Promotion of knowledge, skill, and performance of emergency medical technicians in prehospital care of traumatic patients: An action-research study

Background: Annually, there is a high rate of mortality due to trauma. Prehospital emergency personnel are the first caregivers present beside trauma patients, and their dexterity to take care of trauma patients is of great significance in the vast majority of patients' survival. Materials and Methods: This study was action research with the participation of 125 prehospital emergency personnel from May 2016 to December 2018 in five stages (observation, reflection, planning, action, and evaluation) in Iran. Knowledge, skills, and performance of personnel were assessed before and after the action. Data collection tools included knowledge questionnaire and PERFECT skill assessment checklist by Objective Structured Clinical Examination method and researcher-made checklist for performance. Data were analyzed using SPSS-21 software. Results: The findings indicated that 67.82 and 84.4 of prehospital emergency staff have median to low knowledge and expertise in respect to trauma care, respectively. Their performance of necessary measurements for trauma patients was poor prior to training. There was a significant difference between the mean knowledge, skills, and performance of medical emergency technicians before and after the training course (P = 0.00). Conclusions: Participation of beneficiaries in planning for trauma patient's care is helpful. Establishment of prehospital trauma life support training in the medical emergency, training curriculum, and its instruction to prehospital emergency personnel while serving in trauma care will be of great benefit

Factors affecting false calls to prehospital Emergency medical services and analyzing The recorded false calls in the dispatch center

INTRODUCTION: False calls to the prehospital emergency medical service (EMS) can divert EMS concentration from people with life-threatening conditions to a false situation and also affect the lives of the at-risk people.MATERIAL AND METHODS: This cross-sectional study, was conducted in 2019. The population consisted of 28 Dispatchers personnel and 130 emergency medical technicians located in 24 urban bases, and the recorded messages of 450 false calls to the prehospital EMS were also analyzed. Both personnel perspectives on the false calls questionnaire and false call content evaluation checklist were used to collect data.RESULTS: The most influential factors in the incidence of false calls were the dimensions of public education (4.38 ± 0.5) and instructions and guidelines (4.28 ± 0.51), respectively. “Insufficient knowledge of people about the sensitivity of EMS work” from the public education dimension (4.60 ± 0.54) and “Lack of codified rules for dealing with false calls to the EMS” from the instructions and guidelines dimension (4.48 ± 0.71) were the most important factors. type of requests from EMS were mostly unnecessary conversations (52.4%) and dispatching an ambulance (21.3%).CONCLUSIONS: Given the importance of emergency, it is required to promote the general public knowledge and culture, as well as stricter rules and training programs for all ages, should be considered to reduce false calls. On the other hand, prehospital emergency medical dispatcher personnel should be trained on how to deal with false calls

Emergency medical technicians occupational stress scale: development and validation

INTRODUCTION: Several stress factors are experienced by emergency medical technicians (EMTs), the identification and management of which may be a major challenge due to the lack of valid and reliable instruments. This study aimed to develop a relevant and easy-to-use occupational stress scale (OSS) for EMTs with adequate psychometric properties. MATERIAL AND METHODS: A mixed method with an exploratory sequential design was used in this research. Items were generated based on the existing literature and a qualitative study, followed by testing the content and face validity of the items. Exploratory factor analysis (EFA) was done with a random sample of 247 EMTs. Also, internal consistency and stability reliability were investigated. RESULTS: From the initial 74 items, 20 with content validity ratio and content validity index were removed. In EFA, the item set resolved to a 50-item scale in the six dimensions include: Patient and family conditions, Environmental and occupational conditions, Traumatic consequences, Supportive management problems, Lack of support, and Interpersonal and individual tension. Cronbach's alpha and Intra-class correlation coefficient (ICC) showed excellent reliability. CONCLUSIONS: The OSS-EMT represents a psychometrically derived instrument that identified important stressors for EMTs., and is probably among the first studies in Iran. While explaining the methodology precisely, this study evaluated the validity and reliability of the OSS in EMTs based on principles of survey instrument development and validation

Perceived Safety Climate in Operating Rooms and Its Relationship with the Awareness of the Operating Room Staff about the Surgical Smoke Hazards: A Cross-Sectional Study

