British Paramedic Journal

360-degree projection simulation versus traditional simulation in undergraduate paramedicine education: a randomised controlled trial

2024-05-18T14:13:50+01:00

Introduction: Simulation is considered a mainstay for teaching and assessment in various clinical fields, including paramedicine. Simulation fidelity in educational practice is constantly changing to accommodate the integration of extended realities (XR) such as augmented, mixed, and virtual realities. However, there has been limited research that directly compares these newer, technology-enhanced methods, such as 360-degree projection simulation, to the traditional methods used in undergraduate education. The purpose of this research was to provide a direct comparison, exploring their effect on ratings of self-perceived performance in second-year paramedicine students.

Methods: Using a single site, parallel randomised controlled, non-blinded trial, participants were randomly allocated to a three-day intensive 360-degree projection (intervention) or traditional (control) simulation program. Ratings of self-perceived performance were collected using the Seattle University Simulation Evaluation tool at three different time points: after participants’ first simulation as “lead paramedic” on Day 1 of the intensive program (Rating 1), after their final simulation on Day 3 of the intensive program (Rating 2), and after their final simulation in a follow-up program after a nine-week washout period (Rating 3).

Results: Out of the 37 participants randomly allocated, 20 participants fulfilled the study requirements, with 11 in the 360-degree projection group, and 9 in the traditional simulation group. Participants reported a statistically significant difference in favour of traditional simulation, indicating higher ratings of self-perceived performance in comparison to the 360-degree projection simulation group (p = 0.04). While both groups showed a non-statistically significant difference in their improvement after the intensive program (Rating 2), a statistically significant difference was noted between groups at Rating 3 (p = 0.02).

Conclusions: This research indicated that measures of self-perceived performance were lower when using 360-degree projection simulation spaces. While there may be some benefit as an adjunct to current traditional methods used, further research is needed to understand the measure of effect in the practical setting and inform future educational interventions.

Funding: Australasian College of Paramedicine

Perceived benefits and limitations of remote decision-making support for ambulance clinicians in a single NHS trust.

2024-07-31T21:25:53+01:00

Background/Aim

Remote decision-making support (RDMS) systems for on-scene ambulance clinicians aim to improve patient safety, avoid unnecessary admissions, and promote appropriate referrals. In the relative absence of previous research, this qualitative study explored the perceived benefits and limitations of a well-established RDMS system in a single NHS ambulance trust. The system described involves Advanced Paramedic Practitioners (APPs) supporting colleagues via an Emergency Crew Advice telephone Line (ECAL).

Methods

Internally circulated invitations resulted in a convenience sample of twenty-seven participants attending online meetings for data collection. Eight meetings with a mean duration of 56 minutes were recorded and anonymised during transcription. A critical realist, experiential approach to thematic analysis was employed on transcripts to produce findings.

Findings

Participants reported various patterns of engagement with ECALs, but experienced paramedics were least involved. ECALs were perceived to benefit patient safety and clinical development, though their influence on appropriate care delivery was considered to be more limited. The information systems, capacity and capability of community care pathways varied considerably across the region, hindering urgent care navigation. Additionally, a cultural shift normalising collaborative decision-making was required that might be enabled by more proactive intervention, but only if ECAL interactions sustained trust in their effectiveness. Some participants had experience of initiatives where co-located community and emergency department clinicians augmented RDMS provision and perceived that these addressed many limitations identified.

Conclusion

This study suggests that RDMS is perceived as beneficial to patient safety and appropriate care delivery, and that APPs familiar with their region and with the clinicians on scene are well suited to provide this support. Collaborative decision-making requires honest and open interaction to be effective and needs to be more widely accepted as standard clinical practice. Improving the consistency and interoperability of community care pathways will maximise their value and inter-professional collaboration may facilitate this.

Exploration of menopause transition experiences of shift and office-working female ambulance staff in the UK: a grounded theory approach (CESSATION Phase 2).

2024-07-31T21:26:43+01:00

Background

Often women will experience the menopause and its associated symptoms during their working lives and there is now increased focus to improve menopause support offerings in the workplace.

Purpose

The aim of this study was to explore the menopause transition experiences of both shift and office-working ambulance staff and identify workplace interventions that may offer improved support to menopausal staff within the ambulance sector.

Methods

Adopting an interpretive approach, a purpose-designed, online survey was disseminated to UK ambulance services for voluntary completion during December 2021 – February 2022. Topics covered included participant age and role, menopause transition phase, symptoms experienced and their severity, expectation and effect of symptoms, work pattern, need for work leave and policy awareness. An opportunity for additional menopause-related comments was included. Quantitative data analysis was performed using descriptive and exploratory statistics; qualitative data were analysed using inductive thematic analysis.

Results

A convenience sample of 1896 survey responses was obtained, the majority of participants self-reported to be in the menopause transition. Pre- and peri-menopausal participants were more likely to undertake shift-based work; menopausal and post-menopausal participants were more prevalent in office-based roles. Shift-working participants reported more severe tiredness or low energy levels, hot flushes, night sweats and gastric problems, whilst office-working staff reported more severe issues with vaginal health, weight, skin changes and oral health. There were significant associations between role type, severity of symptom impact and need for leave from work. Recommended areas for organisational improvement to support menopausal women in the ambulance workplace are alternative work opportunities, menopause education and training, appropriate menopause policies and guidance, expert resources and support and access to improved physical work environment.

