Iatrogenic Tracheal Rupture Related to Prehospital Emergency Intubation in Adults: A 15-Year Single Center Experience

Objective: Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored. Methods: Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed. Results: Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors. Conclusions: Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.

Investigating the relationship between low back pain and quality of life in emergency medical personnel and the role of demographic variables in this regard

Introduction: Back pain is one of the most important occupational problems among health care workers that have detrimental effects on their personal and professional life. Therefore, this study aimed to investigate the relationship between low back pain and quality of life in prehospital emergency staff and the role of demographic variables in this regard. Materials and Methods: This is a descriptive correlational study. The population was a prehospital emergency staff that entered to study by using the census method at 2020. Data gathering instruments were demographic characteristics, low back pain, and quality of life questionnaires. Data were entered into SPSS 22 and were analyzed using descriptive and analytical statistics. Results: The results showed that the related to the low back pain score of emergency medical technicians was 51.34± 4.149, which is high. In addition, the quality of life mean and standard deviation was 30.35± 4.851, which shows a low level. There is a significant relationship between back pain and quality of life (p = 0.001, R = 0.723). Conclusion: Low back pain is so common among emergency medical personnel that the issue may affect a person's life and work and creates many problems in terms of personal, family, socially, economically, and professionally, which reduce their quality of life.

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.

A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.

Effect of Professional Ethics Workshop on the Moral Intelligence of Prehospital Emergency Personnel in East Azerbaijan, Iran

Background: Moral intelligence is one of the several types of human intelligence. It is the ability to understand right from wrong and behave based on the value which is believed to be right. Objectives: This study was conducted to evaluate the effect of a professional ethics workshop on the moral intelligence of prehospital emergency technicians in East Azerbaijan Province, Iran, and consequently the improvement of their performance and increase in their work efficiency. Methods: In this before- and after-interventional study conducted in Tabriz University Prehospital Emergency Center, Iran, in 2020, a total of 234 participants were evaluated. The sample was collected using the Lennick and Kiel’s Moral Intelligence Questionnaire and full census method. Before the workshop, the questionnaire was completed by the participants. After the workshop, the same questionnaire was completed again. Results: The pretest and posttest scores for moral intelligence were 83.02 ± 7.33 and 83.49 ± 8.40, respectively, which showed a statistically significant difference (P < 0.05). In the three components of moral intelligence, namely consistent behaviors based on principles, values, and beliefs, persistence for the right, and responsibility for personal decisions, there were statistically significant differences (P < 0.05) before and after the workshop. Conclusions: According to the results, holding a professional ethics workshop was effective in increasing the overall level of moral intelligence, particularly in the three aforementioned components of moral intelligence. It is recommended to continue holding such workshops and improve the conditions and methods of training to increase their efficiency as much as possible.

Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers

Background. Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Recognizing and Responding to Elder Mistreatment: Developing and Testing an Online Training for EMS Practitioners

Elder mistreatment is an urgent and under recognized public health concern with devastating consequences for older adults, families, and health systems. Risk for elder mistreatment has increased during the COVID-19 pandemic, further highlighting the urgency to address it. Prehospital emergency medical service (EMS) practitioners have unique opportunities to recognize signs of elder mistreatment but often lack the training and tools required to facilitate consistent identification and intervention. To address this gap, Education Development Center collaborated with a team of expert advisors and EMS practitioners to develop and pilot test Recognizing and Responding to Elder Mistreatment: An Online Training for EMS Practitioners with funding from the RRF Foundation for Aging. This training aims to prepare EMS practitioners to recognize potential mistreatment and report suspected elder mistreatment in line with state laws and their professional code of ethics. In this presentation, we will describe the iterative development process, present results from a pilot test conducted with EMS practitioners in Massachusetts and share strategies and progress for disseminating the training nationally. The pilot study utilized a pre-post design to assess changes in knowledge, attitudes, and practices at baseline, immediately after and two months following participation in the training. Results indicate statistically significant improvements in knowledge related to elder mistreatment identification and response from pre- to post-training and maintenance of these improvements two months later. Participants reported feeling more prepared to address elder mistreatment in their work as EMS practitioners and applying their new knowledge and skills during the two months following the training.

Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts

Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract