Session Theme: Models of Care – Systems
3MT: How do paramedics navigate conveyance decisions?
Alannah Morrison1, Alison Craswell1, Fiona Bogossian1
1UniSC, Sippy Downs, QLD, Australia
Introduction: Conveyance decision-making is central to paramedic care and patient safety. Referring patients away from the ED and to alternative care pathways or discharging patients at the scene is imperative to patient-centred care. While paramedicine has rapidly evolved over the past few decades, more research is needed to understand how paramedics navigate conveyance decisions.
Aims: This presentation explains how paramedics navigate conveyance decisions.
Methods: Constructivist grounded theory methodology was employed. Through purposive and theoretical sampling, a total of 19 participants were recruited resulting in 16 individual interviews and one asynchronous focus group with four participants. Using concurrent constant comparative analysis, data analysis commenced after the first interview to facilitate theoretical sampling and theoretical saturation.
Results: Three themes were revealed and one of the categories was: in the absence of certainty, defer to the ED. Although it became evident that paramedics were looking to provide certainty for the patient in relation to their triple-0 call there are numerous points of patient care that may provide uncertainties. Access to the patient’s past medical history was frequently a point of great uncertainty which paramedics were often unable to resolve. Moreover, access to diagnostic information or referral pathways limited the paramedic’s ability to provide certainty for the patient. Referring patients directly to the ED provided both paramedics and patients with the reassurance that they would gain certainty.
Conclusion: Conveyance decision-making is required as paramedics, often occurring with short timeframes, diverse situations, limited support, and uncertainty, however, defaulting to transferring all patients to the hospital may not facilitate treatment due to access block and ramping. More work needs to be completed by education providers, professional bodies, and employers to support paramedics to make safe patient-centred conveyance decisions.
Reimagining the ambulance services of the future: An evidence based redesign.
Timothy Makrides1,2
1Ambulance Tasmania, Hobart, Tasmania, Australia;
2Monash University, Melbourne, Victoria, Australia
Introduction: Over the past two decades, the demands placed on modern paramedic systems has significantly increased. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand. In this abstract, we present a rapid discussion of our recently completed research series (6 publications) completed as part of PhD exploring new and innovative systems of practice within paramedicine.
Methods: This fun, engaging and agile presentation will take the audience through a series of research publications exploring the history of paramedicine (narrative review), the identification of two novel system of practice (scoping review), a Delphi study, which used experts to define the new systems, and a survey which compared systems performance using prehospital quality indicators.
Results: in short, our research series identified two new systems of practice known as the Directive and Professionally Autonomous paramedic systems. Our panel of experts defined these two new systems, and we then compared them. The results of the comparison study showed a significant difference in performance of the two systems, with the Professionally Autonomous system (found in Australia, UK and NZ) outperforming the Directive system when compared using 11 domains of prehospital quality indicators.
Conclusion: Why is this important? This presentation is the first in the world which provides empirical evidence upon which base an argument for changes to system design. The work is designed to generate robust discussion and debate about contemporary paramedic system design. Our final paper in the presentation provides health leaders with a roadmap for change, tailored to their needs of their community.
Harnessing Global Insights for Local Action: Navigating Community Paramedicine Programs Across Borders
Brendan Shannon1, Alan Batt1, Georgette Eaton2, Matthew Leyenaar3, Peter O'Meara1, Tomas Barry4, Chelsea Lanos5, Gary Wingrove6, Brett Williams1, Michael Nolan5, Ray Carney4, JD Heffern5, Kelly-Ann Bowles1
1Monash University, Melbourne, VIC, Australia;
2Oxford University, London, Oxford, United Kingdom;
3University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada;
4PHECC, Nass, Co Kildare, Ireland;
5The County of Renfrew Paramedic Service, Pembroke, Ontario, Canada;
6International Roundtable on Community Paramedicine, Duluth, Minnesota, USA;
Introduction: Community paramedicine is an emerging area of paramedicine in Australia, but what international experience can be used to better inform its development? This study seeks to delve into the international shared experience, specifically, seeks to understand the importance of system-level integration and its implications for Australia's healthcare system.
Aim: The aim is to uncover key insights that could guide the development and implementation of community paramedicine programs in Australia, leveraging lessons learned from international experiences.
Methods: Participants from seven countries were chosen using a purposive sampling technique. They provided their insights via a bespoke survey designed to elicit open-ended responses. A qualitative reflexive thematic analysis was employed, using an inductive coding method at the semantic level, to create prominent themes from the participant responses.
Results: Valuable responses were gathered from 29 participants involved in the development or delivery of community paramedicine programs across seven countries. Three principal themes emerged from the data: (1) "Community Engagement and Responsiveness," highlighting the importance of adapting programs to meet specific community health needs; (2) "Establishing and Sustaining Collaborative Relationships," emphasizing the critical role of effective partnerships with diverse stakeholders for successful program integration; and (3) "Clear Communication and Role Clarification," focusing on the need for articulating roles, responsibilities, and program objectives clearly to dispel misconceptions and ensure smooth operation.
Conclusion: The study underscores the importance of community involvement, stakeholder collaboration, and effective communication in the successful implementation and management of community paramedicine programs. The shared international experiences provide valuable lessons for Australia, highlighting the need for a community-centred approach, effective stakeholder relationships, and clear communication strategies in the design and implementation of community paramedicine programs. The findings could significantly influence policy decisions and practical approaches in Australia's community health sector, leading to improved health service provision in diverse settings.
Parliament to the frontlines: Viewpoints on community paramedic specialists within emergency medical services
Matt Wilkinson-Stokes1, Celene Yap1, Di Crellin1, Ray Bange2, George Braitberg1, Marie Gerdtz1
1University of Melbourne, Melbourne, Victoria, Australia;
2University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
Introduction: In 2022, Australian jurisdictional ambulance services (JASs) responded to over 3.9 million patients, transporting 85% of these to an emergency department at a cost of $4.8 billion AUD. Over 60% were not classified as ‘emergency’ patients. Community Paramedics (CPs) specialising in urgent- primary care have existed for over a decade, and with increasing low acuity presentations to JASs their role continues to expand.
Aims: To explore stakeholder viewpoints on CPs within Australian JASs.
Methods: A multidisciplinary team including professors in medicine, nursing, and paramedicine was formed. From constructivist epistemology, inductive semantic and latent thematic analysis was completed using a 6-step process. Rigor and trustworthiness were ensured via 8 mechanisms, with a focus on reflexivity, credibility, transferability, dependability, and confirmability. 44 participants were selected purposefully and via open advertisement and interviewed in focus groups (n=11 groups) or individually (n=9): parliamentarians (n=2), Chief Officers (n=3), government executives (n=7), ED, GP, and paramedicine policymakers (n=5), JAS CEOs, medical directors, and mangers (n=7), academics (n=7), frontline clinicians in medicine, nursing, and paramedicine (n=8), and patients (n=5).
Results: There was strong consensus that consumer demand has fundamentally and permanently shifted to primarily low acuity, JASs are insufficiently integrated and have unrealistic risk aversion, MPDS is unfit for purpose, there is over- transportation to the ED, and multiple solutions should be pursued (17 identified by interviewees). A latent theme was that stakeholders are focussed on their own field, with a lack of overall ownership inhibiting collaborative solutions. There was compelling widespread support for CPs, with a small but avidly dissenting contingent of national policymakers.
