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Carrillo EA, Ignell SP, Wulfovich S, Vernon MJ, Sebok-Syer SS. Critical Steps for Determining Capacity to Refuse Emergency Medical Services Transport: A Modified Delphi Study. PREHOSP EMERG CARE 2024:1-18. [PMID: 39269329 DOI: 10.1080/10903127.2024.2403650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/16/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES Emergency physicians without specialized Emergency Medical Services (EMS) training are often required to provide online medical oversight. One common ethical question faced by these physicians is the assessment for decision-making capacity in a patient who does not accept EMS transport to the hospital. We sought expert consensus for a standardized set of guiding questions and recommendations to ensure a rigorous and feasible capacity assessment. METHODS A modified Delphi method approach was used to achieve group consensus among expert individuals. Nineteen physician experts were recruited from across the country, representing populations totaling over 22 million and a variety of urban, suburban, and rural practice environments. Experts completed a Round 1 survey that included 19 questions surrounding best practices for capacity evaluation among patients refusing transport. The threshold for consensus was predefined as 80% agreement. Participants gathered virtually meeting where the results from the first round were shared with the group. Discussion generated new items and refined the language of existing items. Following the virtual meeting, a Round 2 survey was conducted, and voted on by the panel for the items that did not meet consensus in Round 1. RESULTS After the first round, 15 of 19 items reached consensus. Three of the items that met consensus were universally noted to require language modification for clarification. A large portion of the discussion involved the proper method of integrating patient concerns around ambulance transport (e.g., cost of transport, financial concerns, social barriers) into the capacity assessment and whether alternate care options should be discussed. After the second round of voting, one additional item was reversed to meet consensus, resulting in a total of 16 items. CONCLUSIONS A consensus expert panel was able to agree upon 16 standardized steps to guide best practices and assist emergency physicians in real-time evaluation of patients that refuse EMS transport.
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Affiliation(s)
- Eli A Carrillo
- Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304
| | - Steven P Ignell
- Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304
| | - Sharon Wulfovich
- Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304
| | - Michael J Vernon
- Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304
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Bowles KA, Batt AM, O'Toole M, Knox S, Hemingway L, Williams J, Williams B, Cummins NM. Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland: a Delphi Study. Health Res Policy Syst 2024; 22:100. [PMID: 39123273 PMCID: PMC11313103 DOI: 10.1186/s12961-024-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Paramedicine is a dynamic profession which has evolved from a "treat and transport" service into a complex network of health professionals working in a diverse range of clinical roles. Research is challenging in the paramedicine context, and internationally, research capacity and culture has developed slowly. International examples of research agendas and strategies in paramedicine exist, however, research priorities have not previously been identified in Ireland. METHODS This study was a three round electronic modified Delphi design which aimed to establish the key aspects of the research priorities via end-user consensus. Participants included interested stakeholders involved in prehospital care or research in Ireland. The first round questionnaire consisted of open-ended questions with results coded and developed into themes for the closed-ended questions used in the second and third round questionnaires. A consensus level of 70% was set a priori for second and third rounds. RESULTS Research Priorities that reached consensus included Staff Wellbeing, Education and Professionalism and Acute Medical Conditions. Respondents indicated that these three areas should be a priority in the next 2 years. Education, Staffing and Leadership were imperative Key Resources that required change. Education was a Key Processes change deemed imperative to allow the future research to occur. Outcomes that should be included in the future research strategy were Patient Outcomes, Practitioner Development, Practitioner Wellbeing, Alternate Pathways, Evidence-based Practice and Staff Satisfaction. CONCLUSION The results of this study are similar to previously published international studies, with some key differences. There was a greater emphasis on Education and Practitioner Wellbeing with the latter possibly attributed to the timing of the research in relation to the COVID-19 pandemic. The disseminated findings of this study should inform sustainable funding models to aid the development of paramedicine research in Ireland.
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Affiliation(s)
- Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Melbourne, Australia.
