Prehospital Care Research Forum Journal Club (Prehospital Care Research Forum)

Compassion fatigue is the acute or gradual loss of benevolence that occurs after exposure to critical incident stress. The study we will review this month uses a cross-sectional survey to identify the prevalence and predictors of compassion fatigue among EMS professionals. Article: Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services

Personnel Authors: Ginny K Renkiewicz, Michael W Hubble https://pubmed.ncbi.nlm.nih.gov/34128453/

To view the video, visit: https://youtu.be/eit0GL-7jB8

Survival from out of hospital cardiac arrest continues to be a benchmark for EMS Agencies across the globe. Focuses on chest compression quality and early defibrillation have led to substantial improvements in return of spontaneous circulation and thousands more cardiac arrest survivors being able to leave the hospital. Join this month’s PCRF Journal Club to discuss a paper that evaluates the size of BVM used and its impact on cardiac arrest survival.

Cadaver dissection is one of the highest-rated days of paramedic school for those programs lucky enough to have access to a cadaver lab. However, a fun experience does not always equate to student learning. Join us for this month's educational journal club as we review "A Know-Brainer: The Power of Cadaver-Based Instruction to Teach Clinical Neuroanatomy" and ask whether cadaver dissections help improve learning.

EMS providers are routinely involved in high-stress situations with limited follow-up or healthy coping mechanisms. These experiences can trigger stress responses and burnout in our first-responder community. Despite the widespread conversation about burnout in EMS, limited literature describes the problem. Join us for this month's PCRF Journal Club to review a study that evaluates burnout in EMS using a validated tool.

In 2012, The National Highway Traffic Safety Administration issued guidelines on the safe transport of pediatric patients to lessen the chance of injury during ambulance transport. However, many EMS clinicians are still unfamiliar with sage transport standards and best practice recommendations in the pediatric population. Join us on the next PCRF Journal Club as we review a study that uses qualitative research methods to explore the range of individual attitudes, organizational policies, and professional norms that may influence choices pertaining to pediatric restraint in ground ambulances. Article: Safe Ground Transport of Pediatric Patients: A Qualitative Assessment of Best Practice Guidelines Implementation https://pubmed.ncbi.nlm.nih.gov/37344226/

Several studies have demonstrated the high frequency of medication errors in pediatric patients by prehospital providers during both patient care and simulation. Does the addition of a pediatric field guide improve the percentage of correct doses? Come join us at the next PCRF Journal Club to find out! Article: Medication Errors in Pediatric Patients after Implementation of a Field Guide with Volume-Based Dosing

Authors: Lara D. Rappaport, Geoffrey Markowitz, Steven Hulac & Genie Roosevelt https://pubmed.ncbi.nlm.nih.gov/35020...

To view the video, visit: https://www.youtube.com/watch?v=-lL5uzBbrDo&list=PLbmCpBsQ87iUYX9o_xvmC8x0mrV1G5B2d&index=3

Prior studies suggest that EMS utilization in children may vary by socioeconomic status. However, most of these studies were small, and focused on regional data. Join us as we review a recently published study that used the National EMS Information System 2019 dataset and the Child Opportunity Index to evaluate EMS utilization in children based on structural, economic, and environmental conditions. One of the study’s authors, Dr. Jen Fishe, will be joining as a guest.

Article: The Child Opportunity Index and Pediatric Emergency Medical Services Utilization

Authors: Sriram Ramgopal, Lindsay Jaeger, Angelica Cercone, Christian Martin-Gill & Jennifer Fishe https://www.tandfonline.com/doi/full/10.1080/10903127.2022.2076268

To view the video, visit: https://youtu.be/qGLr_tZrAoA

Medication for opioid use disorder is extremely effective and can reduce overdose mortality by two-thirds. However, treatment initiation rates are low among overdose survivors. Prehospital buprenorphine administration after an overdose has the potential to help treat withdrawal symptoms and reduce repeat overdoses. Come join us at the next PCRF Journal Club to find out if the prehospital administration of buprenorphine has beneficial effects on clinical outcome measures in patients with naloxone-precipitated withdrawal.

Carroll G, Solomon KT, Heil J, Saloner B, Stuart EA, Patel EY, Greifer N, Salzman M, Murphy E, Baston K, Haroz R. Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services. Ann Emerg Med. 2022 Sep 30:S0196-0644(22)00506-6. doi: 10.1016/j.annemergmed.2022.07.006. Epub ahead of print. PMID: 36192278.

