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Research Presentations


(Click on the article title to request the complete abstract)

Bentley MA, Fernandez AR, Studnek JR (2012). Predictors of Stress among Nationally Certified EMS Professionals. Oral presentation at the annual meeting of the Society of Academic Emergency Medicine.
The objectives of this study were to estimate the prevalence of stress and to describe predictors of stress among nationally certified EMS professionals. The overall prevalence of stress was estimated at 5.9%. The odds of stress in paramedics was 32% higher when compared to EMT-Basics (OR=1.32, 95% CI=1.23-1.42). When compared to ≤2 years of experience, individuals with 3-7 years (OR=1.10 95% CI=0.89-1.36), 8-15 years (OR=1.56, 95% CI=1.24-1.95) or ≥16 years (OR=1.67, 95% CI=1.28-2.18) were more likely to be stressed. EMS professionals working in county (OR=1.28, 95% CI=1.07-1.51), and private services (OR=1.35, 95% CI=1.16-1.56) were more likely than those working in fire-based services to be stressed. Lastly, as perceived general health declined odds of stress increased; excellent general health was compared to very good (OR=1.60, 95% CI=1.35-1.91), good (OR=2.74, 95% CI=2.30-3.28), and fair/poor health status (OR=6.09, 95% CI=4.53-8.17).

Gibson GS, Eggerischs-Purcell, Bentley MA (2012). Protecting the Public: Public Perception of EMS workforce Screening and Licensure Removal. Oral presentation at the annual meeting of the Journal of Emergency Medical Services (awarded best oral presentation).
The objective of this study was to look at data collected on the public’s expectations regarding pre-employment screening and license removal for EMS professionals. 1,051 respondents completed the survey (response rate = 62.3%). Highest agreement on pre-hire screening was for illegal drug use, and the lowest was physical fitness. Highest agreement for license removal was for stealing from a patient, and the lowest was for improper patient care. Findings indicate public support for pre-hire screening and for licensure removal.

Eggerichs-Purcell J, Bentley MA (2012). Demographic and Work-life Characteristics Associated with Overall Job Satisfaction among Nationally Certified EMS Professionals. Poster presentation at the annual meeting of the Journal of Emergency Medical Services.
The objective of this study was to determine if overall job satisfaction was associated with demographic and work-life characteristics among Nationally Certified EMS Professionals. There were 593 (91.5%) EMS Professionals classified as satisfied with their overall job. When looking at overall general health, 363 (62.4%, p=0.001) of the people that were satisfied also had good health. With respect to service type, job satisfaction was highest (60.9%, p=0.036) in governmental versus nongovernmental services. Those working primarily emergency calls were most satisfied when compared to those working scheduled transports and both emergency and scheduled calls, (85.9% versus 5.6% and 8.9%, respectively, p=0.001). An average age of those reporting satisfaction was 40.5 years (SD=11.5) versus unsatisfied being 36.3 years (SD=10.4).

Eggerichs-Purcell J, Gibson, GC (2012). Public Perception and Value of EMS Compared to Other Public Service Entities. Poster presentation at the annual meeting of the Journal of Emergency Medical Services.
The objective of this study was to assess the public’s perception and value of EMS when compared to other public service entities. 1,041 respondents completed the survey (62.3%). The majority of individuals were willing to pay the same for EMS when compared to both police and fire services (63.7% and 69.7%, respectively). The majority of respondents also reported that EMS is equally important when compared to police and fire (74.4% and 79.5%, respectively). While the public acknowledges EMS is as equally important to both fire and police services, they are more willing to cut funding to EMS before fire and police.

Gibson GS, Sahni R, Bentley MA (2011). What do we know about EMS Training Officers? Poster presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
The study reports on demographic, work, and training characteristics of EMS Training Officers (TOs). With respect to demographics, TOs are primarily male (78.8%), white (88.9%), and have completed some college (49.0%). The majority are paramedics (58.5%), who have taken an EMS instructor course (63.8%), and are in paid full-time positions (65.1%). On average, TOs have worked 18.6 years in EMS (SD = 8.7). In terms of being satisfied with their positions as TOs, on a scale from 1 (very dissatisfied) to 10 (very satisfied), the mean satisfaction was 7.6 (SD = 1.9). With respect to TO training, 15.1% reported no training, 25.0% reported in-service education from previous TO, 37.6% indicated utilizing an educational method, 43.1% took an EMS instructor course, and 14.7% reported other methods.

Gibson GS, Bentley MA, Sahni R (2011). Examining the Amount and Types of Contact Medical Directors have with their EMS System Training Officers. Poster presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
This study examined the amount and types of interaction Medical Directors (MDs) have with their Training Officers (TOs), and further examined if these interactions varied significantly by service type. In a typical week, TOs reported interacting with a MD a median time of 12.0 minutes (SD = 85.1). Significant differences exist between this interaction and service type (F= 4.19, p-value<0.001) with fire-based services having higher MD interaction than hospital-based (Mean Difference = -33.6, p=0.002). Face-to-face interaction was the most common (median=5.0, SD = 61.1), followed by e-mail (median=5.0, SD = 37.2), and telephone (median=3.0, SD 26.5). With respect to service types, hospital-based services had the highest percentage of lecture (50.0%, p-value=0.002), run reviews (75.0%, p-value<0.001), protocol revisions (84.1%, p<0.001), ride alongs (17.7%, p-value=0.004), while private not-for-profit had the highest percentage for other tasks (14.0%, p-value=0.008).

Fernandez AR, Bentley MA (2011). A Survey-based Assessment of the Influence of Shift Length and Sleepiness on Error-Related Events in EMS. Poster Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
The objectives of this study were to 1) quantify error-related events in EMS and 2) assess the relationship between shift length, sleepiness, and error-related events. Of the 1,069 answering the difficulty remembering protocols item, 249 (23.3%) answered yes. Of the 1,071 answering the incident report item, 25 (2.3%) answered yes. When combined, 24.4% (261/1,069) reported an error-related event. The final multiple logistic regression model revealed that the odds of an error-related event for those working ≥24 hour shifts were 1.72 (95% Confidence Interval=1.22-2.42) times that of someone working <24 hours. Furthermore, for every point increase in ESS, the odds of an error-related event increased 16% (Odds Ratio=1.16; 95% Confidence Interval=1.12-1.20). The final model demonstrated good fit as indicated by the Hosmer-Lemeshow Goodness of Fit test (p-value = 0.1772).

Bentley MA, Fernandez AR, Braithwaite SA (2011). Perception of Ambulance Diversion among Nationally Certified Emergency Medical Services (EMS) Professionals. Poster Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
The objectives of this study were to 1) Describe EMS provider perception of the patient and system-level effects of crowding and ambulance diversion and 2) Describe the frequency of these effects and any correlation with system type. 61.7% of individuals reported ambulance diversion in their area in the past 12 months. Those working for fire-based services reported the highest frequency of working in areas that allowed ambulance diversion (fire-based 40.1%, private 25.3%, other services 18.5%, municipal 16.1%, p-value<0.05). A higher percentage of those with a typical call volume of 10-39 calls in a week reported ambulance diversion when compared to lower and higher call volumes (10-39 calls 52.5%, 0-9 calls 39.0%, ≥8.5%, p-value<0.05). Perceived patient care impacts noted occasionally, frequently, or often due to diversion included prolonged patient pain (26.8%), deterioration of vital signs (6%), prolonged transport time (29.5%), and delay in patient turnover time at hospital (48.1%).

Bentley MA, Fernandez AR, Studnek JS (2011). Predictors of Anxiety among Nationally Certified EMS Professionals. Poster Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
The purposes of this study were to estimate the prevalence of anxiety among EMS professionals and to describe predictors of anxiety. 6.0% of participants were determined to be anxious. When compared to excellent general health, those who reported very good (OR=1.84, 95% CI=1.52-2.21), good (OR=3.88, 95% CI=3.23-4.67), and fair/poor health status (OR=10.81, 95% CI=8.14-14.34) were at a higher odds of being anxious. When compared to EMT-Basics, the odds of anxiety among paramedics was 1.14 (95% CI=1.08-1.21). EMS professionals working in county (OR=1.71, 95% CI=1.45-2.03), private (OR=1.64, 95%CI=1.41-1.91), and hospital-based services (OR=1.51, 95% CI=1.25-1.82) were all more likely than those working in fire-based services to be anxious. The odds of anxiety among those EMS professionals who reported no exercise in the past month was 1.56 (95% CI=1.35-1.80) times the odds of anxiety among those who did exercise.

Bentley MA, Studnek JS, Gibson GS, Fernandez AR (2011). Identification of Components Related to Initial Prehospital Clinical Competency. Poster Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
The objective of this study was to identify components used by field training officers to determine that an entry level paramedic has reached a level of clinical competency such that they can practice independently. Seven out of ten randomly selected EMS systems participated in this study. After completing the seven step NGT process, seven components of clinical competency were identified: 1) demonstrates the ability to assess and appropriately treat a patient; 2) expresses character through actions; 3) possesses the ability to accurately document patient care; 4) shows patient advocacy; 5) demonstrates the ability to perform as a team leader consistently; 6) exhibits safe practices; 7) direct observation of correct skill performance.

Gibson GC, Bentley MA, Pirrallo R (2011). Public Perceptions of 9-1-1 Field EMS: National Implications. Poster Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
This study examines the public perception of six issues thought to influence a decision to call 9-1-1. Six factors were rated for how strongly certain factors may influence a decision to call 9-1-1 (percentage “agree to call EMS” are reported): (1) patient care capabilities of the ambulance personnel (64.8%); (2) cost of services provided (37.9%); (3) severity of my illness (82.7%); (4) severity of my injury (84.4%); (5) proximity of hospital (60.6%); and (6) availability of personal transportation (56.4%). When these same items were cross-tabulated with “If you thought you were having a heart attack and had a car available, would you call 9-1-1 or drive yourself to the hospital,” for each of the six factors, over 85% of respondents are calling 9-1-1. These six factors did not produced significant findings at p-value = .05 in the cross-tabulation.

Gibson GC, Bentley MA, Pirrallo R (2011). What Does the Public Think about Safety in Providing Field EMS? Oral Presentation at the annual meeting of the National Association of Emergency Medical Service Physicians.
This study examines the public’s perception of providing EMS services in three hazardous situations, and asks about an EMS professional’s likelihood of sustaining a career-ending injury. On providing emergency care when there are risks, for the risk of being shot, 25.0% = yes, 46.1% = no, 29.0% = don’t know); for the risk of being assaulted, respondents answered: 28.3% = yes, 47.2% = no, 24.5% = don’t know; and for risk of drowning, respondents answered: 30.0% = yes, 43.6% = no, 26.5%= don’t know. As for a career-ending injury, 45.7% think a police officer is likely to sustain a career-ending injury, 44.8% think a firefighter, and 9.5% think an EMS professional.

Gibson GC, Bentley MA (2011). Training Officers as Educators: The Pedagogical Truth. Poster presentation at the annual symposium of the National Association of EMS Educators.
This study sought to learn the pedagogy of training officer, particularly, utilization of educational resources available and the self-reported importance they associate with specific topics. Scale from 1 (hardly used) to 5 (used very often), highest usage was reported for national certification requirements mean = 3.86, SD = 1.4), CE course materials (mean = 3.86, SD = 1.4), and refresher plans (mean 3.36, SD = 1.5). Scaled from 1 (very unimportant) to 10 (very important), system-related topics, e.g., errors in patient care (mean 8.5, SD = 0.2) and new protocols (mean 8.4, SD = 2.3) received the highest importance for what to train in their respective systems. This study lends support to the argument that decisions for what to teach in an EMS system are driven by national requirements and system medical direction.