Conclusion: This research reports stakeholder perspectives on CPs within Australian JASs. Five themes (facing reality, no silver bullet, finding the right space, the missing middle, and measuring success) were identified, with 13 sub-themes, 10 enablers, 11 barriers, and 7 outcomes of interest.
What is the relationship between professional registration, identity and professionalisation in Australian Paramedics?
Buck Reed1,2, Peter O'Meara3, Leanne Cowin1, Christine Metusela2, Ian Wilson2
1Western Sydney University, Campbelltown, NSW, Australia;
2University of Wollongong, Wollongong, NSW, Australia;
3Monash University, Frankston, VIC, Australia
Introduction: Australian paramedics became nationally registered in 2018. Previously, there was no national or central regulation of the profession with paramedics relying primarily on employer-based organisational regulation. As paramedics expanded their scope, role and range of employers, there was an increasing need for centralised professional regulation.
Aims: This study seeks to examine the impact of paramedic registration on identity and professionalisation. It examines perceptions of paramedics about impending regulation and the impact of regulation on the development of the profession in the period following its implementation.
Methods: Two surveys were undertaken, one pre- and one post-registration. The pre-registration survey deployed in the month prior to regulation commencing (N=419) and the second survey 31 months later (N=407). Analysis was undertaken within a social constructivist paradigm with quantitative analysis of numeric data, and qualitative analysis of textual data utilising Interpretive Phenomenological Analysis.
Results: Although support for regulation increased over time, strong minority dissent exists across both surveys. Some supported registration but were disappointed by its outcomes. Others rejected registration seeing it as divisive and oppressive. However, the majority registration and saw it as empowering to the profession. After 31 months of regulation, respondents reported increasing knowledge of the scheme and ease of navigation. Impacts of regulation became more nuanced and less polarised than in the first survey. Exploration of identity suggest a shift from employment status and qualifications as key elements to community of practice and registration.
Conclusion: Paramedics are coming to terms with increasing professionalisation. Regulation is one of many factors influencing professional identity and professionalism. Changes can be seen in identity and engagement with professional practice; however, this is nascent and deserving of additional research to track the profession as it evolves. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution.
Session Theme: Models of Care – Patients
3MT: The patient experience of accessing community healthcare in rural NSW: addressing barriers with alternative models of primary care.
Gregory Murphy1, Belinda Flanagan1, Louise Clark1
1University of Tasmania, Hobart, TAS, Australia
Introduction: People who live in rural and remote places have limited access to health services and significant barriers exist based on geographical location. Health equity is a key driver for health services presently and is explored through the experiences of people living with chronic disease.
Aims: The study aims to explore the primary outcome of rural community experiences for accessing health services and the potential feasibility to address any barriers with a mobile healthcare model.
Methods: A purposive sample of persons living in the northern rivers area of New South Wales with chronic health conditions were included for recruitment.
Narrative interviews explored their experience of accessing health services in rural areas. The analysis was conducted narratively, with a semantic approach used to identify explicit meanings within the data. Themes were drawn from the analysis using open coding.
Results: Participants with chronic health conditions reported various difficulties in accessing healthcare. Barriers included geographical remoteness, physical limitations related to their conditions, prolonged wait times for specialist referrals, and external social influences. Participants also highlighted environmental limitations such as the impact of recent extreme weather events and the COVID-19 pandemic, which further hindered their ability to address their healthcare needs.
Conclusion: Addressing the healthcare crisis in rural NSW has centred on boosting general practitioners and community nurses, however funding, employment, and retention remain challenging. Community paramedicine proposes a regional primary healthcare model, utilising paramedics to reach patients throughout NSW. Community paramedics, operating within an integrated healthcare practitioner framework, offer care coordination and augment existing workforce schemes. This approach presents a viable solution to the mounting barriers confronting patients with chronic health conditions.
Does parent/carer and paramedic choice for hospital destination differ in the setting of Children with Special Health Care Needs?
Tanie Stickland
1,2
1Monash University, Melbourne, Victoria, Australia;
2Ambulance Victoria, Melbourne, Victoria, Australia
Introduction: One of the most notable trends in child health has been the increase in the number of Children with Special Health Care Needs (CSHCN). They are an extraordinary group of children striving to live with some of the rarest, complex, functionally limiting and life-threatening health problems. When compared to other children, CSHCN have disproportionately higher rates of ambulance usage; emergency department presentations; inter-hospital transfers and hospital admissions.
Aims: The primary aim of this study was to determine if parent/carer and paramedic transport destination choice differs whilst also exploring factors influencing paramedic destination choice for transport of CSHCN.
Methods: A scoping review of OVID Medline, CINAHL, PubMed and Scopus were conducted including forwards and backwards citation searching in Google scholar. Title, abstract and full text screening were performed with the following inclusion criteria; paediatric patients aged <21; Children with Special Health Care Needs; children with complex care medical needs; any location; Prehospital/Paramedic/EMS/Emergency Department/Parent/Carer interactions; no date limit set.
Results: A yield of 21 articles were included in the final thematic analysis and summary, all of which were from the USA. Two major themes emerged: addressing gaps in transitional care to align parent/carer-paramedic preferences and parent/carer-paramedic preferences differ due to lack of paramedic awareness and competency. Current research acknowledges education gaps in paramedic training and limited exposure to paediatric cases leads to differing confidence levels in transport destination decision making and emphasises the importance of family-centred care.
Conclusion: Paramedics work in a dynamic stressful environment, with often limited and varying exposure to paediatric patients especially CSHCN. Future research is urgently needed to address three key areas: implementation of a family-centred approach to transport of CSHCN, education and training of paramedics and the development of an organisational-driven Clinical Practice Guideline specifically tailored for CSHCN.
A retrospective cohort study of the performance of MPDS in identifying patients requiring chest compressions at overdose prevention sites
Richard Armour1,2,3,4, Brian Grunau3,5,6, Sammy Iammarino7, Jane Buxton8,9, Brooke Kinniburgh7, Heather Burgess7, Suzanne Nielsen4, Kali Sedgemore7, Paul Choisil7, Linda Ross1
1Department of Paramedicine, Monash University, Melbourne, Victoria, Australia;
Ambulance Victoria, Melbourne, Victoria, Australia;
3British Columbia Resuscitation Research Collaborative, Vancouver, British Columbia, Canada;
4Monash Addiction Research Centre, Melbourne, Victoria, Australia;
5Department of Emergency Medicine, University of British Columbia & St Paul's Hospital, Vancouver, British Columbia, Canada;
6Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada;
7British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada;
8University of British Columbia, Vancouver, British Columbia, Canada;
9School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
Background & Aims: The medical priority dispatch system (MPDS) (R) is used in British Columbia to triage 9-1-1 calls according to patient acuity. With the on-going unregulated drug poisoning crisis, we sought to examine the performance of MPDS at overdose prevention sites (OPS) and supervised consumption sites (SCS) for the detection of patients requiring telephone cardiopulmonary resuscitation (T- CPR).
Methods: We conducted a retrospective cohort study of patients attended by the provincial emergency medical system between May 1st 2019 and January 31st 2023.
Results: The sensitivity and specificity of MPDS (R) at OPS/SCS were 66.7% and 87.3% respectively, compared with 62.4% and 98.1% in non-OPS/SCS locations. The positive predictive value of MPDS for T-CPR requirements was 0.32% vs. 35.7% in non-OPS/SCS locations. The negative predictive value of MPDS at OPS/SCS was 99.9%, compared with 99.4% in non-OPS/SCS locations.
