Reforming the paramedic profession? Two weeks with paramedics in Germany

2021 ◽  
Vol 11 (1) ◽  
pp. 19-26
Author(s):  
Esther Dittmar
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Emergency Physician ◽  
Clinical Guidelines ◽  
Scope Of Practice ◽  
Career Opportunities ◽  
German Model ◽  
Anglo American ◽  
Increasing Demand ◽  
Physician Role

While paramedics in Anglo-American emergency medical services enjoy relative autonomy, paramedic practice in the Franco-German model deployed in Germany depends heavily on emergency physician input. Increasing demand, especially from low-acuity incidents, causes challenges in these countries. To address this, German politicians plan to implement extensive emergency care reforms and consider an update of regulations around paramedic practice. A 2-week placement allowed for practice observation, discussions with stakeholders and a review of various resources to identify current issues in Germany. These include legal discrepancies, significant local differences in scope of practice, limited career opportunities and influence on clinical guidelines. Although the update and reforms are intended to resolve some of these problems, a groundbreaking evolution of the profession from its current restrictions is not expected. Possible development of the emergency physician role and associated specialities as a response to emergency care challenges is less debated.

Guidelines for Pediatric Emergency Care Facilities

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 526-537
Author(s):  
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Emergency Medical ◽  
Care Facilities ◽  
Trained Personnel ◽  
Pediatric Emergency Care

Emergency care for life-threatening pediatric illness and injury requires specialized resources including equipment, drugs, trained personnel, and facilities. The American Medical Association Commission on Emergency Medical Services has provided guidelines for the categorization of hospital pediatric emergency facilities that have been endorsed by the American Academy of Pediatrics (AAP).1 This document was used as the basis for these revised guidelines, which define: 1. The desirable characteristics of a system of Emergency Medical Services for Children (EMSC) that may help achieve a reduction in mortality and morbidity, including long-term disability. 2. The role of health care facilities in identifying and organizing the resources necessary to provide the best possible pediatric emergency care within a region. 3. An integrated system of facilities that provides timely access and appropriate levels of care for all critically ill or injured children. 4. The responsibility of the health cane facility for support of medical control of pre-hospital activities and the pediatric emergency care and education of pre-hospital providers, nurses, and physicians. 5. The role of pediatric centers in providing outreach education and consultation to community facilities. 6. The role of health cane facilities for maintaining communication with the medical home of the patient. Children have their emergency care needs met in a variety of settings, from small community hospitals to large medical centers. Resources available to these health care sites vary, and they may not always have the necessary equipment, supplies, and trained personnel required to meet the special needs of pediatric patients during emergency situations.

Abstract WP261: Non-English-preferring Patients Have No Differences in Stroke Symptom Recognition or Emergency Care Time Metrics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shaw Natsui ◽  
Khawja A Siddiqui ◽  
Betty L Erfe ◽  
Nicte I Mejia ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Medical Services ◽  
Similar Response ◽  
Language Preference ◽  
Emergency Department Care ◽  
Hospital Arrival ◽  
Stroke Symptom ◽  
Emergency Medical ◽  
Significant Difference

Introduction: The influence of patients’ language preference on the delivery of acute ischemic stroke (AIS) care in the pre-hospital and in-hospital emergency care settings is scarcely known. We hypothesize that stroke knowledge differences may be associated with non-English preferring (NEP) patients having slower time from symptom discovery to hospital presentation and less engagement of emergency medical services (EMS) than English preferring (EP) patients. Language barriers may also interfere with the delivery of time-sensitive emergency department care. Objectives: To identify whether language preference is associated with differences in patients’ time from stroke symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DIT), and door-to-needle (DTN) time. Methods: We identified consecutive AIS patients presenting to a single urban, tertiary, academic center between 01/2003-04/2014. Data was abstracted from the institution’s Research Patient Data Registry and Get with the Guidelines-Stroke Registry. Bivariate and regression models evaluated the relationship between language preference and: 1) time from symptom onset to hospital arrival, 2) use of EMS, 3) DIT, and 4) DTN time. Results: Of 3,190 AIS patients who met inclusion/exclusion criteria, 9.4% were NEP (n=300). Time from symptom discovery to arrival, and EMS utilization were not significantly different between NEP and EP patients in unadjusted or adjusted analyses (overall median time 157 minutes, IQR 55-420; EMS utilization: 65% vs. 61.3% p=0.21). There was no significant difference between NEP and EP patients in DIT or in likelihood of DIT ≤ 25 minutes in unadjusted or adjusted analyses (overall median 59 minutes, IQR 29-127; DIT ≤ 25 minutes 24.3% vs. 21.3% p=0.29). There was also no significant different in DTN time or in likelihood of DTN ≤ 60 minutes in unadjusted or adjusted analyses (overall median 53 minutes, IQR 36-73; DTN ≤ 60 minutes 62.5% vs. 58.2% p=0.60). Conclusion: Non-English-preferring patients have similar response to stroke symptoms as reflected by EMS utilization and time from symptom discovery to hospital arrival. Similarly, NEP patients have no differences in in-hospital AIS care metrics of DIT and DTN time.

Non-traumatic chest pain: pericarditis

2020 ◽  
Vol 12 (3) ◽  
pp. 1-5
Author(s):  
Andrew Mootham
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Treatment Regimen ◽  
Emergency Care ◽  
Signs And Symptoms ◽  
Heart Sounds ◽  
Scope Of Practice ◽  
Bacterial Pericarditis

Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction. Its signs and symptoms include chest pain, which may radiate to the arm and jaw and pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over each other) on auscultation of heart sounds. The diagnosis of straightforward pericarditis may be within the scope of practice of the emergency care practitioner. It should be possible for an emergency care practitioner to reach a working diagnosis and to initiate a treatment regimen, which would predominantly consist of providing analgesia to make the patient more comfortable.