Gibson GC, Bentley MA (2011). Roles and Responsibilities of Training Officers: Allied Educators. Poster presentation at the annual symposium of the National Association of EMS Educators.
The objectives of this study were to determine how much time training officers engage in tasks other than developing, planning, and delivering continuing education, and to identify if participation in these tasks vary significantly by service type. Delivery of direct patient care scored highest (mean = 14.9 hours, median = 8 hours, and SD = 18.2 hours), while developing, planning, and delivery of continuing education was third (mean = 8.3 hours, median = 8 hours, and SD = 10.0 hours). Time spent in run reviews, disciplinary action, new employee orientation, and ride alongs varied significantly by service type, with private training officers engaged in these activities for the greatest number of hours in a typical week.

Gibson GC, Bentley MA (2011). Public Perceptions of EMS Provider Education: Are We All the Same? Poster presentation at the annual symposium of the National Association of EMS Educators.
The objectives of this study were to determine what the general public knows about the education and training of EMS professionals, and to determine if respondents’ age produced significant effects. Findings indicate that the public has no concrete idea how much EMS education and training a paramedic has (Mean = 261.1, SD = 341.7). Additionally, the public thinks EMTS should have some college and paramedics should have Associates degrees. The public placed a high level of importance on educational requirements for license renewal and on graduation from a nationally accredited training program. Respondent’s age did produce significant correlations: the amount of education for EMTs and paramedics drops with respondents’ increasing age, while educational requirements for license renewal, and graduation from a nationally accredited program increases with respondents’ age. In sum, EMS can do a much better job of educating and informing the public about the training of paramedics.

Bentley MA, Crawford JM, Wilkins, JR, Gibson GC, Fernandez AR (2011). Depression Among Nationally Certified Emergency Medical Service Professionals: A Descriptive Study. Poster presentation at the annual meeting of the Society of Academic Emergency Medicine.
The study objectives were to identify characteristics associated with, and the prevalence of, depression among EMS professionals. The prevalence of depression was 6.8% (n=1,589). Paramedics were more depressed than EMT-Basic’s (9.3% vs. 4.4%). A step-wise increase was seen with experience; those with ≤2 years of experience (4.9%), 3-7 years (5.0%), 8-15 years (7.6%), and ≥16 years (9.2%) were depressed. The prevalence of depression was higher for hospital-based (9.2%) services when compared to county (8.9%), private (9.0%), fire-based (5.4%) and those service types categorized as other (4.2%). Those reporting moderate call volume (10-39 calls, 8.1%) were more likely to be depressed than low (5.5%) and high (7.9%) call volumes. A step-wise increase in depression proportion was seen with decreasing health; with 2.7% of those with excellent, 5.8% with very good, 11.0% with good, and 29.8% with fair/poor health, reporting depression

Bentley MA, Fernandez AR, Gibson GC (2011). 12-Lead ECG Obtainment and Interpretation Among Nationally Certified Paramedics. Poster presentation at the annual meeting of the Journal of Emergency Medical Services.
The objectives of this study were to quantify how often nationally certified paramedics obtain and interpret 12-lead ECGs and identify work-life characteristics associated with obtaining and interpreting 12-lead ECGs. While 5.2% of nationally certified paramedics reported never obtaining a 12-lead ECG, the majority of paramedics reported obtaining a 12-lead ECG more than once per week to once per month (83.1%). Similarly, 6.8% reported never interpreting a 12-lead ECG while 81.9% interpreted a 12-lead more than once per week and to once per month. None of the work-life variables assessed were significantly associated with obtaining or interpreting 12-lead ECGs.

Bentley MA, Fernandez AR, Gibson GC (2011). Utilization of Capnography Among Nationally Certified Paramedics. Poster presentation at the annual meeting of the Journal of Emergency Medical Services.
The objective of this study was to quantify utilization of capnography among nationally certified EMS professionals and to determine significant associations between demographic/work-life characteristics and capnography utilization. Of those 601 (80.9%) who performed ETI, 14.1% reported never utilizing capnography. None of the demographic variables assessed revealed statistically significant associations with the utilization of capnography. Frequency of intubation was the only work-life characteristic variable assessed which revealed a significant association with the report of utilization of capnography. Specifically, there was a stepwise increase in the frequency of ETI and the percentage of paramedics reporting using capnography (≤once per year: 69.7%, between once per year and once per month: 85.1%, ≥once per month: 95.5%; p<0.001).

Fernandez AR, Studnek JR, Margolis GS, Crawford JM, Bentley MA, Marcozzi D (2011). Disaster Preparedness Among Nationally Certified Emergency Medical Services Professionals. Poster presentation at the annual meeting of the National Association of Emergency Medical Services Physicians.
The objectives of this study were to quantify EMS professional’s individual-level preparedness training (ILPT) in terrorism and disaster preparedness, and participation in multi-agency disaster drills (MDD) and to determine whether ILPT training was correlated with the perception of preparedness (PoP). A complete case analysis was performed (n=21,438). Overall, 19,551 (91.2%) individuals received ≥1 hour of ILPT and 12,828 (59.8%) individuals reported participating in MDD, in the last 24 months. However, 40.9% (8,769) reported <1 hour of ILPT in the treatment and management of patients involved in structural collapse. Spearman rank correlation coefficients revealed that for each topic, more hours of ILPT were significantly correlated with increased PoP (for each topic area: spearman’s rho >0.40, p-values < 0.001).

