Background Frequent users of emergency medical services (EMS) comprise a disproportionate percentage of emergency department (ED) visits. EDs are becoming increasingly overwhelmed and a portion of use by frequent callers of EMS is potentially avoidable. Social factors contribute to frequent use however few studies have examined their prevalence. This study aims to describe social isolation/loneliness, poverty, and quality of life in a sample of frequent callers of EMS in the Hamilton region, a southern Ontario mid-sized Canadian city. Study design Cross-sectional quantitative study. Methods We surveyed people who called EMS five or more times within 12 months. A mailed self-administered survey with validated tools, and focused on four major measures: demographic information, social isolation, poverty, and quality of life. Results Sixty-seven frequent EMS callers revealed that 37–49% were lonely, 14% had gone hungry in the preceding month, and 43% had difficulties making ends meet at the end of the month. For quality of life, 78% had mobility problems, 55% had difficulty with self-care, 78% had difficulty with usual activities, 87% experienced pain/discomfort, and 67% had anxiety/depression. Overall quality adjusted life years value was 0.53 on a scale of 0 to 1. The response rate was 41.1%. Conclusions Loneliness in our participants was more common than Hamilton and Canadian rates. Frequent EMS callers had higher rates of poverty and food insecurity than average Ontario citizens, which may also act as a barrier to accessing preventative health services. Lower quality of life may indicate chronic illness, and users who cannot access ambulatory care services consistently may call EMS more frequently. Frequent callers of EMS had high rates of social loneliness and poverty, and low quality of life, indicating a need for health service optimization for this vulnerable population.

Background Clinical practice is increasingly being digitalised. Little is known about how medical students learn and were exposed to telehealth during COVID-19. This is particularly important if we wish to further improve healthcare access and equity in rural areas and vulnerable populations. This formative study sought to explore the exposure and attitudes of medical students on telehealth and COVID-19 during their rural clinical placement in 2020 and provide recommendations. Methods Focus groups were held in August 2020 after completion of a 12-month rural placement. Questions centred around students’ exposure and experiences with telehealth during COVID-19. Data was analysed using thematic analysis. Results There has been a clear shift in students now acknowledging the importance of telehealth and, more importantly, expressing a clear wish for telehealth to be embedded in the curriculum starting in their first year. In tandem with this, students expressed the need for their clinical supervisors or hospital teams to have the capability to practice telehealth efficiently as this will improve the telehealth experience and lead to better engagement for both staff and students. Furthermore, it was felt that rural clinicians should play a lead role in telehealth implementation given it is integral to rural practice. Conclusions Medical students are more exposed to and more interested to learn about telehealth since COVID-19 and wish to see telehealth training built into their curriculum from the outset of medical school. Themes that emerged from this formative study can potentially assist in planning for telehealth education during and post COVID-19 and inform further telehealth research. Embedding telehealth skills training and guidelines into the medical program, and particularly rural medicine training programs, is essential to prepare the future medical workforce to ensure access and quality patient care during pandemics and also to improve access for rural Australians.

Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. ResultsFifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health.  

Sense of coherence (SOC), the capacity to muster, believe in and value resources to support resilience, is a central component of the salutogenic approach to wellness. Assessing patients' SOC in a salutogenic model may be useful to paramedics as an adjunct to effective referral to care pathways other than via the emergency department and for predicting patient engagement. A tool to help direct practitioners in the prehospital environment towards the most appropriate resources for each patient's unique situation appears to be lacking. This article examines the literature around salutogenic and SOC theories and provides an overview of how a salutogenic assessment tool could be used in paramedic practice. Taking a multifactorial approach to determining health status and predicating patient capacity for adaptive coping may make health professionals better able to assist patients in overcoming health events and build health resilience to improve their future health outcomes.