Research - Publications
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Blau G., Gibson G., Bentley MA., Chapman S (2012). Testing the Impact of Job-Related Variables on a Utility Judgment Training Criterion Beyond Background and Affective Reaction Variables. International Journal of Training and Development. 54-66 This study evaluated the incremental impact of a job-related set of variables for explaining a utility judgment training effectiveness variable, course completion skill preparedness. We found for both samples that the quality of course materials and quality of lead instructor variables each significantly explained course completion skill preparedness variance beyond controlled for background variables. We also found that the set of job related variables explained further, additional variance and that job satisfaction was positively related to course completion skill preparedness for both samples.
Studnek JR, Crawford M, and Fernandez, AR. (2012). Evaluation of Occupational Injuries in an Urban Emergency Medical Services System Before and After Implementation of Electrically Powered Stretchers. Applied Ergonomics, 43:198-202. The objective of this study was to evaluate occupational injuries in an urban EMS system before and after implementation of hydraulic stretchers. There were 2087 and 706 person-years of observation pre- and post-intervention, respectively. The incidence rates for overall injury pre-intervention and post-intervention were 61.1 and 28.8 per 100 FTE, with a corresponding RR of 0.47 (95% CI 0.41e0.55) indicating a significant decrease in the rate of injury. The subcategory of stretcher-related injuries had the lowest RR (0.30; 95% CI 0.17e0.52) when comparing pre- and post-intervention time periods.
Blau G., Chapman S., Gibson G., Bentley MA (2011). Exploring the Importance of Different Items as Reasons for Leaving Emergency Medical Services Between Fully Compensated, Partially Compensated, and Non-Compensated/Volunteer Samples. Journal of Allied Health;40(3): e33-e37 The purpose of our study was to investigate the importance of different items as reasons for leaving the Emergency Medical Service (EMS) profession. Results showed that the desire for better pay and benefits was a more important reason for leaving EMS for the partially compensated versus fully compensated respondents. Perceived lack of advancement opportunity was a more important reason for leaving for the partially compensated and volunteer groups versus the fully compensated group.
Blau, G and Gibson, G. (2011). Exploring Antecedents of Intrinsic Versus Extrinsic Satisfaction in a Sample of Emergency Medical Service Professionals. Journal of Workplace Behavioral Health, 26:240-251. This study analyzed the potential of personal, job perceptions, work attitudes, and intent to leave the field of EMS variables on intrinsic and extrinsic job satisfaction measures. Sample consisted of LEADS respondents who had completed annuals surveys in 2006, 2007, and 2008 (n = 292). Sample was found to be demographically representative of the larger survey group of LEADS respondents. Findings indicate that prior intrinsic (extrinsic) satisfaction was the dominant antecedent of subsequent intrinsic (extrinsic) satisfaction. Additionally, continuing education instructor quality as a significant antecedent across both types of subsequent satisfaction.
Fernandez, AR, Studnek JR, Margolis GS, Crawford M, Bentley, MA, and Marcozzi M (2011). Disaster-preparedness of Nationally Certified Emergency Medical Services Professionals. Academic Emergency Medicine 18(4): 403-412. This study sought to quantify the amount of individual-level training EMS professionals received in terrorism and disaster-preparedness, and assess EMS professionals’ participation in multiagency disaster drills across the US. Findings indicate that 91.2% of respondents reported receiving at least 1 hour of individual-level preparedness training, and 59.8% reported participating in multiagency disaster drills in the prior 24 months. Perceptions of preparedness and amount of individual-level training were significantly correlated with the perception of preparedness. A majority of nationally certified EMS professionals reported participation in individual-level and multiagency disaster-preparedness training, and reported feeling adequately prepared to respond to disasters.
Studnek JR, Fernandez AR, Shimberg B, Garifo M, and Correll M. (2011). The Association between Emergency Medical Services Field Performance Assessed by High-fidelity Simulation and the Cognitive Knowledge of Practicing Paramedics. Academic Emergency Medicine, 18:1177-1185. The objective of this study was to assess the association between the performance of practicing paramedics on a validated cognitive exam and their field performance, assessed on a simulated emergency medical services (EMS) response. This was an observational study of 107 paramedics from a single-tiered, urban, advanced life support EMS agency. Participants reported a median of 7.7 years of service (interquartile range [IQR] = 4.1 to 12.8 years). Ninety-two (86.0%) participants received a passing score for the simulation and 77 (72.0%) passed the cognitive exam. There were 70 (65.4%) individuals who passed both the simulation and the cognitive exam, eight (7.5%) who failed both the simulation and cognitive exam, 22 (20.6%) who passed the simulation but failed the cognitive exam, and seven (6.5%) who failed the simulation but passed the cognitive exam. Results demonstrated an association between a practicing paramedic’s performance on a cognitive examination and field performance, assessed by a simulated EMS response.
