This study adopted a narrative inquiry methodology in order to explore paramedic experiences and perceptions about their student preceptorship and their role as a preceptor. The questions that this research sets out to answer are: What are the experiences of practising paramedics in Ontario in their roles as preceptors? Additionally, what were the preceptor’s experiences as students during their own preceptorship? There were six participants within the region of Ontario that took part in individual in-depth narrative interviews. In order to understand the data collected, a sociocultural theoretical framework was used, focusing on Rogoff’s guided participation (2003). The findings revealed four main themes: i) the role of education in preceptorship, ii) the importance of interpersonal relationships, iii) the need for enhanced communication among institutional levels, and iv) the role of compensation in preceptorship. Taken together, the themes reveal the preoccupations and concerns of the paramedics who recounted their experiences both during their student preceptorship and as paramedic preceptors. All of the participants recommended further education and a modification to the current preceptor practises. They stressed the value of creating safe environments through good relationships with their students. The lack of communication between the paramedic service and educational bodies as well as between the paramedic service and the preceptors was also of concern to the participants. Finally, regarding compensation, the participants spoke about both the positive and negative aspects of compensation for the preceptor.

The use of simulation is becoming increasingly important in the education of practitioners whose field of work contains a low tolerance for error. In aerospace, aviation, medicine, paramedicine, and the military, simulations are expected to provide working practitioners with on demand experience. However, the ways in which learning emerges out of simulation have been poorly understood. This research provides insight into the processes of learning that are generated and the forms of knowledge that arise out of learning endeavors based upon the use of simulation. This study employed a form of naturalistic inquiry. Eight individuals from seven domains of work were extensively interviewed regarding their simulation experience. Conceptually, the methods are premised upon Pattons (2002) understanding of qualitative inquiry, Van Manens (1997) phenomenological approach to lived experience, and Ricoeurs hermeneutical approach to the interpretation of the text. Ricoeurs (1986) conceptualization of ideology and utopia as a dialectic which comprises the social imaginary and Kearneys (2003) analysis of the Other inform the analysis. It is the central finding of this study that experience in simulation is consistently interpreted to be both real and an imagination of the real. Experiential learning has at least five dimensions: purpose, interpretation, engagement, self, and context (Fenwick, 2003) all of which are affected in the pedagogical activity of simulation. The learning that emerges out of simulation always involves the social imaginary. Simulation forces an engagement with the symbolic nature of the social imaginary, and it is because a specific aspect of the social imaginary is reproduced in simulation that a need for interpretation is provoked and learning occurs. This study is theoretically significant because it adds to the academic literature through an improved understanding of simulation as a complex entanglement of the real and the imaginary. Practical significance lies in understanding the effective use of simulation as a pedagogical tool which can inform or reify the existing dimensions of experiential learning. Overall, the study contributes to our knowledge about how learning emerges out of simulation and how simulation fosters such an emergence. / Adult Education

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Introduction Simulation-based learning is an example of learning in context in which clinical contexts are recreated in controlled settings to facilitate deliberate practice. While widely regarded as effective, unanswered questions exist about what elements of the clinical context must be recreated in simulated settings to promote authenticity. Moreover, the degree of authenticity (or fidelity) required for optimal learning is not known, with current thinking often deemphasizing the importance of physical realism. We therefore sought to explore contextual influences on performance in a ‘context-rich’ clinical setting: paramedicine. Methods We followed constructivist grounded theory principles and recruited currently practicing paramedics to participate in one-on-one, semi-structured interviews. We asked the participants to describe a recent experience in which they attempted to resuscitate a victim of sudden cardiac arrest and asked them how to recreate their experiences in simulated settings. Results Fourteen paramedics provided a total of seventeen interviews, each describing a distinct cardiac arrest event, yielding over ten hours of audio data for analysis. We iteratively identified three major interrelated themes describing contextual influences: the event – its physical characteristics, circumstances and people present; the conceptual response – the cognitive processes and challenges encountered; and the emotional response – the degree of emotional engagement in the management of the resuscitation. We also identified a major theme related to how to simulate these events. Collectively, our results suggest a complex and dynamic interplay between the physical, conceptual and emotional domains of context. Conclusion In contrast to other conceptualizations of context and fidelity, our results suggest that conceptual and emotional responses occur as a result of physical features in the practice environment, arguing in favour of physical authenticity in simulation. / Thesis / Master of Science (MSc) / Educators in the health professions have the important task of preparing their students – future physicians, nurses, paramedics, etc. – to perform effectively in clinical practice. This transition from healthcare student to healthcare professional is challenging, in part because classrooms and clinical contexts are different entities: the environment, the people within it, the way knowledge is generated, recalled and applied are all different. To narrow the gap between classroom and clinical practice, educators often promote learning in context, using various strategies to make the classroom more like the clinic (or any other setting in which health care is delivered). The challenge, however, is that exactly what features of the practice setting (context) should be recreated to promote learning is not known. We undertook this study, viewing the clinical context through a paramedic lens, to better understand what features present in real world conditions might influence learning and performance.

