Volume 12 Issue 3

Challenges and changes with COVID-19: Canadian paramedics' experiences

Background: Healthcare systems, practitioners and communities have experienced momentous change and strain because of the COVID-19 pandemic. Although paramedics are an essential component of the public health emergency response, the literature has focused primarily on the views of physicians, nurses and hospital administrators. Aims: This research sought to improve the understanding of the lived experiences of paramedics throughout the initial stages of the COVID-19 outbreak. Methods: The perspectives of paramedics were captured through an online survey consisting predominantly of open-ended questions. Findings: Three main themes describing the experiences of paramedics arose: challenges with change management; changes in day-to-day operations; and implications for mental health. Conclusion: This study has offered insights for future pandemic response in terms of information dissemination, practitioner involvement in policy and operational changes, and mental health and wellbeing support needs during and beyond a pandemic.

Identifying effective paramedic leadership skills

Introduction: Paramedics who assume leadership positions rarely receive education and training to prepare them for the change in role. This study examines the experiences and beliefs of paramedic leaders and suggests ways that practitioners looking to move into leadership positions can develop their leadership skills before assuming such a role. Methods: Qualitative, semistructured interviews were conducted with paramedic leaders from the different emergency medical services (EMS) models, including fire department, ambulance district, hospital and private EMS systems from urban, suburban and rural response areas to determine leadership training best practices, based on the leaders' own experiences. Results: Despite employer and regional variations, all the participants had similar experiences during the transition from frontline clinician to leader. Common themes included a lack of preparatory training, a struggle with moving from peer to boss, issues with learning how to communicate effectively and an ongoing need to perform direct patient care while also fulfilling the tasks of a manager. These issues were a source of considerable stress and self-doubt for many participants. Conclusion: Leadership training is not typically given to EMS field clinicians looking to assume leadership positions. Paramedic leaders have developed the necessary skills to succeed on their own by learning on the job, developing mentor/mentee relationships, and undergoing training and education in the form of advanced degrees. EMS agencies need to prioritise proactive and meaningful leadership development not only to retain current staff but also to support organisational succession plans.

Thermal comfort during emergency transport by ambulance services

Background: Cold is an unpleasant sensation and is linked to increased anxiety, pain and risk of hypothermia. A question was developed to test the authors' hypothesis that patients would feel cold while being transported to an Irish emergency department (ED) by the Ambulance Service (NAS). Method: A survey of a convenience sample of 96 respondents was undertaken, for 77 consecutive hours in March 2020 at University Hospital Limerick's ED. During that period, the NAS transported 163 patients to the ED. A seven-point Likert satisfaction rating scale was used to assess perception. Taking this in combination with a visual assessment of personal insulation and the vehicle's patient compartment heater status, this project endeavoured to determine the passengers' thermal comfort. Results: Fifty-three per cent of the sample (<em>n</em>=51) were women, 22% (<em>n</em>=21) were escorts and 78% (<em>n</em>=75) were patients. Forty-two patients (56%) were aged &gt;65 years. Of those interviewed, 66.6% (<em>n</em>=64) rated 0 (neutral/comfortable/I didn't notice) at the beginning of their journey and 67.7% (<em>n</em>=65) rated 0 at the end of their journey. Thirteen reported finding the ambulance cold at the beginning of their journey, and five reported still being cold at the end of it. In contrast, 15 respondents found the ambulance warm. The vehicle's patient compartment heater was switched on in 80% (<em>n</em>=69) of the 86 journeys. Transportation had a median time of 27.5 minutes (range: 3–90 minutes). The recorded air temperature at the nearest weather station ranged between −0.8°C and 10.1°C, significantly lower than the average for the time of the year. Conclusions: During this relatively cold week, two-thirds of passengers rated their thermal comfort in the ambulance as comfortable, 15 were warm beyond comfortable and very few felt cold.