Systematic Review of Incidence, Prevalence, and Trends in Health Outcomes for Australian and New Zealand Paramedics.

INTRODUCTION: The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organizations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this article was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context. METHODS: A systematic search of key databases and gray literature was conducted to identify all available studies reporting on quantitative health outcomes for paramedics working in Australia or New Zealand. The review was conducted using the JBI methodology for prevalence studies and uses a narrative synthesis approach to reporting. RESULTS: There were k = 20 studies that met inclusion criteria, and most used Australian samples. Results indicated between 57.3-66.5% of paramedics studied were classified as overweight or obese, while up to 80% reported poor sleep, and 55.6% reported fatigue. Incidence rates per 100,000 full-time equivalent (FTE) included 26.62 for completed suicide, 5.46 for drug-caused death, and 9.3 for workplace fatalities. The most recent incidence per 1,000 FTE for injury compensation claims was 141.4. CONCLUSIONS: Australian and New Zealand paramedics demonstrate poor health according to several metrics. Our sample demonstrated considerably worse health than the general population or similar occupations. There is a minimal amount of trend data available; therefore, it was difficult to ascertain if rates are changing. The range of health outcomes studied was limited, and correlations between different health outcomes were rarely considered by authors. Data relating to specific rates for gender and sexuality, location of work, and First Nations status or ethnicity was often not available. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO): CRD42021232196.

An observational study of peripheral intravenous and intraosseous device insertion reported in the United States of America National Emergency Medical Services Information System in 2016.

OBJECTIVE: To investigate the prevalence of intravenous and interosseous device insertion in the prehospital setting by prehospital clinicians, and the characteristics of patients receiving these devices as reported to the United States of America National Emergency Medical Services Information System. METHODS: A retrospective analysis of the United States of America National Emergency Medical Services Information System public release dataset for the 2016 calendar year. RESULTS: A total of 20,454,975 events involving 40,438,959 procedures were analysed. One or more peripheral intravenous catheters were inserted during 27.4 % of events, and one or more intraosseous devices in 0.4 % of events. Insertion was completed with one attempt in 71.6 % of peripheral intravenous catheter insertions and 86.9 % of intraosseous devices insertions. Insertion was successful for 74.7 % of peripheral intravenous catheter insertions and 85.4 % of intraosseous device insertions. High rates of peripheral intravenous catheter insertion were found with: being female (51.6 %), aged 40-90 years (80.2 %), having a cardiac rhythm disturbance (70.3 %), having a primary symptom of change in responsiveness (58.7 %), or when there was initiation of chest compressions (50.4 %). There were high rates of intraosseous device insertion if the patient was male (57.8 %), aged 40-90 years (77.2 %), experienced a cardiac arrest (29.2 %), had chest compressions initiated (33.6 %), or died (16.4 %). Scene time was longest for events with intraosseous devices inserted (19.7 min, IQR 13.2-28.6) but transport time shortest (9.0 min, IQR 5.0-15.0). CONCLUSIONS: The distribution of patient factors and the insertion of peripheral intravenous catheters and intraosseous devices is described at a national level for the first time. The results provide prehospital clinicians and Emergency Medical Services rigorous data to compare, and possibly improve, practice.

Peripheral intravenous catheter and intraosseous device insertions reported from the 1st July 2016 to 30th June 2017 in an Australian state ambulance service: An observational study.

OBJECTIVE: To overcome the lack of larger, population-based studies reporting the prevalence of insertion of PIVCs and IO devices, and to describe the patient-related and service-related characteristics of these devices, inserted by paramedics, in an Australian state ambulance service. METHODS: A retrospective analysis of the electronic Ambulance Report Form (medical record) and Computer Aided Dispatch system from the 1st July 2016 until 30th June 2017. RESULTS: 709,217 events were analysed. Of these, 20.4% involved at least one successful PIVC insertion and 0.07% involved at least one successful IO device insertion; most of the time on first attempt (89% and 86.4% respectively). Most PIVCs were inserted into the right antecubital fossa or dorsum of the right hand while IO devices were inserted into the proximal tibia. Of male patients, 21.4% received PIVCs while 19.5% of female patients received PIVCs. Very low numbers of both male and female patients received IOs (0.1%). Medical, non-traumatic presentations were the most common presentation and received the most insertions of both devices, followed by trauma presentations. Advanced Care Paramedics inserted 84.0% of PIVCs while Critical Care Paramedics inserted 94.4% of IO devices. Time treating and transporting patients generally increased with number of attempts at vascular access undertaken. CONCLUSIONS: Queensland paramedic practices relating to insertion of PIVCs, and IO devices appears consistent with documented practice internationally. Further study is required to determine whether the antecubital fossa and dorsum of the hand insertions are clinically necessary in this population as areas of flexion and distal extremities are generally to be avoided for PIVC insertion.

Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory.

INTRODUCTION: We report an experiment using Australian paramedics (n = 64) and Australian paramedicine undergraduates (n = 44), on the processes underlying the formation of an intuitive diagnostic impression, based on limited dispatch information. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the diagnosis comes to mind (answer fluency) as important in impression formation. METHOD: Participants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. Diagnostic impression, confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics. RESULTS: Likelihood, answer fluency, self-reported typicality and confidence predicted the impression but there was no effect of experience. Students and experienced paramedics had comparable accuracy and performance. CONCLUSION: The results support a role for answer fluency and confidence in forming that impression. We have shown it is possible to experimentally manipulate various factors associated with paramedic diagnostic impressions. These experimental methods can form the basis for additional studies into paramedic decision making.

Paramedic students' experiences of stress whilst undertaking ambulance placements - An integrative review.

Work integrated learning (WIL) in the ambulance setting is an essential part of the paramedic curriculum. However, qualified ambulance personnel are reported to experience higher suicide rates and mental stress disorders due to high pressure work environments, and there is growing concern for the wellbeing of students entering this setting. The aim of this integrative review was to explore how studies have reported paramedic students' experience of stress whilst undertaking WIL. Five studies met the inclusion criteria and were evaluated for quality according to validated tools from the Critical Appraisal Skills Program, then ranked on the level of evidence used. Data was summarised in a comprehensive research paper matrix, and findings were categorised into levels and sources of stress. Levels of stress were measured by the percentage of paramedic students who developed post-traumatic stress disorder. The primary sources of stress were experiencing death and fear of making clinical mistakes. Students also identified emotional expression as a negative attribute. Future research should prioritise identifying the levels and sources of stress students face in each year of their academic program when undertaking WIL to provide a direction for preparatory activities that may mitigate the negative effects of stress.

Patient experience of non-conveyance following emergency ambulance service response: A scoping review of the literature.

INTRODUCTION: Evolution of ambulance service response models has resulted in significant numbers of patients not being conveyed to Emergency Departments. Prior research has attempted to measure patient-safety aspects of non- conveyance with inconclusive results. Several authors have recommended investigation of patient experience as an alternative metric. Understanding patient experience is acknowledged as a core requirement for design and evaluation of changes to healthcare delivery. However, it is unclear to what extent patient experience of non-conveyance is described in academic literature. AIMS: To map scholarly literature that describes patient experience of non-conveyance and identify knowledge gaps that guide future research. METHODS: Scoping review guided by the Joanna Briggs Institute (JBI) framework. RESULTS: Ten studies of heterogenous methodology were included. Commonly, high levels of satisfaction with paramedic care were reported, yet contributing factors to satisfaction were generally not described. Qualitative studies provided deeper insight into experience. Value was attributed to reassurance and being empowered in the decision-making process. Not having concerns validated by paramedics led to negative experiences. CONCLUSION: There is a scarcity of quality research that has investigated patient experience of non-conveyance following emergency ambulance service response. Methods used by existing research is of low-quality. Patient experience of non-conveyance is not fully known.

Prehospital use of peripheral intravenous catheters and intraosseous devices: An integrative literature review of current practices and issues.

INTRODUCTION: Peripheral intravenous catheters and intraosseous devices have been widely used in the prehospital setting for a considerable period. Changes in technology and guidelines have led to an increase in situations where use of these devices in a prehospital setting is recommended. Despite being commonplace they are not without risk of harm to the patient. STUDY OBJECTIVE: To examine critically the research-based literature related to incidence of insertion of peripheral intravenous catheters and intraosseous devices, the use of these vascular access devices and to determine which health professionals insert them, most commonly, in the prehospital setting. METHODS: An integrative review was undertaken using material retrieved following a systematic search of research literature databases, grey literature and secondary sources written in English. No date limit was applied to the search and the searching was undertaken until September 2019. Articles specifically addressing peripheral intravenous catheter and intraosseous device use in the prehospital setting were selected. RESULTS: The search resulted in 20 articles being included in the review, 17 related to peripheral intravenous catheters and three for intraosseous devices. All articles related to observational studies across a variety of services and settings. CONCLUSION: The role of vascular access in the prehospital setting continues to be significant, particularly for patients who are critically unwell. This review identified that differences in service structure, geography and the patient's condition all impact on the insertion and use of these vascular access devices. Despite this there are limited data reported that can allow prehospital clinicians and services to benchmark their practice.

