Ambulance paramedics are members of a discipline that forms a unique part of the emergency services. As pre-hospital providers they are constantly and increasing faced with heavy workloads that are physically, mentally and emotionally tiring. Fatigue and sleep disturbance are factors which can compromise the effectiveness of these workers, and as a result not only hamper patient safety but can have detrimental consequences on the paramedics' health and overall well-being. The objective of this study was to investigate the impact shift work on physical fatigue, sleep and psychological factors among paramedics in Australia. Methods A convenience sample of paramedics was asked to complete a number of self-reporting standardised questionnaires: The Epworth Sleepiness Scale (ESS) (8-items), Berlin Questionnaire (BQ) (10-items), Pittsburgh Sleep Quality Index (PSQI) (19-items) and the Beck Depression Inventory (BDI) (21-items). Ethics approval was granted. Results The study recruited 60 participants, the majority of which were male 77% (n=46), > 45 years of age 31% (n=19), and having worked shift work between 5-10 years 35% (n=21). Nine out of ten (92%, n=55) of paramedics reported having experienced fatigue in the last 6 months, with 88% (n=53) believing it had affected their performance at work. The ESS reported 30% (n=18) of people had excessive daytime sleepiness, and 10% (n=6) being dangerously sleepy. Statistical significance was observed in the ESS items 'chance of dozing while sitting and talking to someone' (p<0.05), and 'whilst stopped in traffic for a few minutes' (p<0.05) between males and females. Almost half (48%, n=29) of paramedics answered yes to having nodded off or fallen asleep whilst driving. The PSQI found 68% (n=41) of participants suffered poor quality sleep, while 21 % (n=13) of respondents were at high risk for sleep apnoea (BQ). Depression was found to be mild among 27% (n=16) and moderate among 10% (n=6) of respondents. Conclusions Shift work affects health and well-being both physiologically and psychologically, which translates from work into home. Further research using a larger sample size is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work in paramedic employees.

Methods This study is a comparative analysis. We implemented an Emergency Department Provider Level Triage Team (PLTT) that consisted of 1 Emergency Medicine Physician Assistant and 1 Combat Medic to intervene in patient care in the ED at Womack Army Medical Center (WAMC), Fort Bragg, North Carolina, USA. Three days of 12 hours shifts were selected during the peak hours of the ED and compared to the same period on days that did not have the intervention. Only patients categorized with an Emergency Severity Index of 2 or 3 were selected and compared. No additional medical, nursing and medic staff were used. This study was approved by the WAMC Institutional Review Board.

Results In total, there were 241 cases during the trial period and 231 controls. Median times were significantly reduced (p=<0.001) during the intervention period. Times to analgesia (97.4 min v 171.1 min, p=0.03), time to laboratory results (103.8 min v 143.9 min, p=0.01), radiology (136.3 min v 181.6 min, p=<0.001), and to disposition (317.4 min v 334.6 min, p=0.05) were all decreased. Nearly 90% of patients in the intervention group said that their experience with the intervention was very good or outstanding.

Conclusion The implementation of the PLTT model in our ED was associated with reduced time to healthcare provider assessment, decreased overall ED length of stay, and improved patient satisfaction.

Methods A retrospective one month audit of South Australian Ambulance Service records was conducted. Characteristics of ambulance call-outs for falls or alarm activations were described (Sample 1). Alarm-activated services for older fallers were matched (by day and type of service) with fallers who did not use a personal alarm (Sample 2).

Results In Sample 1, 379 of 1700 callers used a personal alarm to call the ambulance, although 58% these alarm-activated calls were false alarms (neither lift nor hospital transport service provided). From Sample 2, most alarm calls were made by females (72%) alone at the time of fall (78%). Ambulance response time did not differ between alarm (median=11 mins) and non-alarm users (median=14 minutes, p=0.56). The difference reflects a clinically non-critical difference in non-life threatening cases. 82% of alarm users and 75% of non-alarm users were on the ground when the ambulance arrived. Of non-alarm users, 11 were self-reported 'long lies' (>one hour) before the ambulance was called, and there were 13 other cases with unknown time on the floor. This compared with 11 self-reported long lies in alarm users.

Conclusion Older women living alone were the major users of personal alarms for assistance after falling. If activated quickly, alarms enabled most fallers to gain ambulance attention within 15 minutes. However, personal alarm use was also associated with a high incidence of false alarms.

Method A literature search was conducted using medical electronic databases, MEDLINE CINHAL, EMBASE, Meditext, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus. These databases were searched from January 1996 until the end of January 2010. Articles were included if the principal objective was to compare ventilation efficiency of the LMA against the BVM in the prehospital setting. References from articles retrieved were reviewed.

Results There were 2937 articles located by the search. Of these, 30 articles met the inclusion criteria with twelve relevant to the prehospital environment. In the twelve prehospital studies, two involved the use of mannequins, four were retrospective, five were observational, and there was one a literature review.

Conclusion The findings from this review suggest that the LMA is more effective at ventilations over time during CPR in adults, as there is less risk of gastric regurgitation and pulmonary aspiration. The BVM is quicker at performing the first ventilation but there is a loss of effectiveness over time. BVM is considered the best method for ventilating children and neonates.