Conclusion: Improved pre-arrival instructions for professional and para-professional responders at overdose prevention sites and supervised consumption sites require investigation.
Organ donation after out-of-hospital cardiac arrest in Canada - a potential role for paramedics
Chelsea Lanos1,2, Ian Drennan3, Karim Solimon4, Steve Lin5, Christian Vaillancourt6, Sonny Dhanani7, Dominique Cook2, Alan Batt8,9,
1County of Renfrew Paramedic Service, Pembroke, ON, Canada;
2Cardiff University, Cardiff, Wales, United Kingdom,
3Sunnybrook Hospital, Toronto, ON, Canada;
4Lakeridge Health, Oshawa, ON, Canada;
5St. Michael's Hospital, Toronto, ON, Canada;
6The Ottawa Hospital Research Institute, Ottawa, ON, Canada;
7The Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada;
8Monash University, Melbourne, VIC, Australia;
9Queen's University, Kingson, ON, Canada
Background: A rise in organ demand has led to exploration of non-traditional pathways for organ donation to increase the potential pool of donors and subsequent transplant recipients. One unexplored avenue in Canada is the inclusion of patients who suffer an out-of-hospital cardiac arrest (OHCA) into the pool of potential donors, of which there are an estimated 40,000 each year in Canada.
Aim: The primary objective of this study was to quantify the potential pool of donors that would be eligible for donation subsequent to OHCA.
Methods: A retrospective observational cohort study was undertaken using data from the Canadian Resuscitation Outcomes Consortium (CanROC) registry.
Consecutive OHCA cases from January 1, 2016 - December 31, 2018 meeting inclusion criteria were included. Several sets of international criteria for donation were applied to the study population in order to generate a range of donor potential.
Results: An additional 830 to 3727 potential donors could be identified (based on best-case versus worst-case criteria scenarios), which translates to an additional 1743 to 7827 organs retrieved per year. This pool of potential donors represents 18,824.4 to 84,531.6 Quality Adjusted Life Years (QALYs) for recipients.
Conclusions: This study demonstrates the viability of the adult OHCA population to increase the donor pool in Canada. However, design and implementation of such programmes would face challenging logistical, geographical, medical-legal and ethical barriers.
Patients’ experiences of non-conveyance following an Australian ambulance service paramedic response: A constructivist grounded theory exploration
Robbie King1, Florin Oprescu1, Bill Lord2,3, Belinda Flanagan4, Terri Downer1
1University of the Sunshine Coast, Sippy Downs, QLD, Australia;
2Monash University, Frankston, VIC, Australia;
3Australian Catholic University, Fitzroy, VIC, Australia;
4Tasmanian School of Paramedicine, Rozelle, NSW, Australia
Introduction: Understanding patient experience is essential for delivery of quality, safe, and effective healthcare. However, there is a scarcity of knowledge explaining how patients experience healthcare delivered by paramedics, particularly surrounding non-conveyance; where care results in a decision to not attend a hospital emergency department.
Aim: This research highlights evolution of the paramedic profession by aiming to explore patients’ lived experience of paramedic-led care that results in non- conveyance.
Methods: Constructivist Grounded Theory methods were used to generate and analyse data from semi-structured interviews with 21 participants, who received paramedic-led care in an Australian ambulance service setting between August 2020 and October 2021.
Results: A theoretical model explaining how patients experience non-conveyance was generated. This substantive theory consists of three categorical concepts and their interconnected relationships that centre on ‘Restoring self-efficacy’. ‘Losing independence’ conceptualises how a precipitating event forces patients to realise their circumstantial vulnerabilities; which if left unresolved, motivates action to seek paramedic support. ‘Restoring self-confidence’, was central to overall experience, and a key influence on patients navigating the non-conveyance decision. When patients perceive that they have received professionally thorough and compassionate healthcare from paramedics, they form a trusting partnership resulting in the interpretation their circumstances do not require conveyance to ED. With this reconstructed perspective, patients demonstrate increased ability for ‘Self-management’, by continuing to cope with their circumstances on their own after the episode of care.
Conclusion: Patient experience of non-conveyance is influenced by dynamic, complex factors associated with restoring their self-efficacy in relation to managing their health concerns. Restoration of self-efficacy was influenced during patients’ interaction with paramedics; particularly patients’ interpretation of paramedics combined professional (clinically thorough), and compassionate behaviours. This theoretical framework has direct impacts on the improvement of patient-centred care by informing paramedic education/practice, emergency ambulance system design, and design of patient-reported-experience measures.
Session Theme: Wellbeing
3MT: Self-compassion and PTSD symptoms in paramedics.
Julia Stone1, Sonja Maria1, Suzanne McLaren1
1Charles Sturt University, Bathurst, NSW, Australia
Introduction: Paramedics are exposed to potentially traumatic events repetitively throughout their career, increasing their risk of developing post-traumatic stress disorder (PTSD). Although estimates vary widely, paramedics appear to suffer from PTSD at even higher rates than their emergency service counterparts. Since trauma exposure is unavoidable for paramedics, factors protective against PTSD must be sought. On this front, self-compassion is a promising avenue of research. To be self-compassionate means to offer oneself the same support that would be offered to a friend going through the same difficult experience. Higher levels of self-compassion have been associated with lower PTSD severity and shorter duration of symptoms in both military and civilian samples, however this has not yet been explored in the paramedic population.
Aims: The aims of this study were to estimate the prevalence of PTSD among paramedics and establish whether self-compassion significantly explains variance in PTSD symptom severity among paramedics.
Methods: Paramedics (n = 334) with emergency ambulance experience (>12 months) in Australia, New Zealand, or the United Kingdom anonymously completed an online survey which assessed self-compassion, PTSD symptoms and depression using validated psychometric tools.
Results: Criteria for probable PTSD was met in 28.4% of participants. Hierarchical multiple regression revealed that self-compassion explained a significant amount of variance in PTSD symptom severity in paramedics. That is, higher levels of self- compassion predicted lower levels of PTSD symptoms, even after controlling for effects of depressive symptoms and demographic variables.
Conclusion: The prevalence of probable PTSD in the current sample of paramedics is concerningly high, supporting previous findings. This is the first study to confirm that levels of self-compassion significantly explain severity of PTSD symptoms in paramedics. Further investigation of self-compassion as a potential protective factor is warranted.
Identifying organ donors attended by prehospital healthcare professionals: A scoping review
Ben Lawson1, Tim Andrews1, Brett Williams1
1Monash University, Melbourne, Victoria, Australia
Introduction: Organ donation is a life-saving intervention that provides hope for patients with end-stage organ failure, improving their longevity and quality of life. However, the demand for organs far exceeds the supply, leading to a significant disparity between patients on transplant waiting lists and the availability of suitable organs. To address this issue, innovative strategies, such as uncontrolled donation after circulatory death (uDCD) programs, have been proposed to expand the donor pool to the prehospital setting.
Aim: This study aimed to systematically map the literature and comprehensively evaluate the involvement of prehospital healthcare professionals in identifying potential organ donors, as well as the barriers and systems impacting this process.
Methods: A scoping literature review was conducted guided by the PRISMA Extension for Scoping Reviews. Four electronic databases and grey literature were searched for articles examining the participation of prehospital healthcare professionals in the organ or tissue donation process. Relevant data were extracted, organised into narrative and tabular formats, and presented.
Results: A total of 33 articles were included for analysis, predominantly focusing on uDCD programs. The review identified a limited evidence-base regarding the role of prehospital healthcare professionals in organ donation. Four common themes emerged: discrepancies in criteria, decision-making processes, bridging strategies, and ethical considerations.
