As our paramedic profession grows throughout the world, so does our need to teach students the importance on research and the role we all play in growing and improving our knowledge.
It is important to stimulate students and to teach them that research is not something to be feared, but rather embraced. It is universities, colleges, and programs, like Fanshawe, that have taken this to heart and are paving the way for our future paramedics to be more actively involved in this branch of paramedicine.
Under the supervision and guidance of their faculty, Fanshawe students lead research-based studies to become more involved in the paramedicine community and help advance our training.
What follows are the abstracts from their research of this year. We hope you find them interesting and a small reminder of the importance of continuing our education throughout career.
Comparing Attitudes: Self-Assessed Mental Preparedness of Paramedic Students
By: Schisler, Collin; Christie, Valerie; Lesser, Sebastian; Romero, Camilo
Under the National Occupational Competency Profile, the maintenance of good mental health is essential to competent paramedic practice. However, little guidance within the curriculum exists for the inclusion of proper mental health training to deal with the mental health challenges of the paramedic profession. The goal of this study was to audit the perceived effectiveness of Fanshawe’s training on the mental health preparedness for the challenges of paramedicine from the student’s point of view. This research is meant as a conversation starter to investigate whether opportunity exists to improve the mental health curriculum in Ontario’s accredited paramedic programs.
The study surveyed second year Fanshawe College paramedic students using an adapted survey from Holmes and colleagues (3). The answers were compared to Holmes’ (3) responses to generate discussion based on mental health preparedness across Australian/ New Zealand and Fanshawe College students.
The results of the survey found that lectures and discussions were predominant teaching tools used in both groups, and students having mixed feelings for whether their program has adequately prepared them. Differences between Fanshawe responses and Holmes (3) were also found regarding positive anticipation for using clinical skills/knowledge and making a difference to patients and their families. There were also differences for what students felt most confident about entering the field. Finally, fears about entering the field of paramedicine were a significant concern for both groups of students, with a high prevalence of fear for personal mental well-being in their responses.
We believe our data requires further investigation to provide a deeper comparison of the trends seen in this initial survey pool. It is planned to have this research expanded to include all the accredited paramedic colleges in Ontario, to obtain a sample more comparable to Holmes’ pool of data. It was found overall that responses were broadly similar, and this may speak to certain similarities in curriculum across the groups. Some novel findings of the Fanshawe paramedic program indicate that certain aspects of the training ought to be addressed. The aim in doing so, would be to provide more certainty to students about their ability to handle the mental health challenges paramedicine has to offer. Further research including all the accredited programs in Ontario, would provide more generalizable conclusions about where improvements could be made in the curriculum.
The Use of Cognitive Aids in Paramedicine to Reduce Medication Errors: A Focus Group Study
By: James Nunn, Sonja De Bruyn, Mark De Brouwer & Donovan Wiebe
The use of medical math in the field of paramedicine is a necessity to perform patient care. The ability to do calculations of medications under time constraints and stress has led to the questioning of the effectiveness of paramedics at math. The use of cognitive aids is a newly emerging aspect that other healthcare careers have adopted to prevent errors. This focus group was held to gain an understanding of the thoughts, feelings, and experiences of paramedics regarding medical math and the use of cognitive aids.
One focus group with ten participants was conducted to get a variety of information about the use of cognitive aids in paramedicine. Questions focused on if the participants felt confident with their abilities at medical math, their experiences with errors in medical math and if they felt their education had prepared them for medical math in the field. The group was also asked if they knew of cognitive aids or use them currently and if the use of a cognitive aid should be used prior to the administration of medication.
5 main themes were examined, medical math confidence, service encouragement, paramedic discretion, frequency of cognitive error, and paramedic opinion. All respondents responded that they feel confident in performing medical math, in ideal conditions, without the use of a cognitive aid, however agreed that there are factors that lower their confidence such as fatigue, stress, etc. All the participants responded that the service they work/worked for encourage the use of cognitive aids, however there was a heavy emphasis on memorization over the use of cognitive aids 5 years prior. When it came to paramedic discretion, paramedics with longer experience reported using cognitive aids only when necessary, whereas recent graduates reported using cognitive aids frequently, even when confident. All the respondents remarked making at least one memorable cognitive error in their career, in which all stated a cognitive error was not present/used when the error occurred. Finally, all respondents agreed that cognitive aids would contribute to a decrease in cognitive aids however more research is needed to determine a clear correlation.
