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BMJ Open Jun 2022To examine the current knowledge and possibly identify gaps in the knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas. (Review)
Review
OBJECTIVE
To examine the current knowledge and possibly identify gaps in the knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas.
DESIGN
Scoping review.
DATA SOURCES
MEDLINE via PubMed, CINAHL, Cochrane and Embase up to December 2020.
STUDY SELECTION
All English studies involving community paramedicine in rural areas, which include cost-benefit analysis or safety evaluation.
DATA EXTRACTION
This scoping review follows the methodology developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We systematically searched for all types of studies in the databases and the reference lists of key studies to identify studies for inclusion. The selection process was in two steps. First, two reviewers independently screened 2309 identified articles for title and abstracts and second performed a full-text review of 24 eligible studies for inclusion.
RESULTS
Three articles met the inclusion criteria concerning cost-benefit analysis, two from Canada and one from USA. No articles met the inclusion criteria for safety evaluation.
CONCLUSION
There are knowledge gaps concerning safety evaluation of community paramedicine in rural areas. Three articles were included in this scoping review concerning cost-benefit analysis, two of them showing positive cost-effectiveness with community paramedicine in rural areas.
Topics: Canada; Cost-Benefit Analysis; Delivery of Health Care; Emergency Medical Services; Humans
PubMed: 35680256
DOI: 10.1136/bmjopen-2021-057752 -
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 -
Australasian Emergency Care Jun 2023Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments,... (Review)
Review
BACKGROUND
Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making.
METHODS
A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies.
RESULTS
Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified.
CONCLUSION
There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.
Topics: Humans; Australia; Catheterization, Peripheral; Catheters; Hospitals
PubMed: 36117094
DOI: 10.1016/j.auec.2022.08.006 -
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 -
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 -
Environmental Pollution (Barking, Essex... Nov 2019A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital... (Meta-Analysis)
Meta-Analysis
A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 μm (PM, PM), the fraction between PM and PM (coarse) and suspended particulate matter (SPM) per 10 μg/m increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO), nitrogen dioxide (NO), and ozone (O) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM at 1.03 (95% CI:1.02-1.04) and at 1.10 (95% CI:1.00-1.21) for asthma and NO associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM, CO and coarse dispatches at 1.05 (95% CI:1.03-1.08), 1.10 (95% CI:1.02-1.18) and 1.04 (95% CI:1.01-1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM at 1.02 (95% CI:1.01-1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.
Topics: Air Pollutants; Air Pollution; Ambulances; Asthma; Carbon Monoxide; Environmental Exposure; Environmental Health; Humans; Male; Nitrogen Dioxide; Ozone; Particulate Matter; Risk; Sulfur Dioxide
PubMed: 31419665
DOI: 10.1016/j.envpol.2019.06.065 -
Critical Care Medicine Mar 2023Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care.
DATA SOURCES
A systematic search of CINAHL, Ovid MEDLINE, and EMBASE was undertaken on September 13, 2022.
STUDY SELECTION
Observational cohort studies of adults assessing the association between socioeconomic status and critical care outcomes including mortality, length of stay, and functional outcomes were included. Two independent reviewers assessed titles, abstracts, and full texts against eligibility and quality criteria.
DATA EXTRACTION
Details of study methodology, population, exposure measures, and outcomes were extracted.
DATA SYNTHESIS
Thirty-eight studies met eligibility criteria for systematic review. Twenty-three studies reporting mortality to less than or equal to 30 days following critical care admission, and eight reporting length of stay, were included in meta-analysis. Random-effects pooled analysis showed that lower socioeconomic status was associated with higher mortality at less than or equal to 30 days following critical care admission, with pooled odds ratio of 1.13 (95% CIs, 1.05-1.22). Meta-analysis of ICU length of stay demonstrated no significant difference between socioeconomic groups. Socioeconomic status may also be associated with functional status and discharge destination following ICU admission.
CONCLUSIONS
Lower socioeconomic status was associated with higher mortality following admission to critical care.
Topics: Adult; Humans; Critical Care; Hospitalization; Patient Discharge; Social Class
PubMed: 36728845
DOI: 10.1097/CCM.0000000000005765 -
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 -
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 -
Prehospital Emergency Care Jun 2023COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA)....
INTRODUCTION
COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions.
OBJECTIVES
The purpose of this study was to synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA.
METHODS
Following a published protocol, we conducted a systematic search of six databases through May 31, 2022. We re-ran this search on April 14, 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance intervals (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review.
RESULTS
Of 4,083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 min [-2.19 to -0.38]) and mean total prehospital interval (-6.42 min [-10.60 to -2.25]) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 [0.02 to 0.33]). Ambulance response interval definitions and terminology varied between regions and countries.
CONCLUSIONS
Our review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimize delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.
PubMed: 37261801
DOI: 10.1080/10903127.2023.2219729