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

Sammanfattning Bakgrund; Inom ambulansyrket utsätts personalen dagligen för tunga lyft, ofta i icke ergonomiska arbetsställningar samt i många fall under tidspress. Dessutom arbetar ambulanspersonal i regel skift och ibland hela dygn vilket medför en rubbad dygnsrytm. Syfte; Att beskriva hur yrkesutförandet påverkar den fysiska hälsan hos ambulanspersonalen, samt att beskriva vilken urvalsmetod som använts i valda artiklar. Metod; Litteraturstudien har en deskriptiv design och består av tolv vetenskapliga artiklar hämtade från databaserna Cinahl och Scopus. I tio av artiklarna har en kvantitativ ansats använts och de andra två består av en mixad ansats. Artiklarna har granskats utifrån likheter. I den metodologiska aspekten urvalsmetod har skillnader och likheter granskats. Resultat; Resultatet visade att ambulanspersonal i högre utsträckning än normgrupper lider av muskuloskeletala besvär. Vilket kan relateras till hög fysisk belastning samt icke ergonomiska arbetsställningar. Ambulanspersonal upplever dessutom högt stresspåslag i arbetet. Resultatet visar även att de oregelbundna arbetstiderna påverkar ambulanspersonalens sömnkvalitét samt kost och motionsvanor negativt. De urvalsmetoder som använts i artiklarna är; slumpmässigt urval, stratifierat sannolikhetsurval, totalurval samt bekvämlighetsurval. Slutsats; Såväl muskelsmärta, störd dygnsrytm, sömnbrist, samt ökat stresspåslag hos ambulanspersonal kan relateras till yrkesutförandet. Oregelbundenheten i arbetet försämrar möjligheten att äta hälsosamt och träna regelbundet. Ambulanspersonal skulle gynnas av bättre träningsmöjligheter på arbetet, längre återhämtningstid och bättre möjligheter till regelbundna måltider. / Abstract Background; Ambulance personnel are in their work exposed for heavy lifting, often in non-ergonomic postures, and in many cases under time pressure. Ambulance personnel also work in shifts and sometimes 24-hours, resulting in a circadian rhythm. Aim; Describe how professional performence affects the physical healt of ambulance personnel and to describe wich sampling method, used in included articles. Method; The literature study has a descriptive design and consists of 12 scientific articles, selected from Cinahl and Scopus databases. In 10 of the articles there is a quantitative approach and 2 of them has a mixed approach. The articles were audited on the basis of similarities. In the methodologocal aspect; sampling method, diffrences and similarities has been audited. Results; The result showed that ambulance personnel in greater occurence than norm groups, suffer from muscle pain. Which can be related to high physical exposure and non-ergonomic postures. Ambulance personnel also experiencing high level of stress in their work. The result also showed that irregular working hours affect the ambulance personnel´s quality of sleep aswell as diet and exercise habits negatively. The sampling method used are; Randomized sampling, stratified probability sampling, total sampling and convenience sampling. Conclusion; Musclepain aswell as disruption of circadian cycles, lack of sleep and increased level of stress in the ambulance personnel can be related to professional performence. The irregularity in the work impair possibilities to eat healthy and exercise regularly. Ambulance personnel would benefit from better exercise opportunities at work, longer recovery and better possibilities to regular meals.