Conclusion: This scoping literature review highlights the significant role of prehospital healthcare professionals in identifying and recruiting organ donors from non-traditional settings. Established uDCD systems show promise in alleviating the burden on transplant waitlists. However, there is a lack of consensus on enrolment criteria, transportation, and ethical considerations for uDCD. Further research is needed to address these gaps, establish evidence-based guidelines, and ensure the efficient and ethical utilisation of potential organ donors from unconventional settings.
“It’s just frustrating…” The experiences of paramedics interacting with aged care staff: A phenomenological study
Sascha Baldry1, Paul Simpson1, Liz Thyer1
1Western Sydney University, Campbelltown, NSW, Australia
Introduction: Australian jurisdictional ambulance services (JAS) respond to residential aged care facilities (RACF) regularly, and yet the paramedics providing clinical care to this population are poorly represented in the research examining practice and policy within this area of elder care. Every paramedic attendance requires an interaction with RACF staff and yet research into this interprofessional relationship is scarce.
Aims: This study aimed to provide an understanding of the paramedic experience of interacting with aged care staff from an underrepresented perspective.
Methods: Giorgi & Giorgi’s descriptive phenomenological method was used throughout the data collection and to analyse the transcripts of online, individual interviews conducted with paramedics employed by a JAS in four different Australian states and territories. Data saturation was achieved by the conclusion of the seventh interview.
Results: Why an ambulance was called, and whether that call was deemed genuine in the eyes of paramedics, formed a key element of the essential structure. Paramedics expected that staff knew the residents in their care but acknowledged that this could be hindered due to workload pressures, while obstructed access to the facility led to feelings of frustration and animosity. There was an expectation that nursing staff could capably manage an acutely unwell resident and that they would handover accurate and detailed clinical information. Paramedics sometimes used transport to hospital as a “desire path” or for reasons other than clinical necessity and their experiences changed over time due to lowered expectations.
Conclusion: This study generated a rich description of the lived experience of paramedics interacting with aged care staff. It emphasises the impact that constructive communication and professional collaboration has on interprofessional practice, and resident outcomes, in the aged care setting.
Out-of-hospital paramedic interactions with people living with dementia: A Scoping Review
Max Han1, Linda Ross1, David Anderson1,2,3, Liam Hemingway1, Cameron Gosling1
1Monash University, Melbourne, Victoria, Australia;
2Alfred Hospital, Melbourne, Victoria, Australia;
3Ambulance Victoria, Melbourne, Victoria, Australia
Background/Aims: Dementia encompasses neurodegenerative disorders that account for a projected $2 trillion disease burden worldwide. One in 12 Australians aged 65 and over have a diagnosis of dementia – which is also the leading cause of death in this age group. Paramedics pervade the community care space and play a crucial role in person-centred dementia care. Given a recent Delphi consensus on paramedic’s integration in inter-disciplinary care teams, the lack of clarity regarding the paramedic role in dementia care requires attention. This scoping review aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting.
Methods: This study was guided by the JBI scoping review framework. Databases were searched from inception until Apr 4th 2023 including OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English, reporting on paramedic-specific interactions with people living with dementia. Data extraction was performed based on study setting, design, and key findings.
Results: Twenty-nine articles were included in the thematic analysis. Three themes emerged: need for training, patterns of attendances and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and fearful of caring for patients living with dementia. They were often called as a last-resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated.
Under-documentation of dementia and pain were found.
Conclusion: Emergency ambulance conveyance of patients living with dementia is a superficial reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to facilitate paramedicine’s recognition as an entity in multidisciplinary dementia care.
I’m not religious but thank God you’re here: A mixed methods study exploring chaplains in Australian Ambulance services
Katie Tunks Leach1, Joanne Lewis2, Paul Simpson3, Tracy Levett-Jones1
1University of Technology Sydney, Sydney, NSW, Australia;
2Avondale University, Sydney, NSW, Australia;
3Western Sydney University, Sydney, NSW, Australia
The inclusion of chaplains in Australian ambulance services remains contentious, as the belief that chaplains only provide religious support to religious people prevails. However, contemporary pastoral and spiritual care has evolved to support all people, regardless of belief/non-belief. Additionally, significant research has demonstrated strong connections between people’s beliefs and health outcomes, including conditions impacting paramedic wellbeing such as post-traumatic growth and burnout. Yet little is known about the role of spiritual care in ambulance or its impact on paramedics. The aim of this study was to explore the role and value of chaplains in Australian ambulance services. This exploratory sequential mixed-methods study began with qualitative semi-structured interviews with paramedics and chaplains in one jurisdictional service (Phase 1).
Findings informed the development of a survey grounded in paramedic culture (Phase 2). The survey was then distributed to AHPRA-registered Paramedics across Australia between Nov-Dec 2022 (Phase 3). Findings from the interviews with 17 paramedics and 13 chaplains were integrated with the 150 survey responses. The four themes identified were: 1) Chaplains provided proactive care to paramedics in their workspaces, and reactive care to bystanders at significant jobs; 2) Employing, training and equipping the right chaplain promoted chaplain use, however poor role clarity or clear standards of practice were barriers; 3) Those who had sought chaplain care reported that value arose from knowing a chaplain and having access to them in their workspaces, which reduced barriers to accessing support and promoted participation in supportive conversations; and 4) Not only religious people sought chaplain care. Paramedics reported that when there was relationship and trust, chaplains positively impacted their wellbeing, regardless of personal beliefs. However, to meet the needs of more paramedics, ambulance services should pivot toward contemporary models of spiritual care based on clear standards for practice, and represent more diverse backgrounds.
Session Theme: Workplace Culture
3MT: Exploring the perceptions and experiences of Australian female paramedics through creative arts-based research
Lisa Hobbs1, Rebecca Scollen1, Beata Batorowicz1, Scott Devenish2
1University of Southern Queensland, Ipswich, QLD, Australia;
2Australian Catholic University, Banyo, QLD, Australia
Introduction: Over the last 30 years, Australian ambulance service culture has moved from a male dominated profession to be more inclusive of female paramedics in the workforce. During this transitional phase the perceptions and experiences of women in paramedicine have been largely unreported or anecdotal. This PhD study explores the perceptions and experiences of female paramedics who have worked in the paramedic profession during the gradual feminisation of Australian ambulance service culture.
Aims: This qualitative study merges creative arts-based research and constructivist grounded theory. The following research sub-questions are addressed in the study: In what ways do female paramedics feel that Australian ambulance service culture has made changes to facilitate the feminisation of the paramedic workforce? In what ways/to what extent has industry modified core business to accommodate the increasing number of women in the workforce? In what ways/to what extent have female paramedics modified their personal and/or professional lives to enable a career in paramedicine? In what ways/to what extent have industry and women adapted to orchestrate a cultural change in the paramedic industry?
Methods: The project consists of an online anonymous survey, semi-structed interviews with creative element, and researcher generated creative outputs, to explore the rich and deep experiences of women working in this historically male dominated profession.
Results: Stage One emerging results suggest women feel silenced or unheard on several topics including but not limited to perceived gender imbalance in relation to career progression; hidden costs associated with flexible work arrangements; experiences of sexual harassment and sexual assault; lack of appropriate organisational policy supporting women in the paramedic workforce; and female specific issues such as lactation and menstruation in the operational environment.