Fernandez AR, Crawford JM, Pennell ML, Buckley TJ, Wilkins JR, Bentley MA, Studnek JR (2011). Emergency Medical Services Work-Life Characteristics Contribute to Clinically Significant Excessive Daytime Sleepiness. Poster presentation at the annual meeting of the National Association of Emergency Medical Services Physicians.
The objectives of this study were to quantify clinically significant excessive daytime sleepiness (CSEDS) in the EMS workforce and identify EMS work–life characteristics and demographics associated with CSEDS. The ESS was completed by 1,047 individuals, and 38% (n = 397) were classified as having CSEDS. Simple logistic regression revealed that the following characteristics were associated with an increased odds of CSEDS: working shifts ≥24 hours, responding to ≥10 calls/week, working >60 hours/week, working rotating shifts, working mandatory or voluntary overtime, leaving EMS, being separated/widowed/divorced, obesity, and having fair/poor overall health. Individuals satisfied with their EMS assignment had decreased odds of CSEDS. Following model selection, working ≥24-hour shifts (OR = 1.79; 95% confidence interval [95% CI] = 1.20–2.65), mandatory overtime (OR = 1.55; 95% CI = 1.07–2.24), voluntary overtime (OR = 1.43; 95% CI = 1.00–2.05), leaving the EMS workforce (OR = 2.52; 95% CI = 1.49–4.26), being separated/widowed/divorced (OR = 1.79; 95% CI = 1.01–3.18), and reporting fair/poor health (OR = 3.62; 95% CI = 1.97–6.67) remained significantly associated with CSEDS.

Bentley MA, Fernandez AR, Brown WE, Margolis GS (2009). Relationship of Education Program Size to First Attempt Pass Rate on the National Paramedic Certification Examination. Oral Presentation at the National Association of Emergency Medical Services Educators.
The objectives of this study were to determine the number of active paramedic programs in the US and to describe the relationship of number of candidates per year and first attempt pass rate. It was hypothesized that large programs would have significantly higher pass rate on the NREMT exam than small and medium programs. To meet the objectives, the NREMT database was queried. Paramedic programs were categorized by small (1-10 students), medium (11-19), and large (≥20). Large paramedic education programs have a higher pass rate than both small and medium sized programs. Over a third of paramedic programs in the NREMT database were inactive (graduated no students during the study period).

Bentley MA, Studnek JR, Fernandez AR (2009). Characteristics Associated with Latex Sensitivity among Nationally Certified EMS Professionals. Oral presentation at the annual meeting of the Journal of Emergency Medical Services (awarded Best Research).
The objectives of this study were to determine individual and work-life characteristics associated with latex sensitivity among EMS professionals. Latex sensitivity was defined as the reported by 15.2 % of EMS professionals. More females reported having a latex sensitivity (21.5% vs. 12.8%, p=0.001). As the reported number of calls per week increased, there was an increase in the frequency of latex sensitivity (0-1=4.0%, 2-29=15.7%, ≥30=20.5%; p=0.001). Those working for a county or municipal service reported the lowest frequency of latex sensitivity, while those who worked for a private service had the highest (county/municipal=11.9%, fire=12.7%, other=14.1%, private=22.4%; p=0.010). More paramedics (17.6%) reported a latex sensitivity than basics (10.8%) or intermediates (10.0%, p=0.025).

Fernandez AR, Studnek J (2009). The Relationship between EMT-Basic Exam Score and Success on the National Paramedic Certification Exam. Poster presentation at the 2009 annual meeting of the National Association of EMS Physicians (awarded Best Poster Presentation).
This study analyzed the relationship between EMT-Basic NREMT exam score and success on the national paramedic certification exam. An individual’s score on the national EMT-Basic certification exam was significantly associated with success on the national paramedic certification exam. Individuals who received =80% on their EMT-Basic exam were five times more likely to pass the paramedic exam on the first attempt than those who scored =71%.

Margolis GS, Romero GA, Fernandez AR, Studnek J (2009). Strategies of High-Performing Paramedic Education Programs. Poster presentation at the 2009 annual meeting of the National Association of EMS Physicians.
Twelve EMS educational programs that achieved consistently high performance on the national paramedic certification exam participated in a focus group to identify the strategies leading to a successful paramedic educational program. A nominal group technique yielded the following twelve suggestions: 1) Achieve and maintain national accreditation; 2) Maintain high level entry requirements and prerequisites; 3) Provide students with a clear idea of expectations for student success; 4) Establish a philosophy and foster a culture that values continuous review and improvement; 5) Create your own exams, lesson plans, presentations, and course materials using multiple current references; 6) Emphasize EMT-Basic concepts throughout the class; 7) Use frequent case based classroom scenarios; 8) Expose students to as many prehospital ALS patient contacts as possible, preferably where they are in charge; 9) Create and administer valid exams that have been through a review process (such as qualitative analysis); 10) Provide students with frequent detailed feedback regarding their performance (such as formal exam reviews); 11) Incorporate critical thinking and problem solving into all testing; and 12) Deploy predictive testing with analysis prior to certification.

Studnek J, Crawford JM, Fernandez AR (2009). Evaluation of Occupational Injuries in an Urban Emergency Medical Services System Before and After Implementation of Mechanical Stretchers. Poster presentation at the 2009 annual meeting of the National Association of EMS Physicians.
This study evaluated occupational injuries in an urban EMS system (Austin Travis County EMS) before and after implementation of mechanical stretchers. This agency experience a dramatic drop in the incidence of work related injuries and lost workdays. While the mechanical stretcher may not be only reason for the decreases, it is presumed to be a significant factor.

Studnek J, Fernandez AR, Margolis GS (2009). Assessing Competency among Low Frequency EMS Providers. Poster presentation at the 2009 annual meeting of the National Association of EMS Physicians.
The primary objective of this study was to assess the continued competence of EMT-Basics practicing in low frequency environments. Participants from two rural and contiguous states were administered a validated general knowledge EMT exam. The amount of continuing education and call volume were not significantly associated with passing the examination.

