Knowledge of Morphine Administration by Ambulance Paramedics: A Comparison of Two Clinical Levels of Paramedics

Objective: The purpose of this study is to identify any differences in adherence to morphine administration protocols between two clinical levels of paramedics within one emergency medical system in Australia. Methods: The participants were made up of 63 Advanced Care Paramedics (ACPs) who were trained in basic and intermediate life support and 45 Intensive Care Paramedics (ICPs) who were trained in advanced life support skills;all were operational and practicing paramedics qualified in morphine administration. Participants were required to complete a survey designed to assess their knowledge of morphine drug therapy protocol (DTP). The survey involved two sections: 1) demographics, and 2) questions related to two scenario-based cases. Scenario one was a cardiac case and scenario two was a pediatric case. Results: In scenario one, more intensive care paramedics administered the correct dose than the advanced care paramedics (25.4% vs. 4.4%;df = 101, P = 0.002);scenario two showed no statistically significant difference between the two groups (35.5% vs. 31.6%;df = 97, P = 0.3). Conclusion: The comparison of the two levels of paramedics and their adherence to drug protocols identified that ICPs had a higher rate than ACPs for adherence to morphine administration protocols for patients suffering cardiac related chest pain. The clinical differences may be based on the length of the opioid-administration training program, clinical exposure to morphine administration, work experience and length of qualifications as an ACP or ICP. Our findings suggest that there is a need for structured initial and ongoing continuing education programs in pain management to maintain knowledge and behavior in pain management strategies. Further research is also required into paramedic’s behavioral intention regarding morphine administration to also identify what constructs affect their intent to administer morphine.

Ambulance Records as an Information Source to Document and Prevent Fall Injuries in Sweden

In Sweden, there has been only limited documentation for injuries requiring ambulance responses. The main objective of this study is, through the use of historic data, to assess the suitability of ambulance records to describe circumstances with fall injuries. Methods: The injury events data around patients were sourced from the ambulance data register. Descriptive statistics were used to describe injured patients based on age group, type of injury, place of injury, injury mechanism and consequence of an injury event. Two-group comparison was performed with Pearson’s chi-squared. Predictors of transport to hospital were identified using logistic regression analyses. Result: Ambulance provides unique data on all injury events, with direct implications for translational research, public policy and clinical practice (safety promotion). In 2002 ambulance attended 3964 injured people which represents 14% of ambulance attended workload in Värmland county, Sweden. The most common trauma location was the traffic area followed by residential area and nursing home. These three injury sites account for 2320 cases (61.6%). The most common cause of injury was falls (63.9%) followed by contact with another person (26.5%). Contact with another person is the most common site of injury in the traffic area (79.5%), and men aged 25-66 years are overrepresented. Conclusion: Logistic regression found that, age-group and place code were significant predictor for being attended by ambulance. Traffic, home and nursing homes were over-represented injury environments (61.6%) that require special attention. Most injury cases occur in the home and nursing homes among people over 67 years of age. Surprisingly, most of the injury events in the traffic environment are about hitting another person. Paramedics can provide rich and valuable data on injury events. Registration of such data is entirely possible and desirable, and can be used in preventive work.

CBL教学在军事院校本科生心肺复苏教学中的应用

目的探讨CBL教学在军事院校本科生救护员心肺复苏教学中的应用效果。方法择五年制临床医学专业学生30人为研究对象,随机分为传统组(15人)和案例组(15人),传统组采用传统示范教学,案例组采用CBL教学,培训结束进行考核+问卷调查,比较两组教学效果。结果案例组学员理论成绩(34.64±1.20)、实践成绩(53.32±2.51)和总成绩(87.96±3.37)均要优于传统组,具有统计学意义(P<0.01);从教学方法整体评价、学习效果自我评价和学习趣味性和积极性三个方面的满意度调查显示,案例组总体满意度(8.11±0.43)显著高于传统组(5.13±0.39),具有统计学意义(P<0.01)。结论运用CBL教学法进行心肺复苏教学,可以有效提高教学效果,帮助学员建立信心,提高学习的积极性,进一步提高心肺复苏能力,也为其他实践类教学内容采用案例式教学方法提供参考。

Prevention of Mother-to-Child Transmission of Hepatitis B in the Urban District Health Baskuy Burkina Faso