Barnett DJ, Levine R, Thompson CB, Wijetunge GU, Oliver AL, Bentley MA, Neubert PD, Pirrallo RG, Links JM, Balicer RD (2010). Gauging U.S. Emergency Medical Services Workers’ Willingness to Respond to Pandemic Influenza Using a Threat-and Efficacy-Based Assessment Framework. PLoS ONE;5:e9856 The purpose of this study was to determine the willingness to respond to the Pandemic Influenza. Of the 586 respondents who met inclusion criteria (currently active EMS providers in primarily EMS response roles), 12% indicated they would not voluntarily report to duty in a pandemic influenza emergency if asked, 7% if required. A majority (52%) indicated their unwillingness to report to work if risk of disease transmission to family existed. Confidence in personal safety at work (OR = 3.3) and a high threat/high efficacy (‘‘concerned and confident’’) EPPM profile (OR = 4.7) distinguished those who were more likely to voluntarily report to duty. Although 96% of EMS workers indicated that they would probably or definitely report to work if they were guaranteed a pandemic influenza vaccine, only 59% had received an influenza immunization in the preceding 12 months.
Studnek JR, Crawford M, Wilkins III J.R., and Pennell ML. (2010). Back Problems Among Emergency Medical Services Professionals: The LEADS Health and Wellness Follow-Up Study. American Journal of Industrial Medicine, 53:12-22. This study described work-life and demographic characteristics associated with reporting recent back pain and estimated back pain severity among Emergency Medical Services (EMS) professionals. There were 470/930 (50.5%) participants who reported one or more days of pain in the back or legs over a 2-week period. The variables most strongly associated with recent back pain and pain severity were prior back problems, self-reported health, and job satisfaction. This study indicated that work-life, health, and demographic characteristics of EMS professionals were associated with reporting recent back pain. Studnek JR, Bentley MA, Crawford JM, Fernandez AR. (2010). An Assessment of Key Health Indicators among Emergency Medical Services Professionals. Prehospital Emergency Care. 14(1): 14-20. The primary objectives of this study included quantifying existing health conditions and describing key health indications among EMS professionals. 23.5% of individuals reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m2. 28.8% of individuals were classified as having normal weight and 25.8% were obese. The overwhelming majority of individuals did not meet the CDC recommendations for physical activity. This study was the first known baseline assessment of EMS professionals regarding the key health indicators indentified by Healthy People 2010.
Fernandez AR, Studnek JR, Cone D (2009). The Association Between Emergency Medical Technician-Basic (EMT-B) Exam Score, Length of EMT-B Certification, and Success on the National Paramedic Certification Exam. Academic Emergency Medicine, 16:1–6 This study analyzed the relationship between EMT-B NREMT exam score, length of EMT-B certification, and success on the national paramedic certification exam. Both EMT-B NREMT exam score and length of EMT-B certification were significantly associated with success on the first attempt of the national paramedic certification exam. Specifically, the largest difference was seen when comparing scores ≤71% to those ≥ 80% (paramedic exam pass rates of 45.6 and 80.8%, respectively; OR = 5.4, 95% confidence interval [CI] = 4.7 to 6.2). Individuals whose length of EMT-B certification was >1.6 years had increased odds of passing the paramedic examination (OR = 1.2, 95% CI = 1.1 to 1.3). While length of EMT-B certification was statistically significant, the adjusted OR calls into question the practical significance of this variable. Educators may wish to consider these two factors when determining paramedic program admission standards and/or consider these variables when determining how to allocate program resources.
Margolis GS, Romero GA, Fernandez AR, Studnek JR (2009). Strategies of High-Performing Paramedic Educational Programs. Prehospital Emergency Care 2009, 13:505-511. A nominal group technique was used to identify the specific strategies used by high-performing Paramedic programs to maintain high first time pass rates. From these, the following twelve recommendations to improve pass rates on the NREMT certification exam were derived: 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 examinations, 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 examinations that have been through a review process; 10) provide students with frequent detailed feedback regarding their performance; 11) incorporate critical thinking and problem solving into all testing; and 12) deploy predictive testing with analysis prior to certification.