Background and Aim: Surgical smoke (SS), is caused by the use of high temperature devices such as electrocautery, laser and ultrasonic scalpel, which are used for cutting and coagulation of tissue during surgery, is considered as a serious threat to the health of operating room (OR) personnel. Various studies have identified the workplace safety climate as one of the main causes of the occurrence or prevention of occupational hazards. This study was conducted with the aim of Perceived Safety Climate (PSC) in ORs and its relationship with the awareness of the OR staff about the SS hazards. Materials and Methods: This cross-sectional study was conducted from April 2021 to July 2022 in the ORs of 26 public hospitals affiliated to Tabriz University of Medical Sciences. In this research, 396 surgical and anesthesia technologists were included in the study by stratified random sampling. Data were collected using a demographic questionnaire, PSC questionnaire and awareness about the hazards of SS questionnaire and analyzed using SPSS software Results: The knowledge of the OR staff regarding the hazards of surgical smoke was evaluated at a moderate level with a mean and standard deviation of 9.82±4.32 (range 0 to 21). The average knowledge score of surgical technologists (11.1±4.56) regarding the hazards of surgical smoke was significantly higher than the average score of anesthesia technologists (8.75±4.1)(P=0.02). The PSC in the OR was evaluated at moderate level with a mean and standard deviation of 62.15±11.1 (range 19 to 95). The results of linear regression analysis showed that the effect of PSC in increasing the awareness of OR staff about the hazards of SS was significant (P=0.001). By increasing one score to the total score of the PSC, the awareness score increases by 0.201. Conclusion: The safety climate of the OR can predict the awareness of the hazards of SS among OR staff. It is recommended to adopt strategies such as educating personnel about the hazards of SS and how to prevent it, creating a suitable supportive environment for personnel, and providing suitable protective facilities to prevent OR staff from being exposed to SS

Work Related Burden of Stress among Emergency Medical Service Personnel

Introduction: The staff of pre-hospital emergency medical service experience many stresses daily in the frontline of emergency responses. Critical conditions and trying to save patients’ lives make operation difficult for emergency medical technicians. The burden of stress in this job group is related with critical incidents, and functional and emotional problems that are the result of the rate of exposure and the intensity of the stressor. Methods: In this descriptive-correlation study, 320 technicians working in pre-hospital emergency bases participated. To gather data, stress burden evaluation questionnaire, which was the result of rate of exposure to stressors, was used. Data were analyzed using SPSS statistical software and descriptive and inferential statistics. Results: In the present study, the most important causes of burden of stress were reported to be environmental occupational factors and patient-related factors. Mean and standard deviation of stress burden was 8.70 ± 3.61. Working with trauma patients, unrealistic expectations of the patient or their relatives, and driving in critical conditions and resuscitation of patients inflicted the highest burden of stress upon the staff. In this study, the mean score of stressor intensity was higher than the mean score of exposure to stressors and a significant correlation was seen between the rate of stress burden with number of operations, educational degree, emergency bases, and status of employment. Conclusion: Proper identification of stressors in terms of prevalence and intensity, leads to better understanding of these factors in pre-hospital emergency and can be of great help in prevention and control of stress burden among emergency medical service staff

Exposure of Iranian emergency medical technicians to workplace violence: A cross sectional analysis

Objectives: Emergency medical technicians (EMTs) in Iran experience concerning levels of workplace violence, although until now there has been no investigation of this phenomenon. The objectives of the present study were to describe the exposure of Iranian EMTs to workplace violence and to identify the importance of related factors from their viewpoint.\ud \ud Methods: In this descriptive, exploratory study, 160 EMTs agreed to participate in a survey that collected data regarding their exposure to the following forms of workplace violence: verbal abuse, physical assault, cultural harassment, sexual harassment and sexual assault.\ud \ud Results: A total of 138 questionnaires were returned, representing a response rate of 86%. The majority of participants 75% (n= 103) experienced at least one form of workplace violence in the 12 months before completing the questionnaire. The most frequently reported form of workplace violence was verbal abuse (71%), followed by physical assault (38%) and cultural harassment (9%). Violence resulting in serious injuries was reported by only 4% of participants, with no more than 8% of participants experiencing workplace violence that included the use of weapons. The most reported response to workplace violence was to 'invite the offender to calm down'. Participants took this approach because they believed that 'follow up of workplace violence is ineffectual' (34%), considered the workplace violence as a common in their job (30%), and did not know whom to report workplace violence to (13%).\ud \ud Conclusion: Iranian EMTs experience a considerable amount of workplace violence. The present study highlights the recommendation for formal training programmes and clearer protocols about how to manage workplace violence, especially verbal abuse in the Iranian prehospital setting