| | - Alan M Batt
- Department of Paramedicine, Monash University, Melbourne, Australia
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Michelle O'Toole
- Department of Paramedicine, Monash University, Melbourne, Australia
- RCSI SIM, Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Irish Paramedicine Education and Research Network (IPERN), Limerick, Ireland
| | - Shane Knox
- National Ambulance Service, Dublin, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Liam Hemingway
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Brett Williams
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Niamh M Cummins
- Department of Paramedicine, Monash University, Melbourne, Australia
- Irish Paramedicine Education and Research Network (IPERN), Limerick, Ireland
- School of Medicine, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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3
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Jeon H, Shin H, Muratbekova M, Zhamankulova M. Policy suggestions for improving nursing education in a low- and middle-income country: A modified Delphi study. Nurs Outlook 2024; 72:102222. [PMID: 38908293 DOI: 10.1016/j.outlook.2024.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/12/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Health policy critically influences a national healthcare system and nurse's roles, working conditions, and professional development opportunities, especially in low- and middle-income countries. PURPOSE To explore and prioritize the major challenges and solution, and establish policy directions for improving nursing education in the Kyrgyz Republic. METHODS The key stakeholders of nursing practice, education, policymaking, and regulation were involved in this modified Delphi study. Following two rounds of exploring priority issues and potential strategies, the participants of the final round assembled for consensual discussions on the establishment of policy directions. DISCUSSION Innovations in nursing education systems, building educational capacity, and ensuring educational outcomes were suggested and agreed upon for the sequential improvement of nursing education. Timely enactment of these policies will enable the Kyrgyz Republic to mitigate nursing shortages, improve the quality of healthcare services, and enhance overall public health outcomes. CONCLUSION The policy suggestions derived from this study, including the improvement of nursing education quality and the assurance of nurses' competencies, have great potential for improving quality healthcare practice and sustaining an effective healthcare system.
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Affiliation(s)
- Hyejin Jeon
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Hyunsook Shin
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea.
| | - Medina Muratbekova
- College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Madina Zhamankulova
- Department of Nursing, I. K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
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Oostema JA, Nickles A, Allen J, Ibrahim G, Luo Z, Reeves MJ. Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment. Stroke 2024; 55:101-109. [PMID: 38134248 DOI: 10.1161/strokeaha.123.043846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Emergency medical services (EMS) is an important link in the stroke chain of recovery. Various prehospital quality metrics have been proposed for prehospital stroke care, but their individual impact is uncertain. We sought to measure associations between EMS quality metrics and downstream stroke care. METHODS This is a retrospective analysis of a cohort of EMS-transported stroke patients assembled through a linkage between Michigan's EMS and stroke registries. We used multivariable regression to quantify the independent associations between EMS quality metric compliance (dispatch within 90 seconds of 911 call, prehospital stroke screen documentation [Prehospital stroke scale], glucose check, last known well time, maintenance of scene times ≤15 minutes, hospital prenotification, and intravenous line placement) and shorter door-to-CT times (door-to-CT ≤25), accounting for EMS recognition, age, sex, race, stroke subtype, severity, and duration of symptoms. We then developed a simple EMS quality score based on metrics associated with early CT and examined its associations with hospital stroke evaluation times, treatment, and patient outcomes. RESULTS Five thousand seven hundred seven EMS-transported stroke cases were linked to prehospital records from January 2018 through June 2019. In multivariable analysis, prehospital stroke scale documentation (adjusted odds ratio, 1.4 [1.2-1.6]), glucose check (1.3 [1.1-1.6]), on-scene time ≤15 minutes (1.6 [1.4-1.9]), hospital prenotification ([2.0 [1.4-2.9]), and intravenous line placement (1.8 [1.5-2.1]) were independently associated with a door-to-CT ≤25 minutes. A 5-point quality score (1 point for each element) was therefore developed. In multivariable analysis, a 1-point higher EMS quality score was associated with a shorter time from EMS contact to CT (-9.2 [-10.6 to -7.8] minutes; P<0.001) and thrombolysis (-4.3 [-6.4 to -2.2] minutes; P<0.001), and higher odds of discharge to home (adjusted odds ratio, 1.1 [1.0-1.2]; P=0.002). CONCLUSIONS Five EMS actions recommended by national guidelines were associated with rapid CT imaging. A simple quality score derived from these measures was also associated with faster stroke evaluation, greater odds of reperfusion treatment, and discharge to home.
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Affiliation(s)
- J Adam Oostema
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Secchia Center (J.A.O.)
| | - Adrienne Nickles
- Michigan Department of Health and Human Services Lifecourse Epidemiology and Genomics Division (A.N., J.A., G.I.)
| | - Justin Allen
- Michigan Department of Health and Human Services Lifecourse Epidemiology and Genomics Division (A.N., J.A., G.I.)
| | - Ghada Ibrahim
- Michigan Department of Health and Human Services Lifecourse Epidemiology and Genomics Division (A.N., J.A., G.I.)
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine (Z.L., M.J.R.)
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine (Z.L., M.J.R.)
