample size.ResultsFour themes were identified. The first, Paramedic Perspectives on the HOME study, highlighted potential benefits for practice and patient care and identified recruitment challenges, including the unpredictable nature of paramedic work, geographical restrictions to recruitment, and poor awareness among hospital staff. The second, Personal and Professional Constraints Impacting Engagement, identified barriers such as time constraints due to demanding work schedules, burnout from high-intensity work, and mixed attitudes toward clinical studies, influenced by factors such as generational differences and past research experiences. The third, Considerations for Research Engagement Among Paramedics, explored factors influencing paramedics’ decisions to participate in research, including personal interest in the study topic, its relevance to their practice, flexibility in engagement, and ethical concerns about patient care. The fourth, Strategies for Enhancing Paramedic Research Engagement, suggested offering incentives for participation, enhancing interaction and recognition, and improving communication and organisational support.ConclusionWith unpredictable workloads, a complex prehospital environment and multiple demands on their time, paramedics face substantial barriers to research engagement. This can be mitigated by remunerating and rewarding participation, adopting flexible approaches to training and research design and optimising communication and organisational support.
Journal Article
PP36 Scoping exercise: paramedic debriefing post out-of-hospital cardiac arrest
BackgroundDebriefing post out-of-hospital cardiac arrest (OHCA) is emerging as a strategy to improve patient outcomes and is recommended by JRCALC and Resus Council UK. There is limited research on debriefing post OHCA and no ‘gold standard’ for paramedics to use. A scoping exercise was conducted to gain insight into current practice and to inform the development of a PhD proposal exploring debriefing post OHCA in the prehospital setting.Methods24 paramedics employed by a UK ambulance service were approached by the author and asked to complete a questionnaire. Inclusion criteria: NHS employed paramedics, who had attended at least 1 OHCA over the past 6 months.ResultsPreliminary results showed that mean experience of participants was 4.5 years and median exposure of OHCA over 6 months was 5 (interquartile range 2-7). 55.48% of OHCA were followed by a debrief. When a debrief was not conducted, 58.33% of paramedics felt they did not need one. Debriefs were led by Team Leader (n=16), HEMS personnel (n=10), self-directed (n=8), Paramedic (n=4) and Clinical Team Educator (n=2). Debriefs took place at hospital (n=19), at scene (n=9) and ambulance station (n=4). Further analysis will look at differences between newly-qualified paramedics and experienced paramedics.ConclusionMore needs to be done to improve the debriefing rate for OHCA. A debrief post OHCA was twice as likely to take place at hospital compared to on scene, despite a low conveyance rate for OHCA. A Team Leader was most likely to lead a post OHCA debrief, but staff in this role are not provided formal training. Further research is needed to explore paramedics’ interpretations of debriefs, what paramedics want from debriefs, and the willingness of paramedics to participate in the debriefing process.
Journal Article
PP26 Development of the retrospective assessment tool in emergency trauma dispatch (RATED) for medical trauma incidents: a modified delphi approach
BackgroundDeciding which medical resources are needed for trauma incidents often results in over- or under-triage. Evaluation of innovations aimed at improving dispatch decision-making (e.g., video livestreaming) requires retrospective assessment of the appropriateness of these decisions, but no tools currently exist.MethodsWe aimed to develop a tool through expert consensus to assess the need for enhanced medical resources (either critical care and/or Helicopter Emergency Medical Services) for trauma incidents. A modified Delphi approach was used, comprising three meetings with an Expert Panel who developed the criteria iteratively. The resulting criteria – the Retrospective Assessment Tool in Emergency Trauma Dispatch (RATED) - were applied to data from a feasibility randomised controlled trial by research paramedics to test reliability: (i) pilot stage: two cases rated independently by two research paramedics; (ii) all cases (n=58) rated independently by two research paramedics (blind to allocation and resource dispatch). A sub-sample (n=30) of cases were rated by the Expert Panel (blind to research paramedic ratings, allocation, and resource dispatch).ResultsCriteria across four areas of decision-making were developed (i) pre-hospital clinical interventions; (ii) injury pattern/physiology/anatomy; (iii) pre-hospital clinical decision making; (iv) patient disposition and geographical considerations. Reliability of ratings between research paramedics was high (2/2 cases, 100% agreement for pilot application; 56/58, 97% agreement for all cases). Expert Panel members agreed with each other in 24/30 cases (80%) and agreed with the research paramedics ratings in 16/30 cases (53%). Expert Panel members discussed cases that lacked agreement (n=14) until consensus was reached. Final agreed ratings were: appropriate (n=40, 70%), over-resourced (n=10, 17.2%) and under-resourced (n=8, 13.8%) dispatches.ConclusionRATED is a novel tool developed to aid evaluation of interventions in the pre-hospital setting. RATED was found to be reliable and easily applied across a range of clinicians. Further evaluation and critique are needed.
Journal Article