Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home.

BACKGROUND: During the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality. METHODS: This was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic's assessment visit by their general practitioner or an out-of-hours general practitioner. The study was conducted from 16 March to 20 May 2020. The outcomes were the proportion of non-conveyed patients who subsequently visited a hospital within 72 hours of the paramedic's assessment visit and mortality at 3, 7 and 30 days. Mortality was estimated using a Poisson regression model with robust variance estimation. RESULTS: During the study period, 587 patients with a median age of 75 (IQR 59-84) years were referred to a paramedic's assessment visit. Three of four patients (76.5%, 95% CI 72.8;79.9) were non-conveyed, and 13.1% (95% CI 10.2;16.6) of the non-conveyed patients were subsequently referred to a hospital within 72 hours of the paramedic's assessment visit. Within 30 days from the paramedic's assessment visit, mortality was 11.1% [95% CI 6.9;17.9] among patients directly conveyed to a hospital and 5.8% [95% CI 4.0;8.5] among non-conveyed patients. Medical record review revealed that deaths in the non-conveyed group had happened among patients with 'do-not-resuscitate' orders, palliative care plans, severe comorbidities, age ≥ 90 years or nursing home residents. CONCLUSIONS: The majority (87%) of the non-conveyed patients did not visit a hospital for the following three days after a paramedic's assessment visit. The study implies that this newly established prehospital arrangement served as a kind of gatekeeper for the region's hospitals in regard to patients suspected of COVID-19. The study also demonstrates that implementation of non-conveyance protocols should be accompanied by careful and regular evaluation to ensure patient safety.

Smart Ambulance Monitoring System Using Iot

A vehicle which is used to transport patients to hospitals is called as ambulance, this ambulance vehicle is equipped with some vital lifesaving equipment's and first aid medicines. With these medicines and equipment's, the patients are given first aid till it reaches the desired hospital. Whenever a patient is in life-threatening emergency, then the ambulance paramedics should act promptly and must update the status of the patient to their doctors. This type of treatment or service is called Emergency Medical Service (EMS). It deals with immediate treatment and timely movement of the patients. For implementing EMS in ambulance several solutions have been developed for faster means of communication between the equipment's used in ambulance and the doctors. But the solutions are not viable in emergency situations. In additions during Covid wave in 2020 there was a scarcity for hospitals beds, it was filled with many covid patients. In many hospitals there was a queue of ambulances with patients waiting outside the hospitals. In some cases, the patients even died before getting any treatment, to overcome such crucial situations we have come out with a new system combining IoT, Sensor system and Embedded Controllers. The system developed here has sensors to monitor patients' vital parameters and transmits to the hospital server, such that a doctor can know the live condition of the patient and he can give instructions to the paramedics to do emergency aids. The system is a compactable and connects to the server with a mobile hotspot. The information is updated every 10 seconds. By implementing this system in ambulances, it saves many valuable lives of the people.

Effects of Critical Incident Stress Management on Nurses During COVID-19 Pandemic

Objective: To analyze the effect of Critical Incident Stress Management on the mental health of nurses during COVID-19. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Jhelum Pakistan from Mar to Jun 2020. Methodology: Forty-six nurses were consecutively recruited and evaluated regarding Knowledge about COVID-19, thoughts regarding its origin, emotional reactions, and coping mechanisms. The evaluation was followed by the provision of Critical Incident Stress Management sessions in March. Finally, in the second phase conducted in June, the participants were evaluated again to assess the effect of intervention regarding the above parameters. Results: Results indicated a statistically significant shift in Knowledge from Social Media to Academic Resources (p<0.001). Thoughts regarding the origin of COVID-19 showed that ‘Religious Causes' and belief in ‘Religious and Biological Causes both” significantly reduced (p=0.001 and p=0.003, respectively), while opinions regarding ‘Biological Causes' increased in frequency (p< 0.001). Emotionally a significant reduction was seen in Confusion (p<0.001). A significant reduction was observed in Religious Rituals (p=0.002) for Coping Mechanisms. However, observing Safety Precautions and Distraction Strategies were insignificantly affected (p=0.668 and p=1, respectively). Conclusion: Critical Incident Stress Management helped healthcare workers sublimate their emotional reactions and helped them cope with a productive mindset for better management of the pandemic.

