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Meijer P, Ford-Jones P, Carter D, Duhaney P, Adam S, Pomeroy D, Thompson S. Examining an Alternate Care Pathway for Mental Health and Addiction Prehospital Emergencies in Ontario, Canada: A Critical Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:146. [PMID: 38397637 PMCID: PMC10888317 DOI: 10.3390/ijerph21020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Paramedics in Ontario have largely been limited to transporting those with mental health or addiction (MHA)-related emergencies to the emergency department (ED). The ED has repeatedly been identified as a problematic and challenging setting for people with MHA needs. This article examines an innovative patient care model (PCM) established by the Middlesex-London Paramedic Service and its partners for specific MHA emergencies where patients were given options for care that included transportation to a Canadian Mental Health Association (CMHA) Crisis Centre or information for support. Qualitative and quantitative data that were utilized for regular reporting to the Ministry were included in the analysis. The findings indicated that the goals of reducing pressures on EDs and paramedic services, enhancing paramedics' ability to address MHA calls, and improving patient care experiences were met. This model improves patient autonomy and options for care, improves the means for addressing patients' social determinants of health, and offers transportation to a non-medicalized facility.
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Affiliation(s)
- Petra Meijer
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Polly Ford-Jones
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Dustin Carter
- Middlesex–London Paramedic Service, London, ON N6E 1R4, Canada;
| | - Patrina Duhaney
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Simon Adam
- School of Nursing, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
| | - Danielle Pomeroy
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
| | - Sheryl Thompson
- Humber Institute of Technology & Advanced Learning, Toronto, ON M9W 5L7, Canada; (P.F.-J.); (D.P.); (S.T.)
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Wardrop R, Ranse J, Chaboyer W, Young JT, Kinner SA, Crilly J. Profile and Outcomes of Emergency Department Mental Health Patient Presentations Based on Arrival Mode: A State-Wide Retrospective Cohort Study. J Emerg Nurs 2023; 49:951-961. [PMID: 37610408 DOI: 10.1016/j.jen.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/08/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION People arriving to the emergency department with mental health problems experience varying and sometimes inferior outcomes compared with people without mental health problems, yet little is known about whether or how their arrival mode is associated with these outcomes. This study describes and compares demographics, clinical characteristics, and patient and health service outcomes of adult mental health emergency department patient presentations, based on arrival mode: brought in by ambulance, privately arranged transport, and brought in by police. METHODS Using a retrospective observational study design with state-wide administrative data from Queensland, Australia, mental health presentations from January 1, 2012, to December 31, 2017, were analyzed using descriptive and inferential analyses. RESULTS Of the 446,815 presentations, 51.8% were brought in by ambulance, 37.2% arrived via privately arranged transport, and 11.0% were brought in by police. Compared with other arrival modes, presentations brought in by ambulance were more likely to be older and female and have more urgent triage categories and a longer length of stay. Presentations arriving by privately arranged transport were more likely than other arrival modes to present during the day, be assigned a less urgent triage category, be seen within their recommended triage time, have a shorter length of stay in the emergency department, have higher rates of discharge, and have waited longer to be seen by a clinician. Presentations brought in by police were more likely than other arrival modes to be younger and male and experience a shorter time to be seen by a clinician. DISCUSSION Discrepancies between arrival modes indicates a need for further investigation to support inter- and intra-agency mental health care interventions.
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Heffernan J, Pennay A, Hughes E, Gray R. The Association between the Police, Ambulance, Clinician Early Response (PACER) Model and Involuntary Detentions of People Living with Mental Illness: A Protocol for a Retrospective Observational Study. NURSING REPORTS 2023; 13:1452-1467. [PMID: 37873829 PMCID: PMC10594445 DOI: 10.3390/nursrep13040122] [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: 08/08/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
Emergency services are frequently called to attend mental health incidents and are looking for innovative ways to improve their responses and reduce the burden on services. Involuntary detention of people living with mental illness is considered more frequent than necessary, leading to increased pressure on emergency departments, and is often a traumatic experience for patients. The Police, Ambulance, Clinician Early Response (PACER) model was developed in 2019 in Canberra, Australia, and seeks to reduce involuntary detentions by embedding a mental health clinician into emergency services as a mobile mental health crisis response intervention. This protocol details a retrospective cohort study that will examine the association between PACER and involuntary detentions using medical and police records and compare the results to standard ambulance and police responses. We will use relative risk and odds ratio calculations to determine the probability of being involuntarily detained or diverted from hospital; and we will describe the patient characteristics and outcomes in the PACER cohort. Results will be reported using the STROBE checklist for reporting cohort studies. This study was not registered on a publicly accessible registry.
