Objective: Emergency medical service (EMS) providers are exposed to a variety of stressors endemic to the profession. These exposures may contribute to stress reactions, including posttraumatic stress. The objective of this study was to evaluate the relationship between work-related stressors and posttraumatic stress. The secondary objective was to determine paramedics' preferred sources of support for managing work-related stress. Methods: 269 paramedics in a county-based EMS service were invited to complete an online survey. Respondents reported their demographic characteristics, levels of chronic stress, critical incident stress, posttraumatic stress symptomatology (PTSS), and preferred sources of support for managing work-related stress.
We appreciate the interest of Tang and colleagues, who have made substantial contributions to advancing care for patients with cardiac arrest. We provide additional information here to clarify the issues they raise, beginning with their last point.The letter expresses concern about an imbalance between groups 1 in the incidence of asystole as an initial rhythm. However, the multishock groups, on which the primary end point is based, are nearly balanced: 2 of 55 versus 0 of 51 patients initially in asystole.The letter expresses concern about aggregating first and subsequent shocks in the primary analysis. An abstract of our study reported separate results for subsequent shocks in which energy levels differ most between groups, revealing a larger advantage for higher-energy shocks: ventricular fibrillation termination, 71% for 150 J versus 85% for 300 to 360 J (Pϭ0.01); conversion, 24% versus 43% (PϽ0.01). 2 Another stated concern is that the automated external defibrillators studied were modified. They were not; study sites used their existing standard LIFEPAK 500 automated external defibrillators, providing protocol choices starting as low as 150 J and increasing to as high as 360 J. Although the Philips automated external defibrillators discussed by Tang and colleagues are limited to a fixed 150-J protocol, many automated external defibrillators allow various protocol choices, including 150 J fixed. Because most devices support multiple protocols and evidence to recommend 1 protocol over another remained lacking, our study addressed an important question: When multiple protocols are available, which should be chosen?The letter suggests that the lower peak current of the 150-J shocks we studied compared with different 150-J shocks discussed in the letter reduces defibrillation effectiveness. This would be true only if the waveform shape were the same. Compared with the 100-F shocks discussed in the letter, the longer time-constant 200-F shocks we studied provide higher average current for any given peak current. Consequently, as established in the literature, highercapacitance waveforms defibrillate with less peak current. 3 Most defibrillators increase energy by increasing shock intensity (current and voltage) rather than changing waveform shape or duration. We evaluated the effect of shock intensity without changing waveform and found that a protocol using higher intensities for subsequent shocks produced better heart rhythm outcomes than one maintaining a lower intensity. The principle demonstrated by our results would apply to any other waveform unless either (1) the first energy level succeeded for 100% of all shocks or (2) increasing the intensity above that of the first shock caused the peak current to exceed the level at which clinically significant myocardial injury appears. Multiple clinical studies report relatively low biphasic ventricular fibrillation termination rates (Ͻ75%) and subsequent shock success lower than the first shock success, providing ample evidence to rule out condition 1 for any def...
Objective The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. Methods A cross‐sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post‐traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non‐responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. Results This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. Conclusion These findings illustrate that a host of different stressors may influence safety‐related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.
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