'Against everything that got you into the job': experiences of potentially morally injurious events among Canadian public safety personnel.

Background: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations.Objective: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada.Method: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences.Results: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes.Conclusion: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.

The objective of this study was to understand the types of events that Canadian public safety personnel (PSP) experience as potentially morally injurious events (PMIEs) as well as the impacts that they associate with these events.The findings illuminate that contextual dimensions are significant in the origin of PMIEs, which PSP experience in the completion of routine duties, because of the organizational culture, or as a result of issues in the broader healthcare system, which led to many negative consequences in their personal and professional lives.PMIEs reduced the trust PSP had in their leadership and the healthcare system to protect the public and themselves, were associated with feelings of anger, frustration, resignation, and helplessness, and connected to internal struggles marked by inner conflict and the erosion of self-concept.

Investigation of Paramedics, Attitude, Knowledge and Practice regarding the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Iran

Background: The Middle East Respiratory Syndrome coronavirus (MERS-Co V) was known as a human pathogen associated with respiratory symptoms. This study aimed to investigate attitudes, knowledge, and practice about MERS-CoV in paramedics. Methods: In this quasi-experimental study, 82 paramedics in Iran in April 2019 were selected in a stratified cluster sampling. Paramedics worked in Health Centers in Iran. We performed educational intervention in this study. A four-point Likert scale researcher-made questionnaire containing demographic (9 questions) and MERS-CoV (33 questions) items was administered to collect the data. The collected data were analyzed by SPSS 18 software. Results: Out of 82 paramedics, who completed questionnaires, 42.7% (35 people) were male, 56.1% (46 people) had a diploma degree, and 19.5% (16 people) had less than 1 year of work experience. about the participants reported 2 laboratory-confirmed infections at Kerman State. In addition, 67.1% (32 people) passed a course to become familiar with disease. Theparamedics' mean age was 37.52±8.88. The knowledge mean score of paramedics was 12.82 (SD=10.04). The highly significant source of data collection in paramedics was the attendance in a course to become familiar with disease (43.9%, 36). The mean score of the practice of paramedics was 13.98 (SD=10.00). The most significant concern in neglecting travel to polluted areas in paramedics was public health defects (39%, 32). There was a significant relationship (P<0.05, t=9.06) between knowledge score and variables: gender (P=0.001), education level (P=0.001), and years in service (P=0.039). Conclusion: The paramedic had concerns and tend to increase the knowledge regarding prevention. The awareness of the transmission of diseases was the most important factor for modifying practice and preventing diseases. Health decision-makers recognized preventive actions to hinder the transmission of this fatal virus. © 2023 Authors. All rights reserved.

Patient Experience With an In-Home COVID Virtual Observation Unit: An Analysis.

We performed a retrospective cohort study of patients admitted to a novel, home-based COVID Virtual Observation Unit (CVOU) from an urban, university-affiliated emergency department with ∼112,000 annual visits. Telephone-based survey questions were administered by nursing staff working with the program. Of 402 patients enrolled in the CVOU, 221 (55%) were able to be contacted during the study period; 180 (45%) agreed to participate in the telephone interview. Overall, 95% (169 out of 177) of the surveyed patients reported 8 to 10 on the likelihood to recommend CVOU and 82% (100 out of 122) rated the quality of care as 10 out of 10. Over 90% of respondents reported that all role groups (nurses, paramedics, and physicians) treated them with courtesy and respect, explained things in an understandable way, and listened to them carefully. Over 80% of respondents reported that the program kept them at home. In summary, patient experiences with this novel home-based care program were highly positive. These data help underscore the importance of patient-centeredness in home-based care, and further support the concept of these innovative care models.

