Effect of COVID-19 on the operational realities of the non-urban Canadian paramedic

IntroductionCOVID-19 has had significant impacts on the provision of pre-hospital care. Media and academic reports have heavily covered the impacts of Covid-19 on society and health care but have primarily focused on the densely packed urban environments which were hardest hit. This study examines the impact of COVID-19 on pre-hospital care outside of major urban centers.MethodsThe electronic patient care records (ePCR) of 3 Ontario paramedic services were compared for 365 days starting March 13 (start of lockdown for Ontario in 2020) for Historic (2018-2019), PreCOVID (2019-2020) and COVID (2020-2021) periods. Demographics were examined using t-Tests and proportion (Goodness of Fit) tests. Call counts in temporal categories were analysed using Chi-Squared tests of goodness of fit, while changes in the distribution of call time intervals were examined using a LR test for equivalence. Ethics for the study was approved by the Trent University Ethics Review Board.Results89,126 ePCRs were examined (Historic: 30,070;PreCOVID: 30,576;COVID: 28,480). Small but statistically significant differences between COVID and PreCOVID were found in the gender and primary problem of patients (p < 0.01) as well as in all temporal fields (p < 0.03), except day-of-the-week (p = 0.87). In time interval comparison, time-on-scene and time-to-patient-contact were significantly increased in the COVID-19 era while time-to-offload (in the ER) was much shorter. Response times were found to be marginally slower, while transport-time-to-ED was found to be significantly faster during COVID.PreCOVID versus Historic comparisons found no significant difference, except in age and CTAS, which had significant differences in both the COVID vs PreCOVID and PreCOVID vs Historic periods (p < 0.001 for both).ConclusionCOVID-19 has had many impacts on prehospital care. However, the practical significance of COVID on rural pre-hospital care may not be as large as that reported in higher density area.

Impactful Approaches to Leadership on the Front Lines of the COVID-19 Pandemic: Lived Experiences of Canadian Paramedics.

The COVID-19 outbreak offered a unique opportunity to capture the experiences of front-line practitioners during substantial and rapid changes to their daily work, including workplace policy, protocols, environment and culture, as well as changes to their overall professional role in the healthcare system. Our team of paramedic researchers collected data throughout the first wave of the COVID-19 outbreak, exploring the lived experiences from a paramedic viewpoint. This article will discuss impactful approaches to leadership in paramedicine - differentiating between successful and failed strategies to leading and supporting teams amid rapid change on the front lines of the fight against COVID-19.

Supporting paramedics on the frontlines amidst the COVID-19 pandemic: exploring impactful leadership approaches in Canada

BackgroundParamedics are experiencing numerous policy and protocol changes in addition to facing enhanced risk of personal exposure during the COVID-19 pandemic. The COVID-19 outbreak offers an opportunity to capture the experiences of paramedics during substantial and rapid changes to workplace policy, protocols, and professional roles in the healthcare system. To date, this ongoing multi-jurisdictional study has captured a better understanding of the lived experiences of Canadian paramedics throughout the COVID-19 outbreak and provided insight to which leadership approaches have been most impactful throughout such unprecedented circumstances.MethodData was collected through an online survey, consisting of quantitative and qualitative questions. Survey responses (n=428) were received between April 2, 2020 and August 1, 2020. The study, theoretically grounded in a phenomenological approach, employed inductive thematic analysis to code the data. The survey remains open and has expanded to include England for further data collection as the pandemic continues to evolve.ResultsMajor themes identified encompassed both professional and personal elements. Although some participants praised organizational leadership and how professional needs had been met throughout the first wave of the COVID-19 outbreak, other respondents expressed weariness to change management approaches and further need for clear communication strategies. Many participants also expressed increased stress, exhaustion and anxiety negatively impacting their mental health.ConclusionsEarly results confirmed a need for paramedics to adapt professional approaches to overcome barriers presented by COVID-19. Although most respondents noted confidence in their ability to provide patient care to those exhibiting symptoms, many noted concern regarding changes to standard of care for patients. In this presentation, we will discuss preliminary results from our study, and share recommendations pertaining to leadership and change management impacting paramedic practice.

Lived experiences of paramedics across England during the COVID-19 outbreak;initial results. Poster Presentation

BackgroundParamedics are experiencing numerous policy and guideline changes in addition to facing enhanced risk of personal exposure during the COVID-19 pandemic. The COVID-19 outbreak offers an opportunity to capture the experiences of paramedics during substantial and rapid changes to workplace policy, guidelines, and professional roles in the healthcare system. To date, this ongoing study has captured a better understanding of the lived experiences of English paramedics.MethodData were collected through an online survey, consisting of QUAN +QUAL questions. The study, theoretically grounded in a phenomenological approach, employed inductive thematic analysis to code the data. QUAN answers were analysed using descriptive statistics and chi-square to test for association between demographic data and answers.ResultsA total of 34 survey responses from September – December 2020 have been received from across England, with the survey remaining open. Major themes to date have identified both professional and personal elements. There is a feeling of increased pressure related to public expectation, with noted increases in call volumes in some areas. There has been a change to the workforce and increased levels of sickness. The type and level of PPE as well as employer communication varies depending on the area respondents work in. Many participants also expressed increased stress, exhaustion and anxiety negatively impacting their mental health.ConclusionsEarly results confirm a need for paramedics to adapt professional approaches to overcome barriers presented by COVID-19. There appears to be a disparity in the amount of communication, PPE and support depending on the area worked in. Respondents are fatigued and worried about others, including families. Yet, there remains a clear professional attitude and commitment to providing care throughout the pandemic. The survey remains open with a comparison of data between Canada and England planned.

Leveraging paramedic data to investigate the effect of COVID-19 on community opioid overdoses

BackgroundOpioid overdoses in Canada have shown dramatic increases over recent years, despite significant investments in harm reduction. Most community monitoring currently relies on emergency department and coroner data. Our team has previously shown that paramedic data can be a useful addition to the current metrics as paramedics regularly interact with opioid overdose patients. This study examines paramedic data to investigate the changes to community opioid overdoses in the era of COVID-19 to better support our strategic partners in their battle against the opioid crisis.MethodsThe electronic ambulance call report database of Peterborough Paramedics (Ontario, Canada) was examined. De-identified records for patients from 2017-2020 with documented problem codes of ‘Opioid Overdose’ were extracted. Patients receiving paramedic naloxone were also included. The data was cleaned and analysed, and incomplete records were removed. Statistical models including chi-squared tests of goodness-of-fit and post hoc pairwise t-tests were applied to the data. Ethics approval for this study was granted by the Trent University’s Research Ethics Board.Results788 opioid overdoses were identified out of 72,737 patients. There were 263 opioid overdoses found in 2020 representing 1.4% patients, a significant increase from 2017-2019 (p value: 0.006). The proportion of patients receiving paramedic naloxone was significantly increased from previous years (p value: 0.005) while bystander naloxone administration was significantly decreased (p value 0.002). Age, gender, and pick-up location types were not significantly different between 2020 and previous years.ConclusionDespite reduced overall call volumes in 2020, paramedics observed an increase in opioid overdoses. The increase in paramedic naloxone administration and decrease in bystander naloxone administration may indicate changes in usage practices of community opioid users or an instability in the drug supply. These factors must be considered in future opioid harm reduction strategies and public health COVID-19 containment measures.