Search Results (57)

Background/Objectives: Acute obstructions of the upper respiratory tract are emergencies that may require a cricothyrotomy as ultima ratio. For this, precise identification of the conic ligament is essential. Point-of-care ultrasound (POCUS) offers a reliable tool for anatomical localization in challenging cases and could be used by a range of emergency medicine workers. This prospective, controlled observational study assesses the development of competencies of paramedics (PMs) in point-of-care ultrasound (POCUS) assisted identification of the conic ligament after structured training, and compares their competence level to emergency physicians (EPs). Methods: PMs and a control group of EPs received an identical structured training program as part of an ultrasound course. It included a 10-min theoretical introduction, a 10-min video, and a 45-min practical session with ultrasound devices. Questionnaires and a practical test assessed both group’s previous experiences, satisfaction with training, and the development of subjective and objective competencies before (T₁) and after (T₂) the training. Results: A total of 120 participants (N = 92 PMs and N = 28 EPs) participated. A minority had previously performed a cricothyrotomy even in training settings (PMs 17%; EPs 11%), and none had identified the conic ligament using POCUS. The study group’s subjective and objective competencies increased significantly (p < 0.001). At T2, the study group demonstrated comparable subjective (p = 0.22) and objective (p = 0.81) competencies to those of the control group. The study group needed significantly (p < 0.01) less time to perform the DOPS. While both groups were satisfied with the study material (PMs 2.2 ± 1.2 vs. Eps 1.6 ± 1.0; p = 0.02) and the training (PMs 1.8 ± 1.0 vs. EPs 1.4 ± 0.7, p = 0.03), the study group rated both significantly better. Conclusions: After structured training, paramedics successfully identified the conic ligament using POCUS comparably to emergency physicians. Integrating POCUS into paramedic training may improve prehospital airway management and enhance patient safety. Further studies should investigate long-term skill retention and real-life application. Full article

Background/Objectives: Performing cardiopulmonary resuscitation (CPR) is cognitively demanding, often requiring helpers to perform cognitive and manual tasks simultaneously. While the human brain primarily switches between tasks rather than processing them simultaneously, it remains unclear whether performing repetitive, monotonous manual tasks, such as chest compressions, affects cognitive performance. This study aimed to assess the impact of chest compressions on mental arithmetic performance. Methods: In a randomized crossover trial, healthy participants trained in advanced life support (physicians, nurses, and paramedics) completed the Paced Auditory Serial Addition Test (PASAT) under two conditions: with or without performing chest compressions on a manikin. The primary outcome was the number of correct PASAT answers. Secondary outcomes included workload assessment using the NASA Task Load Index (TLX) and chest compression (CC) performance. The trial was registered at clinicaltrials.gov and approved by the local ethics committee. Results: Thirty-eight participants were included. The number of correct PASAT responses was significantly lower during chest compressions compared to the control (36.5 vs. 41; p < 0.01). NASA TLX values were significantly higher in the chest compression condition, indicating increased perceived workload. Chest compression performance showed statistically significant differences between a phase of just chest compressions and during the PASAT, especially increased levels of incomplete recoil. Conclusions: This study demonstrates that even a simple repetitive motor task like chest compressions impairs cognitive task performance significantly. Furthermore, multitasking was shown to decrease chest compression quality. These findings strongly highlight the importance of effective task allocation and minimizing multitasking during CPR to optimize performance and thereby patient outcomes. Full article

An emerging alternative to conventional piezoelectric technologies, which continue to dominate the ultrasound medical imaging (US) market, is Capacitive Micromachined Ultrasonic Transducers (CMUTs). Ultrasound transducers based on this technology offer a wider frequency bandwidth, improved cost-effectiveness, miniaturized size and effective integration with electronics. These features have led to an increase in the commercialization of CMUTs in the last 10 years. We conducted a review to answer three main research questions: (1) What are the commercially available CMUT-based clinical sonographic devices in the medical imaging space? (2) What are the medical imaging applications of these devices? (3) What is the performance of the devices in these applications? We additionally reported on all the future work expressed by modern studies released in the past 2 years to predict the trend of development in future CMUT device developments and express gaps in current research. The search retrieved 19 commercially available sonographic CMUT products belonging to seven companies. Four of the products were clinically approved. Sonographic CMUT devices have established their niche in the medical US imaging market mainly through the Butterfly iQ and iQ+ for quick preliminary screening, emergency care in resource-limited settings, clinical training, teleguidance, and paramedical applications. There were no commercialized 3D CMUT probes. Full article