بار استرس مرتبط با عملیات اورژانس در تکنسین های فوریت های پزشکی

Introduction: The staff of pre-hospital emergency medical service experience many stresses daily in the frontline of emergency responses. Critical conditions and trying to save patients’ lives make operation difficult for emergency medical technicians. The burden of stress in this job group is related with critical incidents, and functional and emotional problems that are the result of the rate of exposure and the intensity of the stressor. Methods: In this descriptive-correlation study, 320 technicians working in pre-hospital emergency bases participated. To gather data, stress burden evaluation questionnaire, which was the result of rate of exposure to stressors, was used. Data were analyzed using SPSS statistical software and descriptive and inferential statistics. Results: In the present study, the most important causes of burden of stress were reported to be environmental occupational factors and patient-related factors. Mean and standard deviation of stress burden was 8.70 ± 3.61. Working with trauma patients, unrealistic expectations of the patient or their relatives, and driving in critical conditions and resuscitation of patients inflicted the highest burden of stress upon the staff. In this study, the mean score of stressor intensity was higher than the mean score of exposure to stressors and a significant correlation was seen between the rate of stress burden with number of operations, educational degree, emergency bases, and status of employment. Conclusion: Proper identification of stressors in terms of prevalence and intensity, leads to better understanding of these factors in pre-hospital emergency and can be of great help in prevention and control of stress burden among emergency medical service staff. مقدمه: پرسنل اورژانس پیش بیمارستانی روزانه در خط مقدم پاسخ اورژانس استرس های فراوانی را تجربه می کنند. شرایط بحرانی و تلاش برای نجات بیماران،عملیات را بر تکنسین های فوریت پزشکی دشوار می نماید. بار استرس در این گروه شغلی مرتبط با حوادث بحرانی، مشکلات عملکردی و عاطفی است که حاصل میزان مواجهه در شدت تنش زا بودن عامل استرس زا است. بنابراین این مطالعه با هدف بررسی بار استرس مرتبط با عملیات اورژانس در بین تکنسین های فوریت پزشکی ایران انجام گرفت. روش کار: در این مطالعه توصیفی- همبستگی 320 تکنسین شاغل در پایگاه های اورژانس پیش بیمارستانی شرکت نمودند. برای جمع آوری داده ها از پرسشنامه ی بررسی بار استرس که حاصل میزان شدت در میزان مواجهه عوامل استرس زا بود استفاده شد. داده ها با استفاده از نرم افزار آماری SPSS و آمار توصیفی و استنباطی مورد تجزیه و تحلیل قرار گرفت. يافته ها: در این مطالعه مهمترین عامل بار استرس عوامل محیطی شغلی و عوامل مربوط به بیمار گزارش شدند. میانگین و انحراف معیار بار استرس 61/3±70/8 بود. کار با بیماران ترومایی، توقعات بیش از حد بیمار و همرا هان آن و رانندگی در شرایط بحرانی و احیاء بیماران، بیشترین بار استرس را بر پرسنل داشتند. در این مطالعه نمره میانگین شدت عوامل استرس زا بالاتر از نمره میانگین میزان مواجهه با عوامل استرس زا بود و بین میزان  بار استرس با تعداد ماموریت، مدرک تحصیلی، پایگاه های اورژانس و وضعیت استخدام ارتباط معنی داری دیده شد. نتيجه گيری: شناسایی خوب عوامل استرس زا از نظر شیوع و شدت، باعث گسترش آگاهی و فهم بهتر از این عوامل در اورژانس پیش بیمارستانی خواهد بود و کمک شایانی در پیشگیری و کنترل بار استرس در پرسنل اورژانس پیش بیمارستانی خواهد کر