Emergency Care Delivery Research: Methodological Considerations

1985 ◽  
Vol 1 (S1) ◽  
pp. 23-24
Author(s):  
Michael Pozen
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Care Delivery ◽  
Disaster Research ◽  
Epidemiological Research ◽  
Emergency Medical ◽  
Fast Pace ◽  
The Many ◽  
Methodological Considerations ◽  
Evaluation Of Care

Methodological considerations should be discussed within the context of emergency medical services (EMS) and disaster research. The fast pace and the information explosion of the society in which we live open new opportunities for epidemiological research and evaluation of care in disasters. The many methodological considerations necessary to generate useful and valid research is the topic of this article.I would like to discuss four major issues which raise a series of questions and suggest a variety of alternatives. The four major areas are: (l) the taxonomy required to do this type of research; (2) the elements of care; (3) comparative samples; and (4) planned as opposed to unplanned disasters.

87 Imbalance in US Emergency Department Openings and Closures Over 18 Years of Increasing Demand for Emergency Care: 2001 to 2018

2020 ◽  
Vol 76 (4) ◽  
pp. S34
Author(s):  
C.A. Camargo ◽  
A.F. Sullivan ◽  
J.A. Espinola ◽  
K.M. Boggs ◽  
D.F. Brown
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Increasing Demand

scholarly journals Nontraditional Career Opportunities for Pharmacists

2016 ◽  
Vol 51 (11) ◽  
pp. 944-949 ◽  
Author(s):  
Sandra Bai ◽  
John B. Hertig ◽  
Robert J. Weber
Keyword(s):  
Health Care ◽  
Health System ◽  
Scope Of Practice ◽  
Pharmacy Services ◽  
Patient Centered ◽  
High Performing ◽  
Nontraditional Career ◽  
Career Opportunities ◽  
Career Options ◽  
Pharmacy Leaders

The changing landscape of health care mirrors that of health-system pharmacy, with pharmacists' scope of practice and provider status being the most significant changes. This creates new roles and opportunities; many of these roles are considered to be nontraditional in today's practice. This article reviews some new roles for pharmacy leaders that provide different career options and pathways. Nontraditional career opportunities discussed include expanded consulting roles in pricing analytics and drug pricing programs (contracting, 340B programs), pharmacogenomics patient consult services and clinics, specialty drug pharmacies, and compounding pharmacy services. To continue to develop high-performing pharmacy departments, pharmacy directors should recognize these roles and ensure they are clearly defined and managed. With the advent of these nontraditional opportunities, pharmacy departments can further expand their ability to provide advanced patient-centered pharmacy services.

Factors Associated with Emergency Medical Services Scope of Practice for Acute Cardiovascular Events

2011 ◽  
Vol 16 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Ishmael Williams ◽  
Amy L. Valderrama ◽  
Patricia Bolton ◽  
April Greek ◽  
Sophia Greer ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Cardiovascular Events ◽  
Scope Of Practice ◽  
Medical Services ◽  
Factors Associated ◽  
Emergency Medical

scholarly journals Evaluation of the Quality of Medical Care to the Population at the Level of Day Stations and Emergency Stations

2022 ◽  
Vol 8 (1) ◽  
pp. 114-121
Author(s):  
B. Niyazov ◽  
S. Niyazovа
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Chronic Diseases ◽  
Emergency Care ◽  
Rural Population ◽  
Medical Services ◽  
Emergency Medical ◽  
Medical Institutions ◽  
Quality Of Medical Care

Insufficient availability of emergency medical services to the rural population is noted. The dynamics of the growth of calls to emergency medical services testifies to the fact that emergency medical institutions have taken over part of inpatient services for the provision of emergency care to patients with chronic diseases and acute colds.

scholarly journals State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Mixed-methods Cross-sectional Survey Study

2020 ◽  
Author(s):  
Jessica Castner ◽  
Lenore Boris
Keyword(s):  
Mixed Methods ◽  
Emergency Care ◽  
Emergency Departments ◽  
New York State ◽  
Scope Of Practice ◽  
Survey Study ◽  
Small Scale ◽  
X Rays ◽  
Cross Sectional Survey ◽  
Cross Sectional

AbstractIntroductionState regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments.MethodsA mixed-methods approach was used with a cross-sectional nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, x-rays, over the counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols.Results350 surveys from 48 states and the District of Columbia were received. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with scope of practice prohibitions. Four qualitative categories emerged: advantages, approval, prohibition, and conditions under which protocols can be used. Prohibitive language was associated with less protocol use for emergency care.ConclusionState scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

scholarly journals Management of COVID-19 Patients in the Emergency Department

2021 ◽  
Vol 11 (10) ◽  
pp. 961
Author(s):  
Ioannis Pantazopoulos ◽  
Stamatoula Tsikrika ◽  
Stavroula Kolokytha ◽  
Emmanouil Manos ◽  
Konstantinos Porpodis
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Current Literature ◽  
Emergency Care ◽  
Emergency Physician ◽  
Care Delivery ◽  
Health Concern ◽  
Global Public Health ◽  
Emergency Physicians ◽  
Public Health Concern

COVID-19 is an emerging disease of global public health concern. As the pandemic overwhelmed emergency departments (EDs), a restructuring of emergency care delivery became necessary in many hospitals. Furthermore, with more than 2000 papers being published each week, keeping up with ever-changing information has proven to be difficult for emergency physicians. The aim of the present review is to provide emergency physician with a summary of the current literature regarding the management of COVID-19 patients in the emergency department.

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