Search Results (49)

Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences in satisfaction with health facility personnel between younger (18–59 years) and older (60+) adults with disabilities in Chile. Data from the 2024 Disability and Citizenship (DISCA) survey were analysed using chi-square tests to examine differences between younger and older people with disabilities with regard to their satisfaction with health facility personnel. Ordered logistic regressions were employed to predict high satisfaction, given socioeconomic and health-related variables. Findings indicated that a higher percentage of older adults with disabilities reported high satisfaction with health facility personnel compared to younger adults. Ordered logistic regressions confirmed that older adults had greater odds of reporting high satisfaction with doctors (OR: 3.83), other health professionals (OR: 4.66), paramedical technicians (OR: 4.31), and administrative staff (OR: 3.13). These results suggest that age influences satisfaction levels among people with disabilities, potentially due to varying expectations, experiences, or interactions with health facility personnel. Understanding the underlying reasons for these age-related differences is essential to inform policies and practices that ensure equitable, person-centred care for people with disabilities across the life course. Full article

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, which were further complicated by the COVID-19 crisis. While public safety research typically focuses on the impact of operational stressors on PSP functioning and wellbeing, relatively less is known about the types and impacts of organizational stressors and how all these affect social wellbeing during the pandemic. The current study surveyed Canadian firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48) that continued to serve the public over the course of the pandemic. Participants responded to two open-ended survey questions about how COVID-19 affected their lives at work and home. Using an inductive thematic analysis approach, responses were coded to identify emergent, data-driven themes while drawing on existing theory for analysis. Across occupational groups, qualitative analyses revealed that the public safety measures imposed by the COVID-19 pandemic further exacerbated existing operational and organizational strains, including increased exposure to distressing calls, absenteeism and coping with alcohol, and a lack of support from management. Participants also identified financial strain and housing insecurity as stressors, as well as frustration and helplessness at others’ non-compliance with public health advisories and protocols. Communication surrounding the rationale behind government decision-making, the efficacy of serology tests, and rates of infection were also identified. Together, these findings offer a nuanced understanding of the interplay among operational, organizational, and social stressors experienced by Canadian PSP during the COVID-19 pandemic, illuminating their impact on mental health and wellbeing, and identifying targeted areas of focus for future planning and meaningful intervention to support PSP wellness. Full article

Background: Paramedics and firefighters frequently encounter critical incidents that require both deep learning and emotional processing. This study investigates how reflective writing facilitates these processes, addressing the need to understand professional development in high-stress environments. Methods: The research analyzed reflective writings from 57 second-year Management of Catastrophe Defense undergraduates who were active emergency service workers. Using Mayring’s qualitative content analysis, the study examined participants’ descriptions of critical workplace incidents, emotional responses, and long-term impacts. The theoretical framework combines Paul’s concept of transformative experiences, Schön’s reflective practice, and Jarvis’s experiential learning theory. Results: The analysis revealed three key dimensions: transformative experiences, the role of conversation with the situation in meaning making and the significance of whole-person learning in understanding emotional presence and absence, and the role of reflective writing in understanding learning processes. The study uncovered complex patterns in how professionals process critical incidents and manage emotions in high-stress environments. Conclusions: Reflective writing serves as an effective tool for processing experiences and developing professional resilience, although the process of engaging with traumatic memories through reflection presents its own complexities. These insights contribute to the understanding of learning processes and professional development in high-stress environments. 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: 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

