The Satisfaction of Team-Based Learning on Discussion in the Training Course of Emergency Medical Technician / 의료커뮤니케이션

BACKGROUND: Team-based learning is known for its effective and satisfying education methods in the study of various medical schools. This study was prepared to confirm the satisfaction of applying this team-based learning to the training course of emergency medical technician.METHODS: A total of 165 new members of the course of second grade National Emergency medical technician at 2019 were finally enrolled in the study. Data were collected with a self-administered questionnaire. The team-based learning method was organized with eight students per group to conduct pre-learning and then proceed to open book to encourage active discussion among individuals. The questionnaire consisted of questions about the satisfaction of the discussion process, such as whether the knowledge gained from the discussion was appropriate, and whether collaboration between colleagues was successful during the discussion, and about the benefits of team-based learning, how well knowledge transfer compared to existing lectures, and the replacement of existing lectures. The questionnaire used a Likert 5 point scale, and the data obtained were analyzed using the SPSS version 22.0.RESULTS: The overall rating of team-based learning was 7.8 ± 1.5 out of 10. Many students answered positively (88.5%) for benefits, while 87.9% responded positively to whether the knowledge transfer effect was better compared to existing lectures. In addition, the satisfaction of team-based learning was generally high, with more than 90 percent of education students giving positive answers to the replacement of other lectures with team-based learning.CONCLUSION: The learners gave positive answers to the satisfaction, usefulness and learning effects of team-based learning. Team-based learning is a discussion-based study, so it is a good way to improve communication skills. Since communication and teamwork are important in first aid activities, the characteristics of team-based learning could lead to improvements in first aid services, leading to high-quality emergency medical services.

Drug calculation ability of qualified paramedics:A pilot study / 世界急诊医学杂志（英文）

BACKGROUND:The inability of paramedics to perform accurate calculations may result in a compromise of patient safety which may result from under or over dosing of drugs, incorrect joules for defibril ation, or a major adverse event such as death. The objective of this study was to identify the drug calculation and mathematical ability of qualified operational paramedics. METHODS:The study used a cross-sectional design with a paper-based calculation questionnaire. Twenty paramedics enrolled in an intensive care paramedic course were eligible to participate in the study. The questionnaire consisted of demographic, drug calculation (seven questions), and mathematical (five) questions. Students were given no notice of the impending study and use of a calculator was not permitted. RESULTS:All eligible students participated in the study. The average time employed as a paramedic was 7.25 years, SD 2.5 years, range four years to twelve years. Four (20％) students got all 12 questions correct, and five (41.6％) got 50％ or less. The average score was 8.6 (71.7％) correct, SD 2.8 correct, range 3 to 12 correct questions. There were eight (40％) conceptual errors, 12 (60％) arithmetical errors, and five (25％) computational errors. CONCLUSION:The results from this study supports similar international studies where paramedic's ability to undertake mathematical and drug calculations without a calculator varies, with some results highlighting the paramedics mathematical skills as a potential risk to patient safety. These results highlight the need for regular continuing mathematical and drug calculation practice and education to ensure a lower error rate.

The role of online medical direction in emergency medical services in India.

Medical direction is a system of physician-directed quality assurance that provides professional and public accountability for medical care provided in the prehospital setting. In an Emergency Medical Services (EMS) system, medical direction provides the operational framework and authorization for EMTs and others to provide emergency treatment outside the hospital. While attending and transporting critical patients to a definitive care setting, there is a need for advanced interventions and administration of drugs to the patients, this will alleviate patient suffering and ultimately allow the patient to be delivered to a receiving hospital in an already improved clinical state whenever possible. The Emergency Medical Technician (EMT) in the ambulance is not licensed to administer drugs to the patient on his own. As EMTs are not aware of administering drugs to the patients in critical situation, there is an urgent need to increase the percentage of critical cases with ERCP advice handled by EMT. The current descriptive study has been conducted to identify the hurdles and gaps preventing communication among the EMT and ERCP among a sample of 40 Emergency Medicine staff through a structured questionnaire. The study showed that there are substantial hurdles when the EMT wants to talk to the emergency physician, which can be removed by a few changes like adopting a new method of enhancing skills and training activities, revision of policies and protocols and a few managerial activities.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