Conclusion: This study has potential to un-silence female paramedics, generate new knowledge and to fill a gap in paramedicine literature.
Review of Australasian Ambulance Service Fatigue Risk Management Systems (FRMS)
Matthew Ferris1,2, Kelly-Ann Bowles3,4, Alexander Wolkow5, Aislinn Lalor6,7
1Monash University, Clayton, VIC, Australia;
2Queensland Ambulance Service, Gold Coast, QLD, Australia;
3Paramedic Health and Wellbeing Research Unit (PHAWRU), Frankston, VIC, Australia;
4Monash University, Frankston, VIC, Australia;
5Turner Institute for Brain and Mental Health, Notting Hill, VIC, Australia;
6Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Frankston, VIC, Australia;
7Department of Occupational Therapy, Frankston, VIC, Australia
Introduction: Fatigue in paramedics is widely documented and reported. Jurisdictional ambulance services employ Fatigue Risk Management Systems (FRMS), which typically include policies, procedures and work instructions aiming to acknowledge and manage the fatigue risk associated with unpredictable, pre- hospital work. While emerging evidence suggests FRMS could be enhanced to better safeguard the wellbeing of paramedics, a critical step in this process is to first identify and compare the FRMS in operation across different ambulance services.
Aims: This study aims to report on the current state-of-play of ambulance service FRMS frameworks in Australasia.
Methods: A Qualitative Document Analysis study design was used. Eleven ambulance services across the Australasia region (Australia, New Zealand and Papua New Guinea), represented by the Council of Ambulance Authorities, were invited to participate in this study. Content analysis of supplied frameworks was conducted in NVivo across three a priori determined key areas of interest: general fatigue management, fatigue monitoring devices, and fatigue mitigation.
Results: Most Australasian services responded to participate in this study (n=9). Jurisdictional services employed several similar fatigue monitoring devices; however, it was noteworthy their risk appetite and implementation of devices varied. There was also variation between jurisdictional fatigue definitions, which is consistent with existing fatigue literature. Further, there were some similar fatigue mitigation strategies, yet multiple variations. Finally, there was minimal consideration by jurisdictional services on fatigue issues in varying geographical terrain or varying staffing arrangements.
Conclusion: Our findings provide insight into existing ambulance service FRMS frameworks across Australasia and present opportunities to enhance fatigue management across the paramedic sector and promote collaboration between services. The inconsistencies between FRMS highlights the need for further research on paramedic fatigue management and mitigation to promote a consistent approach across Australasia.
The F word: Perceptions and attitudes about fatigue among Australian paramedics
Sian Wanstall1, Anjum Naweed2, Brandon Brown1, Meagan Crowther1, Tim Rayner1, Robert Adams1, Amy Reynolds1
1Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, SA, Australia;
2Appleton Institute, CQUniversity, Australia, Adelaide, SA, Australia
Introduction: Australian paramedics experience high levels of fatigue due to occupational requirements including shift work and acute job demands. Fatigue is associated with poor physical and mental wellbeing, burnout, absenteeism, and impaired performance and safety; consequently, effective management is important. Discerning how paramedics understand and experience fatigue is critical for effective design and implementation of fatigue risk management systems, as well as sleep and fatigue educational interventions for workers and organisations. Yet, perceptions and attitudes about fatigue among Australian paramedics are under-researched.
Aims: This qualitative study explored the lived experience of fatigue among Australian paramedics to better understand perceptions and attitudes surrounding fatigue.
Methods: Thirty registered Australian paramedics (31.0 ± 5.4 years, average occupational experience 5.5 years) participated in a semi-structured interview. A scenario invention task was used to elicit insights into fatigue experiences while managing challenging scenarios typically encountered in paramedic roles. Forty- one hours of transcribed data were analysed using inductive thematic analysis.
Results: Preliminary interpretation of findings suggest that Australian paramedics experience high levels of fatigue and perceive multiple causes beyond time of day and shift timings. These include ramping, high workload, no breaks, limited leave access, low acuity work, and post-shift overtime. Paramedics reported physical, mental, and emotional fatigue, which is often perceived to be a normal part of the paramedic identity and experience. Early themes include a survival mentality and normalisation of fatigue to cope, poor relationships between paramedics and their employers related to fatigue management, and fear and stigmatisation of formally reporting fatigue. A culture of under-reporting fatigue and limited knowledge of fatigue management policies and screening tools was evident.
Conclusion: There are numerous barriers to effective fatigue management in Australian paramedics. Considerations for how to address these include involving paramedics during the design of organisational fatigue management policies, developing alternative fatigue screening tools, and education.
The impact of workplace factors, workload and culture on the medication safety practices of paramedics
Dennis Walker1, Janet Hou2, David Long1, Brendan SueSee3, Clint Moloney4,
1University of Southern Queensland, Ipswich, Queensland, Australia;
2University of Queensland, St Lucia, Queensland, Australia;
3University of Southern Queensland, Springfield, Queensland, Australia;
4University of Southern Queensland, Toowoomba, Queensland, Australia
Introduction: Established guidelines for medications safety focus on hospital, pharmacy, nursing and operating theatre settings, with little to no mention of paramedic practice. A systematic review published in 2022 established the factors that contribute to medication safety in paramedic practice. This study builds on that work to quantify those factors contributing to medication errors in paramedic practice, both in terms of their contribution to known errors and their prevalence in paramedic practice.
Aims: The study seeks to quantify the workplace factors contributing to medication errors in paramedic practice.
Methods: This study utilised a cross-sectional methodology. Data was collected from 135 registered paramedics and student paramedics within Australasia using an online survey tool. Descriptive and relational statistics were generated using SPSS.
Results: 65.2% of participants experienced fatigue at work on at least a weekly basis, 16.9% during every shift. Shifts were extended beyond scheduled finishing time every day worked for 46.8% of participants, with 81.5% stating this occurred at least weekly. Less than 50% of respondents agreed (or strongly agreed) that medication errors were managed fairly (46.4%), transparently (38.2%), confidentially (43.1%) and supportive of the paramedic making the error (44.5%) in their organisation. 78% of respondents had personally witnessed a medication error. Of the medication errors witnessed, 29.8% were not reported. Fatigue, time pressure, distractions, failure of cross-checking procedures and communication breakdowns were rated as the top 5 contributors to medication errors.
Conclusions: A range of factors within the workplace influence medication safety, however fatigue appears to be both very common and a contributor to the majority of witnessed medication errors. Reporting of errors remains an issue, which could be improved with better medication safety culture. This study was limited by sample size; further research is required to determine relationships between identified factors.
Workplace sexual harassment experiences of early-career female paramedics in New South Wales.
Grace Madden1, Jessica Biles1, Alisha McFarlane1
1Charles Sturt University, Port Macquarie, NSW, Australia
Introduction: The numerical representation of female paramedics has transformed significantly over the decades; however, gender parity is yet to be achieved nor has gender equality. Workplace sexual harassment (WSH) in cognate professions identifies most (but not all) victims as females. Limited research on WSH as part of the paramedic culture is available and requires further exploration.
Aim: This research study investigated the WSH experiences of early-career female paramedics in New South Wales (NSW). It explored what these experiences involved for women in the profession and the effects of these experiences on the individual.
Methods: This research study employed a qualitative design, utilising an interpretive phenomenological approach. This research answered two research questions: What are the workplace sexual harassment experiences of early-career female paramedics in NSW? What is the impact these experiences have on the individual? Semi-structured interviews (n=4), conducted via online Zoom™ followed by data analysis occurred over four months. Data analysis was informed by Braun & Clarke’s six-step method.
