Chest Compressions and Defibrillation as Aerosolgenerating Procedures

SARS-CoV-2 is a highly contagious respiratory pathogen associated with significant mortality in certain patient populations. Patients may be asymptomatic, which causes problems regarding infection control and prevention. Health professionals are required to adhere to strict protocols regarding infection control and personal protective equipment (PPE), particularly when engaging in resuscitation activities thought to be aerosol-generating procedures (AGPs). While adherence to enhanced PPE protocols can delay life-saving interventions, non-adherence may put responders at risk. The aim of this scoping literature review was to establish if chest compressions and defibrillation should be classified as AGPs. Following application of systematic literature search criteria, a limited selection of studies was identified in relation to chest compressions and defibrillation as AGPs. An assumption that endotracheal intubation posed a high risk of nosocomial transmission was noted. Emerging evidence suggests that endotracheal intubation produces fewer aerosol particles than coughing so could be classed as a low-risk-procedure. Because of the lack of adequate prospective studies investigating chest compressions and defibrillation as AGPs, there is a clear need to perform further, well-controlled studies to better understand the aerosol-generating potential of chest compressions and defibrillation.

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research.

Objectives: We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice. Hypothesis/research question: What does published literature tell us about heroism and paramedic practice? Setting: Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes. Participants: We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied. Results: 151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice. Conclusion: Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice. Study registration: PROSPERO: CRD42021234851.

Experiences of personal protective equipment and reasons for non-compliance

Background: The COVID-19 pandemic created challenges in prehospital care. Paramedics have been required to adhere to strict protocols regarding infection control and the use of personal protective equipment (PPE). These protocols have evolved as the pandemic progressed. Understanding the experiences of paramedics in using PPE and their reasons behind not adhering to recommended guidelines should improve the limited evidence base and assist healthcare organisations to form tailored PPE guidance, enabling better protection of paramedics. Aim: This study aimed to analyse evidence on paramedics' experiences of using PPE and explore the reasons behind non-compliance to inform PPE policies. Methods: Searches of five key databases identified papers relating to frontline practitioners' experiences of using PPE;frontline was defined as working in patient-facing roles in prehospital, emergency department or critical care settings. Articles were then subject to thematic analysis as part of this narrative review. Results: Three themes emerged: physical and emotional wellbeing;impact on patient care and clinical effectiveness;and PPE fatigue. The evidence explores health professionals' experiences of working in this difficult environment but very little data exist regarding the impact of PPE, specifically on UK paramedics or their reasons for not adhering to PPE protocols. Conclusion: PPE affects wearers in a variety of ways. Factors behind non-adherence are multifactorial. A paucity of literature exists regarding paramedics' experiences of using PPE.

"See us as humans. Speak to us with respect. Listen to us." A qualitative study on UK ambulance staff requirements of leadership while working during the COVID-19 pandemic.

BACKGROUND: The COVID-19 Ambulance Response Assessment (CARA) study aimed to enable the experiences of UK frontline ambulance staff working during the first wave of the pandemic to be heard. Specifically, CARA aimed to assess feelings of preparedness and well-being and to collect suggestions for beneficial leadership support. METHODS: Three online surveys were sequentially presented between April and October 2020. Overall, 18 questions elicited free-text responses that were analysed qualitatively using an inductive thematic approach. FINDINGS: Analysis of 14 237 responses revealed participants' goals and their requirements of leadership to enable those goals to be achieved. A large number of participants expressed low confidence and anxiety resulting from disagreement, inconsistency and an absence of transparency related to policy implementation. Some staff struggled with large quantities of written correspondence and many desired more face-to-face training and an opportunity to communicate with policymakers. Suggestions were made on how best to allocate resources to reduce operational demands and maintain service delivery, and a need to learn from current events in order to plan for the future was stressed. To further support well-being, staff wanted leadership to understand and empathise with their working conditions, to work to reduce the risks and if required, to facilitate access to appropriate therapeutic interventions. CONCLUSIONS: This study demonstrates that ambulance staff desire both inclusive and compassionate leadership. Leadership should aim to engage in honest dialogue and attentive listening. Resultant learning can then inform policy development and resource allocation to effectively support both service delivery and staff well-being.

