Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups.

This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers.

The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022.

Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.

This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.

The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting.

The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS.

A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used.

A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS.

As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.

Mass-casualty incidents (MCIs) are events in which many people are injured during the same period of time. This has major implications in regards to practical concerns and planning for both personnel and medical equipment. Smart glasses are modern tools that could help Emergency Medical Services (EMS) in the estimation of the number of potential patients in an MCI. However, currently there is no study regarding the advantage of employing the use of smart glasses in MCIs in Thailand.

This study aims to compare the overall accuracy and amount of time used with smart glasses and comparing it to manual counting to assess the number of casualties from the scene.

This study was a randomized controlled trial, field exercise experimental study in the EMS unit of Srinagarind Hospital, Thailand. The participants were divided into two groups (those with smart glasses and those doing manual counting). On the days of the simulation (February 25 and 26, 2022), the participants in the smart glasses group received a 30-minute training session on the use of the smart glasses. After that, both groups of participants counted the number of casualties on the simulation field independently.

Sixty-eight participants were examined, and in the smart glasses group, a total of 58.8% (N = 20) of the participants were male. The mean age in this group was 39.4 years old. The most experienced in the EMS smart glasses group had worked in this position for four-to-six years (44.1%). The participants in the smart glasses group had the highest scores in accurately assessing the number of casualties being between 21-30 (98.0%) compared with the manual counting group (89.2%). Additionally, the time used for assessing the number of casualties in the smart glasses group was shorter than the manual counting group in tallying the number of casualties between 11-20 (6.3 versus 11.2 seconds; P = .04) and between 21-30 (22.1 versus 44.5 seconds; P = .02).

The use of smart glasses to assess the number of casualties in MCIs when the number of patients is between 11 and 30 is useful in terms of greater accuracy and less time being spent than with manual counting.

Unexpected disasters, such as earthquakes or fires, require preparation to address knowledge gaps that may negatively affect vulnerable patients. Training programs can promote natural disaster readiness to respond and evacuate patients safely, but also require evidence-based information to guide learning objectives.

There is limited evidence on what skills and bedside equipment are most important to include in disaster training and evacuation programs for critically ill infants.

An expert panel was used to create a 13-item mastery checklist of skills for bedside registered nurses (RNs) required to successfully evacuate a critically ill infant. Expert nurses were surveyed, and the Angoff method was used to determine which of the mastery checklist skills a newly graduated nurse (ie, the “minimally competent” nurse) should be able to do. Participants then rated the importance of 26 commonly available pieces of bedside equipment for use in evacuating a hemodynamically unstable, intubated infant during a disaster.

Twenty-three emergency department (ED) and neonatal intensive care unit (NICU) charge RNs responded to the survey with a mean of 19 (SD = 9) years of experience and 30% reporting personal experience with evacuating patients. The skills list scores showed an emphasis on the newly graduated nurse having more complete mastery of skills surrounding thermoregulation, documentation, infection control, respiratory support, and monitoring. Skills for communication, decision making, and anticipating future needs were assessed as less likely for a new nurse to have mastered. On a scale of one (not important) to seven (critically important), the perceived necessity of equipment ranged from a low of 1.6 (breast pump) to a high of 6.9 (face mask). The individual intraclass correlation coefficient (ICC) of 0.55 showed moderate reliability between raters and the average team ICC of 0.97 showed excellent agreement as a group.

Experts rated the ability to manage physiological issues, such as thermoregulation and respiratory support, as skills that every nurse should master. Disaster preparedness activities for nurses in training may benefit from checklists of essential equipment and skills to ensure all nurses can independently manage patients’ physiologic needs when they enter the workforce. Advanced nursing training should include education on decision making, communication during emergencies, and anticipation of future issues to ensure that charge and resource nurses can support bedside nurses during evacuation events.

Mass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.

Traditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.

This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.

There was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”

Hospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.

BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of Electronic Versus Manual Mass-Casualty Incident Triage. Prehosp Disaster Med. 2018;33(3):273–278.

It is important that health professionals and support staff are prepared for disasters to safeguard themselves and the community during disasters. There has been a significantly heightened focus on disasters since the terrorist attacks of September 11, 2001 in New York (USA); however, despite this, it is evident that health professionals and support staff may not be adequately prepared for disasters.

An integrative literature review was performed based on a keyword search of the major health databases for primary research evaluating preparedness of health professionals and support staff. The literature was quality appraised using a mixed-methods appraisal tool (MMAT), and a thematic analysis was completed to identify current knowledge and gaps.

The main themes identified were: health professionals and support staff may not be fully prepared for disasters; the most effective content and methods for disaster preparedness is unknown; and the willingness of health professionals and support staff to attend work and perform during disasters needs further evaluation. Gaps were identified to guide further research and the creation of new knowledge to best prepare for disasters. These included the need for: high-quality research to evaluate the best content and methods of disaster preparedness; inclusion of the multi-disciplinary health care team as participants; preparation for internal disasters; the development of validated competencies for preparedness; validated tools for measurement; and the importance of performance in actual disasters to evaluate preparation.

The literature identified that all types of disaster preparedness activities lead to improvements in knowledge, skills, or attitude preparedness for disasters. Most studies focused on external disasters and the preparedness of medical, nursing, public health, or paramedic professionals. There needs to be a greater focus on the whole health care team, including allied health professionals and support staff, for both internal and external disasters. Evaluation during real disasters and the use of validated competencies and tools to deliver and evaluate disaster preparedness will enhance knowledge of best practice preparedness. However, of the 36 research articles included in this review, only five were rated at 100% using the MMAT. Due to methodological weakness of the research reviewed, the findings cannot be generalized, nor can the most effective method be determined.

GowingJR, WalkerKN, ElmerSL, CummingsEA. Disaster Preparedness among Health Professionals and Support Staff: What is Effective? An Integrative Literature Review. Prehosp Disaster Med. 2017;32(3):321–328.

Over the past decade, numerous groups of researchers have studied the willingness of health care personnel (HCP) to respond when a disaster threatens the health of a community. Not one of those studies reported that 100% of HCP were willing to work during a public-health event (PHE).

The objective of this study was to explore factors associated with the intent of HCP to respond to a future PHE.

The theory of planned behavior (TPB) framed this cross-sectional study. Data were obtained via a web-based survey from 305 HCP. Linear associations between the TPB-based predictor and outcome variables were examined using Pearson's correlations. Differences between two groups of HCP were calculated using independent t tests. A model-generating approach was used to develop and assess a series of TBP-based observed variable structural equation models for prediction of intent to respond to a future PHE and to explore moderating and mediating effects.

The beginning patterns of relationships identified by the correlation matrix and t tests were evident in the final structural equation model, even though the patterns of prediction differed from those posited by the theory. Outcome beliefs had both a significant, direct effect on intention and an indirect effect on intention that was mediated by perceived behavioral control. Control beliefs appeared to influence intention through perceived behavioral control, as posited by the TPB, and unexpectedly through subjective norm. Subjective norm not only mediated the relationship between control beliefs and intention, but also the relationship between referent beliefs and intention. Additionally, professional affiliation seemed to have a moderating effect on intention.

The intention to respond was influenced primarily by normative and control factors. The intent of nurses to respond to a future PHE was influenced most by the control factors, whereas the intent of other HCP was shaped more by the normative factors. Health care educators can bolster the normative and control factors through education by focusing on team building and knowledge related to accessing supplies and support needed to respond when a disaster occurs.

ConnorSB . Factors Associated with the Intention of Health Care Personnel to Respond to a Disaster. Prehosp Disaster Med. 2014;29(6):1-6.