New Simulation-Based Education Using a Simulation App in Paramedic Education / 医学教育

A simulated defibrillator using an iPad application was introduced for simulation education of endogenous diseases in paramedic training education. As a result, the reality of the scenario was increased, and a living body could play the role of the injured person, enabling simulation education in a different format than before. The use of a simulated defibrillator in EMT training can be a useful tool to motivate students and improve educational effectiveness.

Manejo deglutorio del adulto mayor institucionalizado por parte de técnicos en enfermería: un estudio cualitativo / Swallowing Management of Institutionalized Older Adults by Nursing Technicians: A Qualitative Study / Manejo deglutório do idoso institucionalizado por parte de técnicos em enfermagem: um estudo qualitativo

Resumen Introducción: se busca profundizar acerca del manejo cotidiano de las complicaciones de la deglución en centros del adulto mayor, las cuales generalmente asume el técnico o auxiliar de enfermería (TENS), quienes son los encargados de su alimentación. Materiales y métodos: se llevó a cabo un estudio con enfoque cualitativo basado en la teoría fundamentada. Se realizaron grupos de discusión y entrevistas en profundidad a dieciocho TENS de tres establecimientos de larga estadía en la Araucanía (Chile). Se analizaron los datos a través de codificación abierta y axial, con los cuales se obtuvieron seis categorías analíticas sobre esta situación. Resultados: los TENS y los auxiliares de la alimentación reportaron desconocimiento del uso y pertinencia de estas; además, comentaron que dichas maniobras las aprendieron mediante la observación a otros profesionales itinerantes dentro del centro, y no producto de la formación o trabajo interdisciplinario. Conclusión: dado el contexto y las limitaciones derivadas de la formación de los TENS, surge la necesidad de incrementar sus conocimientos y mejorar sus prácticas relacionadas con la deglución y alimentación, con el objetivo de disminuir el riesgo de ocurrencia de situaciones que agraven la salud de los adultos mayores. Se discute, así mismo, la pertinencia de que estos centros cuenten con profesionales capacitados en cuanto al abordaje de los trastornos de la deglución, pues ello contribuirá a mejorar este aspecto, en función del trabajo coordinado con el resto del equipo.

Abstract Introduction: This study examines the daily management of swallowing complications of older adults in centers, which generally assumes that the technician or auxiliary nurses (TENS) are the ones in charge of their feeding. Materials and Methods: A study was conducted with a qualitative approach based on the grounded theory. A focus group and in-depth interviews were performed with 18 nursing technicians and assistants from 3 long-stay facilities in Araucanía, Chile. Data were analyzed through open and axial coding, obtaining 6 analytical categories on this situation. Results: The TENS and auxiliary feeding reported to have no knowledge of the use and relevance of these maneuvers and reported that these were learned via the observation of other traveling professionals within the center and were not a product of interdisciplinary training. Conclusion: Given the context and the limitations derived from the formation of TENS, there is the need to increase their knowledge and improve their practices related to swallowing and feeding, with the aim of reducing the risk of occurrence of situations that aggravate the health of older adults. The relevance of these centers incorporating qualified professionals in the management of swallowing disorders, who would also contribute to improving these aspects, based on coordinated work with the rest of the team was also discussed.

Resumo Introdução: se busca aprofundar acerca do manejo cotidiano das complicações da deglução em centros do idoso, os quais geralmente os assume o técnico ou auxiliar de enfermagem (TENS) os quais são os encarregados de sua alimentação. Materiais e métodos: levou-se a cabo um estudo com enfoque qualitativo baseado na teoria fundamentada. Se realizaram focus group e entrevistas em profundidade a 18 TENS de 3 estabelecimentos de longa estadia em Auracanía, Chile. Se analisaram os dados através de codificação aberta e axial, obtendo-se 6 categorias analíticas sobre esta situação. Resultados: os TENS e auxiliares da alimentação reportaram desconhecimento do uso e pertinência destas, comentando para além de ditas manobras foram aprendidas através da observação a outros profissionais itinerantes dentro do centro, e não produto da formação ou trabalho interdisciplinar. Conclusão: devido ao contexto e às limitações derivadas da formação dos TENS, surge a necessidade de incrementar seus conhecimentos e melhorar suas práticas relacionadas à deglução e alimentação, com o objetivo de diminuir o risco de ocorrência de situações que agravem a saúde dos idosos. Se discute para além da pertinência de que estes centros contem com profissionais idóneos em quanto à abordagem dos transtornos da deglução, que contribuíram também a melhorar estes aspectos, em função do trabalho coordenado com o resto da equipe.

