Joint Position Statement on Degree Requirements for Paramedics

Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization

BACKGROUND

Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice.

OBJECTIVE

To provide health leaders and policy makers with a framework from which to drive paramedic system modernization.

METHODS

This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system.

RESULTS

A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within.

CONCLUSION

This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.

A novel study of situational awareness among out-of-hospital providers during an online clinical simulation

BACKGROUND

Out-of-hospital providers must be situationally aware in order to maintain safety for themselves, their patients, the public, and their crew. They must be able to recognize situations, interpret them, and predict how those situations may unfold in the future.

METHOD

A mixed-methods explanatory sequential design where out-of-hospital providers in Oklahoma, USA, participated in an 18-minute online simulation and then had their situational awareness (SA) measured. Upon completion, participants provided feedback during scheduled interviews.

RESULTS

A total of 156 out-of-hospital providers participated. Participants were not situationally aware. While not statistically significant, those with higher education had higher SA scores. Participants perceived that the simulation processes were beneficial to their ongoing care in the field, and were satisfied with the online simulation environment.

CONCLUSIONS

Out-of-hospital providers are not situationally aware during an online clinical simulation. While they are focused intently on the surroundings of the scene, they do not put that same focus on the patient. With the appropriate technology and setup, the use of the Situational Awareness Global Assessment Technique (SAGAT) during online simulation is feasible and could enhance clinical performance. Further studies are needed to determine if overall education or years of clinical experience play a role in out-of-hospital SA.

Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011–2019

Background

Describing the US emergency medical services workforce is important to understand gaps in recruitment and retention and inform efforts to improve diversity. Our objective was to describe the characteristics and temporal trends of emergency medical technicians (EMTs) and paramedics in the United States.

Methods

We performed a repeated cross‐sectional evaluation of US Census Bureau's American Community Survey 1‐year Public Use Microdata Sample data sets from 2011–2019. We included respondents working as an EMT or paramedic. Survey‐weighted descriptive statistics of demographic and employment characteristics were calculated. Trend analysis was conducted using joinpoint regression to estimate slope and annual percent change (APC).

Results

The total estimated number of EMTs and paramedics in the United States increased from 216,310 (95%CI 204,957–227,663) in 2011 to 289,830 (95%CI 276,918–302,743) in 2019 (APC 3.0%; 95%CI 1.4%, 4.7%). There was a slight increase in the proportion of females (2011, 31%; 2019, 35%). There was a significant decrease in proportion of non‐Hispanic whites (2011, 80%; 2019, 72%; APC −1.5%; 95%CI −2.0%, −0.9%) with concurrent increases in other racial/ethnic groups (e.g., Hispanics, 2011, 10%; 2019, 13%). About half worked >40 hours per week, with little change over time. Between 15% and 18% lived and worked in different states, and about 40% traveled ≥30 minutes to their workplace.

Conclusions

The number of EMTs and paramedics actively working in EMS as their primary paid occupation has increased over time. However, there have been only modest changes in their demographic diversity.

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

BACKGROUND

Paramedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes.

OBJECTIVE

The aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley's model for SA, can improve overall SA during emergency calls.

METHODS

A prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores.

RESULTS

The overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011.

CONCLUSIONS

A targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.

A bibliometric analysis of paramedicine publications using the Scopus database: 2010-2019

BACKGROUND

Paramedicine is an evolving profession undergoing increases in scholarly activity and peer-reviewed publications. This study aims to complete the first extensive bibliometric examination of the worldwide paramedicine literature.

METHOD

Scopus was utilised to search for paramedicine-based articles published in peer-reviewed journals between 2010 and 2019 inclusive. The included articles were examined for citation count, journal, journal quartile, country of origin, university affiliation, collaboration, and topic.

RESULTS

Paramedicine-based publications have steadily increased and are predominantly published in prehospital or emergency healthcare journals. The majority of highly cited authors were located in Australia; however, only one of these authors was identified as a paramedic. Monash University (Australia) was the most productive institution (11.7% of total articles) and collaboration was mostly within national boundaries (53.2%).

CONCLUSION

This study demonstrates the progressive increase in paramedic scholarly activity over the past decade. Although a large number of articles originate from two countries (Australia and the USA) and one university, numerous nations and institutions are contributing to this body of knowledge. The growing literature base is indicative of the evolution of paramedicine; however, the high level of non-paramedic authors suggests the opportunity for further scholarly development within the paramedic discipline.

EMS Curriculum Should Educate Beyond a Technical Scope of Practice: Position Statement and Resource Document

Position Statement and Resource document approved by the NAEMSP Board of Directors on April 27, 2021.