On December 3rd, 2019 the Georgian College Paramedic Program (Barrie, ON) held its 4th annual student-led research day. As a component of the third semester in the primary care paramedic program students are required to complete and present a research project of their choice, approved by the course instructor. Students are responsible for developing their own independent research project from creating a question, through REB submission, to carrying out the study and data analysis. The course culminates with the presentation of their research during Paramedic Research Day.
This year there were a total of seven research projects presented on the research day. The abstracts for the student projects are below. If you have any questions about these projects or the research day held at Georgian College please contact the course instructor, Ian Drennan (Ian.Drennan@GeorgianCollege.ca).
Paramedic Students’ Ability to Manage a Female vs Male Cardiovascular Event
Students: Ashlyn Pickthall; Briar Delorme; Keegan Hawkins
Introduction: Acute coronary syndrome is the leading cause of death for females worldwide, however 2/3 of all heart disease research is based on the male population. Females present with atypical symptoms and up to 53% of female heart attack symptoms may go unnoticed, possibly delaying prehospital treatment.
Methods: We conducted two 8-minute scenarios (one female and one male patient). Each scenario represented a patient having an ST-elevation myocardial infarction with gender specific presentations. Eleven 2nd year Georgian College paramedic students volunteered. Half of the participants started with the female patient, where the other half started with the male patient. The order of participants was randomized. All participants completed the two scenarios on the same day, back to back.
Results: We observed an overall delay and/or lack of the following procedures in the female scenario: 12-lead ECG, acetylsalicylic acid (ASA) consideration and administration. Most notable was a 1.5 minute delay in ASA administration. There was a 36.3% increase in the number of male patients who were given ASA, and 81.8% of male patients were transported on a STEMI-bypass compared to 45.5% of females. Participants indicated they were more comfortable treating the male patient.
Conclusion: There was an obvious delay in proper treatment and management of the female patient. Further and more in-depth education is recommended in relation to female presentation. Continued awareness and research is required surrounding women’s cardiovascular health.
Paramedic Student Preparedness for Managing Abusive Relationships in The Field
Students: Riley Thomas, Genevieve Langlois, William Yang
Introduction: Intimate partner violence (IPV) is on the rise in today’s society. One in 3 women experience IPV at least once in their lifetime. International Guideline agencies emphasize the need to increase the education of frontline healthcare practitioners who encounter IPV patients. Paramedics are expected to recognize, refer, and take appropriate steps when managing calls for IPV in the field. The objective of this study was to evaluate the preparedness of Georgian College paramedic students to manage 911-calls involving psychological and physical abuse within an intimate relationship.
Methods: We recruited 11 second year Georgian College paramedic students to complete two different 8-minute simulated scenarios. One scenario contained pre-determined components of psychological abuse, while the other contained pre-determined components of physical abuse. Participants were evaluated using a modified Global Ratings Scale (GRS). Participants were asked to complete a post-scenario survey after each scenario to determine their perceived knowledge of the scenario, including what they believed to be the underlying problem of the call.
Results: The average age of participants was 25 years old with 55% female. Only 9% of participants recognized the abuse during the psychological abuse scenario while 73% of participants recognized abuse in the physical abuse scenario. None of participants considered notifying police during either scenario.
Conclusion: Our results show there is a deficit in the ability of paramedic students to deal with scenarios involving abuse. More in-depth focus on this topic could better prepare students to recognize and manage abusive relationships in the field.
Virtual Reality & its Potential in Paramedic Education
Students: Lydia Abel; Andrea Christakakos; Crystal White; Nikita Thoi
Introduction: Virtual reality (VR) is currently implemented as a training and simulation tool in the medical field to improve clinical skills. VR has the potential to provide students with a more realistic experience, and an elevated sense of presence. Our objective was to determine whether VR is a valuable tool in conjunction with lab-based simulation in paramedic education.
Methods: Ten second-year paramedic students volunteered for the study. Students were randomized to complete two comparable scenarios back-to-back, one in VR and the other in lab-based simulation. The order in which clinical decisions were made was evaluated during each scenario and following each scenario participants were asked to complete a short survey on their perceptions of the scenario they completed.
Results: The majority of participants found VR helpful for visual and auditory learning. Participants demonstrated 80% similarity between VR and lab-based scenarios when conducting scene safety and 50% for their primary survey. History gathering had the lowest similarity percentage (20%) between scenarios. Half of the participants had a 50% or greater similarity in the order in which they completed their assessments demonstrating potential for VR to work in conjunction with lab-based simulation. The majority of participants suggested ‘communication with the patient’ needed improving in VR.
Conclusion: Participants completed scenarios in a different order in VR compared to lab-based simulation. Participants felt that some aspects of the scenario were easier in VR while others were less realistic. VR has the potential to supplement traditional lab-based simulation
The Ability of Second Year Paramedic Students to Ventilate Using a Bag-Valve-Mask
Students: Brianna Dezeeuw; Lukasz Perchal; Mathew Ghanzideh-Khoob; Emily Achmatowicz-Otok
Introduction: The use of a Bag-Valve-Mask (BVM) is a valuable tool in the prehospital setting to help manage respiratory emergencies. Proper technique is essential, however, there is little research measuring the efficiency of BVM ventilations done by students.