To view the video, visit: https://youtu.be/-fJFub6oEAM

Most of our pediatric patients cared for and transported by EMS have low acuity, which results in very favorable outcomes. Despite this, EMS providers still experience adverse safety encounters while caring for pediatric patients. Join this month's PCRF Journal Club as we review a study that evaluated the frequency, type, and potential harm from these adverse safety encounters across 15 EMS Agencies in 3 states.

EMS witnessed out-of-hospital cardiac arrest can be challenging for the EMS clinicians attending to the patient, even though patients who suffer OHCA in front of emergency medical services (EMS) clinicians have a greater likelihood of survival. Little is known about how EMS clinicians think about and experience those events. Come join us at the next PCRF Journal Club where we review a study that sought to understand how EMS clinicians assessed patients who devolved to cardiac arrest in their presence and uncover the perceived barriers and facilitators associated with recognizing and treating witnessed.

Article: A Qualitative Analysis of the Experiences of EMS Clinicians in Recognizing and Treating Witnessed Cardiac Arrests. Prehosp Emerg Care. 2022 Sep 9:1-16. https://pubmed.ncbi.nlm.nih.gov/36082980/

To view the video, visit: https://youtu.be/lA1b8OimkWY

Is AVPU just as informative as GCS? This cross-sectional study is aimed to assess whether prehospital AVPU categorization correlates with GCS severity categorization and, similarly, with mortality rates in trauma victims.

Article: https://doi.org/10.1016/j.ajem.2022.06.042

To view the video, visit: https://youtu.be/8j62LLueSNY

Join us for this end-of-year special edition of the PCRF Education Research Journal Club when each of our panelists will share a favorite article from the educational literature in 2023.

As out-of-hospital medicine evolves, emergency medical services (EMS) education practices must also be updated to ensure that EMS professionals acquire and maintain the skills needed to best serve patients. Join the authors who identified and ranked the top 10 research priorities related to EMS education in the United States.

The societal burden of traumatic brain injuries (TBIs) is enormous. One major focus of evidence-based TBI treatment guidelines is the prevention and treatment of hypotension. However, little is known about the out-of-hospital blood pressure ranges associated with optimal outcomes in TBI. Join us at the next PCRF Journal Club as we review a study that identified the out-of-hospital systolic blood pressure range that is associated with optimal outcomes in major TBIs

Article: Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension Authors: Daniel W. Spaite, MD; Chengcheng Hu, PhD; Bentley J. Bobrow, MD; Bruce Barnhart, MSN, RN; Vatsal Chikani, MPH; Joshua B. Gaither, MD; Kurt R. Denninghoff, MD; Gail H. Bradley, MD https://pubmed.ncbi.nlm.nih.gov/35339285/

To view the video, visit: https://youtu.be/kjZoZleaR64

The inherent risk of injury and illness comes with most jobs, more so in the first responder community. Working on the front lines during disasters, roadway collisions, and violent encounters, paramedics experience their fair share of risk. However, limited large-scale data analysis describes the injuries and illnesses paramedics face. Join this month's PCRF Journal Club as we review a study that evaluated workforce data to describe these challenges paramedics face and how we compare to other first responders and those in health care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548021/

Prehospital needle decompression is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain. This Journal Club episode reviews a study that examined the association of prehospital needle decompression with early mortality in patients requiring emergent chest decompression.

Article: Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression https://pubmed.ncbi.nlm.nih.gov/35976642/

To view the video, visit: https://youtu.be/IplgoRj8N_Q

Can one email from a professor improve students' exam scores? This isn't a story about an accidental email sent with the answer key attached. It is a story about a professor who, using a growth mindset, encourages students to keep pushing forward in their biology class. Join us for this month's education journal club as we explore the impact of faculty mindset on student performance, specifically on first-generation college students, following this experience.

https://www.lifescied.org/doi/full/10.1187/cbe.23-07-0131

EMS providers respond to patients suffering from shortness of breath every day and have a vast array of treatment options in the prehospital setting. However, limited analysis describes the nation's EMS treatment of patients suffering from shortness of breath. Join us this month for the PCRF Journal Club to discuss this recent publication describing nationwide trends in the treatment of patients with bronchospasm.

