Irish Journal of Paramedicine
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Defining Mentorship in Prehospital Care: A Qualitative Analysis of the Characteristics of Prehospital Mentors
Full text linkIntroductionThis study sought to begin to define the current understanding of the term mentor within the prehospital environment (emergency medical services or EMS) as described by nomination letters written by mentees for a newly launched prehospital mentor award.MethodsThe John Ross Paramedic Mentor Award was created in the fall of 2015 to recognize outstanding mentors in prehospital care. In the spring of 2016, nineteen nomination letters were received from registered prehospital professionals in Alberta detailing why their mentor should receive the mentor award. Written text from the nominations for this peer nominated award were analyzed using thematic and content analysis (n=19) to identify the current understanding of mentorship in EMS, desirable qualities of prehospital mentors, and what a successful mentoring relationship looks like in the prehospital environment from the perspective of mentees. Demographic data of the mentees and mentors were obtained. ResultsMentees and nominated mentors had varying years of experience, worked in diverse practice areas within prehospital care and represented varying scopes of practice (PCPs and ACPs). Three themes were identified from thematic analysis of the nomination letters 1) nominators seek to emulate their mentors, 2) mentors create a safe and nurturing environment, and 3) mentors act as advocates. In addition, content analysis was used to identify a number of desirable professional and personal traits of prehospital mentors.ConclusionThis study describes the qualities of prehospital mentors and identifies a number of common elements in a successful mentoring relationship (from the perspective of the mentee). These results highlight exceptional mentoring that is already occurring within the prehospital care environment. This research has the potential to provide guidance to those who aim to support both formal and informal mentoring within the prehospital care environment
Why MICAS?
Full text linkIntroductionThe Mobile Intensive Care Ambulance Service (MICAS) was initiated in 1996 to assess, stabilise and transfer critically ill patients from a referring hospital to a receiving hospital to meet their clinical needs. Critically ill patients are transferred throughout Ireland to an increased level of care, repatriation for continuity of care following specialist treatment, specialist critical care services or in some instances, are considered too unstable to be transported by local staff. In 2015, it was estimated that approximately 1000 ICU patients are transported per annum (Murphy, Dwyer). These numbers are likely to increase as a result of the reorganisation of health services, the development of hospital groups, the establishment of the hub and spoke critical care services and introduction of trauma centres. This increases the requirement of inter hospital transfers throughout the country.AimsThe aim of this audit was to establish the rationale for a critical care retrieval service and to evaluate the adverse events for inter hospital transport of critically ill patients in Ireland over a 3 year periodMethodsA retrospective chart review of all patients transported by MICAS between January 2015 and December 2017 was undertaken. Clinical records were reviewed for acuity and for adverse events. Results339 patients were transported in this timeframe with 7% experiencing an adverse event overall.ConclusionThe MICAS data shows an increasing number of critically ill patients transferred by MICAS within the timeframe. The rationale for MICAS includes the provision by a specialist team with transport specific equipment with reduced adverse events.
A scoping study and qualitative assessment of care planning and case management in community paramedicine
Full text linkIntroduction: Community paramedicine (CP) establishes an ongoing patient relationship beyond short emergency care episodes. How care planning and case management have been adapted from the isolated incidents of traditional practice is unclear. The objective of this study is to contribute to paramedic practice by examining broad areas of care planning in CP, identifying gaps in the evidence, clarifying key concepts, and reporting on the types of evidence that address and inform practice. A qualitative analysis of included literature outlines program capacities and identifies comprehensive models of care that can inform clinical practice in CP. Methods: A scoping study was completed that included conducting a systematic search of the literature (in MEDLINE and CINAHL) and selecting relevant studies, followed by data extraction, summarizing, and reporting. The authors of included studies were contacted to confirm the aspects of care planning that were extracted from their respective studies. Aspects of care planning were compared between studies and used to generate a comprehensive list of existing practices. Results: Ten of 1648 studies met inclusion criteria. Qualitative analysis identified 22 aspects of care planning along four themes; enrollment (n=3), assessment and management (n=6), intervention and care (n=5), and collaboration (n=8). No study included all 22 aspects of care planning. One aspect of care planning was present in all 10 studies; collaboration with primary care providers. Conclusion: The aspects of care planning identified through this study provide a framework that can guide service providers in the delivery of care and researchers in defined outcome measures to be assessed. Future program development should be guided by the finding that all articles included in this study included collaboration with primary care providers. By summarizing care planning within CP programs, ongoing program development can embrace collaboration with other care providers to help insure that patients receive the appropriate care
Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.
Full text linkIntroductionEvery patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.AimFor patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.MethodsAll NAS incidents closed with a refusal of treatment or transport, from 1st Jan 2017 to 9th November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.Results31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.ConclusionClinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel
Treat the patient, not the machine...always true? A case report of silent myocardial infarction.
Full text linkAfter an unusual prehospital ST-segment elevated myocardial infarction (STEMI) presentation, with a completely asymptomatic patient, a literature review was performed investigating the incidence and pathophysiology of true asymptomatic myocardial infarction
Influence of Family on Saudi Arabian Emergency Medical Services Students
Full text linkObjective: To identify influences on learning for Saudi male students studying Emergency Medical Services at a college in Riyadh, Saudi Arabia. Previous research on influences on student learning in the Kingdom of Saudi Arabia focused on the historical development of education in Saudi Arabia, English language development, and intrinsic motivations of students and excluded a focus on students studying Emergency Medical Services. Methods: Exploratory sequential mixed-methods study was deployed. Results: Family support was an exceptionally strong predictor of student confidence in both skills and post-graduate EMS employment. Concepts involving application, memorization, motivation, and English language did not present as statically significant. The discovery of the strong influences that a family can have on Saudi EMS student’s confidence is noteworthy, as this was not previously discovered in the literature. Conclusion: This discovery holds practical implications for EMS education and training programs as emphasizes the importance of developing practical ways to include a student’s family as a source of support in ensuring student success and confidence.
Identifying the barriers to female leadership in Paramedicine
Full text linkThe main message is clear: women are not making it to the top in any profession, anywhere in the world, and the field of prehospital and academic medicine is not immune. Whether in the public or private sphere, from the highest levels of government decision-making to common households, women continue to be denied equal opportunity with me
On shift simulation in aeromedical operations - making it work
Full text linkPatient care in the prehospital and retrieval medicine (PHARM) environment presents many technical and non-technical challenges. Clinicians are frequently required to perform complex interventions in a time critical and resource limited setting. Intensive training is required prior to operational deployment, and ongoing training is vital to ensure optimal team performance in the delivery of high quality patient care. Regular simulation training with high situational fidelity is valuable in developing and maintaining excellence in PHARM. We describe the methods employed by two Australian aeromedical retrieval services to facilitate daily on shift simulation
Building research capacity among Irish prehospital practitioners.
Full text linkThe National Prehospital Research Strategy was published in 2008, which aimed to gauge current levels of prehospital research activity in Ireland; ascertain the research strengths that exist in the Irish prehospital community; pinpoint the obstacles to high quality research in the prehospital arena; determine the building blocks for a national prehospital research culture; outline an implementation plan for the strategy; and, identify expected and measurable short and long-term outcomes of implementing the strategy.The characteristics of systems that facilitate research productivity include: the promotion of a research culture; mentoring by established scholars; communication with a professional network; rewards for research; and brokered opportunities.Almost ten years later, the development of research capacity within the practitioner cohort has not progressed as much as hoped. A culture of research provides a supportive context in which research is uniformly expected, discussed, produced, and valued. We propose that a culture of research does not yet exist among Irish prehospital practitioners.