Results: This study found that all participants experienced WSH within paramedicine and the identification of the impacts of these experiences were addressed. The experiences of participants are discussed through four major themes: Men, women, and power in paramedicine; The old boys club; Workplace sexual harassment in paramedicine; Silence, invisibility, and hope. Implications on the individual, organisation, and delivery of service because of WSH were identified by all participants in this study.
Conclusion: The identification of these WSH experiences in paramedicine will provide guidance, support, and change to other females subject to similar experiences in both paramedicine and cognate professions. This study will contribute to ongoing research into WSH and provide insight into experiences that may facilitate change in paramedicine and other male-dominated professions.
Session Theme: Clinical Improvement
Chronic Pain in the Paramedic Practice Setting - A Qualitative Study of Patients’ Perspective
Lucinda Peacock1,2, Rachel Lewandowsky2, Kelly-Ann Bowles1, Bill Lord1,3, Tim Andrews1,4,
1Monash University, Frankston, VIC, Australia;
2NSW Ambulance, Rozelle, NSW, Australia;
3Australian Catholic University, Fitzroy, Vic, Australia;
4Ambulance Victoria, Doncaster, VIC, Australia
Introduction: Chronic pain is highly prevalent in the community and has a significant impact on the Australian population. Chronic pain is now recognised by the ICD, which has allowed for the development of a unique evidence-based approach to caring for these patients, incorporating the biological, psychological and social dimensions in which chronic pain transverses. However, in the paramedic practice setting, chronic pain has received scant mention. This knowledge gap includes many Australian paramedics operating without guidelines suitable for the care of chronic pain patients. Eight jurisdictional ambulance services operate within Australia's states and territories, however only three services guidelines include any reference to patients with chronic pain.
Additionally, there is no reporting of the incidence of chronic pain presentations to the paramedic practice setting or most importantly, literature exploring the perspective and experiences of this cohort.
Aims: To describe and understand the experience of patients requiring ambulance attendance for chronic pain related complaints.
Methods: Qualitative semi-structured interviews conducted via Zoom with six participants. Interviews were audio and video recorded, then transcribed. Analysis was performed using reflexive thematic analysis.
Results: The six participant interviews revealed two connected themes; ‘the impact of stigma’ and ‘inadequate paramedic education’. Most participants shared similar attitudes and experiences towards paramedic management expressing dissatisfaction with the current standard of practice in relation to chronic pain complaints, voicing desire for change.
Conclusion: Results from this study demonstrate that there is significant room for improvement in the way chronic pain patients are managed in the paramedic practice setting. These findings highlight the potential benefit chronic pain patients could experience by further research being conducted in this area.
Working toward a more structured and collaborative approach may alleviate some of the concerns raised by patients surrounding both stigma and education.
Assessment of optimal methods for preoxygenation in prehospital emergency anaesthesia
Hannah Lindsay1, Benjamin Meadley1,2, Matthew Humar1,2
1Monash University, Frankston, Vic, Australia;
2Ambulance Victoria, Doncaster, Vic, Australia
Introduction: Oxygen desaturation is a potentially life-threatening complication of prehospital emergency anaesthesia (PHEA). To reduce the risk of this, preoxygenation with a bag-valve-mask (BVM) device that delivers 100% oxygen is crucial. Studies have shown that preoxygenation with a BVM and reservoir bag with 15L.min-1 oxygen flow can deliver a high oxygenation concentration and extend safe apnoea time. The impact of alternative preoxygenation methods is unclear.
Aims: This study compared a demand-driven oxygen refill valve connected to a bag-valve-mask (BVM+RV), with a BVM and reservoir bag with 15L.min-1 oxygen flow (BVM15). The primary outcome was percentage of expired oxygen (ETO2) at 1 and 3 minutes. The secondary outcome was ETO2 at 1 and 3 minutes with nasal cannulae (NC) added at 15L.min-1 oxygen flow (BVM+RV+NC, and BVM15+NC).
Methods: Eleven healthy volunteers were recruited and provided informed consent. Participants were randomised to each of four methods (BVM+RV, BVM15, BVM+RV+NV, BVM15+NC), and were oxygenated for 3 minutes whilst lying supine and spontaneously breathing.
Results: When comparing BVM+RV to BVM15, there was no difference between in EtO2 at 1min (BVM+RV 70.1 (±12.7)%, vs BVM15 64.4 (±9.4)%, p = 0.994), or 3min (BVM+RV 83.3 (±7.9)%, vs BVM15 85.0 (±2.6)%, p>0.999). However, when adding NC there was a significant difference between BVM15 at 1min (64.4 (±9.4%), vs BVM15+NC (86.3 (±3.2)%, p = 0.011), and BVM15 (85.0 (±2.6)%, vs BVM15+NC 91.3 (±1.7)%, p = 0.004) at 3min.
Conclusion: At the 1- and 3-minute timepoints, expired oxygen percentage was similar for BVM+RV and BVM15. The addition of NC to both methods increased EtO2 significantly. Irrespective of the oxygenation device, addition of NC is likely to be beneficial for preoxygenation during PHEA. Further research is required to determine if these findings are replicated in critically unwell patients.
Development of an international CPR-Induced Consciousness guideline: A Delphi study
Jack Howard1,2, Eystein Grusd3, Don Rice4, Nikiah Nudell5,6, Carlos Lipscombe1,7, Matthew Shepherd1,2, Alexander Olaussen1,8,9,10
1Department of Paramedicine, Monash University, Melbourne, Victoria, Australia;
2Ambulance Victoria, Melbourne, Victoria, Australia;
3Department of Health Sciences Gjøvik, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Gjøvik, Gjøvik, Norway;
4University of Nebraska Medical Center, Omaha, Nebraska, USA;
5Trauma Research Department, Medical Center of the Rockies, UCHealth, Loveland, Colorado, USA;
6The Paramedic Foundation, Dunluth, Minnesota, USA;
7London Ambulance Service NHS Trust, London, London, United Kingdom;
8National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia;
9Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia;
10School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Introduction: Improved prehospital systems are contributing to increased presentations of CPR- Induced Consciousness (CPRIC). Data registries do not report CPRIC presentations and thus continued lack of evidence exists, causing a significant variation of prehospital CPRIC management guidelines. The result is variation in recognising and managing CPRIC. Steps are needed to improve knowledge of CPRIC and model evidence-based guidelines.
Aims: An international panel of experts was recruited to create CPRIC definitions, guidelines, and a reporting framework which can be used for reporting purposes.
Methods: A Delphi methodology was used to gain consensus, defined as ≥70% agreement rate, on three domains or areas of interest: Definition, management guideline and data reporting. Participants were invited from the author’s professional organizations, as well as social media outlets to recruit as many international clinicians as possible. The study administered four rounds of online surveys. Each round had multiple consensus statements for participants to respond to.
Results: Eighty-two percent of panellists reported seeing or managing CPRIC suggesting either improved awareness or increased exposure. Consensus was achieved in all three domains. There was agreement on a clear definition of CPRIC. The panel developed two subgroups of CPRIC; interfering and non-interfering CPRIC. Ketamine was the preferred choice to treat CPRIC. Panellists overwhelmingly felt CPRIC needed to be included into the Utstein guidelines.
Conclusions: This study successfully created definitions of CPRIC, management guidelines, and a data reporting framework. Using this study as a building block, the study team hopes stronger, evidence-based guidelines can now be researched and published.
