Paramedicine

Study Aim To understand the survival and emergency medical service call triage and response to patients who suffer an out-of-hospital cardiac arrest after the emergency medical service call is connected. Methods: A descriptive retrospective data analysis of two years’ of out-of-hospital cardiac arrest registry data, 2018-2019, linked to computer aided dispatch data was completed in a single system emergency medical service in the South West of the United Kingdom. Data analysis included descriptive statistics and chi squared analysis for association. Results: There were 4245 out-of-hospital cardiac arrest patients included for analysis. Patients who suffer an out-of-hospital cardiac arrest after the emergency call is connected receive a lower priority response, have a significantly longer response time and where the cardiac arrest is not witnessed by the emergency medical service have poorer outcomes than those patients who have already suffered a cardiac arrest at the time of the emergency call. Conclusion: Emergency medical service response times were significantly shorter for patients who had already suffered a cardiac arrest at the time of the call for help in comparison to those patients who continued to suffer a cardiac arrest after the call for help was connected. Patients who suffer a cardiac arrest after the connection of the emergency call and where the out-of-hospital cardiac arrest is not emergency medical service witnessed have the poorest outcomes.

Kim Kirby

Paul White

Sarah Voss

Jonathan Benger

Understanding the emergency medical service response to patients who are at imminent risk of out-of-hospital cardiac arrest

了解急救医疗服务对即将发生院外心脏骤停风险患者的响应

In this perspective, the authors argue that paramedicine's core structure and mandate (i.e., the 9-1-1 system) can innovate to better align with the needs of the public and address the evolving healthcare landscape. Examining Canada as a case, paramedic services are increasingly utilized by the public as a first point of contact for health and social care and often for nonemergent events. Existing emergency-focused paradigms leave the health profession poorly aligned or underprepared to meet the needs of the public and isolated from other healthcare providers and systems. While advances in healthcare policy, infrastructure, and best practices have been proposed to address Canada's healthcare challenges, these advances have yet to sufficiently translate into core paramedicine systems. To illustrate these points, the authors critically examine the alignment of paramedicine models of care with public need, paramedicine's response to government and scholarly advances in healthcare policy and practice, and contemporary public healthcare issues in Canada. Paramedicine's changing landscape is also examined as context for innovation and change. The authors argue that core paramedicine systems be augmented with (not replaced by) an integrated interprofessional primary care paradigm and introduce a novel conceptual strategy, approach, and model of care referred to as IMPACC—Improving Patient Access to Care in the Community, including its guiding principles, conceptual framing, intended outcomes and domains for education. The authors conclude that paramedicine in Canada stands at a pivotal juncture and that the traditional emergency-focused model is increasingly misaligned with contemporary health and social care needs, necessitating a shift toward a more integrated, interprofessional primary care approach. The IMPACC concept offers a viable conceptual blueprint for this transformation, proposing a redesigned 9-1-1 system that incorporates timely primary care services and fosters interprofessional collaboration and integration for differentiated and undifferentiated patients in the community within core paramedicine systems.

Walter Tavares

Sanne Kaas-Mason

Chris Spearen

Natalie Kedzierski

Jeremy Watts

Phil Moran

Matthew S Leyenaar

Redesigning paramedicine systems in Canada with “IMPACC”

用“IMPACC”重新设计加拿大的急救医疗系统

Background:There was a perceived gap in knowledge around the emotional detachment strategies used by paramedics to cope with stress. Therefore, this study investigated adaptive and dysfunctional emotional detachment in paramedics currently working in Australia and New Zealand and explored if and how sense of community (SOC) relates to emotional detachment. Methods: A quantitative survey combined three subscales: the detached coping subscale of the Coping Styles Questionnaire; the dysfunctional detachment subscale of the Relationship Profile Test; and the Brief Sense of Community Scale. Results were calculated using descriptive and correlational statistical analysis using IBM TM SPSS TM (v.27) statistics software. Results: The survey collected 335 total responses (282 complete, 53 partial) from New Zealand (209) and Australia (115), including 159 females, 164 males, and 2 gender-diverse participants. On average, females ( M = 22.91 ± 7.02) scored significantly lower ( P ≤ .001) on adaptive detachment than males ( M = 26.31± 6.80). No other statistically significant results were found between demographic categories. Total SOC scores correlated positively with adaptive detachment scores ( r = .188; P = .002) and negatively with dysfunctional detachment scores ( r = −.279; P ≤ .001), indicating a relationship between SOC and emotional detachment. Of the four dimensions, emotional connection ( r = .213; P ≤ .001), membership ( r = .199; P = .001), and needs fulfilment ( r = .136; P = .023) were statistically significant factors for adaptive detachment. All dimensions were statistically associated with dysfunctional detachment, specifically needs fulfilment ( r = −.253; P ≤ .001), membership ( r = −.256; P ≤ .001), emotional connection ( r = −.222; P ≤ .001), and influence ( r = −.190; P = .001). Conclusions: Female paramedics are a demographic likely to benefit from adaptive detachment techniques. SOC scores correlated positively with adaptive detachment scores and negatively with dysfunctional detachment scores, implying a supportive relationship between SOC dimensions and detachment-based coping styles in Australasian paramedics.