High-stakes testing is used for the purposes of providing results that have important consequences such as certifications, licensing, or credentialing. The purpose of this study was to examine aspects of an exam recently written by flight paramedics for recertification and make recommendations for development of future exams. In 2008, an unexpectedly high failure led to revisions in the exam development process for flight paramedics. Using principles of classical test theory and generalizability theory, I examined the decision consistency and dependability of the examination and found the decision consistency for dichotomous items to be within acceptable limits, yet the dependability was low. Discrimination was strong at the cut-score. An in-depth look into the process used to set the exam, as well as the psychometric properties of the exam and the items have led to recommendations that will contribute to future development of dependable exams in the industry that result in more valid interpretations with respect to paramedic competence. / Thesis (Master, Education) -- Queen's University, 2012-09-06 22:41:41.552

Class of 2016 Abstract and Report / Objectives: Specific Aim #1: Assess the impact of the Community Integrated Paramedic program on the participants. Our working hypothesis is that the participants will find the program to be impactful in many aspects and beneficial. Specific Aim #2: The impact of the program on the participating paramedics. Our working hypothesis is that the paramedics will report positive themes as a result of participation in the program. Methods: 5 individuals who were enrolled in the paramedicine program and 6 volunteer paramedics participated in semi-structured face-to-face interviews. Interviews were transcribed data was grouped into categories and subcategories to identify common themes associated with participation in a community paramedicine program for both participants and paramedics. Results: Three primary themes emerged for participants: disease-self management, safety and support. Disease-self management included 7 subdomains: medication management, exercise, diet, resources and utilization, communication with providers, disease education, and self-awareness. Safety included 4 subdomains: medication safety, home safety, fall prevention, and environmental hazards. Support included 2 subdomains: physical and emotional. One primary theme emerged for volunteer paramedics: job satisfaction. Job satisfaction included 8 subdomains: helping people, decreasing emergencies, learning new skills, educating people, expand knowledge base, rewarding experience, building relationships, and documenting impact. Conclusions: A community paramedicine program is positively correlated with emotional support, disease management and safety for participants involved. Additionally, the program is associated with increased job satisfaction for paramedics.

During the first aid process, when patients are threatened by poor medical conditions, ambulance paramedics are required to administer emergency treatment based on instruc- tions provided by a remote emergency doctor through voice communication. However, such voice communication is always limited in expressing abundant detailed information for the patient. This thesis presents a framework for a stereoscopic and intelligent telemedicine sys- tem that can provide 3D live video communication between paramedics and emergency doctors. The proposed system captures 3D video from the paramedic headset carried by the paramedics, transmits the video through wireless live streaming, and displays the video with a 3D effect for emergency doctors in the hospital. The video can be analyzed to extract information about the patient through embedded algorithm such as face de- tection algorithm. In this thesis, the hardware, functional mechanism and face detection algorithm are introduced separately. The hardware of the system consists of a paramedic headset, a server box and a 3D PC, which are used to capture 3D video, transmit video through live streaming and display video with a stereo effect, respectively. The functional mechanism includes two subsystems, which work for pushing the stereo video to multiple live streams and displaying the 3D video from the live stream. In order to detect the patient information from the video, a multi-task face detection algorithm is applied to analyze the stereo video using deep learning technology. We improved the neural networks of face detection by utilizing 1 ⇥ 1 convolutional layers and retrain the network based on the transfer learning to achieve better and faster performance. This system has achieved good and stable performance in network delay (0.0489ms) and objective video quality evaluations. The face detection algorithm has achieved no- table accuracy (91.78% In FDDB dataset) and efficiency (19.71 ms/frame).

Objective: The Florida Adult Trauma Triage Criteria (FATTC) define specific parameters concerning injury mechanism and physiologic data that prompt paramedics to initiate a trauma alert and necessitate transport to a trauma center. In the state of Florida, paramedics are also given discretion to bring patients to the trauma center who do not meet those criteria. Our aim was to compare the injury characteristics and outcomes of adult patients who were evaluated in our trauma center after activation due to FATTC criteria vs. paramedic discretion (PD) and to identify predictors of PD. Methods: This retrospective study included all patients 18 years and older evaluated in our trauma center from January 1, 2007, to December 31, 2014. Descriptive statistics were computed for all variables. Bivariate and multivariate analyses were performed to compare demographic, injury severity, and outcome differences between groups. Results: A total of 13,963 patients met FATTC during the study period, and 1,811 were brought in by PD. PD patients had lower injury severity and crude mortality. Regression modeling of demographic and injury variables found that only the combination of older age and higher heart rate predicted PD when both were lower than FATTC alone. Conclusions: While PD patients were less seriously injured and had lower mortality, they experienced similar lengths of stay and resource utilization after presentation. Paramedics may be able to identify patients at risk for poor outcomes who would otherwise not be captured by FATTC.