Registered nurse (RN) insufficiency is both a major contributor to and effect of emergency department overcrowding (EDOC) in the United States and is implicated in increased patient mortality, ED wait times, and general congestion of the healthcare system. Licensed paramedics represent a viable solution to this crisis given their extensive training in emergency care by serving as RN adjuncts and alternatives in the ED setting. Paramedics utilize high-level clinical judgment and patient assessment skills to form detailed clinical impressions and employ a wide range of therapies to initiate treatment. Although they less frequently possess a college degree than their RN counterparts, paramedics complete a comparable study of medical science principles, patient assessment, and pathophysiology, and devote significantly more time to critical care and emergency medicine than RNs. Implementation of paramedics in U.S. EDs in the 1980s and 1990s highlighted their manual and technical skill prowess as well as their ability to rapidly assess emergency situations, including their unexpectedly widespread use in pediatric EDs. Modern implementation includes expansion of the psychomotor skills available to ED-based paramedics, with emphasis on medication administration and emergency procedures, but there is a significant lack of research into paramedic assessment and triage skills in the ED. Barriers to further implementation of ED paramedics include resistance from nursing advocacy organizations, regulatory and legal challenges, and public opinion and attitudes of nurses and paramedics. Nursing advocacy groups have historically opposed paramedic integration, fearing job encroachment and increased autonomy for non-nursing healthcare professionals. Regulatory challenges involve certification vs licensure discrepancies, limitations on paramedic scope of practice, and the wide-reaching effects of state Nurse Practice Acts. Societal resistance, cultural factors, and attitudes within the nursing and paramedic communities also impede further ED paramedic implementation. Practice recommendations are proposed, including the development of standardized ED orientation programs for paramedics, and redefining the minimum education for paramedics at the associate degree level. Legislative recommendations involve eliminating statutory restrictions on paramedic practice, reevaluating language in state Nurse Practice Acts, and clarifying the legal relationship between RNs and ED paramedics. The limitations of this literature-based thesis include a lack of large-scale studies, regional variability, and the absence of empirical examination of paramedic integration in reducing ED overcrowding. Future suggestions for study include randomized controlled trials comparing ED patient outcomes between RNs and paramedics, interrater reliability studies on assessment and triage skills, and comparisons of scope of practice and education between paramedics in different countries.

Introduktion: I den moderna prehospitala akutsjukvården kan ambulansens och ambulanshelikopterns samverkan ha stor betydelse för den svårt skadade eller sjuka patienten. Syfte: Syftet med studien var att undersöka vad sjuksköterskor inom ambulansen och sjuksköterska/läkare från helikoptern/akutbilen upplevde kunde påverka teamarbetet i den prehospitala miljön. Metod: En kvalitativ deskriptiv innehållsanalys med semistrukturerade intervjuer användes. 10 informanter från ett län i mellansverige inkluderades, fem kvinnor och fem män. Urvalet bestod i att informanterna skulle ha varit verksamma inom ambulansverksamheten i minst ett år samt ha erfarenhet av det prehospital samarbetet mellan ambulans och ambulanshelikopter. Intervjuerna spelades in, transkriberades till text och analyserades. Resultat: Studiens resultat presenterades i två teman med sju underkategorier. De två temana var: Ett dynamiskt teamarbete påverkas av tydliga roller och ett kontinuerligt förbättringsarbete och Teamarbete och kommunikation mellan kompetenserna i teamet. Konklusion: De olika rollerna vid teamarbetet har blivit tydligare med tiden och teamarbetet upplevdes ha blivit bättre med tiden. Hospitering och tid till övning beskrevs kunna optimera teamarbetet. Informanterna upplevde sig delaktiga i vården. Den prehospitala erfarenheten och bristen på den var av betydelse vid samverkan mellan enheterna. / Introduction: In the modern prehospital emergency care, ambulance and ambulance-helicopter's interactions play an important role for the severely injured or sick patients. Aim: The aim of the study is to examine what nurses in ambulance and nurse/doctor from the helicopter/emergency car experienced could affect the team work in the prehospital environment. Method: A qualitative descriptive content analysis of semi-structured interviews were used. 10 pieces of informants from a province in central Sweden were included five women and five men. The sample consisted of informants would have been active in the ambulance business for at least 1 year and have experience in the full spectrum of cooperation between ambulance and ambulance helicopter. The interviews were recorded, transcribed to text and analyzed. Results: The results of the study were presented in two themes with seven subcategories. The two themes were: A dynamic teamwork are influenced by clear roles and a continuous improvement and Team work and communication between the competencies of the team. Conclusion: The different roles in the cooperation has become clearer with time and team work was perceived to have become better with time. Site visits and time to exercise described to optimize teamwork. The informants perceived themselves involved in care. The prehospital experience and the lack of it was of importance to cooperation between units.

<p>Sammanfattning</p><p>Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre.</p><p>Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal.</p> / <p>Abstract</p><p>The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada.</p><p>The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients.</p><p>Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.</p>

Sammanfattning Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre. Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal. / Abstract The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada. The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients. Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.

Source: Masters Abstracts International, Volume: 47-06, page: 3546. Adviser: Bahman S. Roudsari. Includes bibliographical references.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2641. Advisers: Arnold J. Schecter; Bahman S. Roudsari. Includes bibliographical references.