Fernandez AR, Studnek JR, Cone D (2008). The Relationship between EMT-Basic Experience and Success on the National Paramedic Certification Examination. Poster presentation at the annual meeting of the Society for Academic Emergency Medicine. June 2008.
This study assessed the association between EMT experience and performance on the National Registry of EMT’s (NREMT) Paramedic exam. First attempt paramedic scores from 2002-2006 in the 14 states that utilize NREMT tests for initial certification of both EMT-Bs and Paramedics were analyzed. The time period between passing the NREMT EMT-B exam and the first attempt of the paramedic exam was used as a surrogate indicator of EMT experience. EMT-Bs with 2.5-10 years experience were most likely to pass their first paramedic exam attempt.

Fernandez AR, Studnek JR (2008). Smoking and Cessation Patterns among Nationally Registered Emergency Medical Services Professionals. Poster presentation at 2008 annual meeting of the National Association of EMS Physicians.
By surveying over 30,000 EMS personnel re-registering in 2007 it was determined that 35.5% EMS professionals have smoked tobacco. Of those, about half no longer smoke. Of the remaining, 98.0% attempted to quit within the last 12 months. A higher percentage of females in EMS reported being current smokers (female 25.5% vs. male 19.7%, p<0.001) with a prevalence notably higher than that found in the general population.

Fernandez AR, Studnek JR (2008). Body Mass Index of Emergency Medical Services Professionals. Poster presentation at 2008 annual meeting of the National Association of EMS Physicians.
EMS personnel re-registering in 2007 were asked to voluntarily provide their current height and weight and body mass index (BMI) was calculated. The mean BMI for study participants was 27.74 (95% CI 27.68-27.81), and 71.5% were classified as having high (=25) BMI. More males reported having a high BMI compared to females (79.2% vs 50.8% p<0.001). A step wise increase in the percentage of those reporting high BMI was present when comparing provider’s certification level (EMT-Basic 68.0%, EMT-Intermediate 73.4%, and Paramedic 77.0% X2 = 185.2, p<0.001). Those working for a military service reported the lowest prevalence of high BMI (61.7%), while those who worked for a fire based service had the highest (77.7%).

Studnek JR, Fernandez AR (2008). Do Emergency Medical Services Professionals Meet CDC Physical Activity Recommendations? Poster presentation at the 2008 annual meeting of the National Association of EMS Physicians.
The Centers for Disease Control recommends that individuals participate in moderate-intensity physical activity for 30 minutes a day, 5 or more days a week. This study was conducted to determine what proportion of EMS professionals meets this guideline. EMS professionals re-registering in 2007 were asked to complete a survey and 24.3% met the CDC recommendations. Males were more likely to report meeting CDC recommendations (25.4% vs. 21.4% p<0.001). A step wise decrease in the percentage of those meeting CDC recommendations was present when comparing provider’s certification level (EMT-Basic 28.5%, EMT-Intermediate 21.5%, and Paramedic 18.0% X2 = 283.5, p<0.001).

Studnek JR, Fernandez AR, Margolis GS, O’Connor RE (2008). Describing the Amount of Medical Director Contact among Nationally Registered Emergency Medical Services Professionals. Poster presentation at the 2008 annual meeting of the National Association of EMS Physicians (awarded Best EMS Professional Research Presentation.)
This project quantified the amount of contact nationally registered EMS professionals have with their medical director. Participants indicated how often they interacted with their medical director in three specific situations (participation in continuing education, met personally to discuss an EMS issue, and saw medical director at the scene of an EMS call). Overall, 62.5% individuals reported having contact with the medical director in one of the above situations within the last 6 months. MD contact increased with certification level and varied by service type. EMS professionals working in urban areas were more likely to report recent MD contact than those in rural areas.

Lerner B, Shah MN, Fernandez AR (2008). Do EMS Providers Think They Should Participate in Disease Prevention? Poster presentation at 2008 annual meeting of the National Association of EMS Physicians.
The objective of this study is to determine EMS providers’ opinions regarding participation in disease prevention initiatives. Eighty-one percent (95% CI: 80.5 -81.6) of EMS providers re-registering in 2006 believed that they should participate in disease prevention programs and 28.8% (95% CI: 28.2-29.5) of respondents reported actually having provided prevention services. Those who had a graduate degree were the most likely to have provided prevention services (40%, p<0.001), as were those who had worked in EMS for more than 21 years (41%, p<0.001).

Studnek JR, Fernandez AR, Margolis GS (2007). Factors Affecting the Probability of Passing the National Paramedic Certification Examination. Oral presentation at the annual symposium of the National Association of EMS Educators (awarded best oral presentation.)
This study combined a number of student and program characteristics to develop a multivariable model to estimate the probabilities for success for individuals entering into paramedic training programs. The parameters, in descending order of statistical significance, included; institutional accreditation, student’s high school class rank, student’s highest level of education, instructor credentials, student’s gender, and race. Variables not significantly associated with student success included; academic setting, course completion as an employment requirement, and student age.

Fernandez AR, Studnek JR (2007). The Association between a Candidates Score on the National Certification Examination and the Elapsed Time from Course Completion to Completion of the Cognitive Examination. Oral presentation at the annual symposium of the National Association of EMS Educators (awarded best research.)
Using 2005 testing data, it was determined that there is an association between a candidate’s score on national EMS certification examinations and the amount of time that has elapsed since completion of an EMS course. There is a statistically significant decrease in score of 0.009% for EMT-Basics and 0.011% for Paramedics for every day delay in taking the testing. While this association is statistically significant, it takes a considerable period of time for it to practically affect an individual score.