Listening to women's voices: the experience of giving birth with paramedic care in Queensland, Australia.

BACKGROUND: Unplanned out-of-hospital birth is generally assumed to occur for women who are multiparous, have a history of a short pushing phase of labour or are experiencing a precipitate birth. However, there is little research that examines the woman's perspective regarding factors that influenced their decision on when to access care. This research aimed to explore women's experience of unplanned out-of-hospital birth in paramedic care. Due to the size of the data in the larger study of 'Women's experience of unplanned out-of-hospital birth in paramedic care' [1], this paper will deal directly with the women's narrative concerning her decision to access care and how previous birth experience and interactions with other healthcare professionals influenced her experience. METHOD: Narrative inquiry, underpinned from a feminist perspective, was used to guide the research. Twenty-two women who had experienced an unplanned out-of-hospital birth within the last 5 years in Queensland, Australia engaged in this research. RESULTS: The decision of a woman in labour to attend hospital to birth her baby is influenced by information received from healthcare providers, fear of unnecessary medical intervention in birth, and previous birth experience. All themes and subthemes that emerged in the women's narratives relate to the notion of birth knowledge. These specifically include perceptions of what constitutes authoritative knowledge, who possesses the authoritative knowledge on which actions are based, and when and how women use their own embodied knowledge to assess the validity of healthcare workers' advice and the necessity for clinical intervention. CONCLUSIONS: The women interviewed communicated a tension between women's knowledge, beliefs and experience of the birth process, and the professional models of care traditionally associated with the hospital environment. It is essential that information provided to women antenatally is comprehensive and comprehensible. The decisions women make concerning their birth plan represent the women's expectations for their birth and this should be used as a means to openly communicate issues that may impact the birth experience.

Women's experience of unplanned out-of-hospital birth in paramedic care.

BACKGROUND: Healthcare literature describes predisposing factors, clinical risk, maternal and neonatal clinical outcomes of unplanned out-of-hospital birth; however, there is little quality research available that explores the experiences of mothers who birth prior to arrival at hospital. METHODS: This study utilised a narrative inquiry methodology to explore the experiences of women who birth in paramedic care. RESULTS: The inquiry was underscored by 22 narrative interviews of women who birthed in paramedic care in Queensland, Australia between 2011 and 2016. This data identified factors that contributed to the planned hospital birth occurring in the out-of-hospital setting. Women in this study began their story by discussing previous birth experience and their knowledge, expectations and personal beliefs concerning the birth process. Specific to the actual birth event, women reported feeling empowered, confident and exhilarated. However, some participants also identified concerns with paramedic practice; lack of privacy, poor interpersonal skills, and a lack of consent for certain procedures. CONCLUSIONS: This study identified several factors and a subset of factors that contributed to their experiences of the planned hospital birth occurring in the out-of-hospital setting. Women described opportunities for improvement in the care provided by paramedics, specifically some deficiencies in technical and interpersonal skills.

Influence of patient race on administration of analgesia by student paramedics.

BACKGROUND: Disparities in the management of pain are associated with factors that include social status, age and race. As there is limited data regarding the influence of race on analgesia provided by paramedics this study investigated associations between patient race and student paramedic management of pain. METHODS: Retrospective study of student paramedic records entered in the FISDAP Skill Tracker database between 1 January 2014 to 31 December 2015. Cases were extracted if aged 16 to 100 years, the patient was alert and the primary or secondary impression was trauma. The primary outcome of interest was the association between patient race and student paramedic administration of any analgesia. The adjusted odds of patients receiving any analgesic was tested with logistic regression using a stepped modelling approach. RESULTS: 59,915 cases were available for analysis; median age was 50 years (IQR 39 years), 50.1% were female (n = 30,040). Fall was the most common case type 43% (n = 26,009) of cases. 14.1% of patients received any analgesia (n = 8424). Caucasian patients have significantly higher odds of receiving analgesia than non-Caucasian patients (p < 0.001). When analgesic administration is adjusted for gender, age category and injury cause, African Americans have the lowest logged odds of receiving any analgesia when compared to Caucasian patients (OR 0.60, p < 0.001). CONCLUSION: The results indicate inequality in the provision of analgesia by student paramedics based on patient race. This suggests a need for interventions to reduce disparities in care based on race.

Palliative care in paramedic practice: A retrospective cohort study.

