EMT domestic violence knowledge and the results of an educational intervention

The Demographics and Education of Emergency Medical Services (EMS) Professionals: A National Longitudinal Investigation

Objectives

The objectives of this study were to assess longitudinal and cross-sectional changes in Emergency Medical Technician (EMT)-Basics and Paramedics: (1) demographics, (2) employment characteristics, and (3) initial Emergency Medical Services (EMS) education.

Methods

These data were collected between 1999 and 2008 employing survey techniques aimed at collecting valid data. A random, stratified sample was utilized to allow results to be generalizable to the nationally certified EMS population. Survey weights that were adjusted for each stratum’s response were estimated. Weighted percentages, averages for continuous variables, and 95% confidence intervals (CIs) were calculated. Significant changes over time were noted when the CIs did not overlap.

Results

In all 10 years of data collection, the proportion of EMT-Paramedics who were male was greater than the proportion of EMT-Basics who were male. A substantial proportion of respondents performed EMS services for more than one agency: between 39.8% and 43.5% of EMT-Paramedics and 18.4% and 22.4% of EMT-Basic respondents reported this. The most common type of employer for both EMT-Basics and EMT-Paramedics was fire-based organizations. About one-third of EMT-Basics (32.3%-40.1%) and almost one-half of EMT-Paramedics (43.1%-45.3%) reported that these organizations were their main EMS employer. Rural areas (<25,000 residents) were the most common practice settings for EMT-Basics (52.1%-63.7%), while more EMT-Paramedics worked in urban settings (65.2%-77.7%).

Conclusions

This analysis serves as a useful baseline to measure future changes in the EMS profession. This study described the demographic and work-life characteristics of a cohort of nationally certified EMT-Basics and Paramedics over a 10-year period. This analysis also summarized initial EMS education changes over time.

BentleyMA, ShobenA, LevineR. The demographics and education of Emergency Medical Services (EMS) professionals: a national longitudinal investigation. Prehosp Disaster Med. 2016;31(Suppl. 1):s18–s29.

A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners

CONTEXT

Intimate partner violence (IPV) is a significant cause of morbidity and mortality in women worldwide. Numerous health organisations have called for increased education for health care practitioners who encounter IPV patients and the first clinical guidelines for health services responding to IPV were recently published. This renewed focus has created a need to examine the current evidence for IPV education so that it may inform the next generation of educational interventions.

OBJECTIVES

This study was designed to examine the effects of IPV educational interventions on the knowledge, attitudes, skills and behaviours of allied health care practitioners (AHCPs).

METHODS

We conducted a systematic search of multiple databases up to the end of May 2015. We selected studies that included IPV educational interventions for AHCPs and that measured knowledge, attitude, skill or behavioural outcomes. Studies were evaluated based on methodological quality, education context and outcome measurement.

RESULTS

We found 2757 articles from which 18 were selected for inclusion. Study participants included nurses, dentists, social workers and paramedics. Educational interventions ranged widely in length, delivery format and topics covered. Findings indicate that improvements in some knowledge, attitudes, skills and behaviours are associated with education, although the lack of high-quality studies indicates that conclusions should be treated with caution.

CONCLUSIONS

Future studies should be conducted using rigorous methodology and validated instruments to measure evidence-based outcomes and should target a wider range of AHCPs. Recommendations are provided on education content and delivery, study methodology and outcome measurement based on insights gained from selected studies.

What do EMS personnel think about domestic violence? An exploration of attitudes and experiences after participation in training

INTRODUCTION

In 2012, the American College of Emergency Physicians (ACEP) reaffirmed that domestic violence is a serious public health hazard that emergency medical services (EMS) personnel will encounter. Many victims of domestic violence may refuse transport to the hospital, making EMS prehospital field personnel --EMTs and paramedics-- their only contact with healthcare providers. Despite these facts, the interaction of field EMS personnel and victims of domestic violence remains largely unexamined.

OBJECTIVES

Given the importance of the interaction of field EMS personnel have with victims of domestic violence, the goal of this study is to explore attitudes about and experiences of EMS personnel on the issue of domestic violence after completing a training on domestic violence.

METHODS

Participants were recruited by researchers contacting multiple EMS agencies. Data were gathered using a survey attached to an online domestic violence training for field EMS personnel (EMTs and paramedics) circulated in a large southern state. Participants were able to obtain continuing education credits for completing the online modules.

RESULTS

A total of 403 respondents completed the survey. 71% of respondents indicated that they frequently encounter patients who disclose domestic violence; 45% believe that if a victim does not disclose abuse, there is little they can do to help; and from 32% to 43% reported assumptions and attitudes that indicate beliefs that victims are responsible for the abuse.

CONCLUSIONS

Implications of the data are discussed suggesting that EMS providers are aware that they frequently assist victims of domestic violence, yet many continue to endorse common myths and negative attitudes about victims. Core components of training that can educate EMS personnel about the dynamics of domestic violence are described, and a new free online training for medical professionals on domestic violence is offered for use as part of ongoing education to enhance the EMS response to victims.

The training needs of Turkish emergency department personnel regarding intimate partner violence

Background

Violence against females is a widespread public health problem in Turkey and the lifetime prevalence of IPV ranges between 34 and 58.7%. Health care workers (HCW) sometimes have the unique opportunity and obligation to identify, treat, and educate females who are abused. The objective of this study was to evaluate the knowledge, attitudes, and experiences of the emergency department (ED) staff regarding intimate partner violence (IPV) at a large university hospital in Turkey.

Methods

A cross-sectional study was conducted in a large university hospital via questionnaire. The study population consisted of all the nurses and physicians who worked in the ED during a two month period (n = 215). The questionnaire response rate was 80.5% (41 nurses and 132 physicians). The main domains of the questionnaire were knowledge regarding the definition of IPV, clinical findings in victims of IPV, legal aspects of IPV, attitudes towards IPV, knowledge about the characteristics of IPV victims and abusers, and professional and personal experiences and training with respect to IPV.

Results

One-half of the study group were females, 76.3% were physicians, and 89.8% had no training on IPV. The majority of the nurses (89.5%) and physicians (71.1%) declared that they were aware of the clinical appearance of IPV. The mean of the knowledge scores on clinical knowledge were 8.84 ± 1.73 (range, 0–10) for acute conditions, and 4.51 ± 3.32 for chronic conditions. The mean of the knowledge score on legal procedures and the legal rights of the victims was 4.33 ± 1.66 (range, 0–7). At least one reason to justify physical violence was accepted by 69.0% of females and 84.7% of males, but more males than females tended to justify violence (chi square = 5.96; p = 0.015). However, both genders accepted that females who experienced physical violence should seek professional medical help.

Conclusion

The study participants' knowledge about IPV was rather low and a training program is thus necessary on this issue. Attention must be given to the legal aspects and clinical manifestations of IPV. The training program should also include a module on gender roles in order to improve the attitudes towards IPV.

Intimate partner violence from the emergency medicine perspective

BACKGROUND

The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful.

METHODS

A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided.

RESULTS

The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem.

CONCLUSION

Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.

A continuous improvement process for health providers of victims of domestic violence

BACKGROUND

Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health system's policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence. THE CONTINUOUS IMPROVEMENT PROCESS (CIP) MODEL: UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education.

RESULTS

Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence.

DISCUSSION

The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.