Margolis GS, Fernandez AR, Studnek JR (2007). Intent to Leave the EMS Profession. Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
This study quantified the percentage of EMS personnel, by system type and level of certification, that intend to leave the EMS profession in the next year. A stratified representative sample of 1,945 Nationally Registered EMS personnel rated the likelihood that they would leave the EMS profession in the next 12 months on a 4 point Likert scale (definitely stay, probably stay, probably leave, definitely leave). Weighted data suggest that 5.65% answered that they will probably or definitely leave the EMS profession in the next 12 months. Subgroup analyses indicated that fire based EMS workers were significantly less likely to report that they would leave the profession in the next 12 months and 2-4 times higher in private-for profit and “other” agencies.

Margolis GS, Studnek JR, Fernandez AR, (2007). A Categorical Schema of EMS Personnel. Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
This descriptive project developed a conceptual framework in which the diversity of the EMS workforce can be considered and quantifies the size of each category. A representative sample of 1950 Nationally Registered EMS personnel were categorized according to three dimensions: Certification level (EMT-Basic and Paramedic), EMS Service Type (Fire Based, 3rd Service, Private-for profit, Other), Remuneration category (Career, Compensated Volunteer (volunteers reporting = $1000/year of EMS related income), and Uncompensated Volunteer (volunteers reporting <$1000/year of EMS related income). The percentage of uncompensated volunteer paramedics is very low and over half of the EMT-Basics are ‘career.’ While more EMS personnel are affiliated with fire departments than any other system-type, the majority of EMS personnel do not work in fire based systems.

Studnek JR, Fernandez AR, Margolis GS (2007). Emergency Preparedness of Nationally Registered First Responders. Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
This study estimates the number of NRFRs who have received training in the management and treatment of patients involved in biological, chemical, nuclear, explosive emergencies and structural collapse. Of the 1957 NRFRs that re-registered in 2006, surveys were received from 1212 (62%). In the last 24 months 60.8% of NRFRs indicated that they had received training in the recognition of BCN hazards while 53.4% have received training on the treatment of patients and 28.0% have participated in multi agency drills in those situations. Training in the treatment of patients involved in explosions or structural collapse was received by 40.0% and 39.0% of NRFRs, respectively. Participation in multi-agency drills involving explosions or structural collapse was reported by 24.9% of NRFRs. In the last 24 months 38.1% of NRFRs have received less than one hour of preparedness training, 40.8% received 1-8 hours and 21.0% have received 9 or more hours. Finally, there were statistically significant differences between rural and urban NRFRs with regards to BCN hazards in the recognition, patient treatment and participation in multi agency drills.

Fernandez AR, Studnek JR (2007). Organizational Description & Community Size of Nationally Registered First Responders. Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
Little is known about the demographics and characteristics of those individuals who obtain the certification Nationally Registered First Responder. This study described the types of organizations and the community size in which Nationally Registered First Responders perform their duties. Of the 1957 NRFRs that re-registered in 2006, surveys were received from 1212 (62%) of which complete data were available for 1003 respondents. The majority of first responders (60.5%) were affiliated with a fire department. Interestingly, 18.5% of NRFRs, the second highest category, were affiliated with an industrial or business emergency response team

Studnek JR, White L (2007). Effect of Sleep Disorders on Emergency Medical Technicians. Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
Using the Longitudinal EMT Attributes and Demographics Study (LEADS) this project intends to describe the effect of self- reported sleep problems on EMTs. In 2004 and 2005 there were 1775/5565 (31.9%) and 1857/6011 (30.9%) respondents respectively. Sleeping problems were identified by 30.6% of EMTs in 2004 and 24.0% in 2005. Of those EMTs reporting sleeping problems in 2004 significantly more had been involved in an ambulance crash in the past 12 months 8.6% compared to 4.7% (p=0.031). In 2005 21.8% of EMTs reporting sleeping problems and missed one or more days of work compared to 9.0% of those with no sleeping problems (p<0.0001). Other characteristics such as satisfaction and overall health were also significantly associated with sleeping problems.

Studnek JR, Fernandez AR (2007). Utilization of Distributive Education to Fulfill National Registry Re-Registration Requirements. Poster presentation at the annual meeting of the National Association of EMS Physicians.
This project was conducted to determine what proportion of nationally registered EMTs and Paramedics report using DE to fulfill their section two re-registration requirements. A sample of 1-2% of all non-military EMT-Basics and Paramedics re-registering in 2004 and 2006 were reviewed. Data was collected from 348 applications from 2004 and 649 from 2006. DE was utilized by 19.3% (67/348) of applicants in 2004 and 20.5% (133/649) in 2006. In both years EMT-Basics were significantly more likely than Paramedics to report using DE (26.4% vs. 12.1%, p<= 0.001 and 23.4% vs. 16.8%, p<= 0.038 respectively). While DE can account for 50% of yearly section two CE, among those who used DE in 2004 and 2006, on average only 20.4% and 27.4% of CE was accounted for through DE.

Studnek JR, Margolis GS, Mistovich JJ, Fernandez AR (2007). Identifying Educational Strategies of Successful EMT-Basic Programs. Poster presentation at the annual meeting of the National Association of EMS Physicians.
This project develops a list of specific educational strategies used by those who attain consistent success. A seven-step nominal group technique (NGT) was used to determine if strategies that lead to a successful EMT-Basic educational program could be identified. Ten out of the twelve EMS educational programs meeting the eligibility requirements participated. After completing the seven step NGT process, 12 strategies were identified as leading to a successful EMT-Basic educational program; accept students who are highly motivated to succeed, assure institutional support, administer multiple assessments, develop standardized lesson plans, have a passing standard that is above the minimum competency level, hire qualified/certified instructors, maintain effective communication between didactic, practical and field instructors, maintain instructional consistency, provide clearly defined objectives, provide immediate feedback for written and practical evaluations to students, require prerequisites, teach test taking skills.

