Unfit for Duty? Evaluation of 4 Years of Paramedic Preemployment Fitness Screening Test Results

Too stressed to think? A scoping review of the literature for healthcare educators utilising high acuity clinical scenarios

BACKGROUND

The practise of paramedicine can be highly stressful particularly where urgent lifesaving decisions need to be made. Traditionally, educators have adopted the approach of placing students in simulated stressful situations as a way of learning to cope with these challenges. It is unclear from the literature whether traditional stress inoculation enhances or hinders learning. This scoping review aims to identify and examine both the peer-reviewed and grey literature reporting physiological stress responses to high-acuity scenarios in paramedicine and cognate healthcare disciplines.

METHODS

Adhering strictly to JBI Evidence Synthesis Manual for conducting a scoping review, medical subject headings and areas, keywords and all other possible index terms were searched across EBSCOhost (Medline, CINAHL and APA PsycInfo), Scopus and, PubMed. English language articles both published (peer-reviewed academic papers, reports and conference proceedings) and unpublished (grey literature, Google Scholar reports) were included, and publications citing retrieved articles were also checked.

RESULTS

Searches performed across five electronic databases identified 52 articles where abstracts indicated potential inclusion. From this, 22 articles which reported physiological or psychophysiological responses to stressful scenario-based education were included.

CONCLUSION

This review identified that an acceptable level of stress during simulation can be beneficial, however a point can be exceeded where stress becomes a hinderance to learning resulting in underperformance. By identifying strategies to moderate the impact of acute stress, educators of paramedic and other healthcare students can utilise high-acuity clinical scenarios to their andragogical armamentarium which has the potential to improve real-world clinical outcomes.

A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks

Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.

Pre-Employment physical capacity testing as a predictor of musculoskeletal injury in Victorian paramedics

BACKGROUND

Paramedic work has periods of intermittent high physical demand, a risk of workplace injury, may be confounded by inherent fitness of the paramedic.

OBJECTIVE

This study aimed to identify the nature of workplace musculoskeletal injury, and determine if there was a relationship between pre-employment physical capacity testing (PEPCT) scores and risk of workplace musculoskeletal injury within the paramedic industry.

METHODS

A retrospective case review using PEPCT scores and workplace injury (WI) manual handling data collected from 2008 to 2015 by an Australian pre-hospital emergency care provider (Ambulance Victoria), enabled comparison and analysis of two distinct data sets.

RESULTS

A total of 538 paramedics were included for analysis with 34 paramedics reporting a workplace musculoskeletal injury from manual handling. The mean time to injury from commencement of employment was 395.4 days (SD 516.2). Female paramedics represented 53.0%and male paramedics represented 47%of the sample. Mean total PEPCT score for the entire sample was 19.1 (SD 2.9) with a range from 16.2-22, while for those reporting injuries it was 18.3 (SD 2.6) with a range from 15.7-20.9.

CONCLUSIONS

Musculoskeletal injury amongst Victorian paramedics is more prevalent where the paramedic is female, and/or within three years of commencement of employment. The PEPCT score did not differentiate those at risk of subsequent injury.

Perceived exertion using two different EMS stretcher systems, report from a Swedish study

BACKGROUND

Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel.

AIM

To describe EMS personnel's perceived exertion using two different stretcher systems.

METHODS

The methodology of this explorative simulation study included enrolling twenty (n=20) registered nurses and paramedics who worked in ten pairs (n=10) to transport a conscious, 165lb. (75kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n=10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport.

RESULTS

No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p=0.3), transporting up a stairway (13.7 vs 12.5 p=0.06), lateral lift (12.1 vs 11.2 p=0.5), or flat ground transportation (10.4 vs 11.1 p=0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p<0.001) and loading into ambulance (11.1 vs 13.0 p<0.001).

CONCLUSION

A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles.

Impact of error self-perception of aerobic capacity in the safety and efficacy of the lifeguards

INTRODUCTION

The strong physical demands that are required of lifeguards during rescues also require an accurate self-perception of one's fitness level to be able to regulate the intensity of effort.

OBJECTIVES

The aim of this study was to determine the real aerobic capacity (RAC) and to compare it with two self-reported measurements: subjective appraisal of aerobic capacity (SAAC) and appraisal of physical exercise (APE).

METHODS

Fifty-two professional lifeguards were included in the study. For an objective assessment of RAC, the lifeguards' maximum oxygen uptake (VO2max) values were measured during treadmill stress tests. A fitness assessment questionnaire was used to obtain the SAAC and APE values.

RESULTS

We found a statistically significant association between the APE and RAC variables in the contingency analysis (p < 0.001). In total, 93.7% of the lifeguards who obtained a VO2max value below 43 ml kg(-1) min(-1) considered their aerobic capacity to be high or very high.

CONCLUSION

This self-perception error of true aerobic capacity could lead to premature fatigue during a rescue, endangering both the lifeguard's life and the life of the victim. These data may help lifeguards and beach managers to become aware of the need to know lifeguards' true physical conditions through testing and structured training programs.