Qualitative Theme Analysis on Perception of Practice Scope among Emergency Medical Service Providers: Focused on Registered Nurses

This study aims to explore how emergency medical service (EMS) providers with registered nurses perceive their practice scope in Korea. This qualitative study analyzed the interview data of nine EMS providers with registered nurses using Braun and Clarke’s thematic analysis. Three themes and 10 subthemes were revealed. Theme 1 was “not clearly knowing the scope.” They perceived their scope as similar to that of a first-grade emergency medical technicians (EMTs), as wider than that of EMTs' scope, as focused on the controversial scope, it is determined according to the medical director. Theme 2 was “anxiety and distrust.” They were concerned whether they can be protected legally by the practice guideline, showed no confidence in the legal protection of the practice guideline, and were confused about their professional identity. Theme 3 was “different strengths in practices.” They reported that EMTs are more experienced and skillful in the prehospital field, as nurses lack education on prehospital emergency. However, they have different strengths from the beginning such as patient’s care. For ensuring stability of and consistency in the provided service, the practice scope of EMS providers with registered nurses needs to be clearly stipulated.

The Relationship Between Death Anxiety and Alexithymia in Emergency Medical Technicians

Introduction: When confronted with traumatic accidents and events that result in death, people are at risk of developing death anxiety. Due to their stressful job, emergency medical technicians (EMTs) will develop alexithymia and be unable to express and manage their emotions over time. Studies show that alexithymia causes physical and mental disorders in many people. The present study aimed to determine the relationship between death anxiety and alexithymia in EMTs.Methods: The convenience sampling method was used to select 400 EMTs in southeastern Iran who met the inclusion criteria for this descriptive-analytical study. The Templer Death Anxiety Scale and the Toronto Alexithymia Scale were used to collect data. SPSS version 20 was used to analyze the data, which included descriptive and analytical statistics (Independent t test, ANOVA, Pearson correlation, and regression). Results: The results of the study showed that the mean score of death anxiety in EMTs was 10.26 ± 3.69. It was revealed that 46.7% of the EMTs experienced severe death anxiety. Furthermore, the total mean score of alexithymia in EMTs was 59.65 ± 8.28, indicating the possibility of alexithymia. The Pearson correlation test showed a direct moderate relationship between death anxiety and alexithymia scores (r = .351, p < .001).Conclusion: According to the results, there is a direct significant relationship between death anxiety and alexithymia in EMTs. Therefore, it is suggested that EMTs be continuously taught effective methods to deal with death anxiety and reduce the physical and mental disorders caused by this problem.

Simulated-Scenario and Peer-Mentorship Curriculum to Train Prehospital Providers in the Practice of Mass Gathering Medicine

Objective: A mass gathering medicine training program was established for a 7,200-seat arena. The objectives of this study were to describe the program schema and determine its impact in preparing novice emergency medical technicians (EMTs) to manage the difficulties of large-venue emergency medical services (EMS). Methods: Optional, anonymous surveys were administered to EMTs. Novice EMTs were assessed pre-/post-program implementation, and both novice and experienced EMTs completed self-reported Likert scales. Data were analyzed with nonparametric methods. Results: A total of 43/56 responses (response rate = 76.8%) were received. Only 37.2% of providers felt prepared to work mass gatherings before the training, and 60.5% stated that their previous education did not prepare them for large-venue challenges. After the training program, novice EMTs were significantly associated with increased knowledge of large-venue EMS procedures (P = 0.0170), higher proficiency using extrication equipment (P = 0.0248), increased patient care skills (P = 0.0438), and both increased confidence working events (P = 0.0002) and better teamwork during patient encounters (P = 0.0001). The majority of EMTs reported the program as beneficial. Conclusion: Upon hire, EMS providers felt unprepared to work large-venue EMS. The analyses demonstrated that this training program improved select large-venue emergency skills for prehospital providers and may fill a gap in the education system regarding mass gathering medicine.