Prehospital Cardiopulmonary Resuscitation by 119 Emergency Medical Technician (EMT) for Increasing the Rate of Return of Spontaneous Circulation; National-Wide 119 EMT Survey

PURPOSE: The out-of-hospital cardiac arrest (OHCA) survival rate of patients in Korea is lower than the global average and it might be caused by an extremely low rate of return of spontaneous circulation in the prehospital field. The authors identified obstacles that disturb on-scene performance of cardiopulmonary resuscitation (CPR) for a certain period from 119 emergency medical technicians (EMTs) through a nation-wide paper survey. METHODS: A total of 1273 first grade EMTs and nurses were surveyed. CPR time performed on the scene (without transfer), CPR experiences, self-assessment of CPR skill performance, and both obstacles to performance of CPR on the scene and solutions to overcoming them for continuous on-scene CPR were investigated using a 28-item questionnaire. RESULTS: The average for work experience and the number of CPR experiences of subjects was 6.8+/-4.5 years and 1.9+/-1.7 times/month, respectively. Survey results for CPR times on the scene showed an average of 4.2+/-2.4 minutes, approximately two periods of CPR (30:2x5 cycles). Obstacles to CPR on the scene were investigated as complaints of family members in 791(62.1%) and fatigue lowering CPR quality due to lack of human resources in 536(41.0%); 627(49.3%) of the subjects answered that they had received complaints due to a long stay on the scene. CONCLUSION: In order to increase the survival rate of OHCA patients, CPR on the scene is needed during a certain period in order to achieve a return of spontaneous circulation. Education, amelioration of guidelines, and support for the EMT administrative system are also needed.

Work Stress and Satisfaction of Emergency Medical Technicians Working in National Emergency Management Agency and Hospital / 산업간호학회지

PURPOSE: To identify work stress and job satisfaction of the emergency medical technician (EMT) and to contribute to the improvement of emergency care under the current emergency medical law. METHODS: The data were collected by questionnaire from the total 849 EMTs (635 National emergency management agency (119) workers and 214 hospital workers) throughout the whole country from January 5, to March 5, 2012. Each level of indicator calculated under 100-point-scale was compared by t-test and ANOVA. Factors affecting stress and satisfaction were analyzed by Multiple Linear Regression Analysis (alpha=.05). RESULTS: Mean level of job stress was markedly higher among 119 workers (76.9) than those in the hospital (56.6) (p<.001). Mean level of job satisfaction was higher among 119 workers (63.2) than those in the hospital (60.2) (p<.001). CONCLUSION: To diminish work stress and to increase job satisfaction, efforts to support the pride and to improve working condition considering the situations of the agency and to offer more education chance to keep and strengthen the specialty are needed.

Effectiveness of Indirect Medical Oversight on the Quality of Prehospital Emergency Care by Emergency Medical Technicians

PURPOSE: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. METHODS: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets, changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. RESULTS: After executing the indirect medical oversight, there was significant improvement in the accuracy of 119 rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. CONCLUSION: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.

Work Stress and Satisfaction of Emergency Medical Technicians Working in National Emergency Management Agency and Hospital / 한국직업건강간호학회지

PURPOSE: To identify work stress and job satisfaction of the emergency medical technician (EMT) and to contribute to the improvement of emergency care under the current emergency medical law. METHODS: The data were collected by questionnaire from the total 849 EMTs (635 National emergency management agency (119) workers and 214 hospital workers) throughout the whole country from January 5, to March 5, 2012. Each level of indicator calculated under 100-point-scale was compared by t-test and ANOVA. Factors affecting stress and satisfaction were analyzed by Multiple Linear Regression Analysis (alpha=.05). RESULTS: Mean level of job stress was markedly higher among 119 workers (76.9) than those in the hospital (56.6) (p<.001). Mean level of job satisfaction was higher among 119 workers (63.2) than those in the hospital (60.2) (p<.001). CONCLUSION: To diminish work stress and to increase job satisfaction, efforts to support the pride and to improve working condition considering the situations of the agency and to offer more education chance to keep and strengthen the specialty are needed.