Mental health and life satisfaction among Canadian paramedics during the COVID-19 pandemic: an update

IntroductionPrevious results suggest that COVID-19 adversely impacted a number of health and coping measures among Canadian paramedics, particularly females. Estimated prevalence for meeting screening criteria for mental health disorders and suicidal thoughts were higher than previously reported.ObjectivesTo provide an update on the impact of the COVID-19 pandemic on the wellbeing of Canadian paramedics with the inclusion of an additional year of participant data.MethodsSelf-reported questionnaire data was collected from paramedics across five Canadian provinces as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project. Validated psychological assessment tools were used to screen for major depressive disorder (MDD, PHQ-9 questionnaire) and probable post-traumatic stress disorder (PTSD, PC-PTSD-5 questionnaire). Satisfaction with life (SWL) scores were adapted from validated Canadian Census questions and confirmed by reliability analysis. All measures were compared before versus during the pandemic using Wilcoxon signed-ranked, Cliff's d, and differences in proportions tests where appropriate.ResultsQuestionnaires from an additional 1662 recruited paramedics were included, now totaling 3568 participants. Prevalence meeting screening criteria remained similar for MDD (31.6%) and PTSD (41.4%), with PTSD risk continuing to not be impacted by COVID-19. Paramedics continued to report higher median SWL scores (20 vs. 17, p<.001) prior to the pandemic, with a large effect size (d=0.58) that suggests a greater probability of reporting higher SWL prior to COVID-19. Suicidal ideation (i.e., ‘thoughts that you would be better off dead, or of hurting yourself in some way') was reported by 9.0% of paramedics, which was consistent with original findings.ConclusionOriginal findings appear stable with the addition of another year of participant data. Future analyses will be employed to investigate whether health and satisfaction measures differed between the original cohort and added participants by adjusting for questionnaire responses with respect to the pandemic timeline.

Changes to infection prevention and control measures used by Canadian paramedics in response to COVID-19

IntroductionCanadian Paramedic services modified infection prevention and control (IPAC) practices in response to COVID-19. These changes may affect risk of exposure to infectious disease agents and can be used to inform future IPAC practices. We characterized COVID-19-related IPAC changes in the provinces of Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan.Materials & MethodsQuestionnaire data (January 2021-Feb 2022) from the national COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project was used to identify which IPAC practices were in place prior to COVID-19, and which were modified in response to COVID-19, including the timing of changes (March-May 2020;June-Aug 2020;Sept-Nov 2020;Nov 2020-present).Results2939 participants were included (146, 1249, 139, 1317, 88 from Alberta, BC, Manitoba, Ontario, and Saskatchewan, respectively), of whom 2674 (91%) reported receiving IPAC training. IPAC measures that were common prior to COVID-19 included: personal protective equipment (PPE) training, patient screening, hand hygiene, N95/P100 respirators, gowns, impermeable suits, and cleaning/disinfection. COVID-related IPAC changes included: screening staff, social distancing, restricting aerosol generating procedures, masking patients, cloth face coverings, surgical masks, face shields, and elastomeric respirators. Changes were reported for all IPAC measures. Most (71%) of these changes were made early in the COVID-19 pandemic (March-May 2020). Differences in proportions across provinces, community practice settings, and professional regulation status were reported (p < .05) for hand hygiene, PPE training, screening of patients, face shields, and various respirator types.ConclusionCanadian paramedic services were quick to modify available IPAC measures. However, these changes were variable across provinces, regulation status, and setting for specific IPAC measures. Inconsistent IPAC measures across jurisdictions may contribute to variable risk of infectious disease exposure. An evidence-informed and nationally coordinated approach may provide more equitable exposure risk mitigation for paramedic workers.

Releasing the pressure

In his first NQP Perspective column, Derek Ford reflects on his journey as a mature student

Effects of with holding treatment on mental health in Canadian paramedics during the COVID-19 pandemic

IntroductionPsychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.Materials and MethodsParamedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.ResultsOf the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3;Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.ConclusionsWithholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.