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Affiliation(s)
- Julia Heffernan
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
| | - Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Melbourne, VIC 3068, Australia;
| | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
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Patch K, Huang C, Hendriks S, Wasserman D, Parrish M, Grady C. "It's Pretty Sad If You Get Used to It": A Qualitative Study of First Responder Experiences with Opioid Overdose Emergencies. PREHOSP EMERG CARE 2023:1-8. [PMID: 37436072 DOI: 10.1080/10903127.2023.2236200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND First responders play a vital role in the United States opioid drug overdose crisis, a public health emergency that has claimed many lives. OBJECTIVE We sought to investigate first responders' experiences and attitudes toward opioid overdose emergencies and the ongoing crisis, as well as emotional effects, coping strategies, and support systems. METHODS A convenience sample of first responders (n = 18) at the Columbus Fire Division, with experience responding to opioid emergencies, participated in semi-structured telephone interviews between September 2018 and February 2019. Interviews were recorded, transcribed verbatim, and analyzed using content analysis for themes. RESULTS While almost all participants described overdose emergencies as routine, they recalled some as memorable and emotionally impactful. Almost all respondents were frustrated by the high rates of overdose among their patients and the lack of sustainable improvements in outcomes, yet expressed a strong moral commitment to caring for patients and saving lives. Themes of burnout, compassion fatigue, and hopelessness emerged, as did themes of increased compassion and empathy. Support for personnel experiencing emotional difficulty was either lacking or underutilized. Further, many felt public policies should prioritize more permanent resources and improve access to care, and believed that people who use drugs should face greater accountability. CONCLUSION First responders perceive a moral and professional duty to treat patients who overdose, despite their frustrations. They may benefit from additional occupational support to cope with the resultant emotional effects of their role in the crisis. Addressing macro-level factors contributing to the overdose crisis and improving patient outcomes could also positively affect first responder wellbeing.
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Affiliation(s)
- Kyle Patch
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Caroline Huang
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Saskia Hendriks
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - David Wasserman
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
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5
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Brien R, Volpe I, Grigg J, Lyons T, Hughes C, McKinnon G, Tzanetis S, Crawford S, Eade A, Lee N, Barratt MJ. Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia. Harm Reduct J 2023; 20:30. [PMID: 36894933 PMCID: PMC9995746 DOI: 10.1186/s12954-023-00761-6] [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: 03/23/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. METHODS An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. RESULTS Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves 'conduits' for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be 'shareable' across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. DISCUSSION Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.
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Affiliation(s)
- Rita Brien
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Social and Global Studies Centre, RMIT University, Melbourne, Australia.,Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Tom Lyons
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Caitlin Hughes
- Law and Commerce, Flinders University, Adelaide, Australia.,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Ginny McKinnon
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Stephanie Tzanetis
- Harm Reduction Victoria (DanceWize), Melbourne, Australia.,CanTEST - Directions Health Services, Canberra, Australia
| | - Sione Crawford
- Harm Reduction Victoria (DanceWize), Melbourne, Australia
| | - Alan Eade
- Safer Care Victoria, Melbourne, Australia.,Department of Paramedicine, Monash University, Melbourne, Australia
| | - Nicole Lee
- 360Edge, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia. .,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia. .,Digital Ethnography Research Centre, RMIT University, Melbourne, Australia.
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Juhrmann ML, Grindrod AE, Gage CH. Emergency medical services: the next linking asset for public health approaches to palliative care? Palliat Care Soc Pract 2023; 17:26323524231163195. [PMID: 37063113 PMCID: PMC10102939 DOI: 10.1177/26323524231163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
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Affiliation(s)
| | - Andrea E. Grindrod
- Public Health Palliative Care Unit, School of
Psychology and Public Health, La Trobe University, Melbourne, VIC,
Australia
| | - Caleb H. Gage
- Division of Emergency Medicine, University of
Cape Town, Cape Town, South Africa
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Ogeil RP, Faulkner A, Beard N, Killian JJ, Arunogiri S, Phan V, Wilson J, Smith K, Lubman DI, Scott D. Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103932. [PMID: 36527909 DOI: 10.1016/j.drugpo.2022.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia. METHODS A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB. RESULTS There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%). CONCLUSIONS We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.