Article: Emergency Medical Services Management of Bronchospasm in the United States: A Cross-Sectional Analysis and Nationwide Quality Assessment

https://www.tandfonline.com/doi/abs/10.1080/10903127.2023.2220021

Can students in self-directed endotracheal intubation training accurately and reliably self-evaluate their abilities? This paper used an algorithm-driven hybrid simulation learning method to assess competence. Including peer-to-peer practical skills training. Join us as we explore this method of learning and algorithm for assessment.

Mental health has long been a focus of the overall well-being of the EMS provider. However, should training in stress management start sooner, perhaps during initial education? Can meditation help improve success during paramedic training? To help answer these questions, join this month's Prehospital Care Research Forum education podcast to learn the impacts of adding a course on meditation. Specifically, what benefits were found in reducing depression, anxiety, and stress in initial education paramedic students?

Checklists have become a part of every EMS provider's day. We use them to check in our ambulances, ensure we have all our equipment, and help us prepare for low-frequency skills. However, can a checklist do more than that? Can a checklist help us perform better in the field? Join us for this month's Prehospital Care Research Forum education podcast, where we will review a study that evaluated if using an easy-to-remember checklist can improve cardiac arrest management.

EMS providers pride themselves on the great care we deliver, but is that care equitable for all our patients? Join us for this second special edition PCRF journal club with the Diversity, Equity, and Inclusion committee of the National Association of EMS Physicians. Dr. Andra Farcas and the panel of authors will discuss their recent systematic scoping review on disparities in EMS care. After screening thousands of abstracts, the authors analyzed over 145 articles. It is time to act on the information they uncovered!

To view the video, please visit: https://youtu.be/g7XOQD5v_bM

Live from Accreditcon ! If you have seen one paramedic education program, you have seen one paramedic education program. As educators, we have all heard this mantra when describing the diversity in training modalities utilized by paramedic education programs. However, as reported in the annual Resource Assessment Matrix, there is limited nationwide evaluation of what programs are doing well and where they are falling short. Join the Prehospital Care Research Forum panel and authors this month for a live discussion of Medical Directors, Facilities, and Finances: Resource Deficiencies in Accredited Paramedic Programs.

Article: Medical Directors, Facilities, and Finances: Resource Deficiencies in Accredited Paramedic Programs https://www.tandfonline.com/doi/full/10.1080/10903127.2023.2245476?src=recsys

Can you educate healthcare students on delivering life-and-death news to patients, and if so, can you standardize it and evaluate student improvement and performance? Can virtual simulation truly bring the realism necessary to deliver this serious news? Join us for this month's Education Journal Club as we unpack the details of this multi-institutional effort, exploring how virtual simulation is being leveraged to create a scalable, competency-based curriculum.

Maintaining skills in pediatric prehospital care is critical since pediatric patient encounters can be high acuity/low frequency. Evidence shows that procedural skills competency decays in as little as three months. These researchers used simulations and first-person video to test the effectiveness of procedural skills training for experienced EMS professionals and its impact on skills retention.

Article: Improving Pediatric Procedural Skills for EMS Clinicians: A Longitudinal Simulation-Based Curriculum with Novel, Remote, First-Person-View Video-Based Outcome Measurement.

Power, hierarchy, and poor team culture can put patient care at risk. By understanding the complex psychosocial and clinical challenges that new graduates face, is it possible for a new graduate to actively intervene on behalf of team and patient safety? Join us to discuss this qualitative study exploring how educators can prepare graduates to speak up for safety.

Did you get out the door in less than 90 seconds? Whether it brings pride or nightmares, this is the most common quality improvement question asked. However, there are other national quality benchmarks for EMS, such as completing a respiratory assessment for patients who are suffering from difficulty breathing and administering medication for patients presenting with a seizure or asthma. Join this month's PCRF Journal Club to discuss this recent publication that evaluates where EMS stacks up on these and other quality benchmarks.

Communication, advocacy, and even history-taking are all behaviors engrained in the EMS provider. In fact, we can all think of an educator, preceptor, or partner who helped teach and role-model these skills. Because these behaviors reflect our training, they are also open to bias based on our different lived experiences. Join us this month for the Prehospital Care Research Forum education podcast as we review this scooping review on using simulation to teach behavioral skills related to diversity, equity, and inclusion.

https://pubmed.ncbi.nlm.nih.gov/36194859/

While studies have found that EMS compliance with recommended prehospital care for patients with acute stroke is inconsistent, little is known about the sources of variability in compliance. Join us as we review a study that utilizes linked statewide stroke registry and EMS data to explore patient and EMS agency-level contributions to variability in prehospital stroke care.

