Paramedics in Switzerland: A Mature Profession

Schmutz, Thomas; Guéchi, Youcef; Dénéréaz, Sandrine; Ozainne, Florian; Nuoffer, Marc; Exadaktylos, A.; Ribordy, Vincent

doi:10.3390/ijerph19148429

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Mobile medical units (Service mobile d'urgence et de reanimation [SMUR]) are dispatched whenever emergency medical dispatchers identify lifethreatening emergencies, along with an advanced life support ambulance. These ambulances are staffed by two paramedics who graduated after a 3-year curriculum [13]. Alternatively, paramedics can request backup by an SMUR unit, either to help with a difficult clinical condition or to resolve a problematic medicolegal situation.…”

Section: Introductionmentioning

confidence: 99%

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Betend,

Suppan,

Chan

et al. 2023

Swiss Med Wkly

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BACKGROUND: Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES:To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit (“service mobile d’urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE:The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS: The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS: In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4–6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13–1.21) and less supervision (aOR: 0.85, 95% CI: 0.82–0.88). CONCLUSION: In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.

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Section: Introductionmentioning

confidence: 99%

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Betend,

Suppan,

Chan

et al. 2023

Swiss Med Wkly

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Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study

Fehlmann,

Stuby,

Graf

et al. 2023

BMC Emerg Med

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Background Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). Methods This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. Results A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81–0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9–66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0–96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. Conclusion The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. Registration This study was registered on the Open Science Framework registries (https://doi.org/10.17605/OSF.IO/VDUZY).

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Attempting to prevent hyperoxaemia after out-of-hospital resuscitation

Scotney

2022

Journal of Paramedic Practice

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Survival to discharge in the UK after an out-of-hospital cardiac arrest is significantly lower than in other similarly developed countries (7.3% in the UK compared with the rest of Europe at 11.7%). One modifiable factor that could be contributing to this is the oxygen administered by paramedics after a successful out-of-hospital resuscitation. Randomised controlled trials on the topic are limited, and most research is observational and often does not differentiate according to the location of the cardiac arrest, leading to conflicting results. Overall, hyperoxaemia may be beneficial for the patient after a successful resuscitation until a critical level is reached; in the prehospital setting, it is not always possible to measure PaO2 as this is outside of the scope of practice of a paramedic in the UK. Above a critical level, excess oxygen becomes damaging and worsens patient outcomes. After a successful resuscitation, where possible, paramedics should consider titrating a patient's oxygenation to a peripheral oxygen saturation of 94–98% unless a more accurate measurement, such as point-of-care arterial blood gas results are available to guide titration.

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Paramedics in Switzerland: A Mature Profession

Cited by 4 publications

References 7 publications

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study

Attempting to prevent hyperoxaemia after out-of-hospital resuscitation

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