Direct admission versus inter-hospital transfer to a level I trauma unit does not improve survival following severe traumatic brain injury
Bianca Hardcastle1, Timothy Hardcastle1,2, Simpiwe Sobuwa3
1Department of Emergency Medical Care & Rescue, Durban University of Technology, Durban, KwaZulu-Natal, South Africa;
2Honorary Associate Professor of Trauma and Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa;
3Department of Emergency Medical Sciences, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
Introduction: Traumatic brain injury (TBI) remains the source of international mortality and morbidity, surpassing all other trauma-related injuries.
Objective: The purpose of this study was to analyse patient outcomes for severe TBI in relation to how they were transported.
Methods: This study was a retrospective, quantitative study based on patient outcomes in patients transported to Inkosi Albert Luthuli Central Hospital (IALCH) between January 2017 to December 2018. Patients older than 12 years of age were included in this study. Patients classified as having a severe traumatic brain injury (TBI) based on the Glasgow Coma Score (GCS) and/or CT scan findings were included in this study.
Results: There were 202 patients included in the study; 167 were males. Motor vehicle collision was the most common mechanism of injury, accounting for 41.1% of patients’ injuries in the study. Mortality was significantly greater in direct admissions compared to interhospital transfers (p<0.001). Patients who were directly admitted to IALCH were admitted for a shorter length of stay compared to inter-hospital transfer. New injury severity score (NISS), revised trauma score (RTS) and Glasgow Coma Scale (GCS) demonstrated good predictions of mortality, with the new injury severity score the most accurate predictor of outcome.
Conclusion: These results suggest that patients admitted directly to a level 1 trauma hospital following severe TBI have worse outcomes than those who arrived from another hospital facility. Furthermore, assessments of physiological/anatomical scoring systems and predictors of the outcome can be a valuable component in predicting mortality in cases of severe traumatic brain injury.
Session Theme: Education Research
A comparison of immersive and traditional simulation methods on self-reported performance in undergraduate paramedicine students
Rachael Vella1, Liz Thyer1, Paul Simpson1
1Western Sydney University, Campbelltown, NSW, Australia
Introduction: Simulation and clinical practice have long served as the foundations of clinical education and assessment in various health fields, including paramedicine. Due to the reduced availability of clinical practice opportunities through work-integrated learning and the rapid advancement of technology, the incorporation of extended realities in simulation practice has emerged as a possible addition to undergraduate paramedicine programs, complementing existing practical methods.
Aims: This study’s primary aim was to determine if immersive or traditional simulation provided greater ratings of self-perceived performance. A secondary aim investigated whether any improvement in self-perceived performance was sustained following a nine-week period. The study also served to assess the feasibility of the methodology to help inform the design of a larger, appropriately powered trial.
Methods: This randomised controlled trial feasibility study allocated second-year paramedicine students to either a three-day traditional simulation program (standard simulation rooms) or an immersive simulation program (360-degree projection simulation room). Ratings were collected using the Seattle University Simulation Evaluation tool after the first simulation of the three-day program (Rating 1), after the final simulation of the program (Rating 2) and following a nine- week washout period (Rating 3).
Results: 37 participants were allocated into the standard (n = 18) and intervention (n = 19) groups. Participants using traditional forms of simulation rated their levels of self-perceived performance higher than those using immersive forms of simulation (p=0.04). Ratings of self-perceived performance were sustained after the nine-week washout period, with a statistically significant difference noted between groups at Rating 3 (p=0.02).
Conclusion: This research suggests that undergraduate paramedicine students expressed higher ratings of self-perceived performance in traditional forms of simulation. The design was deemed feasible, with the data derived appropriate for powering future larger scaled trials, to ascertain the most effective educational methods for both undergraduate paramedicine students and the wider paramedicine discipline.
Lifelong Learning is Key: Exploring the Factors that Improve Self-directed Learning in Undergraduate Education
Ashleigh Finn1,2, Caitlin Fitzgibbon2, Natalie Fonda1, Cameron Gosling1
1Monash University, Melbourne, Vic, Australia;
2Australian Catholic University, Melbourne, Vic, Australia
Introduction: The field of healthcare is constantly evolving and many healthcare accrediting bodies and organisations globally, are promoting the use of self- directed learning as a critical skill for ‘lifelong learning’. Therefore, there is greater emphasis within tertiary education, including paramedicine programs, for students to become self-directed learners.
Aim: To explore the drivers that improve the student learning experience, in undergraduate clinical science programs that utilise self-directed learning.
Methods: Five peer-reviewed electronic databases were comprehensively searched in April 2022: MEDLINE, Embase, Emcare, Scopus and ERIC. The original search was developed in MEDLINE and then adapted to the other databases. The Joanna Briggs Scoping Review Methodology guided this study, and articles were screened first by title and abstract, and then by full text. Included articles were also quality assessed.
Results: The search resulted in 2209 articles for screening. Twenty articles met the inclusion criteria. Five key factors were identified which improve the student learning experience in self-directed learning: i) curricular elements; ii) role of the educator; iii) peer support and collaboration, iv) learning environment; and v) clinical placement opportunities and supervision.
Conclusions: There are several external factors which can improve the student learning experience in clinical science programs that utilise self-directed learning. A more thorough understanding of these factors will allow educators to implement self-directed learning strategies more effectively within tertiary curriculum. This may ensure students are better equipped to enter the professional workplace and engage in ‘lifelong learning’.
Paramedic and Medical Students’ Experiences of Sexual Harassment During Clinical Placement: A Systematic Review
Hannah Stack1, Prue Gonzalez1
1Charles Sturt University, Port Macquarie, NSW, Australia
Introduction: Workplace sexual harassment is an alarming worldwide issue that can cause severe adverse effects for victims, especially women from traditionally male-dominated professions. As a result, paramedics and doctors are exposed to concerning rates of sexual harassment in the workplace. However, there is little understanding of whether this also consequently affects paramedic students who undertake clinical placement in the same environment as paramedics.
Aims: This systematic review aimed to explore paramedic and medical students’ experiences of sexual harassment whilst undertaking clinical placement. The review findings also aimed to investigate the extent of the adverse effects of sexual harassment that paramedic and medical students are subjected to.
Methods: This systematic review was guided by the Joanna Briggs Institute Manual for Evidence Synthesis. The search strategy was conducted across four journal databases and was accompanied by citation searching and snowball sampling.
The inclusion criteria consisted of paramedic or medical students who had reported acts of sexual harassment when undertaking clinical placement. Studies were excluded if they were not presented in the English language or were issued earlier than 2010. Data synthesis was completed through a thematic and content analysis.
Results: Of the twelve studies eligible for study inclusion and analysis, seven focused on medical students as the participants of interest and five related to paramedic students. The thematic analysis revealed seven themes: sexual harassment experiences, forms, occurrences, sources, potential influences, reporting, and education and awareness. The content analysis identified the three most reported adverse effects of sexual harassment, including overall poor student well-being, students changing career specialisation, and students struggling to obtain graduate job positions due to victimisation.
Conclusion: This systematic review found paramedic and medical students can experience sexual harassment when undertaking clinical placement. Furthermore, it can lead to many deleterious effects that negatively impact students before their careers begin.
The use of social media and online focus groups for contemporary research in Paramedicine
Alannah Morrison1, Alison Craswell1, Fiona Bogossian1
1UniSC, Sippy Downs, QLD, Australia;
Introduction: Traditional methods of recruiting research participants may not yield the number and type of participants required to conduct robust research particularly with a geographically isolated workforce often working unsociable hours. Technology is one-way flexibility in recruitment and methods may enhance research participation.