Background/Objectives: Resilience, defined as the ability to adapt and cope effectively with stress, plays a crucial role in preparing candidates for the paramedic profession. This study aimed to assess the resilience intensity as a personality trait and identify stress-coping styles among paramedic candidates. Methods: A cross-sectional cohort study was conducted across multiple Polish universities offering bachelor’s degree programs in emergency medical services. The study included 138 participants (56 females, 82 males, aged 18–51). Data collection involved demographic surveys and standardized tools, including the Polish version of the Resilience Scale (SPP-25), the Satisfaction with Life Scale (SWLS), and the Coping Inventory for Stressful Situations (CISS). Results: The study revealed a positive correlation between resilience and age (p = 0.002). Males exhibited significantly higher resilience compared to females (p = 0.0004). While both genders demonstrated average life satisfaction (SWLS), men scored significantly higher (p = 0.0082). Task-oriented coping strategies were predominant among all participants, but females scored higher in emotion-oriented coping (p = 0.0003). Resilience was positively correlated with task-oriented coping (0.4872) and negatively correlated with emotion-oriented coping (−0.4727). Conclusions: These findings emphasize the importance of resilience in paramedic training and selection, as it significantly influences stress management and professional performance in high-pressure situations. Full article

Recent major disasters, including the COVID-19 pandemic and floods in Europe, highlight the unpredictability of crises and the necessity for systemic preparedness at all levels of crisis management, including pre-hospital emergency medical services. Paramedics observed, under these challenging conditions (but not exclusively during them), cases of insufficient knowledge and skills in providing pre-hospital medical care, which lead to inadequate or prolonged decision making in delivering assistance. For this reason, the authors aimed to determine the extent to which such situations occur and to examine their causes, focusing on potential gaps and shortcomings in the education of paramedics. This study examines the impact of educational systems on the professional preparedness of paramedics in V4 European countries (the Slovak Republic, the Czech Republic, Hungary, and Poland) during pre-hospital care through a questionnaire survey. A survey involving over 1600 respondents revealed significant disparities in perceived knowledge and skill gaps, with Poland demonstrating the highest deficiencies (78%) and the Slovak Republic the lowest (57%). Key factors influencing these gaps included the frequency of external educational and training activities, years of experience, and expertise in managing critical conditions. The findings underscore the importance of innovative technologies, such as simulations and virtual reality, in enhancing paramedic training, along with integrating digital solutions across all phases of disaster management. Recommendations focus on strengthening system resilience, fostering interdisciplinary approaches, and improving system sustainability and adaptability. By using the results obtained and leveraging technological advances, the study aims to contribute to more effective crisis preparedness, population protection, and sustainable development goals (SDGs), namely (3, 4, 9, and 11), especially in the field of crisis management. This reinforces the broader role of SDGs in building more robust, future-ready disaster management frameworks. Full article

