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British Paramedic Journal Mar 2021The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by...
AIMS
The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health (Ivers et al., 2012). Within a pre-hospital context, systematic reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review was to identify, describe and synthesise the published literature on the types and effects of feedback received by emergency ambulance staff.
METHODS
This study is a systematic mixed studies review including empirical primary research of qualitative, quantitative and mixed-methods methodology published in peer-reviewed journals in English. Studies were included if they explored the concept of feedback as defined in this review, i.e. the systematised provision of information to emergency ambulance staff regarding their performance within pre-hospital practice and/or patient outcomes. The search strategy consisted of three facets: ambulance staff synonyms, feedback synonyms and feedback content. Databases searched on 11 June 2020 from inception were MEDLINE, EMBASE, AMED, PsycInfo, HMIC, CINAHL and Web of Science. Study quality was appraised using the Mixed Methods Appraisal Tool (Hong et al., 2018), and data were analysed using narrative synthesis guided by Popay et al. (2006) following a parallel-results convergent synthesis design.
RESULTS
The search strategy yielded 2424 articles, excluding duplicates. Seventy-eight studies met the inclusion criteria after full-text review, of which 37 only mentioned feedback as a solution to improving specific circumstances (e.g. decision-making, burnout). The remaining 41 studies consisted of: 34 interventional pre-hospital feedback studies; four non-interventional feedback studies; and three preparatory studies. The source, content and mode of pre-hospital feedback represented in the studies varied greatly and encompassed feedback on behaviour and/or feedback on outcomes of behaviour (Michie et al., 2013). The main outcome measure of included studies was quality of care (e.g. quality of CPR, adherence to guidelines) but softer measures such as staff wellbeing, professional development and clinical decision-making were also represented.
CONCLUSION
It is anticipated that the review findings will be useful to guide the development of future pre-hospital feedback interventions, for which there is growing interest in the national and international pre-hospital setting. Further empirical research is required to explore whether the published literature reflects current pre-hospital practice.
PubMed: 34421383
DOI: 10.29045/14784726.2021.3.5.4.68 -
The British Journal of General Practice... Jun 2020Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with...
BACKGROUND
Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.
AIM
To provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.
DESIGN AND SETTING
A systematic review.
METHOD
Searches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the , and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.
RESULTS
In total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.
CONCLUSION
Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.
Topics: Allied Health Personnel; Ambulatory Care; Emergency Medical Technicians; Humans; Patient Satisfaction
PubMed: 32424047
DOI: 10.3399/bjgp20X709877 -
Nursing Reports (Pavia, Italy) Dec 2022Police, ambulance, and mental health tri-response services are a relatively new model of responding to people experiencing mental health crisis in the community, though... (Review)
Review
Police, ambulance, and mental health tri-response services are a relatively new model of responding to people experiencing mental health crisis in the community, though limited evidence exists examining their efficacy. Reducing unnecessary involuntary detentions and emergency department presentations is believed to be a benefit of this model. A systematic review was performed to review the evidence base around the relationship between the police, ambulance, mental health tri-response models in reducing involuntary detentions of people experiencing mental health crisis. We searched key health databases for clinical studies and grey literature as per a previously published protocol. Two researchers completed title and abstract screening and full text screening. Our search identified 239 citations. No studies or grey literature met the inclusion criteria. We report an empty review. It is recommended that further investigation of the tri-response mental health crisis model be undertaken to determine its effectiveness and value as a health and emergency service initiative.
PubMed: 36548169
DOI: 10.3390/nursrep12040096 -
Prehospital and Disaster Medicine Oct 2023Emergency Medical Services (EMS) are integrated services involving doctors, paramedics, nurses, and social workers. This research was carried out to synthesize the... (Review)
Review
INTRODUCTION
Emergency Medical Services (EMS) are integrated services involving doctors, paramedics, nurses, and social workers. This research was carried out to synthesize the evidence concerning social work roles for EMS. The aim of this study was to synthesize literature on the social worker's role in EMS settings.
METHODS
The study was a systematic review. Data were collected through selected databases. The researcher used Scopus, Sociology Database, Social Science Database, and Public Health Database related to EMS and social work settings. English papers were selected, without restrictions on publication time, place, and year. The searched keywords were: "Social Work AND Emergency Medical Services AND Ambulance Services," "Social Worker AND Emergency Medical Systems AND Ambulance Services," "Social Work AND EMS," "Social Worker AND EMS," "Social Work OR Social Worker," "Social Work Role AND EMS," Social Worker AND EMS," "Emergency Medical Services OR/AND Emergency Medical Systems."
