Objective: To determine the factors associated with an increased risk for PTSD in ambulance personnel and the barriers faced in accessing support for work related stress (WRS). Methods: A cross-sectional study of voluntary participants comprising 388 ambulance personnel was conducted. Participants completed self-administered questionnaires: Impact of Event Scale-Revised (IES-R), EMS Critical Incident Inventory (CII), EMS Chronic Stress Questionnaire (EMSCSQ), SF-36 Quality of Life questionnaire (SF-36) and Connor-Davidson Resilience Scale (CD-RISC) which were used to assess PTSD and level of occupational stressors. Results: The prevalence of PTSD in the study population was 30%. Participants were predominantly female (55%), median age 38 (IQR; 31 - 44) years with a professional qualification (83%). Those with PTSD were more likely current smokers (OR=1.76, 95% CI: 1.05 - 2.95), current illicit drug users (OR=16.4, 95% CI: 1.87 - 143.86) and problem drinkers (OR=3.86, 95% CI: 1.80 - 8.23). A self-reported mental health condition (OR=3.76, 1.96 - 7.21), being treated for a medical condition (OR=1.95, 1.22 - 3.11), exposure to chronic WRS (OR=1.05, 1.04 - 1.07) and high critical incident stress score (OR=1.03, 1.02 - 1.04) were positively associated with PTSD risk. Barriers to seeking help for WRS included concerns that services were not confidential, and that the participant's career would be negatively affected. Conclusion: The PTSD prevalence in ambulance personnel is considerably higher than that found in previous studies conducted among this occupational group in the Western Cape. Identified risk factors should inform interventions designed to support ambulance personnel and a greater focus on addressing barriers to accessing care is needed.

Paramedic services are developing a new model of service delivery known as community paramedicine (CP). This service delivery model seeks to build on existing paramedic skills, establish collaboration with non-traditional health care partners, and create alternative pathways for accessing care. Frequent users of paramedic services represent patients that are of particular interest to CP programs. Chapters 2 and 3 of this thesis address questions of effective delivery of these programs. The second chapter is a spatial-temporal analysis of frequent users in Hamilton, ON. Drawing on concepts of time-geography and dynamic ambulance deployment, this analysis identifies space-time patterns in paramedic service utilization by frequent users. Data were aggregated to represent daily demand in terms of space and time. Analysis employed generalized linear mixed models that included a random slope effect for time intervals for each geographic unit. Fixed effects included distance to emergency department, proportion of residential addresses, and proportion of older adult population. Locations and times that had greater or less than expected daily demand from frequent users were identified. The findings can be used to tailor deployment of community paramedics in dual-capacity roles to address the system demand of frequent users. The third chapter analyzes the geographic influence of CP service delivery in Renfrew County, ON. This research draws on concepts of spatial accessibility and geographic profiling to estimate spatially defined probabilities of paramedic service use by frequent users. Due to ongoing CP programs within the county, the resultant community health profiles serve as an evaluation of the benefit of these programs. The community health profiles can also be used to assess community level probabilities of patient needs for future interventions. This analysis can serve as a new way to assess spatial accessibility to health care services and identify locations with increased risk of frequent use of paramedic services. / Thesis / Master of Arts (MA)

No description available.

Introduction Role identity theory explains that people derive a sense of purpose and meaning from holding social roles, which, in turn, is linked with health and well-being. Paramedics have a respected role in society but high rates of mental illness. I used role identity theory to explore what might be contributing to poor mental health among paramedics. Objectives My objectives were to estimate the prevalence of Post-Traumatic Stress Disorder (PTSD), depression, and anxiety; assess for relationships with a measure of paramedic role identity; and finally, explore how role identity conflict could lead to distress. Methods I used a mixed methods approach situated in a single paramedic service in Ontario, Canada, distributing a cross-sectional survey during the fall 2019/winter 2020 Continuing Medical Education (CMEs) sessions while also interviewing a purposively selected sample of 21 paramedics. The survey contained a demographic questionnaire, a battery of self-report measures, and an existing paramedic role identity scale. Each interview was transcribed verbatim and analyzed thematically with role identity theory as a conceptual framework. Results In total, 589 paramedics completed the survey (97% of CME attendees), with 11% screening positive for PTSD, 15% for major depressive disorder, 15% for generalized anxiety disorder, and 25% for any of the three. Full-time employees, women, those with ‘low’ self-reported resilience, and current or former members of the peer support team were more likely to screen positive. The dimensions of paramedic role identity were not associated with an increased risk; however, I defined a framework through the interviews wherein chronic, identity-relevant disruptive events contribute to psychological distress and disability. Conclusions Our prevalence estimates were lower than have been previously reported but point to a mental health crisis within the profession. Role identity theory provided a useful framework through which to reconceptualize stressors. / Dissertation / Doctor of Philosophy (PhD) / Role identity theory explains having a sense of purpose and meaning people from social roles (such as a parent or volunteer) is good for health and well-being. Paramedics are an important part of Canada’s public safety infrastructure and generally hold a respected position in society, but there is growing recognition of a mental health crisis within the profession. I used role identity theory to explore why and how role identity theory could contribute to poor mental health among paramedics. By surveying and interviewing paramedics from a single paramedic service in Ontario, Canada, I discovered that 25% of active-duty paramedics met the criteria for either post-traumatic stress disorder, depression, or anxiety. The risk varied across demographic categories, including gender. During the interviews, I discovered that role identity conflict – a discrepancy between what the paramedic thinks their role should be and what is achievable – can lead to significant psychological distress.