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Gage CB, Terry M, McKenna KD, Powell JR, Hollern M, Ozanich M, Richards CT, Martin-Gill C, Panchal AR. Consensus Standard for Evidence Integration into EMS Education and High-Stakes Testing. Prehosp Disaster Med 2023:1-7. [PMID: 37139715 DOI: 10.1017/s1049023x2300047x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Incorporating emerging knowledge into Emergency Medical Service (EMS) competency assessments is critical to reflect current evidence-based out-of-hospital care. However, a standardized approach is needed to incorporate new evidence into EMS competency assessments because of the rapid pace of knowledge generation. OBJECTIVE The objective was to develop a framework to evaluate and integrate new source material into EMS competency assessments. METHODS The National Registry of Emergency Medical Technicians (National Registry) and the Prehospital Guidelines Consortium (PGC) convened a panel of experts. A Delphi method, consisting of virtual meetings and electronic surveys, was used to develop a Table of Evidence matrix that defines sources of EMS evidence. In Round One, participants listed all potential sources of evidence available to inform EMS education. In Round Two, participants categorized these sources into: (a) levels of evidence quality; and (b) type of source material. In Round Three, the panel revised a proposed Table of Evidence. Finally, in Round Four, participants provided recommendations on how each source should be incorporated into competency assessments depending on type and quality. Descriptive statistics were calculated with qualitative analyses conducted by two independent reviewers and a third arbitrator. RESULTS In Round One, 24 sources of evidence were identified. In Round Two, these were classified into high- (n = 4), medium- (n = 15), and low-quality (n = 5) of evidence, followed by categorization by purpose into providing recommendations (n = 10), primary research (n = 7), and educational content (n = 7). In Round Three, the Table of Evidence was revised based on participant feedback. In Round Four, the panel developed a tiered system of evidence integration from immediate incorporation of high-quality sources to more stringent requirements for lower-quality sources. CONCLUSION The Table of Evidence provides a framework for the rapid and standardized incorporation of new source material into EMS competency assessments. Future goals are to evaluate the application of the Table of Evidence framework in initial and continued competency assessments.
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Affiliation(s)
- Christopher B Gage
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
- The Ohio State University College of Public Health, Columbus, OhioUSA
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
| | - Kim D McKenna
- St. Charles County Ambulance District, St. Peters, MissouriUSA
| | - Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
- The Ohio State University College of Public Health, Columbus, OhioUSA
| | - Megan Hollern
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
| | - Matt Ozanich
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
| | | | | | - Ashish R Panchal
- National Registry of Emergency Medical Technicians, Columbus, OhioUSA
- The Ohio State University College of Public Health, Columbus, OhioUSA
- The Ohio State University Wexner Medical Center, Columbus, OhioUSA
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6
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Martin-Gill C, Brown KM, Cash RE, Haupt RM, Potts BT, Richards CT, Patterson PD. 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care. PREHOSP EMERG CARE 2023; 27:131-143. [PMID: 36369826 DOI: 10.1080/10903127.2022.2143603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel. OBJECTIVES We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel. METHODS We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing. CONCLUSIONS This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel M Haupt
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Benjamin T Potts
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Martin-Gill C, Panchal AR, Cash RE, Richards CT, Brown KM, Patterson PD. Recommendations for Improving the Quality of Prehospital Evidence-Based Guidelines. PREHOSP EMERG CARE 2023; 27:121-130. [PMID: 36369888 DOI: 10.1080/10903127.2022.2142992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Evidence-based guidelines that provide recommendations for clinical care or operations are increasingly being published to inform the EMS community. The quality of evidence evaluation and methodological rigor undertaken to develop and publish these recommendations vary. This can negatively affect dissemination, education, and implementation efforts. Guideline developers and end users could be better informed by efforts across medical specialties to improve the quality of guidelines, including the use of specific criteria that have been identified within the highest quality guidelines. In this special contribution, we aim to describe the current state of published guidelines available to the EMS community informed by two recent systematic reviews of existing prehospital evidenced based guidelines (EBGs). We further aim to provide a description of key elements of EBGs, methods that can be used to assess their quality, and concrete recommendations for guideline developers to improve the quality of evidence evaluation, guideline development, and reporting. Finally, we outline six key recommendations for improving prehospital EBGs, informed by systematic reviews of prehospital guidelines performed by the Prehospital Guidelines Consortium.