Conclusions

Women can experience menopausal symptoms that impact their working lives; their work role and setting can influence their menopause experiences. Workplace interventions for improved menopause awareness, support and staff wellbeing are warranted.

ECG Characteristics as Indicators of The Aetiology of Pulseless Electrical Activity: A Systematic Review

2024-07-12T12:16:35+01:00

Background

The incidence of pulseless electrical activity (PEA) as a presenting rhythm is rising in comparison to other rhythms. Prompt recognition of the cause of PEA can improve outcomes. The assessment of ECG characteristics during resuscitation has been suggested as a source of diagnostic information for clinicians.

The aim of this systematic review is to determine whether ECG characteristics can indicate the aetiology of PEA, and to critically appraise how these may be utilised in clinical practice.

Methods

Case series, observational studies, randomised controlled trials and empirical research investigating the ECG characteristics of adult patients and reporting the aetiology of PEA were searched for via a systematic literature search of the MEDLINE, CINAHL Plus and EMBASE databases. Searches for grey literature, and reference screening were also performed. A risk of bias assessment was performed for each included study.

Results

A total of 4 articles were selected for final inclusion. One study reported a statistically significant correlation between the presence of wide QRS complexes and hyperkalaemia. No further associations between ECG characteristics and the aetiology of arrest were reported. Three studies were found to be at moderate risk of bias due to incomplete inclusion of patients. Studies often assessed groups of aetiologies, rather than specific causes. Consequently, this limits their application in clinical practice.

Conclusion

ECG characteristics should not be used in isolation as an indicator of the aetiology of cardiac arrest in patients with PEA. The included studies often employed broad categorisations of aetiologies, limiting their ability to identify specific characteristics associated with individual causes.

Future research should include analysis of specific aetiologies and the evaluation of ECG characteristics to augment other diagnostic tools.

Providing feedback to Frontline Paramedics Recruiting Patients in a Clinical Trial of an Investigational Medicinal Product: A Service Evaluation within Yorkshire Ambulance Service

2024-11-10T20:10:38+00:00

Background: Many clinical trials within ambulance services, require trained frontline paramedics to directly recruit or enrol eligible patients. Research paramedics may then review study documents and often contact recruiting paramedics to provide feedback or obtain missing data. Using the example of the Paramedic Analgesia Comparing Ketamine and MorphiNe in trauma (PACKMaN) study, we aimed to evaluate the provision of feedback by the Yorkshire Ambulance Service (YAS) research team to recruiting paramedics.

Methods: This was an observational study using a qualitative design. Data collection was conducted in January 2023 and consisted of a focus group and document analysis. The focus group lasted 1 hour and involved nine YAS research staff involved in feedback provision. Preliminary results were presented to focus group members to facilitate member checking. Reviewed documents included written feedback sent by the local research team and a standard operating procedure on incidental clinical errors. Data was analysed using the Framework Method.

Results: Research paramedics provided recruiting paramedics with feedback on ‘research study activities’ e.g. missing data, (in)-eligible patients (not) enrolled, or study protocol (not) followed. Feedback on ‘clinical practice’ not related to research activities, but incidentally discovered, were not considered within the remit of research paramedics. Barriers were the lack of awareness of recruiting paramedics that feedback would be provided and a perception that unsolicited feedback is mostly negative. Using different formats to provide feedback and engaging in a dialogue with recruiting paramedics was seen to facilitate more meaningful feedback.

Conclusions: Training for recruiting paramedics should highlight that performance and documentation will be scrutinised as part of their involvement in the clinical trial. Although flexibility of local teams regarding feedback format and delivery was important, researchers planning interventional studies in ambulance services may wish to consider the impact of different ways of working with frontline clinicians in their protocol development and study evaluation.

Foreign language skills of student paramedics studying undergraduate Paramedic Science in the UK: A nationwide cross-sectional feasibility study

2024-09-10T09:50:54+01:00

Introduction

Effective communication is essential in healthcare, but language barriers between clinicians and patients can compromise care quality. The UK's diverse linguistic landscape, with a growing number of foreign language speakers with limited English proficiency, complicates these challenges. Despite the clinical advantages of clinicians having foreign language skills, paramedic education in the UK does not include formal language training. This study aims to evaluate the feasibility of assessing foreign language skills among student paramedics in the UK.

Methods

This feasibility study employed a quantitative, cross-sectional design using an online survey distributed to student paramedics across 24 higher education institutions in the UK during April and May 2024. The survey captured demographic data and language competencies. Descriptive statistics were used to analyse the data.

Results

Out of 105 respondents, 73 were female (69.5%), and the mean age was 23.65 (±8.25). Over half of the respondents (56/105, 53.3%) reported proficiency in at least one foreign language, predominantly European languages such as French (48.2%), Spanish (35.7%), and German (21.4%). Most respondents had beginner-level skills (64.3%), with no formal language training in their paramedic programs. However, 60 respondents (n=104, 57.7%) expressed interest in studying an optional foreign language module.

Discussion

The feasibility study successfully identified foreign language skills among student paramedics, revealing a significant proportion with basic proficiency. However, the findings are limited by potential self-selection bias and low response rates, suggesting the need for improved recruitment strategies. Despite these limitations, the study provides preliminary insights into the subject and methodological effectiveness to inform future research.

Conclusion

This feasibility study demonstrates the potential to capture foreign language skills among student paramedics. Addressing methodological challenges in future research will be essential to develop a valid and reliable methodology for a larger study.