Let\u27s Make This Our Thing . Leveling the Playing Field for a Brighter Future in Paramedicine

The majority of paramedic services internationally are multifaceted with frontline paramedics, specialty teams, supervisors, educators, quality assurance, and senior management. Across these services, women have been found to be underrepresented in paramedicine in canada, and the estimated number of women that hold leadership positions is less than 5 percent. Since the data in this area is lacking in paramedicine, we must draw parallels from research performed in academic medicine, business, and the technology industries to gain insight into the ways that gender bias impacts career profession for women

Disaster preparedness and response in older adults: a review and discussion

Older adults are disproportionately affected by disasters when they occur, from health, psychological and social perspectives. The needs of older adults are different, complex, and are often overlooked during disaster planning and response. The aim of this study was to review the current literature surrounding the needs of older adults from disaster preparedness and response perspectives

Implementation of an ST-Segment Elevation Myocardial Infraction Bypass Protocol in the Northern United Arab Emirates

Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infraction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016-August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48-124), and 81% of patients had a D2B time \u3c90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of \u3c90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events

HCV genome-wide genetic analyses in context of disease progression and hepatocellular carcinoma

<div><p>Hepatitis C virus (HCV) is a major cause of hepatitis and hepatocellular carcinoma (HCC) world-wide. Most HCV patients have relatively stable disease, but approximately 25% have progressive disease that often terminates in liver failure or HCC. HCV is highly variable genetically, with seven genotypes and multiple subtypes per genotype. This variation affects HCV’s sensitivity to antiviral therapy and has been implicated to contribute to differences in disease. We sequenced the complete viral coding capacity for 107 HCV genotype 1 isolates to determine whether genetic variation between independent HCV isolates is associated with the rate of disease progression or development of HCC. Consensus sequences were determined by sequencing RT-PCR products from serum or plasma. Positions of amino acid conservation, amino acid diversity patterns, selection pressures, and genome-wide patterns of amino acid covariance were assessed in context of the clinical phenotypes. A few positions were found where the amino acid distributions or degree of positive selection differed between in the HCC and cirrhotic sequences. All other assessments of viral genetic variation and HCC failed to yield significant associations. Sequences from patients with slow disease progression were under a greater degree of positive selection than sequences from rapid progressors, but all other analyses comparing HCV from rapid and slow disease progressors were statistically insignificant. The failure to observe distinct sequence differences associated with disease progression or HCC employing methods that previously revealed strong associations with the outcome of interferon α-based therapy implies that variable ability of HCV to modulate interferon responses is not a dominant cause for differential pathology among HCV patients. This lack of significant associations also implies that host and/or environmental factors are the major causes of differential disease presentation in HCV patients.</p></div

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Assessing student paramedics measurements of fatigue and quality of CPR on a simulated cardiac arrest case: A pilot study

Background: Ambulance services throughout the world respond to and deal with cardiac arrests on a daily basis. Most ambulance services rely on manual cardiopulmonary resuscitation (CPR) being performed by paramedics or suitable bystanders with the addition of airway adjuncts, defibrillation and pharmacological interventions. Recent advances in healthcare technologies have introduced mechanical devices and biofeedback to individuals performing CPR with the aim to improve the quality of CPR. Purpose/aims: The aims of the proposed study are two-fold: (1) to evaluate the influence of providing biofeedback using the Q-CPR system on the quality of compression in the hands of student paramedics; and (2) to evaluate the effects of maintaining effective CPR on indices of measured fatigue. Methods: 40 student paramedics completed CPR on an instrumented manikin with and without audio-visual biofeedback (Q-CPR within the Phillips MRx defibrillator) in a balanced cross-over fashion. Manikin feedback system (SimMan 3G; Laerdal, Sweden) will be used to quantify the quality of CPR in terms of the percentage of applied compressions that meet the current ARC guidelines in terms of rate, depth, and recoil time. Results/findings: In this study it was found that the rate, recoil time and depth was different between the two genders during normal manual CPR without any prompting. However, it was found that once the Q-CPR prompt was introduced, the depth and fatigue levels increasedsignificantly. This highlights that there is a correlation between correct depth and increased fatigue. Conclusion: Over a 7-year period, the Ambulance Services have recorded a decline from 26.2% of cardiac arrests surviving to discharge from hospital to 25.5%. This decline may be attributed to techniques relating to performer fatigue. However, to our knowledge no study has evaluated the influence ofperforming effective CPR, in-line with the current ARC guidelines, on indices of physiological fatigue in Australian Paramedics trained to an advanced level. This pilot study provides Impact and translation to practice through a broader scale research project into pre-hospital CPR performance, especially reviewing physiological fatigue parameter