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Oostema JA, Nickles A, Luo Z, Reeves MJ. Emergency Medical Services Stroke Care Performance Variability in Michigan: Analysis of a Statewide Linked Stroke Registry. J Am Heart Assoc 2022; 12:e026834. [PMID: 36537345 PMCID: PMC9973590 DOI: 10.1161/jaha.122.026834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Emergency medical services (EMS) compliance with recommended prehospital care for patients with acute stroke is inconsistent; however, sources of variability in compliance are not well understood. The current analysis utilizes a linkage between a statewide stroke registry and EMS information system data to explore patient and EMS agency-level contributions to variability in prehospital care. Methods and Results This is a retrospective analysis of a cohort of confirmed stroke cases transported by EMS to hospitals participating in a statewide stroke registry. Using EMS information system data, the authors quantified EMS compliance with 6 performance measures derived from national guidelines for prehospital stroke care: prehospital stroke scale performance, glucose check, stroke recognition, on-scene time ≤15 minutes, time last known well documentation, and hospital prenotification. Multilevel multivariable logistic regression analysis was then used to examine associations between patient-level demographic and clinical characteristics and EMS compliance while accounting for and quantifying the variation attributable to agency of transport and recipient hospital. Over an 18-month period, EMS and stroke registry records were linked for 5707 EMS-transported stroke cases. Compliance ranged from 24% of cases for last known well documentation to 82% for documentation of a glucose check. The other measures were documented in approximately half of cases. Older age, higher National Institutes of Health Stroke Scale, and earlier presentation were associated with more compliant prehospital care. EMS agencies accounted for more than half of the variation in EMS prehospital stroke scale documentation and last known well documentation and 27% of variation in glucose check but <10% of stroke recognition and prenotification variability. Conclusions EMS stroke care remains highly variable across different performance measures and EMS agencies. EMS agency and electronic medical record type are important sources of variability in compliance with key prehospital performance metrics for stroke.
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Affiliation(s)
- J. Adam Oostema
- Department of Emergency MedicineMichigan State University College of Human Medicine, Secchia CenterGrand RapidsMI
| | - Adrienne Nickles
- Michigan Department of Health and Human Services, Lifecourse Epidemiology and Genomics DivisionLansingMI
| | - Zhehui Luo
- Department of Epidemiology and BiostatisticsMichigan State University College of Human MedicineEast LansingMI
| | - Mathew J. Reeves
- Department of Epidemiology and BiostatisticsMichigan State University College of Human MedicineEast LansingMI
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Hack KE, Levy MJ, Garfinkel E, Margolis AM. Establishing consensus-based high-acuity low-occurrence skills for EMS physicians: A pilot survey of EMS fellowship faculty. AEM EDUCATION AND TRAINING 2022; 6:e10828. [PMID: 36562031 PMCID: PMC9763967 DOI: 10.1002/aet2.10828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Background The specialty of emergency medical services (EMS) medicine focuses on providing out-of-hospital patient care, including initial stabilization, treatment, and transport in specially equipped vehicles including ambulances and airframe platforms to hospitals and better-resourced destinations. The Core Content of EMS Medicine outlines the knowledge, procedures, and psychomotor skills relevant to prehospital patient care. However, this document does not specify the high-consequence skills that are infrequently performed and that carry high levels of complexity as well as potential morbidity. We refer to these as high-acuity low-occurrence (HALO) skills. Additionally, there is no consensus definition of what meets the criteria for a HALO skill. The goals of this pilot study were twofold: (1) to determine a consensus definition for a HALO skill and (2) to survey EMS fellowship faculty to identify an initial set of EMS physician trainee skills that meet the HALO definition. Methods Using a modified Delphi method, we established a consensus definition of a HALO skill as well as skills that met this definition for EMS physicians. Demographic information was collected from the experts. Results There was 100% agreement in the definition provided of a HALO skill. No additional proposed definitions were provided. Thirteen HALO skills were suggested by the panel from the originally proposed 56 skills, requiring three rounds to establish consensus. Final skill domains emphasized by the expert panel include airway management, obstetric emergencies, and shock management. Conclusions We present an initial consensus definition of a HALO skill and a recommended list of HALO skills for EMS physicians in training. Opportunity exists for further research to validate the definition and list of HALO skills through the sampling of a broader group of EMS physicians.