The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

Factors Affecting Burnout of Staff in Emergency Medical Service (Focusing on 119 rescuers in Busan and Gyeongnam) / 산업간호학회지

PURPOSE: This study aims to investigate the degree of burnout of 119 rescuers, to determine factors influencing their burnout, and to provide basic data for development of intervention programs to prevent the burnout. METHODS: Subjects of this study were all 119 rescuers working at fire stations located in Busan and Gyeongnam. The data were collected from May 1, 2010 to June 30, 2010. The collected data were analyzed with SPSS/WIN 17.0. RESULTS: When the difference in the degree of burnout by general characteristics was investigated, the means of burnout were significantly different depending on age, period of service, position, license, annual salary, desire to work continuously and types of working hours. Job stress, job satisfaction, social support, self efficacy and self esteem showed a statistically significant correlation with burnout. The degree of burnout became higher with more job stress and lower job satisfaction, social support, self efficacy and self esteem. As a significant factor affecting the degree of burnout of 119 rescuers, job stress showed 47.3% of explanatory power. The explanatory power of all of job stress, job satisfaction, self efficacy, types of working hours, annual salary and license was 62% and the power of job stress was the highest. CONCLUSION: From these results, job stress, job satisfaction and self-efficacy were found to be factors affecting the burnout of 119 rescuers. Therefore, intervention programs to reduce job stress and to improve job satisfaction, social support, self efficacy and self esteem should be developed to lower the degree of burnout of 119 rescuers. In addition, further researches to analyze works of 119 rescuers and legal and institutional strategies to improve their treatment are necessary and supplementary training in various practices by different circumstances based on standardized protocols should be conducted.

Undergraduate paramedic students cannot do drug calculations / 世界急诊医学杂志（英文）

@#BACKGROUND: Previous investigation of drug calculation skills of qualified paramedics has highlighted poor mathematical ability with no published studies having been undertaken on undergraduate paramedics. There are three major error classifications. Conceptual errors involve an inability to formulate an equation from information given, arithmetical errors involve an inability to operate a given equation, and finally computation errors are simple errors of addition, subtraction, division and multiplication. The objective of this study was to determine if undergraduate paramedics at a large Australia university could accurately perform common drug calculations and basic mathematical equations normally required in the workplace. METHODS: A cross-sectional study methodology using a paper-based questionnaire was administered to undergraduate paramedic students to collect demographical data, student attitudes regarding their drug calculation performance, and answers to a series of basic mathematical and drug calculation questions. Ethics approval was granted. RESULTS: The mean score of correct answers was 39.5％ with one student scoring 100％, 3.3％ of students (n=3) scoring greater than 90％, and 63％ (n=58) scoring 50％ or less, despite 62％ (n=57) of the students stating they 'did not have any drug calculations issues'. On average those who completed a minimum of year 12 Specialist Maths achieved scores over 50％. Conceptual errors made up 48.5％, arithmetical 31.1％ and computational 17.4％. CONCLUSIONS: This study suggests undergraduate paramedics have deficiencies in performing accurate calculations, with conceptual errors indicating a fundamental lack of mathematical understanding. The results suggest an unacceptable level of mathematical competence to practice safely in the unpredictable prehospital environment.