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

Strengthening primary healthcare (PHC) is vital for enhancing efficiency and improving access, clinical outcomes, and population well-being. The World Health Organization emphasizes the role of effective PHC in reducing healthcare costs and boosting productivity. With growing healthcare demands and limited resources, efficient management is critical. Background/Objectives: Building on this point, this study aimed to evaluate the efficiency of PHC units across Greece, focusing on Health Centers (HCs) and Local Health Units (ToMYs). The objective was to assess their efficiency levels and identify factors contributing to observed inefficiencies. This study explores a novel research area by being the first to assess the efficiency of restructured primary healthcare facilities in Greece, utilizing 2019 data—the first year operational data became available for the newly established ToMY facilities following recent healthcare reforms. Methods: We applied a comprehensive suite of non-parametric methods, including Data Envelopment Analysis (DEA) under variable, constant, increasing, and decreasing returns to scale (VRS, CRS, IRS/NDRS, DRS/NIRS) assumptions, along with the Free Disposal Hull (FDH) model, all oriented toward output maximization. Efficiency scores were refined using bootstrapping to calculate 95% confidence intervals, and efficient units were ranked via the super-efficiency model. Outliers were identified and removed through the data cloud algorithm. For the first time at this scale, the final sample included the vast majority of PHC facilities in Greece—234 Health Centers and 94 Local Health Units—with inputs categorized into three human resource types: medical, nursing/paramedical, and administrative/other staff. Outputs encompassed scheduled visits, emergency visits, and pharmaceutical prescription visits. This diverse and comprehensive application of DEA methods represents a novel approach to evaluating PHC efficiency in Greece, with potential relevance to broader healthcare contexts. Results: The analysis revealed significant inefficiencies and differences in technical efficiency between HCs and ToMYs. HCs could nearly double their outputs (VRS score: 1.92), while ToMYs could increase theirs by 58% (VRS score: 1.58). Scale efficiency scores were closer, with HCs slightly more aligned with their optimal scale (1.17 vs. 1.20 for ToMYs). Conclusions: There is significant potential to improve efficiency in PHC, with variations depending on unit characteristics and regional differences. This evaluation provides a foundation for policymakers to identify areas for improvement and enhance the overall performance of healthcare services in Greece. Full article

Children in prehospital emergency care are particularly vulnerable to medication errors, often with serious consequences. A prior study analyzing prehospital pediatric medication dosing errors, conducted after the implementation of a statewide pediatric drug-dosing reference for emergency medical services (EMS), identified an alarmingly high error rate. This significant finding led to the current study, which aims to develop technological interventions to reduce the frequency of medication errors for children during treatment by EMS. The current study focuses on the design and development of a safety strategy to automate medication administration using mixed-reality technology. Simulations were conducted to inform the design process, focusing on three scenarios: cardiac arrest, seizure, and burns. The design team included medical and engineering researchers, paramedics, and emergency medical technicians from multiple emergency medical service agencies. Root cause analysis (RCA) and failure mode and effects analysis (FMEA) were conducted after the simulations were completed. The RCA and FMEA were used to identify and prioritize failure points, which were then addressed in a mixed-reality solution using Microsoft HoloLens 2 to automate and enhance pediatric medication administration in prehospital emergency care. The resulting application will provide real-time assistance to guide paramedics through the complicated medication dosing and administration process using a detailed step-by-step guide, aiming to decrease medication errors and improve medication dosing accuracy. Full article

Background: Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. Methods: The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. Results: The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly—switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). Conclusions: Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly. 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

Violence against paramedics is increasingly recognized as an important occupational health problem, but pervasive and institutionalized underreporting hinders efforts at risk mitigation. Earlier research has shown that the organizational culture within paramedicine may contribute to underreporting, and researchers have recommended involving paramedics in the development of violence prevention policies, including reporting systems. Eighteen months after the launch of a new violence reporting system in Peel Region, Ontario, Canada, we surveyed paramedics about their experiences reporting violent encounters. Our objectives were to assess their willingness to report violence and explore factors that influence their decisions to file a report. Between September and December 2022, a total of 204 (33% of eligible) paramedics chose to participate, of whom 67% (N = 137) had experienced violence since the launch of the new reporting process, with 83% (N = 114) reporting the incidents at least some of the time. After thematically analyzing free-text survey responses, we found that the participants cited the accessibility of the new reporting process and the desire to promote accountability among perpetrators while contributing to a safer workplace as motivating factors. Their decisions to file a report, however, could be influenced by the perceived ‘volitionality’ and severity of the violent encounters, particularly in the context of (un)supportive co-workers and supervisors. Ultimately, the participants’ belief that the report would lead to meaningful change within the service was a key driver of reporting behavior. 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