Brown WE, Studnek J, Levine R (2006). Relationship Between Shift Work and Work Life of Emergency Medical Technicians: A Preliminary Analysis. Poster presentation at the 134th Annual Meeting of the American Public Health Association (APHA).
A prospective study of Emergency Medical Technicians (EMT) was conducted to determine if relationships exist between shift work and the job performance, family life, personal health and safety of EMTs. EMTs indicating that they work 24-hour shifts had significantly higher ESS scores than those not working 24-hour shifts (p=.03). EMTs working 24 hour shifts were more likely to report having difficulty driving emergency vehicles long distances (12.4% vs. 6.2%, p=.007) and to report having difficulty remembering treatment protocols because they were sleepy or tired (13.3% vs. 7.1%, p=0.006). Nearly one-quarter (23.3%) of the EMTs working 24-hour shifts reported that being sleepy affected their relationship with family, friends or work colleagues compared to 17.2% of those not working 24 hours (p=0.04).

Fernandez AR, Studnek JR (2007). Quantifying and Describing Actively Practicing Nationally Registered EMT-Basics. Poster presentation at the annual meeting of the National Association of EMS Physicians.
This study utilized a survey distributed to a random sample of nationally registered EMT-Basics to illustrate the number who were actively practicing. An actively practicing EMT-Basic was defined as an EMT-Basic who performed EMS work for at least one organization and had responded to at least one EMS call in the last month. It was determined that 77.5% Nationally Registered EMT-Basics met the a priori criteria for “actively practicing”. Actively practicing EMT-Basics were then compared to those not actively practicing with respect to their volunteer status and whether they report EMS as their primary career. Those who are actively practicing were just as likely to report being a volunteer EMT as those who did not meet the criteria. Actively practicing EMT-Basics were more likely to report EMS as their primary career however, almost three quarters of those who were actively practicing report that EMS was not their primary career

Fernandez AR, Studnek J (2006). Quantifying the Educational Background of EMS Educators. Poster at the annual symposium of the National Association of EMS Educators.
As part of the biennial re-registration paperwork, Nationally Registered EMS professionals were asked to complete a survey reporting their highest level of education and their primary role in EMS. Those individuals who reported their primary role in EMS was that of an EMS educator reported the following was their highest level of education. 11.6% High School/GED, 38.5% Some College, 20.9% Associate Degree, 21.3% Bachelor’s Degree, 7.8% Graduate Degree. Overall, EMS instructors have similar educational credentials to the students that they are teaching.

Studnek JR, Porter K (2006). The Relationship between Ambulance Crashes and Emergency Medical Technician Age. Poster presentation at the annual meeting of the Society for Academic Emergency Medicine.
Ambulance crashes can have devastating effects on the community. This study intends to determine what EMTs have an increased chance of involvement in an ambulance crash. In 2004 a cohort of nationally registered EMTs and Paramedics were asked to report if they had been involved in an ambulance crash. Variables significantly associated with accidents in the past year were call volume (p<0.0001), ambulance time (p=0.0008), and age (p=0.0004). Controlling for call volume and ambulance time, the odds of having had a crash within the past year were significantly higher the younger the EMT. When controlling for call volume and ambulance time, the odds of having been in an ambulance accident within the past year was significantly higher for younger EMTs.

Margolis GS, Studnek JS (2006). How Many Volunteer EMTs Are There, Really? Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
This study was survey of randomly selected and stratified nationally registered EMT-Basics and Paramedics. Half of the EMT-Basics report being a volunteer and one-third were uncompensated (report less than $1000/year of EMS related income). Approximately 20% of paramedics report being a volunteer; however the percent of uncompensated volunteers was only 2.6%. Many volunteer EMTs and paramedics have significant EMS related income. Compensated EMT-Basic volunteers report an average of $10,239 of EMS related income, and Paramedic report an average of $32,772.

Studnek J, Porter K (2006). Are Paramedics Practicing as Traditional EMS Providers? Poster presentation at the annual Meeting of the Journal of Emergency Medical Services.
This study was conducted to quantify the number of Nationally Registered Paramedics working as traditionally practicing EMS providers. A random sample of Nationally Registered Paramedics completed a questionnaire to determine the number of “traditionally practicing” Paramedics. A traditionally practicing Paramedic was defined as a respondent who, performs EMS work for at least one EMS organization, works for an EMS organization that utilizes their Advanced Life Support skills, and in a typical week responds to ³ 6 EMS calls, initiates ³ 2 prehospital IVs, completes ³ 3 patient care report forms and responds to ³ 3 911 calls. There were 183 (70.4%) paramedics classified as “traditionally practicing”. There appears to be a large proportion of Nationally Registered Paramedics not filling the role of the traditionally practicing Paramedic. This may contribute to the perception that there is a shortage of Paramedics. Simply increasing the number of certified Paramedics is unlikely to resolve the perception of a Paramedic work force shortage.

Margolis GS, Levine RL, Wijetunge G (2006). The Change in Full-Time EMS Provider Career Satisfaction in their First Three Years of Employment. Oral presentation at the annual meeting of the National Association of EMS Physicians.
The longitudinal study compared full-time EMS workers level of career satisfaction in the initial year of certification to their satisfaction two years later. EMT-Basics career satisfaction did not change; however, there was a significant decrease in career satisfaction among Paramedics. The decrease in career satisfaction appeared to be more dramatic in rural settings.

Studnek J, Crawford JM (2006). Predictors of Back Problems among Emergency Medical Technicians. Poster presentation at the annual meeting of the National Association of EMS Physicians.
Using a cohort of nationally registered Emergency Medical Technicians (EMTs) this project intends to describe possible predictors of back problems among EMTs. A case-control analysis was performed; wherein cases were 104 subjects reporting new back problems in 2004. Controls were 475 subjects reporting no back problems in 2003 and 2004. Paramedics were significantly more likely to report back problems compared to EMT-Basics (OR = 1.72; 95% Confidence Interval (CI) = 1.004-2.93), as were those EMTs dissatisfied with their current EMS assignment (OR = 9.33; 95% CI = 3.04-28.67) and EMTs reporting good (as compared to excellent) fitness (OR = 3.39; 95% CI = 1.54-7.45). Results from this analysis, one of few analytic studies in this field, suggest several factors that could contribute to self-reported back problems among EMTs, including job dissatisfaction and physical fitness.