Yes / The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase ‘see and treat’ opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients’ blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated. / The full-text of this article will be released for public view at the end of the publisher embargo on 1 Jun 2024.

This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.

The purpose of this research was to examine physical layout and organization of equipment as it pertained to patient care in rotor-wing air ambulances. The qualitative approach included observations, interviews, surveys and incident report reviews; and involved paramedics, educators, engineers and physicians affiliated with Ornge Transport Medicine. Findings showed that there is inconsistent placement of equipment within and between bases. A standardized approach to storing equipment, including labelling, could improve readiness for a call by assisting paramedics in ensuring equipment is properly stocked. It was also found that the layout of the patient care compartment was not optimal for some tasks, such as intubation and documentation, due to lack of space. Future helicopters should have seating, both behind the head and at the side of the patient that accommodates safe postures and allows paramedic’s access to the supplies necessary for the full spectrum of patient care expected in this environment.

The purpose of this research was to examine physical layout and organization of equipment as it pertained to patient care in rotor-wing air ambulances. The qualitative approach included observations, interviews, surveys and incident report reviews; and involved paramedics, educators, engineers and physicians affiliated with Ornge Transport Medicine. Findings showed that there is inconsistent placement of equipment within and between bases. A standardized approach to storing equipment, including labelling, could improve readiness for a call by assisting paramedics in ensuring equipment is properly stocked. It was also found that the layout of the patient care compartment was not optimal for some tasks, such as intubation and documentation, due to lack of space. Future helicopters should have seating, both behind the head and at the side of the patient that accommodates safe postures and allows paramedic’s access to the supplies necessary for the full spectrum of patient care expected in this environment.

Syftet var att studera begreppet akut i avsikt att identifiera dess karaktäristika, förutsättningar och konsekvenser inom ambulanssjukvården. Intresset väcktes då begreppet används i flera olika sammanhang och är individuellt upplevt, vilket kan missuppfattas i kontakten med patient och annan vårdpersonal. Metoden utgjordes av en begreppsanalys och datamaterialet av vetenskapliga artiklar, tidskrifter, läroböcker, uppslagsverk med mera som har med begreppet att göra. I en begreppsanalys förtydligas begreppet genom att man synliggör dess karaktäristika. Genom tydliggöring av begreppets karaktäristika blir det tydligt vad begreppet innebär och vad det inte innebär. Att klargöra ord som ibland används i många sammanhang eller att det är ett vagt begrepp är vanligt inom vårdvetenskapen och kan behöva förtydligas enligt Walker och Avant (2011), för att få fram betydelsen och förhoppningsvis få fram en gemensam innebörd för begreppet. I den lexikala genomgången har lexikon och ordböcker använts. Sammantaget kan man säga att det gemensamma för svenskans och engelskans innebörd av begreppet är främst skarp. Under den litterära analysen har flera utmärkande karaktäristika av begreppet identifierats, detta genom tolkning av de utvalda vetenskapliga artiklarna. I sammanfattningen av begreppet ’akut’ framkommer att det kan beskrivas som en subjektiv upplevelse relaterat till en sjukdom eller tillstånd hos den hjälpsökande personen.

Indiana University-Purdue University Indianapolis (IUPUI) / EMS personnel experience emotionally charged calls, such as CPR, trauma, or domestic violence. This study examined the changes on communication by these events. Communication Complex metaframework allowed use of other disciplines. There is a lack of scholarship surrounding EMS communication. Research from other military and other fields was translated into the EMS community. Mental illness is a growing concern in EMS as 37% contemplate suicide and 6% complete it. Part of understanding the affect is an exploration of how the culture of EMS (i.e. training, traditions, machismo) shapes the way new EMS are acculturated. EMS have repeated exposure to trauma over a career. These exposures change communication patterns. Using a three-chapter autoethnography, I was able to examine my communication and mental status changes from rookie until retiring 14 years later with PTSD and constant suicidal ideation. Ethnographic interviews of veteran EMS provided insight into the old school ideology of emotional repression and shelving. I analyzed using the NREMT Patient Assessment skill sheet as a guide in a three-step process to discover and reassess themes. The primary survey indicated common job-related stressors- pedi calls and staffing problems. The secondary survey revealed themes of emotions, senses, and support. Finally, the reassessment revealed subtle changes in EMS culture, including decreased PTSD stigma, increased resiliency training, and increased administrative support. Future research could examine the effect of spousal support and changes in cultural emotional suppression. The goal is to develop programs to help allies understand the emotionality in EMS and create dedicated support structures to increase EMS mental health.