RESULTS
The study synthesized the literature about the social work role in pre-EMS, during emergency, and post-EMS. The following themes were highlighted: social workers act as cultural liaisons, effective communicators, emergency workers, and mental health practitioners, collaborating with other disciplines and researchers, for this study. In pre-emergency stages, social workers have roles as educators, communicators, advocates, and awareness builders. During an emergency, social workers act as search and rescue workers, advocates, facilitators, networkers, psychosocial assessors, consultants, counselors, and liaisons for referral activities. And in the post-emergency period, social workers have roles as planners, liaisons, interdisciplinary collaborators, researchers, evaluators, and individuals responsible for follow up.
CONCLUSION
This study synthesizes the roles of social workers in EMS settings. It is the first study on this topic, aiming to produce new knowledge, evidence, and an EMS practice framework for the social worker.
Topics: Humans; Emergency Medical Services; Social Work; Mental Health; Ambulances
PubMed: 37525489
DOI: 10.1017/S1049023X23006143 -
Accident; Analysis and Prevention Jun 2018Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among... (Review)
Review
BACKGROUND
Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions.
METHODS
We searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available.
RESULTS
Sixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers' training and risk management programs were associated with 19-50% and 19-58% reductions in ESVIs, respectively.
CONCLUSIONS
Only a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs.
Topics: Accidents, Traffic; Ambulances; Automobile Driving; Databases, Factual; Emergencies; Emergency Medical Dispatch; Emergency Medical Services; Emergency Responders; Engineering; Firefighters; Humans; Motor Vehicles; Policy; Risk Management
PubMed: 29621721
DOI: 10.1016/j.aap.2018.01.006 -
Resuscitation Jul 2020Involving laypersons in response to out-of-hospital cardiac arrest through mobile-phone technology is becoming widespread in numerous countries, and different solutions... (Review)
Review
INTRODUCTION
Involving laypersons in response to out-of-hospital cardiac arrest through mobile-phone technology is becoming widespread in numerous countries, and different solutions were developed. We performed a systematic review on the impact of alerting citizens as first responders and to provide an overview of different strategies and technologies used.
METHODS
We searched electronic databases up to October 2019. Eligible studies described systems to alert citizens first responders to out-of-hospital cardiac arrest through text messages or apps. We analyzed the implementation and performance of these systems and their impact on patients' outcomes.
RESULTS
We included 28 manuscripts describing 12 different systems. The first text message system was implemented in 2006 and the first app in 2010. First responders accepted to intervene in median (interquartile) 28.7% (27-29%) of alerts and reached the scene after 4.6 (4.4-5.5) minutes for performing CPR. First responders arrived before ambulance, started CPR and attached a defibrillator in 47% (34-58%), 24% (23-27%) and 9% (6-14%) of cases, respectively. Pooled analysis showed that first responders activation increased layperson-CPR rates (1463/2292 [63.8%] in the intervention group vs. 1094/1989 [55.0%] in the control group; OR = 1.70; 95% CI, 1.11-2.60; p = 0.01) and survival to hospital discharge or at 30 days (327/2273 [14.4%] vs. 184/1955 [9.4%]; OR = 1.51; 95% CI, 1.24-1.84; p < 0.001).
CONCLUSIONS
Alerting citizens as first responders in case of out-of-hospital cardiac arrest may reduce the intervention-free time and improve patients' outcomes.
Topics: Ambulances; Cardiopulmonary Resuscitation; Emergency Medical Services; Emergency Responders; Humans; Out-of-Hospital Cardiac Arrest
PubMed: 32437783
DOI: 10.1016/j.resuscitation.2020.05.006 -
Prehospital and Disaster Medicine Apr 2023Proximal femoral fractures are characterized as one of the most common and most painful injuries sustained by patients of all ages and are associated with high rates of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Proximal femoral fractures are characterized as one of the most common and most painful injuries sustained by patients of all ages and are associated with high rates of oligoanalgesia in the prehospital setting. Current treatments include oral and parenteral opiates and sedative agents, however regional anesthesia techniques for pain relief may provide superior analgesia with lower risk of side effects during patient transportation. The fascia iliaca compartment block (FICB) is an inexpensive treatment which is performed with minimal additional equipment, ultimately making it suitable in prehospital settings.
PROBLEM
In adult patients sustaining proximal femoral fractures in the prehospital setting, what is the effect of the FICB on non-verbal pain scores (NVPS), patient satisfaction, success rate, and adverse events compared to traditional analgesic techniques?
METHODS
A librarian-assisted literature search was conducted of the Cochrane Database, Ovid MEDLINE, PubMed, Ovid EMBASE, Scopus, and Web of Science indexes. Additionally, reference lists for potential review articles from the , the , the , , and the were reviewed. Databases and journals were searched during the period from January 1, 1980 through July 1, 2022. Each study was scrutinized for quality and validity and was assigned a level of evidence as per Oxford Center for Evidence-Based Medicine guidelines.