A fall in isolation: reflection on a complex case

This case review focuses on a male patient who had fallen and was found to be profoundly hypothermic, with an altered level of consciousness and evidence of seizure activity. With multiple time-critical features, this clinical presentation was made particularly challenging by the presence of several human factors. A reflective model that considered these human factors in the context of the COVID-19 pandemic, when this incident occurred, was employed. Reflecting on this incident revealed how some subconscious (intuitive) thinking led to a degree of unconscious bias compounded by availability heuristics and human factors present. This meant that the author encountered difficulty when trying to obtain peripheral vascular access and, although several alternative interventions were identified, the majority of these were unavailable at the time and some would require a change to standard clinical practice for many paramedics. The only intervention that could have been used earlier in the management of this patient was rectal diazepam, but the need for this was removed by the patient's seizure activity self-terminating. Given the increasing prevalence of falls, social isolation, mental health problems, alcohol and substance misuse, especially in the pandemic, this type of case was unlikely to be an isolated event, strengthening the argument that the range of clinical interventions available to paramedics should be increased.

A Cohort Study of Occupational Fatalities among Paramedicine Clinicians: 2003 through 2020.

INTRODUCTION/STUDY OBJECTIVES: Emergency medical technicians (EMTs) and paramedics respond to 40 million calls for assistance every year in the United States; these paramedicine clinicians are a critical component of the nation's health care, disaster response, public safety, and public health systems. The study objective is to identify the risks of occupational fatalities among paramedicine clinicians working in the United States. METHODS: To determine fatality rates and relative risks, this cohort study focused on 2003 through 2020 data of individuals classified as EMTs and paramedics by the United States Department of Labor (DOL). Data provided by the DOL and accessed through its website were used for the analyses. The DOL classifies EMTs and paramedics who have the job title of fire fighter as fire fighters and so they were not included in this analysis. It is unknown how many paramedicine clinicians employed by hospitals, police departments, or other agencies are classified as health workers, police officers, or other and were not included in this analysis. RESULTS: An average of 206,000 paramedicine clinicians per year were employed in the United States during the study period; approximately one-third were women. Thirty percent (30%) were employed by local governments. Of the 204 total fatalities, 153 (75%) were transportation-related incidents. Over one-half of the 204 cases were classified as "multiple traumatic injuries and disorders." The fatality rate for men was three-times higher than for women (95% confidence interval [CI], 1.4 to 6.3). The fatality rate for paramedicine clinicians was eight-times higher than the rate for other health care practitioners (95% CI, 5.8 to 10.1) and 60% higher than the rate for all United States workers (95% CI, 1.24 to 2.04). CONCLUSIONS: Approximately 11 paramedicine clinicians are documented as dying every year. The highest risk is from transportation-related events. However, the methods used by the DOL for tracking occupational fatalities means that many cases among paramedicine clinicians are not included. A better data system, and paramedicine clinician-specific research, are needed to inform the development and implementation of evidence-based interventions to prevent occupational fatalities. Research, and the resulting evidence-based interventions, are needed to meet what should be the ultimate goal of zero occupational fatalities for paramedicine clinicians in the United States and internationally.

Barriers to, and enablers of, paramedics responding to suspected or confirmed COVID-19 cases: An integrative review.

BACKGROUND: The coronavirus pandemic (COVID-19) has focused attention on healthcare workers' concerns about working during a pandemic, yet research on the effect of the pandemic specifically on paramedics is lacking. This literature review aims to critically examine the current knowledge of paramedics' experience of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases. METHODS: An integrative review was undertaken using articles found by a systematic search of four research databases. Inclusion criteria included paramedics or emergency medical technicians who had experience of barriers or enablers responding to patients during the coronavirus pandemic. RESULTS: Nine articles met the inclusion and exclusion criteria. Barriers included communication and poor leadership, fear of infection to self and family, frequent changes in guidelines and inconsistencies across agencies, stress/burnout, and concerns with personal protective equipment. Enablers included job security, perceived social support, solidarity with other paramedics, and use of modern technologies for communication. CONCLUSIONS: There are unique experiences of working during the COVID-19 pandemic in the prehospital environment. Particular challenges occurred with leadership, communication within the organisation and between agencies, and working in an unpredictable environment.