Fernandez AR, Studnek JR, Cone D (2009) The Association Between Emergency Medical Technician-Basic (EMT-B) Exam Score, Length of EMT-B Certification, and Success on the National Paramedic Certification Exam. Academic Emergency Medicine, 16:1–6. This study analyzed the relationship between EMT-B NREMT exam score, length of EMT-B certification, and success on the national paramedic certification exam. Both EMT-B NREMT exam score and length of EMT-B certification were significantly associated with success on the first attempt of the national paramedic certification exam. Educators may wish to consider these two factors when determining paramedic program admission standards and⁄or consider these variables when determining how to allocate program resources.
Studnek J, Fernandez AR, Margolis GS (2009). Assessing Continued Cognitive Competency Among Rural Emergency Medical Technicians. Prehospital Emergency Care, 13:357-363. 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. Overall, 151(63.2%) individuals met or exceeded the passing standard of the NREMT-Basic cognitive examination, with 90 (70.9%) passing in state A and 61 (54.5%) passing in state B. Individuals reported an average of 48.6 continuing education hours. A clear majority of individuals reported responding to 0 or 1 call in a typical week. A logistic regression model was constructed in which level of education and volunteer status were significantly associated with passing the examination.
Lerner B, Fernandez AR, Shah MN (2009). Do EMS Providers Think They Should Participate in Disease Prevention? Prehospital Emergency Care, 13:64-70. The objective of this study is to determine EMS providers’ opinions regarding participation in disease prevention initiatives. EMS professionals reregistering in 2006 were asked to complete an optional survey regarding their opinions on and participation in disease and injury prevention. 82.7% felt that EMS professionals should participate in disease prevention; with those working 20 to 29 hours per week being the least likely to think they should participate. About a third of the respondents reported having provided prevention services. About half of the respondents agreed that prevention services should be provided during emergency calls, and 8% of the respondents reported providing prevention services during emergency calls.
Studnek JR, Fernandez AR, Margolis GS, O’Connor RE (2009). Physician Oversight in EMS: Where Are We? Prehospital Emergency Care, 13:1, 53-58. 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 significantly increased with certification level (EMT-Basic 47.6%, EMT-Intermediate 62.3%, and Paramedic 78.5%) and varied by service type (hospital based 78.8%, county/municipal 70.8%, private 67.6%, military 62.4%, government 61.1%, fire based 57.0%, and volunteer 50.8%). EMS professionals working in urban areas were more likely to report recent MD contact than those in rural areas (64.9% vs. 59.2%).
Studnek JR and Fernandez AR (2008). Characteristics of Emergency Medical Technicians Involved in Ambulance Crashes. Prehospital and Disaster Medicine, 23(5): 432-37. This study utilizes a national sample of Emergency Medical Services (EMS) professionals to explore the demographic and work related characteristics associated with involvement in ambulance crashes. 8.6% of the EMS professionals surveyed being involved in an ambulance crash within the past 12 months. When controlling for call volume and time in an ambulance, the odds of involvement in an ambulance crash within the past year were significantly higher for younger EMS professionals and those reporting sleep problems.
Studnek JR and Fernandez AR (2008). Organizational Description and Emergency Preparedness of Nationally Registered First Responders. Prehospital and Disaster Medicine, 23(3): 250-255. This project resulted from the analysis of Nationally Registered First Responders (NRFR) re-registering in 2006. The majority (75%) of NRFR performed work in rural areas and work for fire departments (61%). More than a quarter of NRFRs received no training in the management and treatment of patients involved in biological, chemical, nuclear, explosive emergencies, or structural collapse within the past 24 months.
Margolis GS, Studnek JR, Fernandez AR, Mistovich J (2008). Strategies of High-Performing EMT-Basic Educational Programs. Prehospital Emergency Care 2008, 12:206-211. A nominal group technique was used to identify the specific strategies used by high-performing EMT-Basic programs to maintain high first time pass rates. From these, the following seven recommendations to improve pass rates on the NREMT certification exam were derived: 1) secure strong institution support, 2) hire well qualified EMT lead instructors, 3) strive for instructional consistency 4) recruit students who are positively motivated to succeed, 5) admit students who have demonstrated that they have the academic skills necessary to complete the course, 6) develop student test taking skills, and 7) establish a course passing standards that exceed minimum competency.