BACKGROUND: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic's role in the care of these patients. AIM: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. DESIGN: This is a retrospective cohort study. SETTING/PARTICIPANTS: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record. Secondary transfers including inter-hospital transport cases were excluded. RESULTS: A total of 4348 cases met inclusion criteria. Median age was 74 years (interquartile range 64-83). The most common paramedic assessments were 'respiratory' (20.1%), 'pain' (15.8%) and 'deceased' (7.9%); 74.4% ( n = 3237) were transported, with the most common destination being a hospital (99.5%, n = 3221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic, morphine, fentanyl or methoxyflurane, and 356 (99.2%) were transported following analgesic administration. Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 h of the previous attendance. CONCLUSION: Paramedics have a significant role in caring for patients receiving palliative care. These results should inform the design of integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.

Effects of the Introduction of Intranasal Fentanyl on Reduction of Pain Severity Score in Children: An Interrupted Time-Series Analysis.

OBJECTIVES: Children are at risk of inadequate analgesia due to paramedics' inexperience in assessing children and challenges in administering analgesics when the patient is distressed and uncooperative. This study reports on the outcome of a change to practice guidelines that added intranasal fentanyl and intramuscular morphine within a large statewide ambulance service. METHODS: This retrospective study included patients younger than 15 years treated by paramedics between January 2008 and December 2011. The primary outcome of interest was the proportion of patients having a 2/10 or greater reduction in pain severity score using an 11-point Verbal Numeric Rating Scale before and after the intervention. Segmented regression analysis was used to estimate the effect of the intervention over time. A multiple regression model calculated odds ratios with 95% confidence intervals. RESULTS: A total of 92,378 children were transported by paramedics during the study period, with 9833 cases included in the analysis. The median age was 11 years; 61.6% were male. Before the intervention, 88.1% (n = 3114) of children receiving analgesia had a reduction of pain severity of 2 or more points, with 94.2% (n = 5933) achieving this benchmark after intervention (P < 0.0001). The odds of a reduction in pain of 2 or more points increased by 1.01 per month immediately before the intervention and 2.33 after intervention (<0.0001). CONCLUSIONS: This large study of a system-wide clinical practice guideline change has demonstrated a significant improvement in the outcome of interest. However, a proportion of children with moderate to severe pain did not receive analgesia.

Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study.

OBJECTIVE: We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation. METHODS: We used a cross-sectional design with a 7-day retrospective sample of adults aged 18 years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0-10 numerical verbal pain score [NVPS]). RESULTS: We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p < 0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P < 0.01), attending patients aged 51 to 64 years (OR 2.04, 95% CI 1.21 to 3.45, p = 0.01), in moderate to severe (NVPS 4-10) compared with lower levels of pain for any clinical condition group compared with the reference condition. CONCLUSION: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.

Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report.

This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety.

Description of vital signs data measurement frequency in a medical/surgical unit at a community hospital in United States.

Vitals signs are measured at scheduled intervals by nurses in typical general wards. Vital signs may be measured more frequently if the patient condition deteriorates. In many units, the vital signs measurement frequency for some patients is different from the scheduled frequency due to various reasons such as staffing, patient acuity etc. In this article, we describe the actual measurement frequency in patients admitted to general ward in a community hospital in Arizona, US. We present the data in the form of 2 sets of graphs. The first set of graphs are histograms which show the distribution of the number of measurements in a 24 h period for 6 different vital signs. The second set of graphs show the proportion of the patient population who had a measurement of a vital sign for each hour of the last day of patient's general ward stay. The significance of this data on predicting deterioration is discussed in Ghosh et al. (2017) [1].

Early Deterioration Indicator: Data-driven approach to detecting deterioration in general ward.

INTRODUCTION: Early detection of deterioration could facilitate more timely interventions which are instrumental in reducing transfer to higher levels of care such as Intensive Care Unit (ICU) and mortality [1,2]. METHODS AND RESULTS: We developed the Early Deterioration Indicator (EDI) which uses log likelihood risk of vital signs to calculate continuous risk scores. EDI was developed using data from 11,864 general ward admissions. To validate EDI, we calculated EDI scores on an additional 2418 general ward stays and compared it to the Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS). EDI was trained using the most significant variables in predicting deterioration by leveraging the knowledge from a large dataset through data mining. It was implemented electronically for continuous automatic computation. The discriminative performance of EDI, MEWS, and NEWS was calculated before deterioration using the area under the receiver operating characteristic curve (AUROC). Additionally, the performance of the 3 scores for 24h prior to deterioration were computed. EDI was a better discriminator of deterioration than MEWS or NEWS; AUROC values for the validation dataset were: EDI - 0.7655, NEWS - 0.6569, MEWS - 0.6487. EDI also identified more patients likely to deteriorate for the same specificity as NEWS or MEWS. EDI had the best performance among the 3 scores for the last 24h of the patient stay. CONCLUSION: EDI detects more deteriorations for the same specificity as the other two scores. Our results show that EDI performs better at predicting deterioration than commonly used NEWS and MEWS.