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / South African Advanced Life Support (ALS) providers follow an autonomous practice model of care. This advanced role profile is characterized by clinical skill competence and autonomous decision making whilst demonstrating a high level of awareness of their own ethical attitudes, values and beliefs. It is through a professional commitment that ALS providers deliver an advanced evidence based practice that should be maintained constantly within a dynamic environment. Continuous Professional Development (CPD) is seen as an instrument for this. CPD should also serve as a means to acquire professional excellence and going beyond the boundaries of meeting the base level standard with the aim of providing the finest quality of care in the interest of patient safety. Purpose of the research The purpose of this research is to identify gaps in the professional development of out-of-hospital ALS providers trained in South Africa by assessing frequency of performance of ALS clinical skills, by determining perceived level of competence and predictors of confidence, and by sourcing information on attendance of CPD activities and training needs. vi Methodology This study used a quantitative non-experimental design. Data was attained from an e-mail based descriptive survey that was limited to a precise and concise questionnaire. The data from 140 (N) ALS providers was subjected to a descriptive statistical analysis using the PASW statistics version 18.0 to systematically show patterns and trends. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using Chi-square and Pearson correlation tests. Results Results indicated that ALS providers performed clinical skills infrequently. Of the total number of respondents 140 (N), the average ALS clinical skills performance was 6 (4.8%) daily. In the 2-6 times a week category 8 (6.4%) ALS clinical skills were performed. ALS clinical skills performance in the once a week category showed an average of 7 (5.6%) and the once a month category, an average of 17 (13.7%) ALS skills were performed. An average of 31 (25%) ALS skills were performed in the once in six months category whilst an average of 54 (43.5%) were performed in the greater than six months category. CPD activities that are appropriate to ensuring the maintenance of competence for these clinical skills were not adequately undertaken. Medical updates were mostly attended by ALS providers, 52 (42.9%) whilst CPD events that addressed clinical skills, was mostly limited vii to the ACLS course 42 (34.7%). The needs assessment for CPD showed that 56 (53%) of respondents expressed a need for paediatric and obstetric simulated skill sessions, whilst 43 (40.9%) requested clinical skills workshops and 39 (37.1%) expressed a need for clinical practice in theatre and coronary care units. Conclusions and recommendations This study shows that ALS clinical skill competence is maintained by frequent practice and appropriateness of CPD activities. The infrequent performance of ALS skills coupled with the lack of appropriate and diverse CPD activity attendance results in poor maintenance of competence. The loss of competence can be related to poor reported levels of confidence which consequently places patient safety at risk. To safeguard against medical error and ensure patient safety, it is strongly recommended that CPD audits be undertaken on all ALS providers for appropriate CPD compliance related to clinical skills performance. In addition to a clinical skills audit, it is recommended that a national clinical skills registry be established with the intention of facilitating clinical skill surveillance, to determine a notifiable, high risk skill set. To safeguard against knowledge and clinical skill attrition and loss of competence, the delivery of CPD activities should be assessed for effectiveness and appropriateness.

Submitted in fulfillment of the requirements for the Degree Masters of Health Sciences in Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2016. / Clinical practicum remains an integral part of training and a vital component of the emergency medical care curriculum that takes place in a realistic and complex emergency care environment. Clinical practicum should provide students with the opportunity to combine cognitive, psychomotor and affective skills to develop competencies to prepare the qualifying practitioner for demands of pre-hospital emergency care in the real world. The aim of this study was to explore the multidimensional aspects of the clinical practicum experience of ALS paramedic students in the Western Cape through the lens of a qualitative research design. The study involved exploring the experience of paramedic students in the clinical practice placement. In addition, the views of paramedic graduates were also explored, to ascertain whether the placement experience adequately prepared them for practice. An analysis of the clinical practice documents utilised in the training of ALS paramedic students was conducted with particular reference to identify correlations with relevant literature. In addition, it was necessary to identify how clinical practice manifested itself, not only in what students and graduates express but also how it was coordinated and conveyed in a professional work related context, against the backdrop of the work integrated learning framework. Using a case study design, focus group interviews were conducted with final year EMC students from CPUT and CCA students from the Western Cape CEC. This was followed with one on one interview with paramedic graduates. Further to this, clinical practice documents were analysed to triangulate the data. This study revealed that the clinical practice learning objectives for paramedic students were not adequately achieved and paramedic graduates felt ill prepared for independent practice. These discrepancies were attributed to the complex issues both in theory and practice. The study provided a number of recommendations for improving the clinical training experience, such that paramedic graduates who enter the complex and challenging world of EMC are better prepared. / M

Thesis (M.S.)--University of Tennessee, Knoxville, 2003. / Title from title page screen (viewed Oct. 14, 2003). Thesis advisor: Ralph Kimberlin. Document formatted into pages (x, 64 p. : ill. (some col.), col. maps). Vita. Includes bibliographical references (p. 58-63).

Thesis (M.Tech.: Emergency Medical Care)-Durban University of Technology, 2007 xiv, 116 leaves / The Professional Board for Emergency Care Practitioners (PBECP), a division of the Health Professions Council of South Africa, regulates the scope of practice and publishes guidelines and protocols that advanced life support (ALS) practitioners are required to follow. These define an acceptable, standardised approach to each commonly encountered emergency. Non compliance with the guidelines and protocols regularly occurs, which could impact on the quality of care delivered and may result in further injury or death of the patient. This study investigated the reasons for non-compliance by ALS practitioners and explored how compliance could be improved.