Fernandez AR, Studnek JR, Margolis GS (2008). Estimating the Probability of Passing the National Paramedic Certification Examination. Academic Emergency Medicine 2008, 15:258-264. The objective of this study was to utilize student and program characteristics to build a multivariable logistic regression model to determine the probability of success on the cognitive portion of the national paramedic certification exam. Two programmatic characteristics (national accreditation and instructor qualification), six student characteristics (high school class rank, years of education, required for employment, age, race, and gender), and one graduate characteristic (estimated time since course completion) had a significant effect on the probability of passing the national paramedic certification examination. A change in either of these variables can increase or decrease a student’s probability of passing the exam.
Russ-Eft DF, Dickison PD, Levine R (2008). Examining Career Success of Minority and Women Emergency Medical Technicians (EMTs): A LEADS Project. Human Resource Development Quarterly, vol. 19, No. 4. This study examined the factors that related to objective and subjective career success. Education, experience, and hours worked predicted objective career success, while satisfactions with others and supervisor predicted subjective career success. Minority status was not related to either objective or subjective career success. Gender was unrelated to subjective career success, but negatively influenced objective success.
Studnek JR, Ferketich A, Crawford JM (2007). On the Job Illness and Injury Resulting in Lost Work Time Among a National Cohort of Emergency Medical Services Professionals. American Journal of Industrial Medicine 2007, 50(12):921-931. This study estimated the prevalence and incidence of job-related illness or injury resulting in lost work time of Emergency Medical Services (EMS). The prevalence of job-related illness or injury with time away from work was estimated at 9.4%, with a one-year incidence estimated at 8.1 per 100 EMS providers. It appears that increasing call volume, an urban work environment and a history of back problems were associated with increased reporting of job-related illness or injury.
Studnek JR, Ferketich A (2007). Organizational Policy and Other Factors Associated with Emergency Medical Technician Seat Belt Use. Journal of Safety Research, 2007;38(1):1-8. As part of biennial re-registration paperwork, nationally registered EMTs were asked to describe their seat belt use while in the front seats of an ambulance. A logistic regression model was fit to estimate the association between seat belt use, organizational seat belt policy, type of EMS organization worked for, EMT certification level, and the size of community where EMS work is performed. Of the 41,823 EMTs that re-registered in 2003, surveys were received from 29,575 (70.7%). Participants reporting no organizational seat belt policy had lower odds of seat belt usage when compared to individuals that do have a seat belt policy. Paramedics and those working in rural areas also had lower odds of seat belt use. Several factors were found to be associated with seat belt usage among EMTs however, it appears that only one, organizational policy, is a modifiable characteristic.
Markson D. Tunik M. Cooper A. Olson L. Cook L. Matza-Haughton H. Treiber M. Brown W. Dickinson P. Foltin G. (2007). A National Assessment of Knowledge, Attitudes, and Confidence of Prehospital Providers in the Assessment and Management of Child Maltreatment. Pediatrics, 119,1:e103-e108. The primary objective of this study was to assess the knowledge and confidence in recognition, management, documentation, and reporting among a representative sample of emergency medical service personnel in the United States. Findings indicate that respondents lack knowledge regarding the developmental abilities of children, management of families in which child maltreatment is suspected, key elements of the history that should be noted, and the degree of suspicion necessary for reporting. Prehospital providers expressed confidence in their abilities to recognize and manage cases of child abuse and neglect; however, significant deficiencies were reported in several critical knowledge areas including identification, interviewing techniques, and appropriate documentation in instances of child maltreatment
Studnek JR, Crawford JM (2007). Factors Associated With Back Problems Among Emergency Medical Technicians. American Journal of Industrial Medicine, 2007;50(6):464-469. This project evaluated the association between back problems and individual and work-related characteristics. EMTs dissatisfied with their current assignment were 9 times more likely to report back problems that those who are satisfied. EMTs reporting good or fair fitness were more than 3 times more likely to experience back problems than those with excellent fitness. Results from this analysis suggest that there are two modifiable factors associated with self-reported back problems among EMTs, satisfaction with current assignment and self-reported physical fitness.