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Affiliation(s)
- Rowan P Ogeil
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia.
| | | | | | - Jessica J Killian
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Vicky Phan
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | | | - Karen Smith
- Department of Paramedicine and Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia; Research and Evaluation, Ambulance Victoria, Blackburn North, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Australia
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8
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Murray S, Walley AY, Reilly B. Caring for People Who Use Drugs: Best Practices for EMS Providers. Health Promot Pract 2022:15248399221126163. [PMID: 36154722 DOI: 10.1177/15248399221126163] [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: 11/15/2022]
Abstract
People who use drugs (PWUD) face stigmatizing treatment and substandard care during all stages of their health care journey, including in the prehospital setting by Emergency Medical Services (EMS) providers. Drawing on the professional and lived experience of the authors, we have developed a training with an intended audience of Emergency Medical Technicians (EMTs) and Paramedics in Massachusetts that will orient them to harm reduction philosophy. The training is delivered online through an asynchronous platform housed at Boston University School of Public Health and centers around several themes including the impact of fentanyl on the drug supply, the role of harm reduction in mitigating the impacts of drug criminalization, and ensuring that EMS providers have access to tools and best practices for improving overdose response, pain management, documentation, and respectful language. The training has been approved for Massachusetts Office of Emergency Medical Services (OEMS) continuing education credit and will be offered for free. We plan to evaluate changes in participant knowledge and attitudes and overall acceptability of the training among EMS providers in Massachusetts.
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Affiliation(s)
| | - Alexander Y Walley
- Boston University School of Medicine, Boston, MA, USA
- Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, MA, USA
| | - Brittni Reilly
- Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, MA, USA
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9
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Önnheim S, Johansson A, Ivarsson B, Hagström C. Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey. NURSING REPORTS 2022; 12:226-234. [PMID: 35324569 PMCID: PMC8954289 DOI: 10.3390/nursrep12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.
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Affiliation(s)
- Sandra Önnheim
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
| | - Anders Johansson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
| | - Bodil Ivarsson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
- Correspondence: ; Tel.: +46-768-870-467
| | - Caroline Hagström
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
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Xanthopoulou P, Thomas C, Dooley J. Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review. BMJ Open 2022; 12:e055393. [PMID: 35115355 PMCID: PMC8814746 DOI: 10.1136/bmjopen-2021-055393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders. DESIGN A systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants' experiences were included. DATA SOURCES MEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed. RESULTS We identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where 'frequent attenders' are repeatedly let down by mental health services. CONCLUSION Lack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.
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Affiliation(s)
| | - Ciara Thomas
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jemima Dooley
- Mood Disorders Centre, University of Exeter, Exeter, UK
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11
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Ford-Jones PC, Daly T. Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:744-752. [PMID: 33034116 DOI: 10.1111/hsc.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n = 31), paramedic services management (n = 5), educators at paramedic college programmes (n = 5) and Base Hospital physicians/directors (n = 5). Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90 hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs. Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.
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Affiliation(s)
- Polly Christine Ford-Jones
- Faculty of Health Science and Wellness, Humber Institute of Technology & Advanced Learning, Toronto, Canada
| | - Tamara Daly
- School of Health Policy and Management, York University Centre for Aging Research and Education, York University, Toronto, ON, Canada
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12
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Daggenvoorde TH, van Klaren JM, Gijsman HJ, Vermeulen H, Goossens PJJ. Experiences of Dutch ambulance nurses in emergency care for patients with acute manic and/or psychotic symptoms: A qualitative study. Perspect Psychiatr Care 2021; 57:1305-1312. [PMID: 33270230 PMCID: PMC8359403 DOI: 10.1111/ppc.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To explore the experiences of ambulance nurses in emergency care of patients with acute manic and/or psychotic symptoms. METHODS In this qualitative study, 14 interviews were conducted and analyzed using thematic analysis according to Braun and Clarke (2006). FINDINGS Psychiatric emergency care causes stress and uncomfortable feelings for ambulance nurses due to a lack of information on the patients, being alone with the patient in a small place and the unpredictability of the situation. PRACTICE IMPLICATIONS More information about the specific patient, education, and good collaboration with other professionals could improve care.
