[About making up for manpower resource of paramedical personnel]

The article deals with the analysis of quality of training of paramedical personnel in the medical colleges of Kursk oblast during last ten years. It is established that during last decade the number of graduates of the Kursk medical college has a tendency to decrease. If in 2001 the college graduated 169 medical nurses, 44 feldshers, and 30 midwives (243 in total) then in 2011 graduated 121 medical nurses, 64 feldshers (185 in totals). The number of college entrants with 11th grade is decreasing against the background of increasing of number of college entrants with 9th grade. Basically, the educational institutions are completed with graduates of rural schools whose resources are limited. The graduates from urban schools have no intent to acquire the profession of medical nurse. Hence, in Kursk oblast under annual decrease of number of paramedical personnel concurrently decreases number of graduates of medical colleges. This situation makes quite problematic the making up of manpower resource both in nowadays and in near-term outlook.

Workforce priorities: three steps to determine what they are & move forward

In recent years, considerable media attention has been given to the shortage of EMTs and paramedics.(1-8) Reports appear often enough to raise concern among the public, the medical community and policymakers alike that an ongoing or pending nationwide "crisis" or "shortage" of EMS professionals is upon us. Rural challenges are particularly prevalent in media coverage.(5,6,9) The recent inclusion of a special rural EMS session at the National Conference of State Legislatures 2007 annual meeting suggests that concern among local politicians has reached a tipping point, which may prompt action.

A good place to work

Of the many problems facing EMS, recruitment and retention can seem among the most intractable. Google the term paramedic shortage, and you'll get more results than you can stand to read. There are no easy answers to this situation, but there are agencies out there that have had success in finding and keeping people. What are they doing right, and what can we learn from them? Here we examine some success stories featuring solutions to personnel paucities that are worth replicating.

Employee retention: applying hospital strategies to EMS. With increasing demand for and decreasing supply of EMTs and paramedics, retention strategies should be a priority for EMS organizations

Retention strategies are a priority for EMS organizations. These strategies must be broad and varied to address the variety of reasons employees leave healthcare organizations. The value of creating these programs should manifest itself through increased employee satisfaction and an increased sense of belonging to the organization.

Prehospital emergency medical services in Malaysia

Once a very slowly developing country in a Southeast Asia region, Malaysia has undergone considerable change over the last 20 years after the government changed its focus from agriculture to developing more industry and technology. The well-known "Vision 2020," introduced by the late Prime Minister, set a target for the nation to be a developed country in the Asia region by the year 2020. As the economy and standard of living have improved, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time, there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.

Emergency medical services workforce in the city of Santo Domingo

Santo Domingo is the largest city in the Dominican Republic. In recent years this city has experienced a significant increase in ambulance services.

OBJECTIVE

To describe the current emergency medical services (EMS) workforce trends in Santo Domingo.

METHODS

This was a cross-sectional descriptive study. Emergency medical services providers working within the city of Santo Domingo filled out a nine-item self-administered questionnaire.

RESULTS

A total of 101 providers, 48 volunteer and 53 paid, returned the survey (response rates of 75% and 91.4%, respectively). The volunteers showed a mean of 7.48 +/- 2.02 years of involvement in EMS, whereas the paid providers had a mean of 3.58 +/- 2.91 years. When asked about planned long-term involvement in EMS, 93.8% of the volunteers responded positively, compared with 58.5% of the paid group. Nine (16.98%) of the paid providers were not satisfied with their jobs, whereas all the volunteers (100%) stated that they were satisfied; 46 (86.8%) and 27 (50.9%) of the paid providers agreed that better salary and better work hours, respectively, would influence their satisfaction. Among the volunteers, 40 (83.3%) stated that occupational health insurance would improve job satisfaction; and 39 (81.3%) stated that life insurance would bring satisfaction to their job. Logistic regression analysis showed no predictive association between job satisfaction and years of service (p = 0.342).

CONCLUSION

Volunteers appeared to be less educated but with a higher long-term interest in EMS. Salary and better work hours seem to be important factors affecting satisfaction of paid providers, whereas occupational health and life insurance appear to affect the satisfaction of volunteers.

Strategic deployment. Two decades of experience provide important lessons on how to deploy emergency resources

When it comes to deployment, one size (approach) doesn't fit all. Progressive public safety and EMS systems will recognize that a successful plan can thoughtfully balance system performance and human needs. Inventive people who learned how to do things better, cheaper and faster built America. Providing optimum system coverage, improved response times and quality care for patients fits the same mold. Sophisticated and accountable EMS systems readily accept this as part of their mandate.