Few studies have been conducted on the epidemiology in pregnancy in sub-Saharan Africa. This study aimed to improve the care of pregnant women infected with hepatitis B virus (VHB) and their newborns in the urban district health. Method: This study was conducted from 01/09/2014 to 01/09/2015. Study involved three types of data collection: a collection of data from health facilities involved in the project;repeated cross-sectional survey among health personnel;a pros- pective study of pregnant women identified positive for HBsAg and followed at the University Hospital Yalgado Ouédraogo (CHU-YO). Knowledge assessment was made among health staff and pregnant women using a knowledge score. Construction of the score came after a factorial analysis of multiple correspondences on population health workers surveyed in the first round (N = 119) on one hand and all pregnant women (N = 266) on the other hand. This had identified among the 79/19 questions, those that discriminated best knowledge of paramedics and pregnant women. For pregnant women, this score was then dichotomized from the center and logistic regression was performed to determine the sociodemographic, medical and obstetric characteristics that influenced it (p value < 005). Results: Health staff had been surveyed twice (N = 119/100). In general, the level of knowledge was good on targeted knowledge, both before and after training. No health worker routinely offered screening for hepatitis B among pregnant women attending antenatal clinics. Altogether 266 pregnant women HBsAg-positive were referred and followed CHU-YO. Half of the patients had a score lower than 2/17. Univariate analysis showed that variables such as education level influenced significantly the level of knowledge. Women with higher levels of education had a higher level of knowledge about the disease, compared to those of primary level [OR = 1.63;[1.34 to 1.99], p value < 0,001]. Newborns during the study period numbered 128 and the vaccine was made in the first 24 hours of life for 83.6% of them. Conclusion: routine screening for infection with VHB during pregnancy and improved knowledge of mothers is strongly reco- mmended in Burkina Faso.

Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran

BACKGROUND:Paramedic and emergency personnel may encounter directly many events that threat their own wellbeing during their daily work.This study was conducted to examine the prevalence rate of post-traumatic stress disorder(PTSD) among two groups of paramedic and emergency personnel in south-east Iran.METHODS:The study employed a descriptive design and was conducted in four hospital emergency wards and a pre-hospital emergency base supervised by Kerman Medical University.Using Mississippi PTSD,we assessed the prevalence rate in paramedics(n=150) and emergency personnel(n=250).RESULTS:The two groups had different levels of education,marital status,experience of traumatic events,work hours per month,and gender.Most(94%) of paramedic and hospital emergency personnel reported moderate PTSD.The two groups had significant different levels of PTSD in all subscale.CONCLUSION:The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.

Vaccination Coverage and the Risk of Hepatitis B Virus Infection amongst Medical and Paramedical Students Practicing at the Bamenda Regional Hospital in Cameroon Sub-Saharan Africa

Introduction: The endemic nature of hepatitis B virus (HBV) in Sub-Saharan Africa is a significant public health problem that places health care providers (medical students inclusive) at increased risk of occupational exposure. However, vaccination against HBV is not systematic among medical students in Cameroon. Thus, we sought to evaluate awareness and HBV vaccine coverage amongst medical students in Cameroon. Aim: The present study was aimed at determining the proportion of Medical and Paramedical students on internship at the Bamenda Regional Hospital (BRH) who are vaccinated and immune to hepatitis B virus (HBV). Methods: This was a hospital-based cross sectional study carried out at the BRH in Cameroon. Questionnaires were administered to 120 participants who signed an informed consent form and venous blood samples collected in dry tubes for the HBV-5 PANEL test. Data were collected within a period of two weeks. HBV vaccine status was defined as complete (3 doses), partial (1 or 2 doses), and unvaccinated. Results: Of 120 participants (87 females and 33 males), 56 (46.7%) were vaccinated at least once against HBV;15 (12.5%) were partially vaccinated and 41 (34.2%) completely vaccinated. Out of the 56 vaccinated individuals, only 13 (23.2%) were confirmed immunized against HBV by testing positive for hepatitis B surface antibodies. Only 3 (5.4%) students had done post-vaccination serologic test to confirm their immunized status. There was high exposure to potentially infected body fluids like blood (97.5%) and urine (87.5%). There was equally poor practice of adequate preventive measures like regular hand washing and the proper use of personal protective equipment. A prevalence of 3.1% of HBV amongst the unvaccinated group was recorded. Conclusion: Only 1 in 3 medical students had completed the HBV vaccination series and only 26.8% of this cohort was confirmed immunized against HBV. This highlights the need for improved health policies aimed at increasing access and coverage of HBV immunization in high risk groups such as health workers.