Long-duration shifts, variable shift scheduling, limited time off between shifts, and other factors are linked to fatigue in EMS shift workers. Odds of injury, error and adverse events are higher among U.S.-based EMS clinicians who report fatigue vs. those who do not. Come join us at the next PCRF Journal Club as we review a cluster-randomized trial that tests whether EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue.

Article: Patterson PD, Martin SE, Brassil BN, Hsiao WH, Weaver MD, Okerman TS, Seitz SN, Patterson CG, Robinson K. The Emergency Medical Services Sleep Health Study: A cluster-randomized trial. Sleep Health. 2022 Nov 10:S2352-7218(22)00181-4. doi: 10.1016/j.sleh.2022.09.013. Epub ahead of print. PMID: 36372657.

Sites referenced: www.emsfatigue.org 412YinzerMedic.org

To view the video, visit: https://youtu.be/YK7sCztJmhQ

Workforce shortages continue to pervade EMS. Despite the pandemic recovery and increased efforts at bringing more people into the field and keeping them there, fewer people are choosing to climb into the back of an ambulance. Little work, however, has been put into describing the experience of being an EMT or paramedic, specifically those who are underrepresented in the EMS workforce. Join the Prehospital Care Research Forum clinical journal club this month to explore the latest research on just that,

The Female Emergency Medical Services Experience: A Mixed Methods Study.

https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2306248

Falls in Older Adults Requiring Emergency Services: Mortality, Use of Healthcare Resources, and Prognostication to One Year Although falls among older adults are common and frequently require emergency services, research on long-term outcomes and prognostication is sparse. Come join us at the next Journal Club to examine healthcare use and one-year survival among older adults who fall and find out if mortality can be predicted.

Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9183773/pdf/wjem-23-375.pdf

To view the video: https://youtu.be/fmUMOR07tGA

Patients with repeat EMS encounters within 72 hours represent an important patient population to better understand risks and resource utilization, yet limited data exist describing characteristics of these encounters. Come join us on the next PCRF Journal Club as we review a study that describes patients who had more than one EMS encounter within 72 hours and compares them to patients who did not have subsequent EMS encounters within a single, large urban EMS agency.

Early recognition and rapid defibrillation of shockable rhythms are strongly associated with survival in out-of-hospital cardiac arrest (OHCA). Little is known about the accuracy of paramedic rhythm interpretation and its impact on survival. Join us on the next podcast to review a study that seeks to determine if paramedic interpretation of initial rhythm would be associated with survival.

Article: Paramedic rhythm interpretation misclassification is associated with poor survival from out-of-hospital cardiac arrest Authors: H. Hill Stoecklein, Andrew Pugh, M. Austin Johnson, Joseph E. Tonna, Michael Stroud, Stavros Drakos, Scott T. Youngquist https://pubmed.ncbi.nlm.nih.gov/34952179/

To view the video. visit: https://youtu.be/HTeiop1zKxg

While most cardiac dysrhythmias fit nicely into a treatment algorithm, atrial fibrillation stands out as lacking clear-cut treatment guidelines. Concerns over patient outcome, risk of potential stroke, and further cardiac damage leave many agencies favoring rapid transport and limited treatment. Additionally, limited data is available to link prehospital treatment to the patient’s hospital discharge status. Join this month's PCRF Journal Club to discuss a landmark paper that evaluates treating atrial fibrillation in the prehospital setting, including a link between prehospital treatment and hospital outcome data.

Law enforcement is often the first responder on scene in out of hospital cardiac arrest. The ability for police to provide high quality CPR and early defibrillation can have a substantial impact on patients lives however has rarely been studied. Join us for this month's PCRF Journal Club to discuss this most recent publication that evaluates the impact of law enforcement on patients suffering from out of hospital cardiac arrest

The administration of a high fraction of oxygen following the return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Join us at the next PCRF Journal Club as we review a study that evaluated whether targeting a lower oxygen saturation in the early phase of post-resuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge.

Article: Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Oct 26. doi: 10.1001/jama.2022.17701. Epub ahead of print. PMID: 36286192. Link: https://pubmed.ncbi.nlm.nih.gov/36286192/

To view the video, visit: https://youtu.be/vXfqIMtcOFE