Comparison between Pediatric-Sized and Adult-Sized Bag-Valve-Mask Ventilation for Achieving Appropriate Tidal Volume in Simulated Adult Out-of-Hospital Cardiac Arrest in a Moving Ambulance

Background: Previous studies proposed that ventilation with pediatric-sized bag-valve-mask (BVM) ventilation resulted in more appropriate tidal volume (Vt) in adult patients than adult-sized BVM ventilation. However, those studies were conducted in stationary, non-moving environment. The authors hypothesized that the result of BVM ventilation in this treatment setting may be different when the investigation was conducted in a moving ambulance. Objective: To compare pediatric-sized and adult-sized BVM ventilation for achieving appropriate Vt in simulated adult out-of-hospital cardiac arrest (OHCA) in a moving ambulance. Materials and Methods: The present study was a randomized crossover trial. Registered nurses (RNs) and basic emergency medical technicians (EMT-Bs) were recruited to perform resuscitation ventilation on a medical training manikin. All participants performed both the pediatric-sized at 500 cc, and the adult-sized at 1,600 cc, BVM ventilation during 30 to 2 chest compressions to ventilation ratio during simulated OHCA in a moving ambulance. Adult-sized mask was used for both scenarios. The manikin was ventilated for 10 minutes during each scenario. The percentage of appropriate Vt was compared between scenarios. The percentages of low Vt at less than 400 cc and high Vt at more than 600 cc between groups were also evaluated. Results: Fifty-two volunteers with 57.7% RNs and 42.3% EMT-Bs were included. Of those 52 volunteers, 44 had less than five years of pre-hospital ventilation experience. The mean Vt was 239.0 cc and 444.5 cc in the pediatric-sized and the adult-sized BVM groups, respectively (p<0.001). Low Vt was observed in 100% of pediatric-sized BVM ventilation. In the adult-sized ventilation group, 52.1±25.6% had appropriate Vt, 11.4±18.6% had high Vt, and 36.5±29.1% had low Vt (p<0.001). Conclusion: A comparison between pediatric-sized and adult-sized BVM ventilation in simulated adult OHCA in a moving ambulance demonstrated the superiority of the adult-sized BVM over the pediatric-sized BVM for achieving appropriate Vt in adult OHCA. Keywords: Bag-valve-mask ventilation; Tidal volume; Out-of-hospital cardiac arrest; Ambulance

Evaluation of the Impact of Webinar Training in Comparison to Conventional Training on COVID-19 Risk Perception in Emergency Medical Technicians

Background: The COVID-19 pandemic has affected in countless ways conventional teaching methods and led to a sudden shift in teaching methods toward distance teaching. Objectives: Hence, this study aimed to evaluate the impact of webinar training compared to conventional training on the risk perception of COVID-19 in emergency medical technicians (EMTs). Methods: This quasi-experimental study selected 70 EMTs employed at the emergency medical services (EMS) affiliated to the Birjand University of Medical Sciences via convenience sampling. The participants were randomly designed into a webinar training group (n = 35) and a conventional training group (n = 35). The risk perception of COVID-19 was evaluated using a researcher-made questionnaire (40 questions) at baseline and immediately after teaching. The study data were analyzed using SPSS V.26, descriptive (frequency, mean, and standard deviation), and inferential statistics (t-test, ANOVA, and Chi-square test). Results: All the 70 participants completed the questionnaire. The mean score of COVID-19 risk perception in both groups improved following teaching (P < 0.001). However, there was no statistically significant difference between the groups immediately after training (P = 0.76). Also, independent t-test and one-way ANOVA showed that the mean score of COVID-19 risk perception had no significant difference with the participants’ demographic data in the two groups (P > 0.05). Conclusions: The webinar in the form of distance teaching can be as effective as conventional teaching in improving COVID-19 risk perception. Therefore, a webinar format can be used during pandemics of infectious diseases when conventional training is impossible.