Retention, learning by doing, and performance in emergency medical services.
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ABSTRACT: Objectives
To examine the strength of the volume-outcome relationship among paramedics, a group of providers that has not been previously studied in this context. By identifying the effects of individual learning on performance, we also assess the value of paramedics' retention. The prehospital emergency medical services (EMS) setting allows us to interpret any volume-outcome relationship as learning by doing, uncontaminated by reputation-based referrals because ambulance units are dispatched based on proximity.Data sources
Incident-level EMS data spanning 1991 to 2005 from the Mississippi Emergency Medical Services Information System collected by the Mississippi Department of Health.Research design
Using linear and quantile methods with and without provider fixed effects, we estimate the relationship between experience accumulation and performance using the universe of trauma incidents involving injured patients (including motor vehicle crashes, falls, stabbings, and shootings).Principal findings
We find that greater individual volume is robustly related to improved performance. In addition, we find that the benefit of learning operates through both recent and past experiences, accrues differentially across tenure groups, and operates on both mean performance and the upper quantiles of the performance distribution.Conclusions
Persistent past and current volume effects suggest that policy and managerial implications in EMS should be directed at retention efforts to take advantage of individual learning by paramedics.
SUBMITTER: David G
PROVIDER: S-EPMC2699914 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThere is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance.Subject and methodsThe study was undertaken in the Riyadh region of Saudi Arabia. Potential participants were currently employed by Saudi Red Crescent EMS as either a technician, paramedic or an EMS station manager, and had a minimum of five years experience with the EMS. Semi-structured interviews were undertaken between October 2019 and July 2020 with first respondents to a call for participants, and continued until data saturation was reached. All interviews were conducted in Arabic and transcribed verbatim. The Arabic transcript was shared with each participant, and they were asked to confirm their agreement with the transcription. The transcribed interviews were then translated into English; the English versions were shared with bi-lingual participants for validation, while independent certification of the translations were performed for data from participants not fluent in English. A thematic analysis methodological approach was used to examine the data.ResultsThe final sample involved 20 participants (10 rural, 10 urban) from Saudi Red Crescent EMS. Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing.ConclusionThe findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, three changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.
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Project description:IntroductionSurvival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting.MethodsA descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills.ResultsOverall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training.ConclusionOverall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.
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Project description:Objectives:The Medical Library Association (MLA) Systematic Review Project aims to conduct systematic reviews to identify the state of knowledge and research gaps for fifteen top-ranked questions in the profession. In 2013, fifteen volunteer-driven teams were recruited to conduct the systematic reviews. The authors investigated the experiences of participants in this large-scale, volunteer-driven approach to answering priority research questions and fostering professional growth among health sciences librarians. Methods:A program evaluation was conducted by inviting MLA Systematic Review Project team members to complete an eleven-item online survey. Multiple-choice and short-answer questions elicited experiences about outputs, successes and challenges, lessons learned, and future directions. Participants were recruited by email, and responses were collected over a two-week period beginning at the end of January 2016. Results:Eighty (8 team leaders, 72 team members) of 198 potential respondents completed the survey. Eighty-four percent of respondents indicated that the MLA Systematic Review Project should be repeated in the future and were interested in participating in another systematic review. Team outputs included journal articles, conference presentations or posters, and sharing via social media. Thematic analysis of the short-answer questions yielded five broad themes: learning and experience, interpersonal (networking), teamwork, outcomes, and barriers. Discussion:A large-scale, volunteer-driven approach to performing systematic reviews shows promise as a model for answering key questions in the profession and demonstrates the value of experiential learning for acquiring synthesis review skills and knowledge. Our project evaluation provides recommendations to optimize this approach.
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