The COVID-19 ambulance response assessment (CARA): measuring the psychological stress and preparedness of ambulance staff to deliver care during the first wave of the SARS-COV–2 pandemic in the UK in 2020

BackgroundThe coronavirus infectious disease 2019 (COVID-19) places significant demand on the NHS. This study aimed to measure the preparedness of healthcare professionals working for ambulance services, in both direct-contact patient facing and remote roles, and the impact the COVID-19 pandemic had on their psychological stress and perceived ability to deliver care.MethodsClinicians working for NHS ambulance services were invited to participate in a three-phase sequential online survey during the acceleration phase of the first wave of COVID-19 in the UK. Participants who participated in the first survey and who consented to be re-contacted were asked to complete two further surveys during the peak and deceleration phases of the pandemic. Open and closed-ended questions were used to assess participants’ perceived preparedness in undertaking their clinical duties. In addition, the General Health Questionnaire-12 (GHQ-12) was utilised to measure participants’ anxiety, mood and general health through each phase of the study. A score greater than 12 indicates the participant may be experiencing psychological distress.ResultsPhase one recruited 3717 participants, reducing to 2709 (73%) by phase two and 2159 (58%) by phase three. Overall, mean GHQ-12 scores were 16.5 (± 5.2) during phase one, reducing to 15.2(±6.7) by phase three. Most participants were found to have a GHQ-12 score great than 12 during the first phase (n = 3112, 84%). Factors leading to higher mean GHQ-12 scores were feeling unprepared for the pandemic, a lack of confidence in both using personal protective equipment and managing out of hospital cardiac arrests in patients with confirmed or suspected COVID-19.ConclusionsA significant number of participants reported psychological distress, the reasons for which are multifactorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in delivery of unscheduled, emergency and urgent care under these additional pressures.

Quantifying the Risk to Health Care Workers of Cough as an Aerosol Generating Event in an Ambulance Setting: A Research Report.

INTRODUCTION AND OBJECTIVE: United Kingdom Health Security Agency (UKHSA) guidance related to mask use for health care workers in a non-aerosol generating procedure (AGP) setting has remained as Level 2 water repellent paper mask (surgical mask) only. Energetic respiratory events, such as coughing, can generate vast numbers of droplets and aerosols. Coughing, considered to be a non-AGP event, frequently occurs in the relatively small, confined space of an ambulance (∼25 m3). The report seeks to explore whether existing research can provide an indication of the risk to ambulance staff, via aerosol transmission, of an acute respiratory infection (ARI) during a coughing event within the clinical setting of an ambulance. METHODS: International bibliographic databases were searched (CINAHL Plus, SCOPUS, PubMed, and CENTRAL) using appropriate search strings and a combination of relevant medical subject headings with appropriate truncation. Methodological filters were not applied. Papers without an English language abstract were excluded from the review. Grey literature was sought by searching specialist databases OpenGrey and GreyNet, as well as key organizations' websites. The initial search identified 2,405 articles. Following screening, along with forward and backward citation of key papers identified within the literature search, 36 papers were deemed eligible for the scoping review. DISCUSSION: Attempts to replicate a clinical environment to investigate the risk of transmission of airborne viruses to health care workers during a coughing event provided evidence for the generation of respirable aerosol particles and thus potential transmission of pathogens. In cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), potential to infect versus true airborne transmission is a debate that continues, but there is general consensus that a large variation of cough characteristics and aerosol generation amongst individuals exists. Studies widely endorsed face masks as a source control device, but there were conflicting views about the impact of mask leakage. CONCLUSION: Further research is required to provide clarity of the risk to health care workers when caring for a coughing patient in the confined clinical ambulance setting and to provide an evidence base to assist in the determination of appropriate respiratory protective equipment (RPE).

