Burnout in frontline ambulance staff

Background: Staff retention is a significant issue for ambulance services across the globe. Exploratory research, although minimal, indicates that stress and burnout, in particular, influence attrition within the paramedic profession. These need to be understood if their impact on retention is to be addressed. Aims: To determine the presence of and contributory factors for burnout in the ambulance service to inform recommendations for positive change. Methods: A two-phased survey approach was adopted using an adapted Maslach Burnout Inventory and Copenhagen self-assessment burnout questionnaire, to measure levels of burnout, depersonalisation (cynicism) and personal achievement. Open-ended questions explored factors that influenced these. Demographic and comparative analysis identified trends and thematic analysis was carried out on the qualitative data. Results: Ninety-four per cent of ambulance staff in this study (n=382) reported a sense of personal achievement within their professional role; however, more than 50% were experiencing varying levels of burnout with 87% displaying moderate or high levels of depersonalisation towards their work. Causes of stress were complex: themes attributed were a perceived lack of management support, the public's misuse of the ambulance service, involuntary overtime and a poor work-life balance. Conclusions: Burnout poses a genuine threat to retention in the ambulance service and needs addressing. Proactive screening, better communication between practice staff and management and access to counselling services are recommended. This problem of burnout is beginning to be acknowledged but further evidence is needed to understand it in more depth in order for effective solutions to be developed.

Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis

Background: People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS).Methods: A retrospective dataset from the NIAS was obtained from the NIAS Trust’s Command and Control system relating to calls where the final complaint group was ‘Diabetes’ for the period 1 January 2017 to 23 November 2019.Results: Of a total 11,396 calls related to diabetes, 63.2% of callers to the NIAS were conveyed to hospital. Over half of the calls related to males, with 35.5% of callers aged 60‐79. The more deprived areas had a higher frequency of calls and conveyance to hospital, with this decreasing as deprivation decreased. Calls were evenly distributed across the week, with the majority of calls originating outside of GP working hours, although callers were more likely to be conveyed to hospital during working hours. Calls from healthcare professionals were significantly more likely to be conveyed to hospital, despite accounting for the minority of calls.Conclusion: This research found that older males were more likely to contact the ambulance service but older females were more likely to be conveyed to hospital. The likelihood of conveyance increased if the call originated from an HCP or occurred during GP working hours. The availability of alternative care pathways has the potential to reduce conveyance to hospital, which has been particularly important during the COVID-19 pandemic. Integration of data is vitally important to produce high quality research and improve policy and practice in this area.