Methods: This study was a crossover simulation study recruiting 10 second year paramedic student volunteers. Participants were asked to perform an 8-minute, opioid overdose simulated scenario using a high-fidelity simulator to evaluate BVM efficiency. Participants were evaluated using the NOCP for BVM ventilations and using simulator feedback. We pre-defined adequate ventilation as 400-600 mL of air and a rate of 6-10 breaths/min. Participant confidence was evaluated pre- and post-scenario using a survey outlining different areas of airway management and troubleshooting ability.
Results: A total of 299 ventilations were delivered throughout all the scenarios, with only 43 (14.4%) delivering ≥400mL of air. The average volume delivered was 310.79mL; highest volume 496mL; lowest measured volume 151mL (0mL was delivered an unknown number of times). The lowest rate of ventilation seen in a scenario was 0 breaths/minute; the highest 7 breaths/minute. One participant utilized 0 adjuncts; 9 participants used an OPA (33% proper size); 8 participants used 2 NPAs; 1 participant used 1 NPA. Improved ventilations were seen when a two-handed seal was utilized.
Conclusion: Overall, ventilations were inadequate, however adequacy improved with adjuncts and a two-handed seal. This suggests best practice for BVM ventilation is to utilize airway adjuncts and to have two people designated to the airway when resources are available.
Barriers to Calling 911 During Opioid-Related Emergencies
Students: Philip Inglis; John Mantello; Jake Ruddy; Drew Wilkinson
Introduction: In response to a rising number of overdose deaths, the Canadian Government passed the Good Samaritan Drug Overdose Act (GSDOA) in 2017. The act’s intention was to reduce fear of police attending overdose emergencies and to encourage the public to help save lives. Several studies in the United States suggest that there is an overall fear of police involvement despite protections in place. Previously, there has been no research conducted on this topic in Canada. Does knowledge of the GSDOA affect a patient or bystander’s willingness to call 911 in the presence of a drug overdose?
Methods: We distributed anonymous surveys over a 1-week period to a local homeless shelter to collect information on the barriers, attitudes, and perceptions to calling 911 during medical emergencies involving opioids.
Results: Our preliminary results showed an association between awareness of the GSDOA and calling 911. 67% of survey respondents who were aware of the GSDOA called 911 versus none of those who were unaware of the GSDOA. 63% of respondents were concerned about personal legal issues if they called 911. 75% of respondents were aware of the GSDOA. 37.5% of all respondents, after an explanation of the GSDOA, did not trust that the GSDOA would effectively protect them.
Conclusions: If respondents are aware of the GSDOA, they were more likely to call 911. Most respondents were concerned about legal ramifications and negative interactions with first responders. These results are preliminary findings to an ongoing study.
Confidence and Comfort: Paramedic Students Providing Death Notifications
Students: Liam Moloney, Jada Thompson, Tori Dzenis
Introduction: Death notification is one of the more difficult parts of being a paramedic. It’s suggested that paramedics struggle in compassionate communication towards families following the death of a patient. During the primary care paramedic program, students spend a minimal amount of time discussing this topic. Our objective was to quantify paramedic students’ confidence and competence in compassionate care towards the patient’s families and to examine changes that may need to be implemented into educational curriculums.
Methods: We recruited 10 second-year Georgian College paramedic students. Students performed a scenario in which they were expected to provide a death notification to a family member. The Global Rating Scale was used with a focus on communication, decision making, and situational awareness. A self-evaluation survey was completed following the scenario to determine their level of confidence in providing comfort during the scenario.
Results: It was clear that students’ performance was better than what they perceived it to be. We determined that students were hesitant to use the term “dead” and often defaulted to colloquialisms. Students second-guessed their decision to withhold resuscitation. 30% of students felt confident withholding resuscitation. 30% felt they knew what to say to the family. 100% indicated they would benefit from further education. Further education would increase confidence, enhance quality of care, and make it easier for paramedics and paramedic students to recover from these types of calls
Conclusion: While student performance was higher than what they perceived, we identified areas for improvement. All students indicated they would benefit from more education on death notification.
Risk of Drug Errors By Paramedic Students for Similarly Named Drugs
Students: Chelsey Lees, Kimerly Tonogbanua, Kyle Williams
Introduction: Medication errors have been identified as a significant issue in healthcare. Wrong drug administered increases morbidity and mortality. In the prehospital setting ampoules are often indistinguishable, apart from the label or printing, which can be difficult to read on chaotic scenes and in low lighting. Due to this, there is often confusion between diphenhydramine and dimenhydrinate.
Methods: This was a simulation study aimed at forcing a drug error in a pediatric anaphylaxis scenario. Students were given dimenhydrinate when they asked for diphenhydramine. Fifteen second year students were recruited and completed a ten-minute scenario. Participants were evaluated using the Global Rating Scale with focus on their ability to identify anaphylaxis, administer appropriate drugs (epinephrine & diphenhydramine) and recognize the forced drug error.
Results: We observed 3 of 15 (20%) participants administered the correct drug (diphenhydramine), 10 of 15 (67%) participants administered dimenhydrinate and 2 of 15 (13%) participants administered no drug after epinephrine. The main cause (60%) of wrong drug administration was from misreading the label. We also observed 10 of 15 (67%) participants administered the incorrect dose of epinephrine, the correct dose being 0.25mg, with 70% incorrectly rounding up to 0.30mg.
Conclusion: The results of this study indicate that similar named drugs affect the student’s ability to recognize and administer the correct drug. Additional safeguards must be implemented to decrease the incidence of drug administration errors. Furthermore, paramedic students must continually develop and be aware of their own commitment to high standards in clinical practice.