Knowledge,attitudes and practices concerning epilepsy among nurses and midwives working in primary health care settings in Ouagadougou of Burkina Faso

Background In developing countries,there is a lack of epilepsy knowledge among health workers.The objective of this study was to assess the knowledge,attitude and practice concerning epilepsy among nurses and midwives working in primary health care settings in Ouagadougou.Methods We carried out a cross-sectional study in the health districts of Ouagadougou from August 1st to September 15th,2017.All nurses and midwives working in three health districts were included in this study.Results A total of 213 participants with a mean age of 39.5 years were included in the survey;79.81%of them had a general certification in secondary education and 62%had a professional experience of more than 10 years.About 99%of the participants had not received training on epilepsy-related care during the last six months.In addition,74.5%of the participants had a good knowledge on epilepsy and 65%had a good practice toward epilepsy.The level of knowledge was associated with the workplace,years of training,and the professional experience.The level of knowledge about epilepsy was also associated with the level of education,while there was a significant link between professional status and nurses’level of practice in the management of seizures.Conclusions Efforts must be made to provide continuing education for nurses in order to improve their knowledge on epilepsy.

Pre hospital medical services and paramedic engagement in Australian health care - Improving the pathways of care through collaborative action

Paramedics Australasia(PA)is the national body representing paramedics engaged in delivery of pre hospital emergency health care.PA is thus uniquely positioned to provide insights into the role of pre hospital medicine in the continuum of care.Every day in Australia,patients are placed at risk of harm within the health-care system.These risks are particularly notable in pre hospital care where paramedics must often tend for patients under adverse operating conditions and per-form interventions that carry significant risks.Paramedics must make clinical judgements that may profoundly affect patient outcomes-often with no access to patient history.Pre hospital medicine has changed dramatically in recent years.Paramedic practice has evolved as a unique discipline combining medicine,public health and public safety.Contemporary pre hospital medical care is now provided by professionally qualified practitioners.These developments have been built on a strong evidence base demonstrating the capacity to enhance patient outcomes through appropriate clinical interventions.Paramedics and pre hospital service providers alike have had to overcome many challenges in this journey,not the least being the education,recruitment and retention of a professional workforce and the difficulties in funding the infrastructure upon which to build a comprehensive emergency response capability.The PA vision for pre hospital medicine is based on the premise that it is an essential part of primary health care and that its seamless integration into health care will better meet patient needs that might otherwise remain unfulfilled.Paramedics can provide a variety of community health services that are crucial in the provision of more comprehensive care,especially in rural and remote communities.PA has endorsed the philosophical approach to health care outlined in the 15 National Health and Hospitals Reform Commission Health Care Principles,and recommends the translation of those principles into the pre hospital medicine environment.Given those principles it is inexplicable how paramedics have remained unrecognised as health professionals and pre hospital medicine has been ignored as part of the health care reform process.Embracing the National Health and Hospitals Reform Commission principles should see pre hospital medicine forming not only part of the local health care system but also meshed into the fabric of the community.There should be community engagement in the assessment and evaluation of pre hospital medicine care and the regulation of practitioners under a national system of professional registration.These processes will better enable the benefits of holistic care to be realised.Despite the excellence and dedication of the paramedic workforce,PA recognises that formidable challenges remain in health care delivery.These include issues of equality and access,demographic coverage,safety and quality,as well as other workforce and resource issues that affect patient outcomes.Paramedics can assist in identifying and resolving many of these issues.Australia’s health system should provide suitably rapid pre hospital medical responses with levels of care appropriate to the circumstances of each patient.Paramedics moreover hold competencies that can provide prevention,evaluation,care,triage,referral and health advisory services that can be mobilised to enhance community healthcare resources.Access to professional paramedic services should thus form an integral part of the care regime available to the community.This should be an inter-professional model of healthcare practice founded on contributions from a dynamic mixture of professional expertise at all stages of the patient journey.In PA’s view,the virtual absence of references to the role and funding of paramedic services as a key component of the health care system at a national level is a grave oversight.A nationally driven policy perspective is needed that integrates pre hospital medicine into the health system.Fulfilling the PA vision of health care requires significant change in the way paramedic services are funded and administered.It will need advice from the best available minds and committed leadership within government and the health professions to bring the already demonstrated benefits of paramedic practice to the community.Many issues need to be addressed including:(a)Sustainable funding models under national access and equity principles;(b)Education,clinical training,staff recruitment and retention;(c)Safety and quality standards and the minimisation of patient risk;(d)Extended community care models in remote and low-volume settings;(e)Clinical governance,service accreditation and practitioner registration;(f)Adequacy of evidentiary data collection to assess patient outcomes,support service evaluation and underpin research;and(g)Infrastructure integration including communication networks and dynamic referral to manage external events and cope with capacity constraints.PA strongly believes that these issues cannot be considered in isolation.Pre hospital medicine practitioners must be involved in contributing their expertise in conjunction with other health professionals so as to create a seamless system of best practice care beginning at the point of need-the patient.To fulfil that promise PA has outlined a vision for the delivery of pre hospital medicine as part of an integrated health care system.Only by incorporating the input of paramedic clinicians into that national policy and operational arena can the best patient outcomes be achieved.