Paramedic occupational violence : A qualitative examination of aggressive behaviour during out-of-hospital care

Occupational violence (OV) is an insidious problem for emergency medical services with continued high levels of paramedic exposure despite significant education and resources devoted to mitigation. Though there is considerable data on the epidemiology of the phenomenon, the available evidence on the experiences of paramedics exposed to acts of violence during healthcare is limited. Utilising a generic qualitative approach and a semi-structured interview framework, we examined the perceptions and experiences of 25 Australian paramedics who had been exposed to incidents of patient-initiated violence during out-of-hospital care. A general inductive methodology and a first- and second-cycle coding process assisted in the development of the principal concepts of the patient and the paramedic from the raw data. Subsequently, a further four main themes and 15 secondary themes were developed which characterise the influence of social interaction on the evolution of paramedic OV. The results of this study provide a unique insight into the phenomenon of paramedic OV. As opposed to the rudimentary manifestation of aggression typically endorsed by emergency medical services, aggressive behaviour during healthcare presents as a judicious interaction of dynamic scene management and situational context. The social interactions that occur during healthcare, and the premises which both promote and suppress this connection, were identified to exert significant influence on the evolution of aggressive behaviour. The consequences of these findings challenge traditional violence mitigation strategies which seek to position the patient as both the focal point of initiation and the key to its extenuation

Working with young dynamos: the benefits of patient public involvement in research design [Abstract only]

This study examined the attitudes and perceptions towards continuous professional development (CPD) of Australasian paramedics working in private and state or territory ambulance services. For the purpose of the study, CPD is described as commitment to both formal and informal life-long learning (LLL) opportunities which are linked to clinical advancements, practitioner competence, professionalism, and the delivery of gold standard patient care. Constructivist grounded theory was used as the methodological framework for this study. Study participants (n = 10) completed their paramedic qualification through two main pathways, namely a postemployment in-house Vocational Education and Training (VET) diploma or a preemployment university degree and had worked as a paramedic for a minimum of 2 years. Ethical approval was obtained from the Queensland University of Technology, and the participants signed consent forms prior to participating in the study. Data were collected by semistructured interviews, which were recorded digitally for transcription and analysis purposes. The study found there was not a considerable step up for paramedics to engage in CPD and LLL, as this was already expected prior to professional registration for paramedics commencing late 2018. Some older paramedics expressed fear about keeping up to date with new technologies and a shift in the paramilitary paramedic culture was identified, where education is forming a new hierarchical stigmatisation. A framework of paramedic CPD has been created from the study’s findings and builds on the extant literature. The framework acknowledges professional, industrial, social, personal, political, organisational, and economic factors which influence or change engagement in CPD

Paramedic disaster health management competencies: a scoping review

Study/Objective: This scoping review aims to identify, categorise and explore the existing range of paramedic disaster health management competencies that have been developed internationally. The objective of the study is to assist EMS agencies to develop core competencies specific to their own environments in order to standardise teaching in the area of paramedic disaster health management response. Background: Paramedics play an essential role in all phases of disaster health management. Previous research has identified potential gaps in content and challenges to the sustainability of knowledge acquired through occasional disaster response training by paramedics. For paramedics to respond competently, they must be equipped with the necessary skills to provide comprehensive care to the populations affected by disasters. Despite this the literature shows that education and training for disaster response is variable and that an evidence based study specifically designed to outline sets of core competencies for Australian paramedics has never been undertaken. Methods: A systematic scoping review will be conducted using the Joanna Briggs Institute (JBI) methodology. The review will use information from four databases: PubMed, MEDLINE, ScienceDirect, and Scopus. Keywords and inclusion and exclusion criteria will be identified as strategies to use in this review. Results: Results will be extracted, mapped, and categorised from appropriate studies. The identified core competencies will be sorted into common domains such as communication, operations, planning, logistics, incident command systems and ethics. A descriptive analysis of the results will then be undertaken. Conclusion: Further research is needed to develop core competencies specific to Australian paramedics in order to standardise teaching in the area of disaster health management response. This study will assist agencies from all jurisdictions in evaluating or creating disaster curricula that adequately prepares and maintains paramedics for an effective all hazards disaster response

Factors impacting the decision-making processes of qualified paramedics moving to a specialist role in community paramedicine

Community paramedicine continues to evolve as a stream of paramedic specialisation. However, little is known about the transition from a 'traditional' role to that of an Extended Care Paramedic (ECP) or Community Paramedic (CP). Moreover, few studies have explicitly examined the rationale for the articulation of an experienced practitioner to an advanced practice role. This research illuminated the events or circumstances participants identified as necessary prior to the active engagement in the transition process. Methods ECPs (n=25) from two Australian jurisdictions and CPs (n=11) from a Canadian provincial health service, participated in a qualitative study exploring their experiences of transition. The data from the three study sites was pooled and interpreted using constructivist grounded theory methodology. Results Qualified Paramedics entered a junctional point in their careers in which the reasons for pursuing a career in community paramedicine were rationalised. The decision-making process involved satisfying two career 'wants': seeking new career options and improving patient outcomes. Subsequently, the paramedic’s perception of the community paramedicine role determined whether the paramedic entered the active phases of transition. Conclusion This study is the first of its kind to qualitatively examine the transition from one clinical specialist stream to another. The findings of this study have the potential to inform the selection criteria of prospective ECP/CP candidates and be utilised as a workforce recruitment tool for community paramedicine programs