Dickison PD, Hostler D, Platt TE, Wang H (2006). Program Accreditation Effect on Paramedic Credentialing Examination Success Rate. Prehospital Emergency Care, Apr-Jun 2006; vol. 10, no. 2. This study described the relationship between completion of an accredited paramedic educational program and achieving a passing score on the National Registry Paramedic Certification Examination. Students who attended an accredited program were more likely to pass the examination. Attendance at an accredited training program was independently associated with passing the examination even after accounting for confounding demographic factors.
Russ-Eft DF, Dickison PD, Levine R (2005). Instructor Quality Affecting Emergency Medical Technician (EMT) Preparedness: A LEADS Project. International Journal of Training and Development, 9:4. Secondary analysis of the LEADS database, examined the effects of instructor quality on the level of preparedness of EMS personnel. Results showed significant differences in the student ratings of ten dimensions of EMS instructor preparedness (trauma patient assessment, medical patient assessment, cardiac arrest management, airway management, spinal immobilization, fracture management, hemorrhage control, childbirth, pediatric patient management, patient transport) for both EMT Basics and EMT Paramedics.
Pirrallo RG, Levine R, Dickison PD (2005). Behavioral Health Risk Factors of U.S. Emergency Medical Technicians: The LEADS Project. Prehospital and Disaster Medicine, Jul-Aug 2005; vol. 20, no. 4. This study describes the behavioral health risk factors for EMTs and paramedics in the United States using a health survey. The responses were compared to surveys from the Center for Disease Control and Prevention and from The National Highway Traffic and Safety Administration. EMT-Basics were shown to drive slower than paramedics. When discussing EMS professionals, males drove faster, drank more and wore their seatbelts less often than females. However, females smoked more and engaged in vigorous exercise less than males. Overall, EMS professionals were shown to wear their seatbelts less, drive faster and were less likely to engage in moderate physical exercise compared to other adults in the United States
Brown WE, Margolis GS, Levine R (2005). Peer Evaluation of the Professional Behaviors of EMTs. Prehospital and Disaster Medicine, Mar-Apr 2005; vol. 20, no. 2. This study used a peer evaluation methodology to assess the affective competencies of practicing EMS providers. EMT-Basics and paramedics rated their partners with respect to 11 categories of professional behavior. Overall national registered paramedics rated their partners significantly lower than did nationally registered EMT-Basics. Experienced EMT-Basics rated their partners significantly lower than did newer EMT-Basics. Those EMS professionals who indicated high satisfaction with their current EMS assignment rated their partners more highly on professional behaviors than did those who were not as satisfied. Overall, the peer evaluation of professional behaviors was “good”.
Brown WE, Dawson DE, Levine R (2003). Compensation, Benefits, and Satisfaction: The Longitudinal Emergency Medical Technician Demographic Study (LEADS) Project. Prehospital Emergency Care 2003, 7:357. This study describes the compensation, benefit package and level of satisfaction with the benefits of nationally registered emergency medical technicians using the Longitudinal Emergency Medical Technician Demographic Study. 86% of compensated EMT-Basics and 85% of compensated paramedics were employed primarily as patient care providers. Mean earnings for EMT-Basics was $18,324 and for paramedics was $34,654. At least 26% of compensated EMT-Basics and 9% of paramedics had no health insurance. The majority of nationally registered EMS professionals reported that their retirement plans were not adequate to meet their financial needs. EMS professionals are not satisfied with the appreciation and recognition they receive from their employers. One third are not satisfied with the benefits they receive and nearly all believe that EMS professionals should be paid more for the job they do.
Dawson DE, Brown WE, Harwell TS (2003). Assessment of Nationally Registered Emergency Medical Technicians Certification Training in the United States: The LEADS Project. Prehospital Emergency Care, 7:114-119. This study describes the adequacy and characteristics of emergency medical services education as assessed by surveying a stratified random sample of nationally registered EMT-Basics and paramedics. EMT-Basics and paramedics were satisfied and felt well prepared by their certification courses. Opportunities to improve certification training exist, particularly related to childbirth and pediatric patient management.
Brown WE, Dickison PD, Misselbeck WJ, Levine R (2002). Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS): An Interim Report. Prehospital Emergency Care, 6:433-439. This was an interim report of The Longitudinal Emergency Medical Technician Attributes and Demographics Study. This report describes many characteristics of nationally registered EMT-Basics and Paramedics including the educational level, gender, racial and ethnic makeup, marital status, and level of practice. Median income and median years worked in the profession were also among the many characteristics described in this report.