Assessment of the quality improvement of prehospital emergency care in Sweden

The optimal competence level of personnel involved in prehospital emergency care is a matter for discussion. In Sweden a national quality improvement process has been initiated including strict regulation of the authorization of ambulance personnel to administer drugs and increased involvement of registered nurses. The aim of the present study was to assess from a national survey the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. A questionnaire, detailing organizational, staffing, competence and functional aspects, was sent to all medical directors of prehospital EMS. The response frequency was 87.5%. Variations in the local organization of the prehospital care were observed. Only a limited number (20%) of the districts organized the ambulance services according to the competence level of the personnel. It was found that the competence level of the personnel involved in prehospital emergency care had improved considerably compared with the situation 5 years ago. A majority of the ambulancemen had increased their competence level by completing nurse assistant training and more registered nurses had been employed. The changes in the competence level and organization of the ambulance services and prehospital emergency care were considered to have had moderate (38.5%) or great (51.9%) impact on the quality of the services during the past 5 years. The effect was reported by 53.2% of the directors to be objectively verified from review of ambulance records, regular proficiency tests, patient survival data (cardiopulmonary resuscitation), and analyses of computer-based records. It is concluded that the present study clearly shows that quality improvement process initiated by the Swedish authorities has resulted in a considerable improvement of prehospital emergency care in Sweden during the past few years.

Military and civilian emergency aeromedical services: common goals and different approaches

Military and civilian organizations in the U.S. operate separate but parallel emergency aeromedical services. Despite common origins, military and civilian approaches and methods have diverged. This article compares and contrasts the capabilities, priorities, safety, equipment, training and personnel of the largest military service, the U.S. Army, to civilian rotary wing (helicopter) emergency aeromedical programs. The different successes of military and civilian emergency aeromedical programs can be considered for use to improve the services of each. In general, Army programs operate larger aircraft and utilize two pilots per aircraft. Safety is a high priority and the Army aeromedical safety record is excellent. The Army also places a high degree of emphasis on crashworthiness and protective gear for the crew. Most civilian air Emergency Medical Service (EMS) programs operate small to moderate-sized aircraft flying with a single pilot. The recent safety record has improved dramatically. Civilian programs may add to their safety by considering two pilots and incorporating the crashworthy and protective advancements made by the military. Civilian programs fly with two highly trained medical technicians, nurses or physicians, equipped with state-of-the-art medical equipment. Army helicopters fly with one lesser-trained medical crewmember and less equipment. Improved combat casualty care and battlefield survival may be possible by increasing both the number and training of the medical attendants on Army aircraft.

Mission, staffing, and budget data of flight programs in the United States

INTRODUCTION

Manage care and other health care reform initiatives have forced all hospitals to evaluate their work processes. In this era of cost containment, many flight programs are examining the structure of their programs to determined whether they are functioning in an efficient, cost-effective fashion.

METHODS

A survey was sent to the chief flight nurse of 240 flight programs in the United States.

RESULTS

Eighty-five programs (35.4%) responded. Data were collected on demographics, management structure, mission information, staffing issues, and budgets. Results in each program varied widely.

CONCLUSION

Benchmark data are available against which programs can compare themselves. Such comparisons may allow the discovery of opportunities to enhance program efficiency and cost-effectiveness.

Comparison of two methods of transporting paramedics to cardiac arrests outside hospital

OBJECTIVE

To compare the deployment of paramedics in a separate rapid response unit with their deployment in a standard emergency ambulance.

DESIGN

A one year period of each deployment.

SETTING

Throughout the community in some parts of West Yorkshire.

PARTICIPANTS

All patients receiving resuscitation for cardiac arrest by paramedics.

INTERVENTIONS

Using the same group of paramedics and central control, 12 months with the paramedics deployed in separate cars in addition to the standard ambulances (period 1) were followed by another 12 months when they were deployed as one crew member of a standard emergency ambulance (period 2).

MAIN OUTCOME MEASURES

Number of arrests attended, number of patients in ventricular fibrillation at paramedic arrival, response times, survival to leave hospital.

RESULTS

In period 1, 580 arrests were attended with 31 survivors. In period 2, 462 arrests resulted in 25 survivors. The mean response time was shorter in period 1 (6.24 versus 6.60 min, Cl--0.01-0.73 min). In period 1, 217 patients were found in ventricular fibrillation (23 survivors): In period 2, 141 patients were found in ventricular fibrillation (11 survivors).

CONCLUSION

Separating paramedics from the standard emergency ambulances increases the number of survivors of cardiac arrest but the difference may not be sufficiently large to justify the additional expenditure.

Driving forward

A new management structure, new equipment and technology are changing the culture of the London Ambulance Service and enabling it to meet the challenges of the 90s. David Lloyd describes how.

EMS offshore. A new horizon for paramedics

The difficulty in getting medical aid to offshore drilling platforms can be a source of life-threatening delays. Recently, some companies have charted new waters by actually stationing EMS crews on their rigs.

Burning the EMS candle. EMS shifts and worker fatigue

Has coffee become your best friend? Do you sleep only in your dreams? Is your bed merely an illusion? If so, you are not alone; sleep deprivation is a fact of life for many EMS personnel. Though widely accepted, isn't it time that we question the effects of those long days and nights?