Aims: To report on the use of social media platforms for recruitment and online asynchronous focus groups for research data collection.
Methods: This descriptive study examined the use of social media and asynchronous online focus groups in comparison to traditional recruitment. Research recruitment included one professional body disseminating the research advertisement and participant information statement. Secondly, an infographic was created for social media, initially posted on three social media platforms (Facebook, Instagram and LinkedIn) through the researcher’s private accounts and paid advertisement on Facebook. Consenting participants were offered a face-to- face focus group, an individual interview or alternatively, an online focus group facilitated through ‘Zoom meeting & Chat’ which was open for 24 hours.
Results: The recruitment method returned vastly different results. No enquiries were received from the professional body advertisement. However, the social media advertisements attracted 72 engagements and received two tweets on Twitter despite, not posting to the platform. Further, the alternate professional body also shared the Facebook post on its Facebook page, despite no request. No participants selected the option of a face-to-face focus group, four participants selected the online focus group and 16 participants selected individual interviews. The asynchronous focus group provided the ability to group geographically disparate participants, and responses were well-considered. However, the key challenge was disjointed and limited conversation between participants, one of the key elements of a traditional face-to-face focus group.
Conclusion: Social media platforms were highly successful in gaining attention and more broad Further consideration is required for asynchronous focus groups.
Session Theme: Best of the Best
The Lived Experience of Paramedics Delivering Care to the Mentally Unwell: A Descriptive Phenomenological Study
Matthew Simpson1, Paul Simpson1, Liz Thyer1, Martin Christensen2
1Western Sydney University, Campbelltown, NSW, Australia;
2Hong Kong Polytechnic University, Hung Hom, Hong Kong
Introduction: Ambulance services have had to adapt models of care to meet consumer demands. While continued expansion in evidence-informed clinical practice for physical health presentations occurs, the same cannot be said for mental health. Current evidence predominantly focuses on involuntary patients, leaving a gap in our understanding of most mental health patients treated by paramedics.
Aims: This study aimed to describe the lived experiences of paramedics who care for mentally unwell individuals in the community. By articulating these authentic experiences, the study sought to understand paramedics' challenges, perspectives, and insights in delivering care to mental health consumers.
Methods: This descriptive phenomenological approach captured in-depth, detailed descriptions of the phenomenon. Seventeen Australian paramedics employed by ambulance services participated in the study. Individual unstructured recorded interviews were conducted, ranging from 25 to 95 minutes. Data were analysed using Colaizzi's seven-step phenomenological approach.
Results: Data analysis illuminated four central themes The clinical interaction, The barriers to accessing care for mental health consumers in a one size fits all system,
It's just all a little bit grey, paramedic education and training in mental health presentations, and The Paramedic, the clinician, and the person. The study revealed that delivering care is a multifaceted phenomenon influenced by structural and non-structural barriers. These barriers originate from personal, professional, and organisational aspects, all playing a role in shaping care delivery.
Conclusions: The study findings shed light on paramedic interactions with mentally unwell persons. Paramedics expressed their limitations in adequately addressing the needs stemming from various mental health conditions and attributed this deficiency to insufficient education, training, and support.
Paramedics found themselves frustrated with a system that prioritises episodic care at the expense of a holistic approach. Furthermore, the limited availability of specialised services and referral networks adds to the complexities of delivering care to mentally unwell persons.
Enablers and Barriers in Community Paramedicine Programs in Australia and Aotearoa New Zealand: Insights for their evolution.
Alecka Miles1,2,3, Brendan Shannon3,4, Peter O'Meara3,4, David Long3,5, Angela Martin1,3,
1Edith Cowan University, Perth, WA, Australia;
2Western Sydney University, Campbelltown, NSW, Australia;
3Australasian College of Paramedicine, Umina Beach, NSW, Australia;
4Monash University, Melbourne, Victoria, Australia;
5University of Southern Queensland, Ipswich, QLD, Australia
Aim: This study aims to investigate the enablers and barriers of community paramedicine program implementation and expansion in Australia and Aotearoa New Zealand to inform their ongoing development.
Methods: Participants were enlisted through purposive sampling and snowballing methods. They responded to survey with open-ended responses or participated in an interview to explore the enablers and barriers related to the community paramedicine program they implemented. We employed an iterative process to thematically analyse data using Braun and Clarke’s six step approach. This allowed us to discern themes from the participants' accounts of the enablers and barriers to their program's implementation and delivery.
Results: Data was collected from 36 participants engaged in the delivery and/or implementation of community paramedicine programs in Australia and Aotearoa New Zealand. Four themes were created: (1) interdisciplinary knowledge, focusing on role clarification and refuting misconceptions about paramedics; (2) policy and legislation, highlighting lack of funding and inflexibility of legislation; (3) paramedic culture and leadership, focusing on fixed mindset of paramedic roles and fear of transitioning to non-ambulance roles; (4) health workforce shortages, has contributed to opportunities for paramedics to work more broadly in health. These themes demonstrate the significance of, interprofessional understanding of paramedic roles, health system challenges that hinders wider paramedic contribution to health care, the impact of fixed mindset roles for paramedics on the growth the profession and the opportunity present due to current health workforce shortages.
Conclusion: This study highlights the significance of interprofessional understanding of paramedic roles, health system challenges that hinders wider paramedic contribution to health care, the impact of fixed mindset roles for paramedics on the growth the profession and the opportunity present due to current health workforce shortages. These findings can inform policymakers, health managers and clinicians in the development and implementation of community paramedicine programs.
Developing a competency framework for contemporary paramedic practice in Canada
Alan Batt1,2, Jennifer Bolster2, Meghan Lysko2
1University, Melbourne, VIC, Australia;
2Fanshawe College, London, ON, Canada
Introduction: Paramedic practice in Canada continues to evolve and there is a duty to ensure our descriptions of practice reflect the complexity of contemporary paramedic practice. Doing so requires that we outline the features required for competent practice in diverse contexts across Canada. The motivation to accurately reflect a profession that is rapidly advancing stems from the prevalence of literature in recent years that outlines contexts of practice, role identity, and integration into the larger health system. It is these new insights that are redefining what it means to be a paramedic.
Methods: The National Occupational Standard for Paramedics (NOSP) project used a six-step model for developing competency frameworks. The six-steps comprise [1] identifying purpose, intended uses, scope, and stakeholders; [2] theoretically informed ways of identifying the contexts of complex, ‘real-world’ professional practice, which includes [3] aligned methods and means by which practice can be explored; [4] the identification of competencies, [5] reporting the process and outputs of identifying such competencies, and [6] built-in strategies to continuously evaluate, update and maintain the competency framework.
Results: A technical committee was established which contains representatives from industry, research, government/regulatory, education, allied professions, the public, and international groups. This committee adopted terminology, decided on scope and purpose of the project (Step 1), and determined a list of contexts of paramedic practice in Canada (Step 2). Step 3 involved the creation of 15 pan- Canadian working groups to explore paramedic practice across Canada to inform the subsequent identification of competencies in Step 4. Canadian paramedic practice is described through 30 activities organised under five domains.
Discussion: Following upcoming public feedback, revision and publication (Step 5), continuous updates will be made to the NOSP, so it may serve as an up-to-date framework that progresses in line with the profession (Step 6).