Studnek J, Margolis GS (2005). Educational Background Correlates to Success on the National Registry of EMTs Written Certification Examination. Poster presentation at the annual symposium of the National Association of EMS Educators.
Self-reported years of education were compared to the pass rates of EMT-Basic students on the written portion of the certification examination using Chi-squared analysis. First time pass rate was significantly associated with education level. Pass rates significantly increase as education level increases. The educational background of EMT-Basic students is highly correlated to first time pass rate on the written portion of the national certification examination. EMS training institutions attempting to improve pass rates on the EMT-Basic national certification examination should investigate their student’s educational background.

Studnek JR, Margolis GS, Levine R (2005). Relationship Between Organizational Policy and EMT Seat Belt Use. Poster Presentation at the annual meeting of the Society of Academic Emergency Medicine.
The objective of this study was to determine the relationship between organizational policy and seat belt use among EMTS. With the 2003 recertification paperwork, EMS professionals were asked to complete a survey on the safety and health risks facing EMS providers. A statistically significant relationship was found between seat belt use and whether or not an EMT worked for an organization that has a written seat belt use policy. EMS organizations with front seat seat belt use policies have a higher number of employees reporting “high” seat belt use than those organizations that do not have seat belt use policies.

Margolis GS, Studnek J, Brazelton TB (2005). The Relationship of a State's Paramedic Program Accreditation Policy to First-Time Pass Rate on the National Paramedic Certification Written Exam. Poster presentation at the annual symposium of the National Association of EMS Educators.
This study compared the performance of candidates taking the National Registry Paramedic exam from states that mandate paramedic program accreditation to those states that do not. The study concluded that states that mandating national paramedic program accreditation have a significantly higher first time pass rate than those not requiring national accreditation. Interestingly, the difference in performance increased throughout the study period.

Studnek J, Margolis GS, Levine R (2005) EMT and Paramedic Rating of the Perceived Effectiveness of EMS Workforce Retention Strategies. Oral presentation at the annual Meeting of the Journal of Emergency Medical Services.
EMTs and Paramedics will identify some retention strategies as more effective than others. Nationally Registered EMTs re-registering in 2004 were asked to complete a survey requesting them to rate the effectiveness of ten strategies for retaining new individuals in EMS. While there were statistically significant differences between EMTs and Paramedics for all strategies and statistically significant differences between paid and volunteer providers for most strategies, effect sizes never exceeded .42, suggesting the differences were of small practical significance. Currently registered and practicing EMTs and Paramedics perceived increasing pay and benefits, opportunities for advancement, and increased appreciation of the work EMTs do as the most effective retention strategies.

Margolis GS, Dickison PD (2005). The Relationship Between Paramedic Instructor Qualifications and Student Performance on the National Certification Written Exam. Poster presentation at the annual meeting of the National Association of EMS Physicians.
Candidates taking the National Registry of EMTs Paramedic exam were asked to identify the clinical credential and highest educational degree attained by their lead instructor which was correlated to the first time pass rate. Students who’s instructor was a nurse performed better than all other instructors (72.9% vs. 55.2%) and a linear relationship exists as the educational degree increases (from 62.7% at the Associates Degree level to 78.5% at the Doctoral level).

O’Keefe M, Levine R (2004). Terrorism Response Training for Emergency Medical Technicians Since September 11, 2001: A Nation Unprepared. Poster presentation at the Annual Meeting of the American College of Emergency Physicians.
The goal of this study was to assess the amount and type of terrorism-related training provided to emergency medical technicians (EMTs) in the two years following September 11, 2001. The median number of hours of such training was less than one hour for EMT-Bs and between one and four hours for EMT-Ps. Less than one hour of training for responding to terrorism was received by 51% of all EMTs. Length of training was also associated with community size, with 41% of urban EMTs reporting less than one hour, compared to 57% of rural EMTs. The majority of EMS providers received less than one hour of training related to terrorism response.

Margolis GS, Wagoner RL (2004). The Relationship Between High School Class Rank and Performance on the Paramedic National Certification Exam. Oral presentation at the annual symposium of the National Association of EMS Educators.
This project compared the self reported high school class rank of candidates on the NREMT paramedic exam with their first time pass rate. Students who graduated in the lower third of their high school class had 53.0% first time pass rate, with graduates in the top 10% having a 79.3% pass rate. About half of the candidates reported graduating the upper 30% of their high school class, with only 5.5% graduating in the lower 30%. The study concluded that there is a strong relationship between a candidate’s self reported high school class rank, and the first time pass rate on the written portion of the national certification exam.

Margolis GS, Dickison PD, Wagoner RL, Mason S, Brown WE (2004). Sources of Satisfaction and Dissatisfaction for Practicing EMS Providers. Oral presentation at the annual Meeting of the Journal of Emergency Medical Services. (Awarded Best Oral Presentation of Research)
As part of the biennial re-registration paperwork, Nationally Registered EMTs were asked to complete a survey ranking their satisfaction in nine aspects (working relationships with other EMTs, pay/benefits, job excitement, technical challenges, variety of tasks/situations, work schedule, advancement opportunities, autonomy, and being able to help others) of their work life. Over 24,000 individuals responded. Reregistering EMTs and Paramedics appeared to be largely satisfied with most major aspects of their EMS position. For both EMTs and Paramedics, the major sources of dissatisfaction appear to be pay/benefits, opportunities for advancement, and work schedule.


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