Protocol for a constructivist metasynthesis of qualitative research of heroism and paramedic practice.

BACKGROUND: Exceptional demands have been placed on paramedics and other healthcare workers (HCWs) during the COVID-19 pandemic. An overwhelming outpouring of public support has unfolded, bringing into focus the relationship between paramedics, other HCWs and society, where they are portrayed as heroes. Scholars have studied the notion of heroism to society, and characteristics of such heroic status include: the voluntary nature of a heroic act, risk of physical or social harm, willingness to accept the consequences of action, acting for the benefit of others and without the expectation of gain. While some HCWs and paramedics may reflect these characteristics, many may not. Such heroic narratives can be damaging, stifling meaningful discussion around limits to duties, failing to acknowledge the importance of reciprocity and potentially imposing demands on paramedics and HCWs to be heroic. AIM: This article prospectively presents the protocol for a metasynthesis which aims to identify, appraise and synthesise the qualitative literature in order to develop theory on heroism and paramedic practice. METHODS: Evolved grounded theory methodology is followed along with the procedural guidelines of Noblit and Hare (1988) to guide the analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) have also been adopted when preparing this protocol and will be followed in the study proper. The protocol has been registered with the International Prospective Register of Systematic Reviews PROSPERO 2021, registration number CRD42021234851. RESULTS: We do not currently have results, but PRISMA guidelines will be followed when reporting our findings. CONCLUSION: Current narratives on heroism and paramedic practice are important in terms of the relationship between paramedics and society. The metasynthesis prospectively reported in this article serves as the first point in our journey of making sense of and developing theory on heroism and paramedic practice.

Paramedic experiences of providing care in wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory.

OBJECTIVE: To explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice. DESIGN: Qualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype. SETTING: Conducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million. PARTICIPANTS: Paramedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed. RESULTS: Emergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services. CONCLUSIONS: Rich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life's pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic. TRIAL REGISTRATION NUMBER: IRAS ID: 282 623.

Mental health, well-being and support interventions for UK ambulance services staff: an evidence map, 2000 to 2020.

BACKGROUND: Prior to COVID-19 there had been a renewed policy focus in the National Health Service on the health and well-being of the healthcare workforce, with the ambulance sector identified as a priority area. This focus is more important than ever as the sector deals with the acute and longer-term consequences of a pandemic. AIM: To systematically identify, summarise and map the evidence regarding mental health, well-being and support interventions for United Kingdom ambulance services staff and to identify evidence gaps. METHOD: Evidence mapping methodology of published and grey original research published in English from 1 January 2000 to 23 May 2020 describing the health risk, mental health and/or well-being of UK ambulance services staff including retired staff, volunteers and students. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases, plus EThOS, Zetoc, OpenGrey and Google, were searched, alongside hand-searching of grey literature and bibliographies. Information was extracted on study aims, sample, design and methodology, funding source, country and key findings. Included studies were categorised into seven a priori theme areas. RESULTS: Of 1862 identified articles, 45 peer-reviewed studies are included as well as 24 grey literature documents. Peer-reviewed research was largely observational and focused on prevalence studies, post-traumatic stress disorder or organisational and individual social factors related to health and well-being. Most grey literature reported the development and testing of interventions. Across all study types, underpinning theory was often not cited. CONCLUSION: To date, intervention research has largely been funded by charities and published in the grey literature. Few studies were identified on self-harm, bullying, sleep and fatigue or alcohol and substance use. Theoretically informed intervention development and testing, including adaptation of innovations from other countries and 24-hour workforces, is needed. This evidence map provides important context for planning of staff well-being provision and research as the sector responds to and recovers from the pandemic. PROSPERO REGISTRATION NUMBER: CRD42018104659.

Caring for carers

The author conveys her concerns on the need for nurses to look after their own physical health and emotional wellbeing during the COVID-19 pandemic, with topics mentioned such as the resolutions of 12 Marie Curie nurses regarding the COVID-19 pandemic, the National Health Service, and the SARS outbreak of 2003.