A Cross-Sectional Study of the Factors Affecting on Turnover Intention of Nurses

Introduction: Nurses are the largest group of health care professionals in health care systems. One of the main challenges of health care systems is the shortage of qualified nurses and Nurses’ intention to leave the profession is one of the key issues in nursing all over the world. The aim of this study was to investigate the factors affecting nurses' turnover in Iran.Methods: This descriptive cross-sectional study was conducted in the School of Nursing and Midwifery, Tabriz, Iran, in 2018. In this study, 500 nurses were selected Convenience sampling method was used for recruitments of samples. Data were collected using Anticipated Turnover Scale (ATC) and Measurement of the intention to leave the profession in nurses and were analyzed using SPSS (version 16).Results: The results showed that the overall score of the Anticipated Turnover Scale was 4.04 ± 0.53. Factors affecting nurses intention to leave included organizational (3.42 ± 0.66), professional (3.05 ± 0.55), faily-work conflict (3.52 ± 0.82) and economic (3.82 ± 0.80) factors. The results showed a significant differences between the mean score of turnover intention and the variables of nurses gender (P= 0.006, T=2.75) and work experience (P= 0.001, F=5.54).Conclusions: Reduction of economic problems and conflict between family and work makenurses stay in the health care system. Also, nurse managers should consider the needs of nurses based on age, gender, work experience and cultural and social differences

A Comparative Study of Emergency Nursing MSc Curriculum in Iran and the USA

Introduction: Conducting comparative studies is one of the research methods for revising and modernizing educational programs. The aim of this study was to compare the emergency nursing MSc curriculum in Iran and the USA. Methods: This descriptive-comparative study was conducted in 2018 at Tabriz University of Medical Sciences. Vanderbilt University was selected through internet searches due to the relative similarity between the fields of study offered by the given universities and then two curricula were compared using Bereday’s four-stage model: description, interpretation, juxtaposition and comparison. Results: The program offered by both universities had certain mission, vision and goals. The goal of Vanderbilt University was to train professional clinical nurses while the goal of Iran's program was to provide the graduates with the proficiency in the clinical, educational, research and managerial fields. The admission requirements in both universities included holding a bachelor`s degree in nursing and having at least two years of clinical nursing experience. In Iran, the graduate students in Emergency Medicine can also take the examination. Some of the requirements for the admission to Vanderbilt University were a confirmation letter of clinical competence, a confirmation letter of at least three faculty members and a good GPA and students can study at a university whether full-time or part-time. Conclusion: The Emergency Nursing MSc curriculum in Iran was designed as a general program, whereas Vanderbilt University curriculum was more specialized and operational with an emphasis on clinical practice. Differences in course credits offered by Emergency Medicine and Nursing bachelor's programs and their different fields of service make it necessary to revise the relevant curricula or develop separate educational paths for these two fields

A 16 Month Survey of Cyclosporine Utilization Evaluation in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Abstract Objectives: Graft versus host disease (GVHD) is a life threatening reaction in the stem cell transplantation process. Nowadays Cyclosporine is the most commonly utilized agent for GVHD prophylaxis and it has a major role in successful transplantation. Cyclosporine has been applied for many years in this field but it could be stated that currently no general consensus is available for its optimal method of administration. Conditions related to cyclosporine administration and possible related adverse reactions observed closely in our patients with the aim of constructing a comprehensive practice guideline in the future. Patients and Methods: Allogeneic stem cell transplant recipients who have been taking cyclosporine were monitored during and after their hospitalization while recording all observations on predefined questionnaires on the basis of periodic clinical and laboratory examinations for a 16 month period. Results: Mean recorded duration of infusions was 1.44 ± 0.68 h and by twice daily administration, means intravenous and oral dose was 101.85 ± 22.03 mg and 219.28 ± 63.9 mg, respectively. A mean CsA trough level after about 12 h of specified unique doses was 223 ± 65 ng/mL. We found hypertension, nephrotoxicity, neurotoxicity, hypertension, and dyslipidemia in about 14, 20, 48, and 94 percent of patients. Conclusions: This study proposed that permanent guidance of healthcare team according to a fixed and standard method of cyclosporine administration routine with using efficient facilities and protocols would be helpful considerably for an optimal pharmacotherapy