Improved outcomes for emergency department patients whose ambulance off-stretcher time is not delayed

Abstract Objective To describe and compare characteristics and outcomes of patients who arrive by ambulance to the ED. We aimed to (i) compare patients with a delayed ambulance offload time (AOT) >30 min with those who were not delayed; and (ii) identify predictors of an ED length of stay (LOS) of >4 h for ambulance-arriving patients. Methods A retrospective, multi-site cohort study was undertaken in Australia using 12 months of linked health data (September 2007–2008). Outcomes of AOT delayed and non-delayed presentations were compared. Logistic regression analysis was undertaken to identify predictors of an ED LOS of >4 h. Results Of the 40 783 linked, analysable ambulance presentations, AOT delay of >30 min was experienced by 15%, and 63% had an ED LOS of >4 h. Patients with an AOT 4 h included: hospital admission, older age, triage category, and offload delay >30 min. Conclusion Patients arriving to the ED via ambulance and offloaded within 30 min experience better outcomes than those delayed. Given that offload delay is a modifiable predictor of an ED LOS of >4 h, targeted improvements in the ED arrival process for ambulance patients might be useful

The 'golden hour': an examination of mortality from major trauma in an informal, decentralised state-wide emergency medical system

ABSTRACT Key words: major trauma, mortality, emergency pre-hospital, performance indicators. Australian and New Zealand Standard Research Classifications: Division 11 (Medical and Health Sciences); Group 1117 (Public Health and Health Services) Background Response times are a common performance measure for many ambulance services and emergency medical response systems and are considered to be a standard measure of emergency medical services quality. The development of formalised Emergency Medical Systems in Australia and internationally have almost universally assumed a link between shorter response times and improved patient outcome measured by survival. While the evidence to support time-criticality for patients who experience a cardiac arrest is considered unequivocal, the assumption that response and scene times are universally important across all patient groups is not consistently supported by the research evidence. Little is known about whether or not the importance of time-dependent performance measures vary as a function of the Emergency Medical System arrangements to which they apply, the skill set of attending paramedics or the epidemiology of the target population. Despite this, response times continue to be one of the key performance measures for ambulance services regardless of the wider health services system in which they operate. Given the significant investment in paramedic training and increasing levels of clinical responsibility witnessed in the last decade, the development of a robust body of evidence about whether this investment and expertise alters outcomes for patients is yet to develop and there has been little shift in measures of performance. Major traumatic injury is associated with significant disease burden in Australia as elsewhere in the world. An estimated 1,500 Queenslanders die each year as a result of major traumatic injury and injury remains the single most common cause of death in Queenslanders between the ages of 1 and 35 years. As such, injury has a massive impact on the health of Queenslanders. Each year, around 10% of Queenslanders will suffer from an injury of some kind and it is known that injury results in 10% of all hospital admissions and 40-60% of attendances at hospital Emergency Departments. In Australia, injury is recognised as one of the seven National Health Priority Areas by the Australian Government. While this document provides for the setting of broad targets for reduction in injury and its social, economic and health corollaries, little advice is provided regarding health service performance with this target group. The emergency pre-hospital environment is absent in this and most strategic policy documents of this ilk in Australia. This thesis has two core aims: • to provide for the first time a descriptive analysis of major trauma in Queensland for the period 1998-2001 including description of the systemic factors influencing patient mortality; and in the light of these findings to • examine the utility of emergency pre-hospital time-dependent performance indicators as predictors of mortality in this patient group. The period of interest 1998-2001 was selected to provide a baseline for the development of the Queensland Trauma Plan implemented by government in 2007. Methods This thesis involved three key activities: (1) a review of the literature on the basis for time-dependent measures of pre-hospital performance in trauma, impacts of system design and emergency pre-hospital skill set on mortality from major trauma; (2) a descriptive quantitative analysis of linked patient data over a four year period (1998-2001) of the relationship between pre-hospital time and mortality; and (3) the theoretical development of alternative emergency pre-hospital performance measures for trauma. Results Of the 23,462 patients in the study population, 29.0% (n= 6,793) died as a consequence of their injuries. Fifteen percent (15.0%) of the patients died in the pre-hospital environment. After adjustment for age, sex and severity (GCS10 minutes (OR 1.11; 95%CI 0.98-1.26) was noted in the pre-hospital period. Scene time >20 minutes (OR 0.75; CI 0.65-0.86) improved the chance of survival to hospital by comparison to scene time