RESULTS
Five studies involving 340 patients were included (ie, two randomized control trials [RCTs], two observational studies, and one prospective observational study). Pain scores decreased after prehospital FICB across all included studies by a mean of 6.65 points (5.25 - 7.5) on the NVPS. Out of the total 257 FICBs conducted, there was a success rate of 230 (89.3%). Of these, only two serious adverse events were recorded, both of which related to local analgesia toxicity. Neither resulted in long-term sequelae and only one required treatment.
CONCLUSION
Use of FICBs results in a significant decrease in NVPS in the prehospital setting, and they are ultimately suitable as regional analgesic techniques for proximal femur fractures. It carries a low risk of adverse events and may be performed by health care practitioners of various backgrounds with suitable training. The results suggest that FICBs are more effective for pain management than parenteral or oral opiates and sedative agents alone and can be used as an appropriate adjunct to pain management.
Topics: Adult; Humans; Nerve Block; Femoral Fractures; Proximal Femoral Fractures; Pain; Emergency Medical Services; Fascia; Opiate Alkaloids; Hip Fractures; Randomized Controlled Trials as Topic; Observational Studies as Topic
PubMed: 36912109
DOI: 10.1017/S1049023X23000298 -
Healthcare (Basel, Switzerland) Jan 2023: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients... (Review)
Review
: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. : We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. : A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. : This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more.
PubMed: 36673557
DOI: 10.3390/healthcare11020189 -
BMJ Open Sep 2021To explore what factors are associated with ambulance use for non-emergency problems in children.
OBJECTIVE
To explore what factors are associated with ambulance use for non-emergency problems in children.
METHODS
This study is a systematic mapping review and qualitative synthesis of published journal articles and grey literature. Searches were conducted on the following databases, for articles published between January 1980 and July 2020: MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. A Google Scholar and a Web of Science search were undertaken to identify reports or proceedings not indexed in the above. Book chapters and theses were searched via the OpenSigle, EThOS and DART databases. A literature advisory group, including experts in the field, were contacted for relevant grey literature and unpublished reports. The inclusion criteria incorporated articles published in the English language reporting findings for the reasons behind why there are so many calls to the ambulance service for non-urgent problems in children. Data extraction was divided into two stages: extraction of data to generate a broad systematic literature 'map', and extraction of data from highly relevant papers using qualitative methods to undertake a focused qualitative synthesis. An initial table of themes associated with reasons for non-emergency calls to the ambulance for children formed the 'thematic map' element. The uniting feature running through all of the identified themes was the determination of 'inappropriateness' or 'appropriateness' of an ambulance call out, which was then adopted as the concept of focus for our qualitative synthesis.
RESULTS
There were 27 articles used in the systematic mapping review and 17 in the qualitative synthesis stage of the review. Four themes were developed in the systematic mapping stage: socioeconomic status/geographical location, practical reasons, fear of consequences and parental education. Three analytical themes were developed in the qualitative synthesis stage including practicalities and logistics of obtaining care, arbitrary scoring system and retrospection.
CONCLUSIONS
There is a lack of public and caregiver understanding about the use of ambulances for paediatrics. There are factors that appear specific to choosing ambulance care for children that are not so prominent in adults (fever, reassurance, fear of consequences). Future areas for attention to decrease ambulance activation for paediatric low-acuity reports were highlighted as: identifying strategies for helping caregivers to mitigate perceived risk, increasing availability of primary care, targeted education to particular geographical areas, education to first-time parents with infants and providing alternate means of transportation.
PROSPERO REGISTRATION NUMBER
CRD42019160395.
Topics: Ambulances; Caregivers; Humans; Parents; Primary Health Care
PubMed: 34588248
DOI: 10.1136/bmjopen-2021-049443 -
Journal of Clinical and Diagnostic... Aug 2014Provision of health care facilities and the extent of their utilization is one of the indices of human development. The services for the masses need to be designed with... (Review)
Review
Provision of health care facilities and the extent of their utilization is one of the indices of human development. The services for the masses need to be designed with the basic objective of alleviating and preventing the vast amounts of diseases of the mass. This could be achieved by mobile dental units (MDUs). The present systemic review access the efficacy of MDUs for community settings. A review of literature was performed both electronically and manually using MeSH Terms- Mobile Dental Units/clinics. Eight articles, which fulfilled inclusion and exclusion criteria were selected for the review. MDUs help in overcoming the accessibility, affordability and sustainability barrier. They are able to reach more people than fixed-site clinics. Even in Government sector, mobile dental vans can help reach the underserved at an affordable cost.The present systematic review revealed that MDUs prove to be an effective adjunct to the oral health service providers like dental colleges and private practitioners.
PubMed: 25302288
DOI: 10.7860/JCDR/2014/8688.4717