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Affiliation(s)
- Thea H. Daggenvoorde
- Center for Bipolar DisordersDimence Mental HealthDeventerThe Netherlands
- Radboud Institute for Health Sciences IQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
| | - Josette M. van Klaren
- Institute of Nursing studiesUniversity of Applied SciencesUtrechtThe Netherlands
- Clinical Health ScienceUniversity of UtrechtUtrechtThe Netherlands
| | - Harm J. Gijsman
- Division of Emergency Mental Health CareDimence Mental HealthDeventerThe Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences IQ HealthcareRadboud University Medical CenterNijmegenThe Netherlands
| | - Peter J. J. Goossens
- Center for Bipolar DisordersDimence Mental HealthDeventerThe Netherlands
- Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesUniversity Centre for Nursing and Midwifery, Ghent UniversityGhentBelgium
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13
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Allana A, Pinto AD. Paramedics Have Untapped Potential to Address Social Determinants of Health in Canada. ACTA ACUST UNITED AC 2021; 16:67-75. [PMID: 33720825 PMCID: PMC7957353 DOI: 10.12927/hcpol.2021.26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The role of paramedics, including select paramedics providing primary and preventive care in homes and community settings, is evolving in health systems around the world. These developments are associated with improvements in health outcomes, improved access to services and reduced emergency department use. Building on these existing trends in paramedicine, and because social conditions contribute to illness and are strong predictors of future health service use, addressing patients' social needs should be integrated into core paramedic practice in Canada. We discuss how paramedic education, culture and governance could better enable paramedics to address the social determinants of health.
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Affiliation(s)
- Amir Allana
- MSc Candidate, Health Services Research, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Fellow, McNally Project for Paramedicine Research; Graduate Student, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON
| | - Andrew D Pinto
- Associate Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Scientist and Director, Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto; Clinician Scientist, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Staff Physician, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON
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14
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Stander C, Hodkinson P, Dippenaar E. Prehospital care providers' understanding of responsibilities during a behavioural emergency. S Afr J Psychiatr 2021; 27:1545. [PMID: 33604073 PMCID: PMC7876971 DOI: 10.4102/sajpsychiatry.v27i0.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/21/2020] [Indexed: 11/01/2022] Open
Abstract
Background Prehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting. Aim To investigate prehospital emergency care providers' understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies. Setting The research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa. Methods A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care - basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach. Results A total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion Participants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.
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Affiliation(s)
- Charnelle Stander
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Enrico Dippenaar
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041882. [PMID: 33672055 PMCID: PMC7919464 DOI: 10.3390/ijerph18041882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.
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16
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Hayden C, Moat C, Newbury-Birch D. Analysing ambulance data to ascertain the prevalence and demographics of individuals who have died by suicide. Emerg Nurse 2021; 29:35-40. [PMID: 32851820 DOI: 10.7748/en.2020.e2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
Suicide is a major public health concern, with data suggesting that suicide rates may be increasing. Ambulance services receive thousands of calls each year related to mental health issues, with responding to suicide a common element of the job. This article uses a service evaluation to explore the data collected by the North West Ambulance Service (NWAS) NHS Trust in relation to deaths by suicide and discuss how this can be used to improve pre-hospital and emergency department practice. The service evaluation used a retrospective patient cohort comprising calls made to NWAS over a six-month period from 1 January to 28 June 2019 inclusive. Of the 46,869 calls made to NWAS, 124 resulted in a death by suicide, with an average age of 43.6 years. The majority of deaths by suicide were by hanging. Investigation of the clinical notes for each case revealed that many of the individuals had mental health issues recorded in their documentation, and almost one fifth had previous contact with the ambulance service. Preventive interventions are important in supporting those bereaved by suicide who may be at increased risk of death by suicide.
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Affiliation(s)
- Craig Hayden
- Clinical Support Hub, North West Ambulance Service NHS Trust, Bolton, England
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17
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Jones R, Woods C, Usher K. Methamphetamines: Cross sectional-survey exploring police and paramedic attitudes and perceptions of deservingness of care. Nurs Health Sci 2020; 23:157-166. [PMID: 33098343 DOI: 10.1111/nhs.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rikki Jones
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Cindy Woods
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, New South Wales, Australia
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18
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Holmberg M, Hammarbäck S, Andersson H. Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study. ACTA ACUST UNITED AC 2020. [DOI: 10.1177/2057158520941753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.