With the expanding scope for paramedics in Ontario, Canada, a solution to the high occurrences of medication errors is necessary. Cognitive aids have the potential to reduce medication errors in the prehospital setting, more research in this area is needed to make this determination.
How Paramedics’ Attitudes Affect First Year Paramedic Students
By: Jake Coady, Ben Hinds, Justin Dixon, Paulina Kapela, and Lauren Swackhammer
The purpose of this research was to investigate the impact that paramedics’ attitudes had on paramedic students participating in clinical placements during their first semester. This study was conducted at Fanshawe College in London, Ontario, Canada using second-year paramedic students, with clinical placements taking place throughout Southwestern Ontario. The research was conducted using 3 focus groups, with 11 second year paramedic students in total. The focus groups were conducted online over Zoom and were transcribed using OTTER.ai. During the focus groups, questions were asked about students’ experiences during ride-outs, their paramedic’s attitudes, and how the paramedic students perceived their ride-out. The discussion that occurred in the focus group provided evidence to suggest that paramedics’ attitudes do impact paramedic students, but not always in a negative manner. Paramedics’ attitudes in general and the way they interacted with patients influenced the way those paramedic students participated in their ride-outs. Due to the limits of this research study, more research is required to discover how prevalent this aspect of the hidden curriculum is in paramedic education.
The Benefits of Having Clear Objectives in a Variety of Clinical Placements for Paramedic Students
By: Lydia Quick, Meredith Rimmer, Mackenzie Cummings, Kerianne De Caluwe, Divisha Thurairajah, Joanna Antonio
Paramedic students often get to experience a variety of placements during their time in school. Placements such as, ambulance ride-alongs, hospital ER’s and long term care facilities/ nursing homes offer a diverse set of learning opportunities. They not only allow students to work with different healthcare professionals and patient populations, but they also allow students to practice skills and work towards completing objectives/ NOCPs set out for them. Previous studies have shown that students are better prepared for their future careers as paramedics when they have adequate experience with interprofessional work while in school. Research has also shown a positive correlation between students who enter placements with clear objectives and a good understanding of where their limitations lie. This study looks at the usefulness of various placements and whether they have clear and achievable student objectives. Fanshawe College (London, Ontario campus) Paramedic Alumni and the graduating class of 2021 students were asked to complete an anonymous Google survey regarding their placement experiences. A total of 22 responses were collected and analyzed by the researchers to find common themes and discrepancies. The results of this study show that there is no correlation between the number of NOCPs and how useful the students perceived each placement. However, some common trends in the data show that students across many placements were able to learn communication skills, patient interaction skills and technical skills. The ultimate goal of this research was to gain a better understanding of the role that clear objectives play in placements and start a discussion as to how these can be improved for future paramedic programs.
Paramedic’s perceptions of family-witnessed resuscitation.
By: Jenna DeSilva, Adam Migchels, Kaela Holmes, Tori Austin, Nina Morrissey
Allowing family members and loved ones to be present during cardiopulmonary resuscitation is a practice that was introduced in the 1980’s, however its delivery remains inconsistent and controversial among health care providers today. Allowing family witnessed resuscitation (FWR), is usually subjective to the beliefs and preference of the attending medical teams and puts less consideration on the family members involved in the event. While there have been numerous studies that have examined the opinions of doctors, nurses, and family members around the world on the topic of FWR, there have been no studies that specifically look at the opinions and perceptions of paramedics in Ontario.
The goal of our study was to determine why paramedics in Southwestern Ontario, Canada chose to include or exclude family members during resuscitation.
A 10 question google survey was sent via email to the Chiefs and Deputy Chiefs of the eleven services under the Southwest Ontario Regional Base Hospital Program (SWORBHP) to distribute. The questionnaire was a combination of short answer questions, yes/no questions, and questions utilizing a 5-point Likert-scale. Responses were automatically recorded within the survey software and no personal identifying information was associated with each response. Follow up emails were sent out at one and three weeks following the initial distribution. Responses have been stored within secure accounts of the authors and were sorted and coded to identify any common themes.
n=30 Nearly all respondents have been exposed to the possibility of FWR (93%) with 30% performing greater than 20. Average FWR exposure =15.56 times, with the range being stated as none to over 100 instances. Likert scale responses stated 70% of respondents agreed that there was no impact on their CPR performance, 76% agreed that it doesn’t change their mind in requesting for a termination of resuscitation, and 77% agreed that FWR better prepares witnesses for the process of grieving and coping following a death. Only 20% indicated that they would be uncomfortable with providing emotional support to the family. There were 0 negative responses from paramedics with 15+ year of experience, suggesting that a paramedics level of comfort with this process may change and become more positive over time.
