Authors

John Meyer, BS, Paramedic; Josh Lopez, BS, NRP; Adam Alford, BS, NRP; Elizabeth Todak, MS, PM; Kyra Wicklund, MPH; Kevin Loughlin; William Camarda MS, NRP; Marilee Rosensweig, MEd, Paramedic; Lynne Fullerton, PhD; William Robertson, DHSc, NRP

Introduction

Paramedic students must act and demonstrate competency as team leader in prehospital patient care encounters to successfully graduate their paramedic program.   In previous research it was found that with the higher acuity of the patient the student’s likelihood to lead decreased.  This study sought to investigate whether the age and acuity of the patient influences the student's frequency to be team leader.

Primary Objective

The objective of the research was to determine if the age of the patient and the criticality of the patient affected the student's frequency and likelihood of team of leads.

Methods

A retrospective review of student records from FISDAP, a national online emergency medical services (EMS) student tracking system, was completed.  The database provided 537,343 patient encounters, among 5,720 students from January 2010 to December 2018 that met the following inclusion criteria for analysis: student provided consent for research, data validated by student’s program or preceptor (“good data”), team lead inputted, patient age inputted, patient criticality inputted and the student’s encounter with patient was in the field.  Team lead was determined by whether students selected the “I was the (Successful) Team Leader” box during patient documentation (Note: The word “Successful” was not always present throughout data set).  Age was divided by subgroups of patients less than 18 years old (0-1 years old, 1-2 years old, 3-6 years old, 7-12 years old and 13-18 years old) and by patient’s older than 18 years old.  Criticality was divided by color categories, as available in FISDAP by the following delineation and definitions: “Green - non critical, ambulatory”, “Yellow - illness/injuries not yet life threatening”, “Red - critical, life-threatening illness/injury”, “Black - patient dead on arrival”.  Patient’s categorized as “Black” were excluded from analysis with regards to student lead vs. criticality.  SPSS was utilized for descriptive analysis of the data to quantify frequency of team lead by age, subgroup and criticality.  Odds ration analysis via Epi Info was utilized to quantify likelihood of students having opportunities to team lead based on age and criticality.  The age group “13-18” was used as referent group.  Younger groups were compared to referent groups via odds ratios and the student group was compared to the preceptor group.  Then, results were stratified by patient criticality.

Results

Paramedic students were the team leader for 43.7% (n = 234,961) of all patient encounters. Paramedic students encountered 66,777 patients under the age of 18 (12.4% of all encounters) and led 30.3% (n = 20,245) of those interactions.  When criticality was analyzed amongst the pediatric population, students encountered 33,416 “green” patients, 20,663 “yellow” patients and 5,711 “red” patients (total = 59,790).  Students led 26.63% (n = 8,900) of “green” patients, 34.02% (n = 7,029) of “yellow” patients and 46.26% (n = 2,642) of “red” patients.  Compared to all criticality 13-18 year old patients, students were less likely to lead all other younger patients across criticalities with the exception of red patients 3-6 years old (OR 1.1) and red patients 7-12 years old (OR 1.06).

Conclusion

Our findings show that paramedic students led less pre-hospital patient encounters than previous studies in past time frames have shown and that paramedic students received even less opportunities to lead with pediatric patients.  However, amongst these pediatric patient encounters paramedic students led a higher percentage of critical encounters than lower acuity, non-critical encounters.  Additionally, students led a similar amount of “Age 0” encounters across criticalities.  Comparatively, students did not lead a similar amount of “Age 13-18" encounters across criticalities.  Students are also significantly less likely to lead younger patient encounters across all levels of criticality.  Further research is required to investigate possible motivations or causes for these findings.