Suzanne Hocking

Elizabeth Asbury

Sense of community and its relationship to emotional detachment in Australasian paramedics

社区感及其与澳大利亚和新西兰护理人员情感脱节的关系

Kathryn Eastwood

Alan Batt

The importance of outcome measures that matter in paramedicine research

急救医学研究中重要结局指标的重要性

Objective: During the COVID-19 pandemic, there was concern that those accessing the 9-1-1 system could overwhelm hospitals. To alleviate this strain, emergency medical services (EMS) in Ontario, Canada, implemented a medical directive allowing paramedics to assess, treat and discharge low acuity patients with suspected COVID-19. Consultation with an EMS physician was required to ensure patient safety. The goal of the study was to measure compliance with and safety of this strategy. Methods: In this retrospective study, we assessed applications of the directive within the catchment of the Sunnybrook Centre for Prehospital Medicine from 1 January 2021, through 31 March 2022. We also monitored whether non-transported patients accessed the 9-1-1 system again within 7 days. Results: Overall, 122 patients were considered by paramedics to have met the COVID-19 medical directive, and, therefore, an EMS physician was contacted. Of these, 53.7% (65/122) were female, and mean age (SD) was 46.8 years (SD 17), range 5 to 96 years. In only 20% (25/122) of cases were all patient assessment findings reported to the EMS physician and within the appropriate ranges specified in the medical directive. The EMS physician approved non-transport in 83% (101/122) of cases. Of those not transported, 12% (12/99) accessed 9-1-1 again within 7 days. Conclusions: We present a non-transport option for patient management, a novel concept within Ontario's paramedic regulatory framework. Assessments provided by paramedics included telephone consultation with EMS physicians. There were no instances in which patient safety was known to have been impacted. Needed is further study of non-transport strategies for low acuity patients that ensure patient safety and study of training strategies to enhance compliance with decision-making tools and joint decision making between paramedics and physicians regarding patient disposition.

James Summers

Ian R Drennan

Linda Turner

Maud Huiskamp

W Scott Gorsline

Michael Merko

Morgan Hillier

Implementation of a strategy to manage EMS COVID-19 patient disposition with physician consultation: A retrospective descriptive study

实施医生咨询下管理急诊科COVID-19患者分流策略的回顾性描述性研究

Publication Information	Publisher: SAGE Publications Inc.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2023，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Paramedicine

Journal Citation Format

A journal article with 1 author

A journal article with 2 authors

A journal article with 3 authors

A journal article with 5 or more authors

Books Citation Format

Thesis Citation Format

Web sites Citation Format

Patent Citation Format

Staying up late manually editing references? ivySCI automatically matches journals and helps you generate references with a single click.

Share Submission Experience

Understanding the emergency medical service response to patients who are at imminent risk of out-of-hospital cardiac arrest

Redesigning paramedicine systems in Canada with “IMPACC”

Sense of community and its relationship to emotional detachment in Australasian paramedics

The importance of outcome measures that matter in paramedicine research

Implementation of a strategy to manage EMS COVID-19 patient disposition with physician consultation: A retrospective descriptive study

Sense of community and its relationship to emotional detachment in Australasian paramedics

Redesigning paramedicine systems in Canada with “IMPACC”

Understanding the emergency medical service response to patients who are at imminent risk of out-of-hospital cardiac arrest

The importance of outcome measures that matter in paramedicine research

Implementation of a strategy to manage EMS COVID-19 patient disposition with physician consultation: A retrospective descriptive study