81% of responses were positive, while 19% were classed as negative. There seems to be vast support for FWR among SWORBHP paramedics. This is somewhat unlike the literature about other healthcare professionals, as we saw an overwhelming number of responses that are for FWR, suggesting that the variance in paramedic opinions may not be as widespread.
Standard Precaution Infection Control Habits
By: BrookLynne Hertner, Meghan Lysko, Matthew Screpnek, Marisa Ramalho and Brittney St Amand
Amongst the large number of patients that use the Canadian healthcare system a year, millions acquire infections originating in hospital. These hospital acquired infections often impact patient’s care leading to longer hospital stays and poorer outcomes. Multiple studies have shown that there is an overall lack of compliance with hand hygiene amongst healthcare workers in both the hospital and prehospital environments. Other studies have shown contamination of highly infectious strains of pathogens on equipment deemed clean and ready for use. There is evidence to suggest that this may stem from a lack of understanding of infection control and compliance along with lack of practice in donning and doffing of personal protective equipment designed for highly infectious diseases. Overall, there is a lack of research in Canada regarding pre-hospital infection prevention and control standards, their education and effectiveness.
The goal of this study was to observe and establish common practices and habits amongst paramedic students in the areas of infection prevention and control to serve as a baseline for further research into infection prevention and control education, understanding and adherence amongst paramedics and in the pre-hospital setting.
This was a randomized retrospective study. Scenario examination recordings of primary care paramedic students from between the years of 2018 and 2020 at Fanshawe College were chosen. Six participants from these years responded with consent and were included in the analysis. These students were observed for deviations from commonly accepted practices as established by the Centres for Disease Control and Prevention in the areas of hand hygiene, personal protective equipment, handling of various textiles, cough/respiratory etiquette, and injection/aseptic technique. These observations were logged on a data collection table designed by the researchers and descriptive statistics were then performed on the data.
The outcome measure for this research was the number of infection prevention and control offences, or deviations, observed throughout the scenario examination recordings. It was found that none of the participants changed their gloves when common practice would indicate to do so, even following heavy glove soilage by bodily fluids. Out of all touching events, 54% of uniform touches occurred with contaminated gloves, the same can be said of 84% of face touches and 100% of head/hair touches. All six participants had concerns regarding self-contamination through soiled glove contact. With regards to personal protective equipment use, 50% of participants did not assess for or verbalize the need for utilization of an N95 respirator mask where appropriate. In the eight cases where utilization of a face shield or goggles would be appropriate, 0% of participants utilized either piece of equipment. All six participants had at least one incident of failing to follow aseptic technique by placing a soiled airway device into or onto a patient.
Overall, there is a lack of compliance with infection prevention and control measures amongst primary care paramedic students at Fanshawe College. This lack of compliance includes the recognition and utilization of appropriate personal protective equipment, appropriate aseptic technique and hand hygiene. This study establishes a baseline for pre-COVID-19 infection prevention and control behaviours and habits, opening the door to research being conducted in the future comparing pre- and post-COVID-19 infection prevention and control habits amongst paramedic students.
Should Primary Care Paramedicine Curriculum Include Community Paramedicine Practices?
By: Daniel Doummar, John Hong, Jason Lee, Jennifer Long, and David Ten Bruggencate
The current primary care paramedic curriculum focuses on managing acute medical or traumatic ailments and fails to adequately address chronic ailments. Community paramedicine is a relatively new discipline within the paramedic field which focuses on management of chronic ailments. Naturally, the education paramedics receive does not incorporate the skill set and requirements to become a community paramedic. This research analyzed the appeal of including community paramedicine education into the current primary care paramedicine curriculum. Using a qualitative research design survey, a focused assessment of active Middlesex-London Community Paramedics was conducted.
The survey contained both closed-ended and anecdotal questions to gauge whether or not community paramedics believe their scope of practice should be implemented into the primary care paramedic curriculum. Their responses underwent an inductive thematic analysis to identify themes by isolating keywords and phrases. The participants were mostly in favour, ranging from strongly agreeing (20%), agreeing (40%) and neutral (20%), for community paramedicine-based courses to be integrated into the paramedic curriculum. Also, participants answered with “yes” to the addition of community paramedic curriculum and provided suggestions for specific education and courses.
In conclusion, most of the community paramedics who participated believed that the current paramedic curriculum would benefit from the inclusion of community paramedicine curriculum. The outcome of this study requires further research and a broader sample set to validate its findings.