Cognition of 119 emergency medical technicians on dental emergency treatment in the Jeju province / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to assess the cognition of 119 emergency medical technician (EMT) on dental emergency treatment. METHODS: A total of 184 subjects completed the questionnaire composed of 14 items during which, 119 EMT participated in periodic refresher training in Jeju province. Independent sample t-test and chi-square test were used to assess the state of 119 EMT on dental emergency treatment. RESULTS: Qualified region of respondents were both in the Jeju province (71.7%) and outside of the Jeju province (28.3%). The class of education on dentistry in formal education that answered 0 hour was 64.7% and 1-3 hours was 16.8% of respondents. The class of refresher training on dentistry that answered 0 hour was 78.3% and 1-3 hours was 13.0%, aggregately 91.3%. The results showed low score in reduction (1.93+/-1.10) and fixation (1.88+/-1.02) of dislocated temporo-madibular joint by 5-point Likert scale. Likewise, the scores were 2.30+/-0.92 in the treatment of maxillofacial trauma, 3.21 +/-1.20 in emergent care of avulsed tooth, and 3.42+/-1.26 in treatment time of avulsed tooth, respectively. The class of education on dentistry in formal education between the qualified regions showed a statistically significant difference (P <.05) and the refresher training time was observed to be borderline (P =0.069). There was no significant difference on the cognition of emergency dental treatment, according to the qualified region. CONCLUSIONS: Considering the result of this study, we think the education of dental emergency could play an important role in the initial management of injuries and suggest a further co-study with EMT.

Factors Affecting Burnout of Staff in Emergency Medical Service (Focusing on 119 rescuers in Busan and Gyeongnam) / 한국직업건강간호학회지

PURPOSE: This study aims to investigate the degree of burnout of 119 rescuers, to determine factors influencing their burnout, and to provide basic data for development of intervention programs to prevent the burnout. METHODS: Subjects of this study were all 119 rescuers working at fire stations located in Busan and Gyeongnam. The data were collected from May 1, 2010 to June 30, 2010. The collected data were analyzed with SPSS/WIN 17.0. RESULTS: When the difference in the degree of burnout by general characteristics was investigated, the means of burnout were significantly different depending on age, period of service, position, license, annual salary, desire to work continuously and types of working hours. Job stress, job satisfaction, social support, self efficacy and self esteem showed a statistically significant correlation with burnout. The degree of burnout became higher with more job stress and lower job satisfaction, social support, self efficacy and self esteem. As a significant factor affecting the degree of burnout of 119 rescuers, job stress showed 47.3% of explanatory power. The explanatory power of all of job stress, job satisfaction, self efficacy, types of working hours, annual salary and license was 62% and the power of job stress was the highest. CONCLUSION: From these results, job stress, job satisfaction and self-efficacy were found to be factors affecting the burnout of 119 rescuers. Therefore, intervention programs to reduce job stress and to improve job satisfaction, social support, self efficacy and self esteem should be developed to lower the degree of burnout of 119 rescuers. In addition, further researches to analyze works of 119 rescuers and legal and institutional strategies to improve their treatment are necessary and supplementary training in various practices by different circumstances based on standardized protocols should be conducted.

Can an EMT Apply the Ottawa Ankle Rules to Patients with Ankle Injury?

PURPOSE: The Ottawa ankle rule (OAR) is a clinical decision rule to detect bony injury in patients with a recent ankle injury. We evaluated the ability of emergency medical technicians (EMTs) to accurately apply and interpret the OAR. METHODS: This prospective study was done from October 2009 to February 2010 in a secondary teaching hospital. Patients >18 years of age presenting at the emergency department within 48 hours of a single ankle injury were included. Seven EMTs and three emergency medicine residents were trained in the application of the OAR through one hour educational session prior to this study. They examined the patient's ankle and recorded the data separately. Sensitivity and specificity of the OAR and interobserver agreement using the Kappa statistic were determined. RESULTS: Fifty-one patients were enrolled, mean age was 40.9 years, and 33 (64.7%) were male. Substantial to good agreement were found for all criteria of the OAR (p<0.001). The sensitivity of the OAR was 100% with a specificity of 27.8% in both of them. CONCLUSION: To the best of our knowledge, our study is the first to assess the ability of EMTs working in an emergency center to evaluate and interpret the OAR in adult patients with acute ankle injury. Even less-experienced EMTs can accurately apply and interpret the OAR. The incorporation of the OAR into the EMT's assessment of ankle-injury patients may be a useful physical examination tool for prehospital and hospital triage.