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Affiliation(s)
- Mats Holmberg
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Staffan Hammarbäck
- Region Sörmland, Department of Ambulance Service, Katrineholm, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
- Linnaeus University, Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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19
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Lubman DI, Heilbronn C, Ogeil RP, Killian JJ, Matthews S, Smith K, Bosley E, Carney R, McLaughlin K, Wilson A, Eastham M, Shipp C, Witt K, Lloyd B, Scott D. National Ambulance Surveillance System: A novel method using coded Australian ambulance clinical records to monitor self-harm and mental health-related morbidity. PLoS One 2020; 15:e0236344. [PMID: 32735559 PMCID: PMC7394421 DOI: 10.1371/journal.pone.0236344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/04/2020] [Indexed: 01/01/2023] Open
Abstract
Self-harm and mental health are inter-related issues that substantially contribute to the global burden of disease. However, measurement of these issues at the population level is problematic. Statistics on suicide can be captured in national cause of death data collected as part of the coroner's review process, however, there is a significant time-lag in the availability of such data, and by definition, these sources do not include non-fatal incidents. Although survey, emergency department, and hospitalisation data present alternative information sources to measure self-harm, such data do not include the richness of information available at the point of incident. This paper describes the mental health and self-harm modules within the National Ambulance Surveillance System (NASS), a unique Australian system for monitoring and mapping mental health and self-harm. Data are sourced from paramedic electronic patient care records provided by Australian state and territory-based ambulance services. A team of specialised research assistants use a purpose-built system to manually scrutinise and code these records. Specific details of each incident are coded, including mental health symptoms and relevant risk indicators, as well as the type, intent, and method of self-harm. NASS provides almost 90 output variables related to self-harm (i.e., type of behaviour, self-injurious intent, and method) and mental health (e.g., mental health symptoms) in the 24 hours preceding each attendance, as well as demographics, temporal and geospatial characteristics, clinical outcomes, co-occurring substance use, and self-reported medical and psychiatric history. NASS provides internationally unique data on self-harm and mental health, with direct implications for translational research, public policy, and clinical practice. This methodology could be replicated in other countries with universal ambulance service provision to inform health policy and service planning.
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Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- * E-mail:
| | - Cherie Heilbronn
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Rowan P. Ogeil
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jessica J. Killian
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Sharon Matthews
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Rosemary Carney
- New South Wales Ambulance, Rozelle, New South Wales, Australia
| | | | - Alex Wilson
- Ambulance Tasmania, Hobart, Tasmania, Australia
| | - Matthew Eastham
- St John Ambulance Australia (NT) Inc., Casuarina, Northern Territory, Australia
| | - Carol Shipp
- Australian Capital Territory Ambulance Service, Fairbairn, Australian Capital Territory, Australia
| | - Katrina Witt
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Belinda Lloyd
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
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20
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Ferguson N, Savic M, McCann TV, Emond K, Sandral E, Smith K, Roberts L, Bosley E, Lubman DI. "I was worried if I don't have a broken leg they might not take it seriously": Experiences of men accessing ambulance services for mental health and/or alcohol and other drug problems. Health Expect 2019; 22:565-574. [PMID: 30945425 PMCID: PMC6543159 DOI: 10.1111/hex.12886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background A large proportion of ambulance callouts are for men with mental health and/or alcohol and other drug (AOD) problems, but little is known about their experiences of care. This study aimed to describe men's experiences of ambulance care for mental health and/or AOD problems, and factors that influence their care. Methods Interviews were undertaken with 30 men who used an ambulance service for mental health and/or AOD problems in Australia. Interviews were analysed using the Framework approach to thematic analysis. Results Three interconnected themes were abstracted from the data: (a) professionalism and compassion, (b) communication and (c) handover to emergency department staff. Positive experiences often involved paramedics communicating effectively and conveying compassion throughout the episode of care. Conversely, negative experiences often involved a perceived lack of professionalism, and poor communication, especially at handover to emergency department staff. Conclusion Increased training and organizational measures may be needed to enhance paramedics' communication when providing care to men with mental health and/or AOD problems.
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Affiliation(s)
- Nyssa Ferguson
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Michael Savic
- Turning Point, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terence V McCann
- Department of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Kate Emond
- Department of Rural Nursing and Midwifery, College of Health, Science and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Emma Sandral
- Turning Point, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Clayton, Victoria, Australia
| | - Louise Roberts
- Department of Paramedics, Flinders University, Adelaide, South Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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