Background: End-of-life (EOL) care is an integral part of paramedic services, requiring not only medical expertise but also communication skills and emotional support. With the evolving role of paramedics in providing palliative care, understanding their attitudes toward EOL care and the impact of specialized training becomes crucial. Aim: This study aims to assess the attitudes of Saudi Arabian paramedics toward EOL care and evaluate the influence of prior EOL care training on these attitudes. Methods: A cross-sectional study was conducted among paramedics in Saudi Arabia using convenience and snowball sampling. Data were collected via an online survey distributed through emails and social networks, encompassing demographic information and attitudes toward EOL care. The survey was structured into two parts, with the second part developed from the relevant literature. Statistical analysis was performed using STATA version 18, employing chi-squared and Fischer exact tests for comparison. Results: The study involved 1049 paramedics, with the majority being aged 26–35 years (54.43%) and predominantly male (65.59%). About half of the participants (50.43%) had previously participated in EOL care courses. Paramedics who received EOL training demonstrated significantly more positive attitudes toward the role of EOL care in their jobs (98.49% versus 32.12%, p < 0.001) and were more comfortable discussing death with patients (51.42% versus 29.23%, p < 0.001). A significant majority viewed caring for a dying patient as a worthwhile experience (95.42%), and 95.33% agreed on the importance of involving the patient’s family in care. Conclusions: The findings highlight the positive impact of EOL care training on paramedics’ attitudes toward palliative care. Specialized training enhances paramedics’ comfort in discussing death and their perceptions of the role of EOL care, underscoring the need for integrating comprehensive palliative care education into paramedic training programs. Future research should focus on developing standardized EOL care courses to further explore their impact on paramedics’ knowledge, attitudes, and practices. Full article

Introduction: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in low- and middle-income countries, complicating 1% to 10% of deliveries. Despite improvement in prevention and management, variations in PPH definitions and measurement methods contribute to challenges in accurately assessing its incidence, with up to 90% of PPH-related deaths in high-income countries deemed avoidable through timely intervention. Oxytocin is the primary drug administered during labour or miscarriage, causing an increase in uterine muscle tone, which reduces bleeding and the risk of complications. The aim of the study was to assess the rate of oxytocin use by paramedics for out-of-hospital births in Poland and to verify adherence to WHO-recommended protocols for preventing postpartum haemorrhage in emergency prehospital settings. Methods: We conducted a cross-sectional study using data from the Polish Central System for Emergency Medical Services Missions Monitoring covering all EMS interventions nationwide from 2018 to 2023. The study included cases where oxytocin was administered during EMS interventions for pregnant women, identified through ICD-10 codes (O30–O92), with 62 verified cases meeting the inclusion criteria. Results: Over 6 years, oxytocin was administered in 62 cases when paramedics responded to emergencies involving pregnant women. The mean age of the patients to whom the oxytocin was administered was 29.48 years (SD = 6.25) and ranged from 15 to 43 years. Conclusions: Oxytocin is rarely administered by EMS teams at the prehospital stage. Oxytocin should be considered for incorporation into the set of medications that EMS teams can administer in prehospital settings. There is a need to train EMS teams in the management of pregnancy-related emergencies in accordance with the current medical guidelines. Full article

Background: The COVID-19 pandemic has significantly impacted the mental health of healthcare professionals, particularly nurses and paramedics. This study investigates the prevalence of Post-Traumatic Stress Disorder (PTSD) and the impact of social ostracism on psychological distress among healthcare workers (HCWs) in Poland, with a focus on exploring the interplay between professional and social factors contributing to their stress. Methods: A cross-sectional survey was conducted between March 2021 and February 2022 with 852 HCWs from four Polish provinces. PTSD symptoms were measured using the PTSD Checklist—Civilian Version (PCL-C), and social ostracism was assessed through a custom-designed questionnaire. Results: Of the participants, 14.1% reported experiencing social ostracism, and 4.9% observed such experiences among colleagues. Those who experienced or witnessed ostracism reported significantly higher PTSD symptoms (p < 0.001). Concerns about personal health and the well-being of older individuals were strongly associated with increased PTSD severity, while concerns for household members were not. Conclusions: Social ostracism exacerbates the psychological burden on healthcare workers, contributing to higher levels of PTSD. This study highlights the need for targeted mental health interventions and support systems, including resilience training and stigma reduction initiatives, to address these challenges. Future research should explore cross-national comparisons and long-term psychological effects among diverse healthcare populations. Full article