The Contents of Emergency Treatment Practice Conducted by Emergency Medical Technician and Related Factors / 農村醫學 地域保健

OBJECTIVES: A study was conducted by analysing the contents and frequency of emergency treatment practiced by emergency medical technicians(EMTs) in emergency situations and contains related factors. METHODS: The study subjects included 80 EMTs who participated in ongoing education classes during the period from June 25th to June 26th, 2008. the survey included 53 EMTs employed within 119 first aid teams in fire stations in both a metropolitan city and a medium-sized city. From the survey results relation between frequency of emergency treatment and subjects characteristics explored statistically including t-test, X2 test, Pearson correlation and finally stepwise multiple regression. RESULTS: The most frequent procedure by EMTs checking vital signs. The statistically significant related factors overall of the 23 items of emergency treatment frequency was the working area and the grading of EMT certification. In contrast, significant related factors with frequency of IV linkage were found to be the subjects gender, institution employed and the importance of recognizing the item. The statistically significant related factors of that of ECG monitoring was the gender of respondents. CONCLUSIONS: To keep the appropriate frequency of emergency treatment by EMT, active efforts to promote their individual importance and confidence cognition are necessary, especially towards males and persons who have 2nd class certification. Moreover, EMTs who work in small cities must be supported.

A Study on the Factors Influencing the Accuracy of Chest Compression during Cardiopulmonary Resuscitation Trying in a Moving Ambulance

PURPOSE: The study offers the recommended guidelines for EMTs to improve their CPR techniques in an ambulance by analyzing external factors to perform more effective and accurate chest compression in a moving ambulance while patients are being transported to hospital. METHODS: Seventeen of the first class EMTs at GyeongGi- Do agreed to participate in the research. In order to analyze the factors that have influenced the accuracy of chest compression, the type of ambulance (Van-type, Truck-type), velocity of a moving ambulance (60, 70, 80 km/hr), chest compression posture (standing, knee supported) and assistive devices (Main stretcher car, CPR board, Long Spine board) for chest compression were compared to each other. The research was conducted according to the phased procedure in an attempt to evaluate the difference between the chest compression posture and the assistive devices in appropriateness of chest compression. RESULTS: The findings of this study included that chest compression posture and the use of assistive devices influenced the effectiveness of chest compression. With regard to compression depth, the chest compression that occurred on the main stretcher in ambulances while in the standing position, were the least effective. Chest compression that occurred on a Cardiopulmonary Resuscitation board (CPR board) was the most effective in the supported posture. In addition, the accuracy of chest compression was higher in a supported posture than in a standing posture. In both postures, the accuracy of chest compression was higher when a CPR board or a Long spine board (LSB) were used, than when a main stretcher was used. CONCLUSION: The study showed that the chest compression posture and the use of assistive devices had an effect on appropriateness of chest compression. As for posture during chest compression, the accuracy of chest compression increased when knees were supported. Also, the study suggested that the use of CPR board among other assistive devices for chest compression was the factor contributing to an increase in the effectiveness of chest compression depth.

A Study on the Perception of 119 EMT's Emergency Medical Service Transpor - tation System (With Seoul, Busan and 5 Metropolitans as the Central Figure)

PURPOSE: As the quality of life and people's own safety awareness rise in our society, the desire for first-aid treatment in early time from all sorts of accidents and disasters increases. So I examined how our Emergency Medical Service (EMS) system responses to the explosive demands on EMS and the terrible accidents laying stress on practical circumstances of the spot. METHODS: I mainly analyzed the processes, as a step before hospital, arrival in spot, 119 first-aid service, and transportation of patients when emergency patients happen. RESULTS: It is found that there must be systematic devices which makes EMT not to be caught on medical dispute, a modernization of emergency equipments, professional firstaid agents, a proper personnel arrangement. CONCLUSION: We must improve deduced problems focusing on structural and functional aspect to make an Emergency Medical Care Transportation system into a realistic one.