The role of videolaryngoscope in endotracheal intubation training programs / O papel do videolaringoscópio em programas de treinamento de intubação endotraqueal

Abstract Background Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. Results Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group-VM (p = 0.008). Conclusions The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs.

Resumo Justificativa Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo-MM e Grupo-MV utilizaram laringoscópios Macintosh e o Grupo-VV e Grupo-VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo-MM e Grupo-VM e videolaringoscópios pelo Grupo VV e Grupo-MV. Resultados As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV (p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo-VM (p = 0,008). Conclusões A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal.

Automated External Defibrillator (AED) Use Among Paramedics in the Emergency Department – What are the Obstacles in Using the Automated External Defibrillator in the Pre-Hospital Care Settings?

This study determined factors that influence usage of automated external defibrillation (AED) on out-of-hospital cardiac arrest among paramedics in Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a cross sectional prospective study conducted between December 2013 and January 2014. Paramedics from Emergency Department were enrolled and assessed using the self-filled questionnaire consisting of multiple sections including knowledge assessment, training and practice. In total, 53 paramedics participated in this study. Only 62% participants used AEDs previously. Not more than 83% participants admitted that they would use it if required. A positive correlation was observed between age and work experience with knowledge on AED usage (p=0.001 and p=0.005, respectively). Government’s institute graduates possess better knowledge and higher confidence level than private institutions graduates (p<0.001). Positive correlation existed between working experience and confidence level in deciding to use (p=0.006), application (p=0.019) and troubleshooting in regards of AED use (p=0.002). The main factor for low confidence level of AED use was lack of training (73.6%) which resulted in reduced confidence to initiate use (45.3%). Eighty eight percent agreed that training is essential before any AED use. Forty one percent felt that Malaysian public is not ready for AEDs use. As a conclusion, AED usage and knowledge among paramedics is still poor and further training is crucial for the improvement of pre-hospital care in Malaysia.

Paramedics’ Perception on Video Assisted Learning Method in Learning Emergency Skills

Information technology use in healthcare education has become a popular medium of instruction. One of the medium of instruction is video assisted learning (VAL). The use of VAL as an instructional method in the teaching and learning of emergency skills is not new. However, there are lack of studies on the perception of using this method in learning emergency skills. This qualitative study involved four focused discussion groups following a VAL instruction on emergency skills. A total of 20 paramedics were divided into four groups. They were involved in a focussed discussion after a VAL instruction session. Findings reveal that the paramedics perceived three major themes which were categorized as : i) advantages of video as teaching tool, ii) barrier in using video as a teaching tool; and iii) suggestions on using video as teaching tool. The findings indicate that the paramedics perceived VAL as a potential tool for learning emergency skills. However, they suggested the language of instruction should be in their mother tongue for better understanding. This implies that using English language has disadvantage in technology enhanced learning for better understanding.

Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran / 世界急诊医学杂志（英文）

BACKGROUND: Paramedic and emergency personnel may encounter directly many events that threat their own wellbeing during their daily work. This study was conducted to examine the prevalence rate of post-traumatic stress disorder (PTSD) among two groups of paramedic and emergency personnel in south-east Iran.METHODS: The study employed a descriptive design and was conducted in four hospital emergency wards and a pre-hospital emergency base supervised by Kerman Medical University. Using Mississippi PTSD, we assessed the prevalence rate in paramedics (n=150) and emergency personnel (n=250).RESULTS: The two groups had different levels of education, marital status, experience of traumatic events, work hours per month, and gender. Most (94%) of paramedic and hospital emergency personnel reported moderate PTSD. The two groups had significant different levels of PTSD in all subscale.CONCLUSION: The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.

Work Experiences of Nurses Working as 119 Paramedics / 산업간호학회지

PURPOSE: The purpose of this study is to examine the work experiences of nurses working as 119 paramedics and to provide basic information to develop administrative and institutional support system for the nurses. METHOD: The data were collected from December, 2007 to July, 2008 and analyzed using the phenomenological method provided by Munhall and Boyd. Participants of this study were 7 nurses currently working as 119 paramedics and who were willing to fully express their experiences. The grand mal question used in this study was "How is your work experience as an 119 paramedic?" RESULT: Narratives of the participants were analyzed and divided into 3 categories such as 'recognizing', 'withdrawal', and 'confrontation'. CONCLUSION: The results showed even if the participants think of their tasks fulfilling and be proud, they have some difficulties due to restrictions of tasks and work environment. Based on the findings, we suggest developing educational programs to improve their task abilities, establishing safety policy and compensatory reward system according to their accomplishments, and providing counseling opportunities for their traumatic experiences with difficult emotion.