Healthcare Workers Weather Respiratory Onslaught

The article offers information on how healthcare workers are facing a rare convergence of a pandemic virus and unusually high levels of seasonal flu and respiratory syncytial virus (RSV). Topics include information on increase in patients with respiratory virus;comments of Ryan Stanton, MD, and a member of Central Emergency Physicians in Lexington, Kentucky;and how physicians are facing lot of strain.

Assessing the Mental Condition of Paramedics and Nurses during the SARS-CoV-2 Pandemic.

BACKGROUND: The COVID-19 pandemic has significantly affected many aspects of life. The aim of this study was to assess the mental state of medical personnel most involved with patients affected by SARS-CoV-2. METHODS: The survey research was conducted between October 2021 and March 2022. The study group included 46 paramedics, 48 nurses, and 6 individuals from both professions, ranging in age from 21 to 67 years. Data were collected using paper questionnaires that contained 44 questions. RESULTS: During the pandemic, respondents maintained good contact with their colleagues and were competent enough to help their patients. The main factors that influenced their stress or dissatisfaction were the number of patients and the number of tasks. The nurses and paramedics most frequently reported symptoms related to tension, insomnia, and problems with intellectual performance. The pandemic situation led to the abandonment of hobbies and deterioration of relationships with friends and family. CONCLUSION: As a result of high stress levels, paramedics and nurses frequently suffered from tension and insomnia. The factors described were associated with poorer well-being of the subjects in various functional areas, even before the pandemic period. This was mainly related to the large number of patients and the tasks. However, this work, as well as studies by other authors, come to alarming conclusions that should draw attention to the mental state of medical staff, as this is the group that is highly responsible for the medical care of patients, especially in such a difficult time as a pandemic.

Factors Affecting Paramedic Response Readiness to CBRN Threats in Ontario, Canada.

OBJECTIVE: To determine factors associated with increased response readiness to CBRN threats of paramedics in Ontario, Canada. METHODS: An internet-based survey was distributed via email and delivered at the start of each shift presentation during October, 2019. The target population was active-duty paramedics in the Ontario region of Canada. The survey was comprised of 6 sections pertaining to demographics, attitudinal components of risk perception, self-efficacy, deployment concerns, and resilience. Survey mean, univariate, and multivariate regression analyses were used to find the individual effect of each variable. RESULTS: The univariate analysis indicated that higher response readiness was associated with additional training, education, CBRN, and family concerns, and incident experience. However, some variables were non-significant in the multivariate analysis. Increased response readiness was associated with CBRN concerns and training. CONCLUSION: CBRN concerns and focused training regarding terrorism were both associated with increased response readiness. The information from the study can be used to build upon existing knowledge and support paramedics though training and preparation for CBRN specific disasters. The findings may also be used to improve current competency-based frameworks focused on response readiness.