Escape rooms in paramedic education

Introduction Even with paramedicine’s evolution, clinical decision-making will always be a crucial learning and teaching requirement. As part of their learning, paramedic students need to develop critical thinking and collaborative approaches with others. The aim was to review the literature around escape room activity as a pedagogical approach for paramedic education. The intent is to contribute to the discussion around authentic and engaging approaches to teaching clinical thinking and decision making in paramedicine. Methods A systematic review was undertaken to review existing literature on using this approach in higher education. EBSCO, Medline, CINAHL, ScienceDirect, ProQuest and PubMed were used to review paramedic and health education strategies using the keywords ‘paramedic and education’, ‘ambulance and education’, ‘paramedic and training’ and ‘health education and higher education curriculum’. Specific education databases were used for a more targeted search with specific keywords used (‘Escape Room’ OR ‘Escape Game’ OR ‘Puzzle Room’ AND ‘Higher Education’). The education databases Education Research Complete, Emerald, Elsevier, ERIC and Teacher Reference Center were used, with Google Scholar also being used for its vast breadth of coverage. Results There were 23 scholarly papers examining the use of escape rooms in an educational context found. There was no reference to using this teaching methodology in paramedicine, but some health contexts were identified for nursing, pharmacy, radiology and medicine. Conclusion With an instructional design that addresses logistical requirements, educational escape rooms can be used effectively in paramedic higher education. This review highlights a longitudinal study is needed to assess an educational escape room’s implementation into the paramedic higher education curriculum. A longitudinal, multi-university study can further explore the feasibility of using a blended online/offline escape room activity in large enrolment paramedic programs

Escape rooms in paramedic education: A systematic literature review and research agenda

Introduction: Paramedic students need to critically think and collaborate with others as part of their role. Adapting the popular entertainment activity “Escape Rooms” for paramedicine educational purposes was reviewed to support their clinical judgement abilities. This approach is an innovative teaching method with the potential to improve the learning experience. Methods: A systematic review was undertaken to review existing literature on the use of this approach in higher education. Multiple databases were used to identify and include publications in the systematic literature review. These databases were selected to obtain both breadth and depth of published literature, with Google Scholar being used for its vast breadth of coverage, and specific education databases being used for a more targeted search. Due to the vast quantity of publications available through Google scholar, a specific search string was used (“Escape Room” OR “Escape Game” OR “Puzzle Room” AND “Higher Education” OR “Paramedic Education”). For the education databases (Education Research Complete, Emerald, Elsevier, ERIC (Education Resource Information Center), and Teacher Reference Center), only the term “Escape Room” was used during each search. Results: Articles not relating to the use of an escape room style activity in an education setting were not considered. After removing duplicates, a total of 23 scholarly papers examining the use of escape rooms in an educational context were found. There was no reference to the use of this teaching methodology in paramedicine, but some health contexts were identified for nursing, pharmacy, radiology, and medicine. Discussion: With an instructional design that addresses logistical requirements, educational escape rooms can be conducted in paramedic degrees. Time requirements for this type of teaching method are substantial, but reasonable if the activity is repeated in subsequent semesters. Educational escape rooms can be used to provide a more enjoyable student experience that immerses them as active participants in the learning environment Conclusion: This review highlights the need for a longitudinal study to assess the implementation of an educational escape room into the paramedic curriculum. A longitudinal, multi-university study can further explore the feasibility of using a blended online/offline escape room activity in large enrolment paramedic qualifications

Development and validation of the theory of planned behaviour questionnaire on student paramedics’ belief of case-based learning

Background The use of case-based learning (CBL) in the paramedic curriculum has been reported to be a valuable learning tool. Despite this, the use of CBL in distance or online education is not well researched, in particular, identifying the motivation for students to use CBL using a theoretical approach to eliciting and reviewing student paramedics’ beliefs. Aims This study aimed to explore the wide range of students’ beliefs when it comes to CBL (elicitation of beliefs) and to develop a tool for assessing beliefs in the setting of the theory of planned behaviour (TPB) (development of an assessment instrument). Methods A sequential exploratory study design was used to explore the methodological challenges associated with eliciting beliefs and forming reliable belief scales. The standard components of developing a questionnaire in the context of the theory of planned behaviour were undertaken. Finally, a cross-sectional non-experimental survey design was used to determine the capability of the TPB to predict students’ perceptions to CBL in their third year of study. Results In order to learn about the factorial structure of the TPB questionnaire on CBL, a 40–50% response rate was required; this study had 12 of 25 students (48%) respond. Using CBL as a focus in paramedic education is subjectively comparable with previous studies in nursing, medicine and allied health professions. It was viewed positively as a linking exercise for consolidation of previously covered work in a paramedic bachelor degree but its true worth not only as a learning tool but for students studying via distance education requires further study and refinement as a model on its own. Conclusion This study was devoted to eliciting students’ beliefs about CBL in their education and developing an instrument to assess students’ beliefs in the context of the TPB. A pilot study utilising the constructs of the TPB is required to be undertaken in predicting students’ behaviour towards CBL within their degree

Implications for reflective practice and safer care in paramedicine: The Bawa-Garba case

Batt, AM ORCiD: 0000-0001-6473-5397; Delport, S ORCiD: 0000-0002-0366-9928Letter to the editor of the Journal of Paramedic Practice