Is unplanned out-of-hospital birth managed by paramedics 'infrequent', 'normal' and 'uncomplicated'?

BACKGROUND: Unplanned out-of-hospital birth is often perceived as precipitate in nature, 'infrequent', 'normal' and 'uncomplicated'. However, international studies report unplanned out-of-hospital birth is associated with increased rates of maternal and neonatal morbidity and mortality. This research describes intrapartum, immediate postpartum and neonatal care provided by paramedics in Queensland, Australia. The objectives were to (1) determine the number of cases where the paramedic documented birth or imminent birth during the study period (2) to describe the incidence of births prior to or during paramedic care (3) to detail any risk factors and/or complications recorded by paramedics during these cases, (4) identify paramedic pain management practices for intrapartum care, and (5) to examine the maternal and neonatal outcomes as documented by paramedics. METHOD: A retrospective analysis of Queensland Ambulance Service (QAS) de-identified patient care records, generated from clinical case data between the 1st of Jan 2010 and 31st of Dec 2011, was undertaken. Descriptive analysis and x 2 tests were used to test associations between categorical variables, and the Wilcoxon rank-sum for associates between continuous variables which were not normally distributed. Content analysis was utilised to code free text fields. RESULTS: Six thousand one hundred thirty-five records were identified as intrapartum cases. This represented approximately 0.5% of the annual QAS caseload; 5722 were classified as maternal records and 413 were neonatal records. Paramedics recorded antenatal and/or intrapartum complications in 27.3% (n = 1563) of cases. Abnormal maternal vital signs were recorded in 30.1% (n = 1725) of cases. Of the 5722 women attended by paramedics during their labour, a birth occured in 10.8% (n = 618) of cases. Parity was documented in 41.4% (n = 256) of mothers who birthed. Neonatal records were available for 66.8% (n = 413) of actual births, 60.0% (n = 248) recorded a full set of neonatal vital signs and an Apgar score. When an Apgar score was recorded, 21.8% (n = 91) scored ≤7 out of 10. CONCLUSIONS: The research described intrapartum, immediate postpartum and neonatal care provided by paramedics and identified factors that may complicate paramedic clinical management of labouring and birthing women. Further research is required to determine if there are opportunities to improve the paramedic management of such cases.

'Popping nana back into bed' - a qualitative exploration of paramedic decision making when caring for older people who have fallen.

BACKGROUND: Older fallers constitute a large proportion of ambulance work, and as many as 25% are not transported to hospital following paramedic assessment. The objective of this study was to explore the decision making process used by paramedics when caring for older fallers. METHODS: A qualitative study was conducted using constructivist grounded theory methodology. Purposive sampling was used to recruit paramedics to participate in semi-structured interviews and focus groups. Data analysis commenced with line-by-line coding, developing into formation of theoretical categories. Theoretical sampling was then used to clarify emerging theoretical concepts, with data collection and analysis continuing until theoretical saturation was achieved. RESULTS: A total of 33 paramedics participated in 13 interviews and 4 focus groups. When caring for older fallers, paramedic decision making is profoundly affected by 'role perception', in which the individual paramedic's perception of what the role of a paramedic is determines the nature of the decision making process. Transport decisions are heavily influenced by a sense of 'personal protection', or their confidence in the ambulance service supporting their decisions. 'Education and training' impacts on decision making capacity, and the nature of that training subliminally contributes to role perception. Role perception influences the sense of legitimacy a paramedic attaches to cases involving older fallers, impacting on patient assessment routines and the quality of subsequent decisions. CONCLUSIONS: Paramedic decision making processes when caring for older people who have fallen appear to be strongly influenced by their perception of what their role should be, and the perceived legitimacy of incidents involving older fallers as constituting 'real' paramedic work.

Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care.

BACKGROUND: Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care-associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care. METHODS: A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. RESULTS: Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. CONCLUSIONS: Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.

Enhancing Nursing and Midwifery Student Learning Through the Use of QR Codes.

A recent teaching and learning innovation using new technologies involves the use of quick response codes, which are read by smartphones and tablets. Integrating this technology as a teaching and learning strategy in nursing and midwifery education has been embraced by academics and students at a regional university.