Background/Objectives: The stress levels in emergency services are enormous. The resulting stress can range from psychological irritation to burnout. This study examines the importance of resilience in the German EMS and its significance for the risk of irritation and burnout among EMS personnel. Methods: A quantitative cross-sectional online survey was conducted among 285 EMS personnel in Germany. Resilience was measured by the RS-13 Scale, irritation by the Irritation Scale (IS), and burnout by the Maslach Burnout Inventory (MBI). Sociodemographic and job-related data were also collected. A classification into resilient groups was used to compare stress levels. Results: More than one-third (39%) of the participants had a low level of resilience. EMS personnel with high levels of resilience had significantly lower scores on the cognitive and emotional irritation dimensions, as well as on the burnout dimensions of emotional exhaustion and cynicism. Conclusions: Resilience plays an important role in the safety culture of emergency services. The results support the hypothesis that high levels of resilience lead to less stress and help people cope better with stress. Almost two-fifths of the participants had lower resilience, underscoring the need for safe communication and targeted measures to strengthen resilience. Regular training, a supportive work environment, and promoting team cohesion and social support can improve emergency responders’ mental health and job performance. Future research should develop specific intervention strategies and evaluate their effectiveness to ensure the long-term health of emergency responders and improve the quality of emergency care. Full article

Background: Prehospital detection and triage of stroke patients mostly rely on the use of large vessel occlusion prediction scales to decrease onsite time. These quick but simplified scores, though useful, prevent prehospital providers from detecting posterior strokes and isolated symptoms such as limb ataxia or hemianopia. Case report: In the present case, an ambulance was dispatched to a 46-year-old man known for ophthalmic migraines and high blood pressure, who presented isolated visual symptoms different from those associated with his usual migraine attacks. Although the assessment advocated by the prehospital guideline was negative for stroke, the paramedic who assessed the patient was one of the few trained in the National Institutes of Health Stroke Scale assessment. Based on this assessment, the paramedic activated the fast-track stroke alarm and an ischemic stroke in the right temporal lobe was finally confirmed by magnetic resonance imaging. Discussion and conclusions: Current prehospital practice enables paramedics to detect anterior strokes but often limits the detection of posterior events or more subtle symptoms. Failure to identify such strokes delay or even forestall the initiation of thrombolytic therapy, thereby worsening patient outcomes. We therefore advocate a two-step prehospital approach: first, to avoid unnecessary delays, the prehospital stroke assessment should be carried out using a fast large vessel occlusion prediction scale; then, if this assessment is negative but potential stroke symptoms are present, a full National Institutes of Health Stroke Scale assessment could be performed to detect neurological deficits overlooked by the fast stroke scale. Full article

Paramedics work under physically and cognitively demanding conditions to provide emergency care. As physical fitness could positively impact the quality of patient care, we investigated within a pilot study whether concurrent training (CT) affects work-related performance parameters in paramedics. At baseline (T1), 16 paramedics performed cardiopulmonary resuscitation whereby resuscitation performance (RP; total resuscitation quality, compressions with correct frequency, and correct ventilation), cognitive performance (CP; reaction time, divided attention, and working memory), and heart rate variability (HRV) were assessed (pre-exertion). Then, participants climbed seven floors carrying 20 kg of gear before completing the same assessments again (post-exertion). The baseline testing was followed by a CT intervention (12 weeks, three sessions/week). After the intervention (T2), the two-stage testing was repeated. We analyzed whether the pre-exertion and post-exertion values, as well as the difference between the pre-exertion and post-exertion values, changed from T1 to T2. Nine paramedics (male: N = 7; age = 26.3 (SD = 8.17) years) took part in the study. The comparison of the pre-exertion values showed significantly better reaction times (p = 0.001) and divided attention (p = 0.02) and a trend toward greater working memory and RP parameters at T2. Regarding the post-exertion values, significant improvements in working memory (p = 0.03) and a trend toward improved reaction time, divided attention, and RP occurred at T2. The difference between the pre- and post-exertion values did not change for any parameter from T1 to T2. HRV decreased significantly from pre- to post-exertion (T1: p = 0.01, T2: p = 0.01). These results indicate that CT is a promising training concept to improve RP and CP in paramedics and should therefore be investigated further to increase patient care quality. Full article