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Affiliation(s)
- Kaytlin E. Hack
- Department of Emergency MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
- Department of Emergency MedicineMedStar Georgetown University HospitalWashingtonDCUSA
| | - Matthew J. Levy
- Department of Emergency MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - Eric Garfinkel
- Department of Emergency MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
| | - Asa M. Margolis
- Department of Emergency MedicineJohns Hopkins Medical InstitutionsBaltimoreMarylandUSA
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Guerrier C, Brailsford J, Patel S, Burcham S, Salloum RG, Martin-Gill C, Richards CT, Panchal AR, Fishe J. Emergency Medical Services Leadership Perspectives on Implementation of Evidence-Based Guidelines: A Qualitative Study. PREHOSP EMERG CARE 2022; 27:946-954. [PMID: 36149372 PMCID: PMC10060435 DOI: 10.1080/10903127.2022.2128484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/04/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
Abstract
Introduction: Prehospital evidence-based guidelines (EBGs) are developed to optimize clinical outcomes for emergency medical services (EMS) patients. However, widespread implementation of EBGs is often inconsistent. Therefore, this study aimed to assess the baseline knowledge and practices of EMS leaders related to EBG implementation.Methods: This was a qualitative study using focus groups to assess prehospital implementation awareness and knowledge. Participants were EMS EBG authors, EMS medical directors, and EMS professional organization leaders. Focus groups were held via video conference, audio recorded, and transcribed. Thematic coding used domains and constructs of the Consolidated Framework for Implementation Research (CFIR).Results: Six focus groups were conducted with a total of 18 participants. A total of 1,044 codes were analyzed. "Process" was the CFIR domain with the most codes (n = 350, 33.5%), followed by the "inner setting" (the EMS agency; n = 250, 23.9%), "characteristics of the intervention" (n = 203, 19.4%), "outer setting" (the health care system and community the EMS agency serves, and the broader national EMS professional context; n = 141, 13.5%), and "characteristics of individuals" (n = 100, 9.6%). The ten most frequent constructs across all domains were: reflecting and evaluating, executing, cosmopolitanism, planning, external policy and incentives, design quality and packaging, learning climate, culture, complexity, and other personal attributes.Conclusion: EMS leadership and stakeholder views on EBG implementation identified dominant themes related to the process of implementation and the culture and learning/implementation climate of EMS agencies. Opinions were mixed on the utility of the CFIR as a potential guide for EMS implementation. Further work is required to gain the frontline EMS clinician perspective on implementation and tie key themes to quantitative prehospital implementation outcomes.
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Affiliation(s)
- Christina Guerrier
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Jennifer Brailsford
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Shama Patel
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Shannon Burcham
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Prehospital Guidelines Consortium
| | - Christopher T Richards
- Prehospital Guidelines Consortium
- Department of Emergency Medicine, School of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ashish R Panchal
- Prehospital Guidelines Consortium
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jennifer Fishe
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
- Prehospital Guidelines Consortium
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Cash RE, Leggio WJ, Powell JR, McKenna KD, Rosenberger P, Carhart E, Kramer A, March JA, Panchal AR. Emergency medical services education research priorities during COVID-19: A modified Delphi study. J Am Coll Emerg Physicians Open 2021; 2:e12543. [PMID: 34458888 PMCID: PMC8380062 DOI: 10.1002/emp2.12543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Our objective was to identify research priorities to understand the impact of COVID-19 on initial emergency medical services (EMS) education. METHODS We used a modified Delphi method with an expert panel (n = 15) of EMS stakeholders to develop consensus on the research priorities that are most important and feasible to understand the impact of the COVID-19 pandemic on initial EMS education. Data were collected from August 2020 to February 2021 over 5 rounds (3 electronic surveys and 2 live virtual meetings). In Round 1, participants submitted research priorities over 9 specific areas. Responses were thematically analyzed to develop a list of research priorities reviewed in Round 2. In Round 3, participants rated the priorities by importance and feasibility, with a weighted score (2/3*importance+1/3*feasibility) used for preliminary prioritization. In Round 4, participants ranked the priorities. In Round 5, participants provided their agreement or disagreement with the group's consensus of the top 8 research priorities. RESULTS During Rounds 1 and 2, 135 ideas were submitted by the panel, leading to a preliminary list of 27 research priorities after thematic analysis. The top 4 research priorities identified by the expert panel were prehospital internship access, impact of lack of field and clinical experience, student health and safety, and EMS education program availability and accessibility. Consensus was reached with 10/11 (91%) participants in Round 5 agreeing. CONCLUSIONS The identified research priorities are an important first step to begin evaluating the EMS educational infrastructure, processes, and outcomes that were affected or threatened through the pandemic.
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Affiliation(s)
- Rebecca E. Cash
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Jonathan R. Powell
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Kim D. McKenna
- St. Charles County Ambulance DistrictSt. PetersMissouriUSA
| | - Paul Rosenberger
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Department of Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Adrienne Kramer
- International Association of Fire FightersWashingtonDistrict of ColumbiaUSA
| | - Juan A. March
- Division of EMSDepartment of Emergency MedicineBrody School of Medicine, East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Ashish R. Panchal
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Department of Emergency MedicineThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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