This study investigates the effectiveness of the Script Concordance Test (SCT) in enhancing clinical reasoning skills within paramedic education. Focusing on the Medical University of Lublin, we evaluated the SCT’s application across two cohorts of paramedic students, aiming to understand its potential to improve decision-making skills in emergency scenarios. Our approach, informed by Van der Vleuten’s assessment framework, revealed that while the SCT’s correlation with traditional methods like multiple-choice questions (MCQs) was limited, its formative nature significantly contributed to improved performance in summative assessments. These findings suggest that the SCT can be an effective tool in paramedic training, particularly in strengthening cognitive abilities critical for emergency responses. The study underscores the importance of incorporating innovative assessment tools like SCTs in paramedic curricula, not only to enhance clinical reasoning but also to prepare students for effective emergency responses. Our research contributes to the ongoing efforts in refining paramedic education and highlights the need for versatile assessment strategies in preparing future healthcare professionals for diverse clinical challenges. Full article

Ambulance services around the world are increasingly attending to calls for non-emergency conditions. These lower-acuity conditions do not always require patients to be transported to the emergency department. Consequently, over the past two decades, ambulance services have implemented strategies to support paramedics in diverting non-urgent patients to alternative care pathways. However, assessing and managing low-acuity conditions can be challenging for paramedics, especially when education and training has traditionally focussed on emergency care. This scoping review explores the education and training provided to paramedics on low-acuity clinical conditions and the use of alternative care pathways. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. The databases searched included Scopus, CINAHL, Embase, Emcare, and MEDLINE (PubMed). The search identified one-hundred sixty-six records, with a total of nine articles reviewed after the removal of duplicates and the screening process. The articles were diverse, with education and training ranging from university degrees for extended care practitioners to short in-service-based training for a suite of protocols or assessment tools. However, the literature addressing education and training on low-acuity conditions and alternative care pathways is limited, with the type and length of education programs appearing to influence practice. There is a need for further research to establish a low acuity education model. Full article

Introduction: The COVID-19 pandemic has considerably impacted the clinical education and training of health workers globally, causing severe disruptions to learning environments in healthcare facilities and limiting the acquisition of new clinical skills. Consequently, urgent adaptation measures, including simulation training and e-learning, have been implemented to mitigate the adverse effects of clinical education. This scoping review aims to assess the impact of COVID-19 on medical education and training, examine the implemented adaptation measures, and evaluate their effectiveness in improving health workers’ education and training during the pandemic. Methods: Employing the PRISMA-ScR framework and Arksey and O’Malley’s methodological guidance, we conducted a scoping review, systematically searching PubMed, medRxiv, Google, and DuckDuckGo databases to account for the grey literature. The search included studies published between 1 December 2019 and 13 October 2021, yielding 10,323 results. Of these, 88 studies focused on health worker education and training during the pandemic. Results: Our review incorporated 31,268 participants, including physicians, medical trainees, nurses, paramedics, students, and health educators. Most studies (71/88, 81%) were conducted in high-income and lower-middle-income countries. The pandemic’s effects on health workers’ clinical skills and abilities have necessitated training period extensions in some cases. We identified several positive outcomes from the implementation of simulation training and e-learning as adaptation strategies, such as enhanced technical and clinical performance, increased confidence and comfort, and an expanded global educational outreach. Conclusions: Despite challenges like insufficient practical experience, limited interpersonal interaction opportunities, and internet connectivity issues, simulation training, e-learning, and virtual training have proven effective in improving clinical education and training during the COVID-19 pandemic. Further research is required to bolster preparedness for future pandemics or similar situations. Full article