ABSTRACT
INTRODUCTION: The COVID-19 pandemic is exacerbating a wide range of symptoms of poor mental health among emergency medical service (EMS) ambulance populations. Evidence suggests that using organisational support can improve employee outcomes and in turn, patient outcomes. Understanding why EMS staff do and do not use support services is therefore critical to improving uptake, ensuring equitable access, and potentially influencing workforce well-being, organisational sustainability and patient care delivery. This systematic review aims to identify what support is available and any perceived barriers and facilitators to accessing and utilising organisational support. METHODS AND ANALYSIS: Searches performed between 18 February 2022 and 23 February 2022 will be used to identify studies that report barriers and facilitators to EMS employee support among all government/state commissioned EMS ambulance systems. Electronic databases, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, EMCARE, HMIC, Medline and PsycINFO will be searched. All relevant English-language studies of adult employees of government/state commissioned EMS ambulance organisations published since December 2004 will be screened and relevant data extracted by two independent reviewers. A third reviewer will resolve any disagreements.The primary outcome is the identification of perceived barriers or facilitators to EMS staff using organisational support for mental health. The secondary outcome is the identification of supportive interventions offered through or by ambulance trusts. Study selection will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of included studies will be appraised by administering rating checklists. A narrative synthesis will be conducted to report qualitative and quantitative data and will include population characteristics, methodological approach and information about barriers and facilitators. ETHICS AND DISSEMINATION: Ethical approval is not required because only available published data will be analysed. Findings will be disseminated through peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42022299650.
Subject(s)
COVID-19 , Mental Health , Adult , Ambulances , Delivery of Health Care , Humans , Pandemics , Research Design , Systematic Reviews as TopicABSTRACT
BackgroundOne of the consequences of delivering the frontline response during the COVID-19 pandemic has been the reduced capacity of UK Ambulance organisations to provide practical placement opportunities for undergraduate paramedic students. In lieu of traditional ambulance shifts, Virtual Reality (VR) can be used to simulate experiences without the student going through the real event. This service evaluation explores student feedback to understand whether VR technology could bridge the gap.MethodsFramed by the Plan, Do, Study, Act [PDSA] improvement cycle a series of VR simulated scenarios, related to mapped learning outcomes, supplemented practical ambulance placements for undergraduate paramedic students in south west England during the COVID-19 pandemic. Following simulated sessions, participating students were asked to voluntarily complete feedback questionnaires. Using Likert-scale questions, students were asked to rate the quality of tutors and the session content. Collated comments were entered into an Excel spreadsheet and content analysis was used to code and categorise responses based upon frequency.ResultsResults are based on eighty-eight nodes systematically generated from free-text feedback comments provided by fifty-three students who undertook a simulated practice placement utilising VR during April and May 2021. Nodes were reduced to fourteen categories and then condensed into nine themes relating to three domains of learning;affective, psychomotor and cognitive. An overarching theme of ‘enthusiasm for VR learning’ was identified.ConclusionsOverall, the utilisation of VR during simulated scenarios for undergraduate paramedic students appears to be a useful and acceptable adjunct to traditional ambulance shifts. The VR approach appears to be particularly useful for supporting the affective domain of learning with several students reporting increased self-confidence, positive interactions with course facilitators and the opportunity to put classroom knowledge into practice. We recommend that future use of VR should pay particular attention to the quality of simulations and the equipment used.
ABSTRACT
BackgroundDrug poisoning deaths in England and Wales have increased by 52% since 2011 with over half involving opioids. Deaths are preventable if naloxone is administered in time. Take Home Naloxone (THN) kits have been distributed through drug services;however, uptake is low and effectiveness unproven. The TIME trial tests the feasibility of conducting a full randomised controlled trial of providing THN administration and basic life support training to high-risk opioid-users in emergency care settings.MethodsA multi-site feasibility trial commenced in June 2019 with two hospitals and their surrounding ambulance services (Bristol Royal Infirmary (BRI) with South Western Ambulance NHS Foundation Trust (SWASFT) and Hull Royal Infirmary with Yorkshire Ambulance Service) randomly allocated to intervention arms;and sites in Wrexham and Sheffield allocated as ‘usual care’ controls. SWASFT began recruiting in October 2019 with the aim of recruiting and training 50% (n=111) of paramedics working within the BRI’s catchment area, to supply THN to at least 100 eligible patients during a 12-month period.ResultsThe trial was suspended between 17.03.2020-06.08.2020 and extended to 01.03.2021 (COVID-19). Despite this, 121 SWASFT paramedics undertook TIME training. TIME trained paramedics attended 30% (n=57) of the n=190 opioid-related emergency calls requiring naloxone administration during the study period. A total of n=29 potentially eligible patients were identified before and n=28 after the COVID-19 suspension. Two patients were supplied with THN during each period. During the COVID-19 suspension, twenty-two potentially eligible patients were missed. The majority of eligible patients presented with a reduced consciousness level, preventing recruitment (73%;n=42/48). These patients were transported to hospital for further treatment (n=39) or died on scene following advanced life support (n=3).ConclusionsThe lowered consciousness levels of prehospital emergency ambulance patients who present with opioid poisoning, often prevent the delivery of training required to enable the supply of THN.