This research investigates the intersection of paramedicine and environmental sustainability (ES) by using mixed methods (surveys and policy analysis) to analyze organizational policy and professional beliefs. It advocates integrating ES into paramedic training and operations to reflect broader environmental values, and challenges, of a sector providing first response service delivery to climate-induced emergencies. Assessing paramedics’ willingness/interest in environmental education, timing (foundational or continuing professional development/CPD and organizational policy governing accreditation and practice in Australia and New Zealand (ANZ) found growing awareness of paramedics’ role in environmental stewardship. Disparity, however, exists between individual interest in ES training and its systemic exclusion in CPD policy and standards. The relevance of sociological thought, specifically Durkheimian theory, for construing ES interdependently, rather than individualistically (as predominated in the under-researched area) is advanced to promote ES reconceptualization, goal articulation and measurement. Results and practical recommendations are discussed amidst multidisciplinary literature to further emerging ES values exhibited in ANZ policy and paramedic beliefs. The article concludes systemic change is timely. Specifically, embedding ES into foundational and/or CPD training may leverage the professional interest found in the study and, importantly, ensure emergency practices promote the long-term environmental health prerequisite to supporting human health, congruent with the sector’s remit. Full article

Background: Cervical collars (CC) are routinely used in prehospital trauma treatment. However, over the past years, their application was discussed more critically since they increase intravenous pressure due to reduced venous drainage and the possibility of secondary cervical spine injury. Guidelines have been adjusted accordingly. The question is how efficient has this been put into practice, and how good, as well as up to date, is the knowledge of prehospital emergency medicine personnel about indications on cervical spine immobilisation? Methods: A 15-item questionnaire regarding the self-evaluation and result checking of the right indications for the use of a cervical collar in the prehospital setting was sent to paramedics and emergency doctors in Germany. Two hundred and nineteen completed surveys were statistically analysed. Results: Mean age of the participants was 30.45 ± 8.8. 72% were male. Regarding subjective safety, the appropriate indication of CC participants reached 79.8 ± 19.5 on a metric scale from 0 (no safety) to 100 (full safety). Mean right answers were as follows: Ambulance man (RS) 0.78 ± 0.84, paramedic (RA) 0.9 ± 0.74, paramedic (NFS) 1.03 ± 0.83 and emergency doctor (ED) 1.75 ± 1.06 (p = 0.013, Kruskal–Wallis Test). Participants who estimated their knowledge < 85% had 0.83 ± 0.8 right answers, and > 85% had 1.14 ± 0.9 right answers. Conclusions: Rational spine immobilisation is still necessary in severely injured patients. This study highlights the importance of continuing education using ongoing training, lectures or online learning with a questionnaire as a monitor for success to ensure the transfer of evidence-based medicine into daily practice. Full article

In the domain of Advanced Air Mobility (AAM), Simplified Vehicle Operations (SVOs) promise a reduction in handling complexity and training time for pilots. Designing a usable human–machine interface (HMI) for pilots of SVO-enabled aircraft requires a deep understanding of task and user requirements. This paper describes the results of two user research methods to gather these requirements. First, a traditional Helicopter Emergency Medical Service (HEMS) mission was examined using a Hierarchical Task Analysis (HTA). The findings were used to formulate a theoretical HTA for a single-piloted electric Vertical Take-Off and Landing (eVTOL) system in such a scenario. In the second step, qualitative interviews with seven subject matter experts (pilots and paramedic support) in HEMS operations produced vital user requirements for HMI development. Key findings emphasize the necessity of a simplified information presentation and collision avoidance support in the HMI. Full article

The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the “Environmental context and resources” domain (57.6%, 95%CI: 49.5–65.4), e.g., lack of professionals, funding, and coordination, and the “Knowledge” domain (52.8%, 95%CI: 44.7–60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS. Full article