The impact of COVID-19 on first responders in the United States of America

Purpose: This project specifically aims to examine (1) the individual impact of coronavirus disease 2019 (COVID-19) on first responders, (2) the organizational impact of COVID-19 on first response agencies and (3) policy and organizational response and support efforts to mitigate potentially harmful effects of the pandemic. Design/methodology/approach: The authors' conducted a mixed-methods analysis, including a review of secondary sources (e.g. government documents, organizational policies and news pieces), state-level policies, encompassing surveys, in-depth semi-structured interviews and PhotoVoice focus groups. Findings: COVID-19 compounded many of the inherent risks facing first responders and added new stressors. First responders assumed added responsibilities during the pandemic which increased workloads, job-related stress, burnout, distance from the community and first responders' feelings of frustration. Even with personal protective equipment (PPE), first responders faced greater exposure to individuals with COVID-19 and were primarily concerned with transmitting the virus to family members, or other members of the first responders' support networks. State-level COVID-19 policies that were geared toward first responders aimed to improve the first responders' personal lives outside of work and mitigate burnout within the profession. First response agencies adapted to the pandemic by implementing a wide range of measures. Practical implications: First responders also identified several weaknesses in the first responders' agencies' approach to the pandemic. To prepare for the next public health emergency, first response agencies should proactively train employees, build up the first responders' supplies of equipment and PPE, implement policies to strengthen their workforce (e.g. increase hiring for understaffed positions, reduce turnover and mitigate role abandonment), allow for greater employee autonomy, improve communication between leaders and employees and prioritize employees' mental health, as well as other factors relating to departments' informal culture. Originality/value: This is one of the largest studies conducted on three types of first responders (police officers, fire firefighters, emergency medical technicians (EMTs) and paramedics) across the United States of America during a public health crisis. © 2023, Emerald Publishing Limited.

Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria.

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.

Paramedics' knowledge, attitudes, and practices regarding the use of personal protective equipment against COVID-19.

The risk of novel coronavirus disease (COVID-19) transmission in the confined mobile ambulance compartment is increased during aerosol-generating procedures and close proximity. Paramedics are encouraged to increase body-surface-isolation by donning additional personal protective equipment (PPE) during patient encounters. This study aimed to better understand paramedics' knowledge, attitudes, and practices related to PPE use during the COVID-19 pandemic in the prehospital setting with a focus on mitigating risks associated with infection control. This prospective quantitative study collected descriptive data using a specifically designed data collection tool. The survey data was then cleaned and analyzed with Microsoft Excel® and the latest version of the Statistical Package for Social Sciences. One thousand frontline paramedics employed by the Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. A total of 282 (28.2% of frontline paramedics) paramedics completed the online survey, of which 80.1% completed the mandatory HMCAS online infection control training program within the last year, and 17.0% between one to two years ago. Approximately 83% of the participants had completed an N95 mask fit test at HMCAS within the past five years, and 91.5% completed the hand hygiene training. The study found that 98.2% of the paramedics were knowledgeable about COVID-19 and its transmission, while 96.1% agreed that aerosol-generating procedures increased airborne transmission. The paramedics' attitudes were mainly positive toward the use of PPE to prevent the spread of the virus, which was synchronous with their practice. The sample population demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitudes and good infection control practices were demonstrative of efforts to mitigate risks associated with the spread of the virus.

A maturity model framework for integrated virtual care: Managing Community Care

Purpose>Remote patient monitoring (RPM) and virtual visits have the potential to transform care delivery and outcomes but require intentional planning around how these technologies contribute to integrated care. Since maturity models are useful frameworks for understanding current performance and motivating progress, the authors developed a model describing the features of RPM that can advance integrated care.Design/methodology/approach>This work was led by St. Joseph's Health System Centre for Integrated Care in collaboration with clinical and programme leads and frontline staff offering RPM services as part of Connected Health Hamilton in Ontario, Canada. Development of the maturity model was informed by a review of existing telehealth maturity models, online stakeholder meetings, and online interviews with clinical leads, programme leads, and staff.Findings>The maturity model comprises 4 maturity levels and 17 sub-domains organised into 5 domains: Technology, Team Organisation, Programme Support, Integrated Information Systems, and Performance and Quality. An implementation pillars checklist identifies additional considerations for sustaining programmes at any maturity level. Finally, the authors apply one of Connected Health Hamilton's RPM programmes to the Team Organisation domain as an example of the maturity model in action.Originality/value>This work extends previous telehealth maturity models by focussing on the arrangement of resources, teams, and processes needed to support the delivery of integrated care. Although the model is inspired by local programmes, the model is highly transferable to other RPM programmes.