Research

Diversification in EMS: Are We as Diverse as We Think We Are?

Marilee Vosper, M.Ed., EMT-P; Rachel Walberg, BA; Scott Craig, CCEMT-P, I/C; A.C. Cook, NREMT-P; Tristan Pennella, BS; Avis Thomas, MS; Sandi Wewerka, MPH, CCRC, EMT-B

Introduction
Research shows that the demographics of EMS professionals in the United States are not diverse and there is a lack of studies examining the demographics of individuals pursuing an EMS career. Understanding the changing demographics of individuals pursuing EMS allows educators to better prepare for their audience and changing learning environment. This study describes the diversification of EMS students during the past six years.

Hypothesis
The demographics of students have changed since 2008.

Methods
Demographic data from EMS students who opened accounts in Fisdap™, an internet-based administrative database, were retrospectively reviewed for students with the following criteria: student provided consent for research, reported age >15 years. Analyses were performed with Chi-Square tests.

Results
162,510 EMS students were included in the study. There was a highly statistically significant change over time in age and sex (p < 0.0001). 79.7% of students reported their sex; there was an increase of 0.32% and 23.6% in male and female students respectively. 26.6% of students reported their age; the population of students aged 18-24 increased, students aged 25-29 increased 0.29%, students aged 30-39 decreased 0.25% and students 40 and older increased 1.61%. Data for ethnicity was only captured for 2013-2014 and only 20% of students reported; there was an increase in population of 0.09% for African American, decrease of 0.06% for Asian, decrease 1.37% for Caucasian, increase 1.35% for Hispanic, and an increase of 0.25% for other.

Discussion
Understanding the changing demographics of individuals pursuing EMS allows for educations to better prepare for their audience and their changing learning environment. This information also provides employers charged with cultivating a diverse workforce a starting point in order to develop diversification efforts and tailor action plans.

Limitations
• FISDAP is a limited data set; only 84% of accredited paramedic programs utilize student accounts.
• Age, Ethnicity and Gender are all optional data points.
• Only 26.6% of students (43,266) reported their age.
• Only 20% of students (35,000) reported their ethnicity. This data was recorded only in 2013 and 2014.
• Only 79.7% of students (129,649) reported their gender.

Conclusion
While we may feel that we have made progress in becoming diverse, the changes, while statistically significant, are small. It was noted that with time, more students reported their age, ethnicity and sex. Future studies may more accurately describe the changing demographics. Further research should compare the demographics of incoming EMS students and those successfully completing programs, as well as the impact of regional or school-specific diversification initiatives on student population.

Early Exposure to Valid Test Items Improves EMT Student Performance on Summative Exams

Ron Lawler, BUS, NRP; Elias Frick, BA, NRP; Ben Getsug, AAS; Brian Hendrickson, MS, EMT-P; Sara Houston, BS, NREMT-P; Evelyn Hunter, BS, MSW, LSW; Andy Lovell, NREMT-P; Luke Stanke, PhDc; Hanorah Vanni, BA; Mark Volker; Rachel Wasilewski, BS; Virginia Wilson, BSBA, BS, EMT-P

Introduction
There are several avenues for formative testing available to EMT programs, however most are not validated. Research in a variety of healthcare educational disciplines shows that valid formative examinations improve student outcomes on summative exams. Existing EMS-specific research is scarce on this subject.

Hypothesis
Exposure to valid, formative, secure EMT exams is predictive of success on valid, summative EMT exams.

Methods
EMT Readiness Exam 2 (ERE2) and EMT Unit Exam (EUE) results were retrospectively collected from Fisdap, an online EMS education data collection system from December 2010 through December 2014. Inclusion criteria consisted of student consent to research. Data points for the ERE2 and each EUE included scores and program ID. Data was fit to a hierarchical linear model (HLM) where level-1 contains information about the number of unit tests taken by a student and level-2 intercept for program affiliation (Table 1).

The EMT Readiness Exam 2 (ERE2) and EMT Unit Exams (EUE) are valid assessments that adhere to the National EMS Practice Analysis developed by the NREMT and current American Heart Association Guidelines. The exams were constructed using classical test theory and pilot-tested with geographically diverse EMT students. The six EMT Unit Exams cover Airway, Cardiology, Medical, Obstetrics/Pediatrics, Operations, and Trauma. Each exam is designed to test knowledge and critical thinking ability in a given subject area. After pilot, the ERE2 was found to be predictive of first-time NREMT success: 97% of students who passed the ERE2 at the recommended Angoff cut score (72%) passed the NREMT exam on their first attempt (Graph 1).

Limitations
There are a number of unknown variables that this study does not control for including: context of EUE use (as pre-tests, module end exams, or pre-final exam prep), if exams were included in grade calculation and if there was any student exposure to other valid formative exams prior to the ERE2.

Results
The mean score of those students who took no EUEs was 67% (n = 22,359) while those who took all six exams was 71% (n = 1,557). Using the HLM to control for students in the same program, students who took all 6 unit exams still scored 1.8% higher on the ERE2 (Table 2).

Conclusion
Improvement in EMT student scores on the ERE2 was correlated with the previous exposure to all six EUEs. Given the predictive value of the ERE2, this small increase in average score would result in more students achieving success on the NREMT certification exam. Based on ERE2 pilot statistics, at the average score without any unit exams (67%), about 74% of students could be expected to achieve first-time NREMT success. At the average score with formative exams (71%), that percentage increases to 92%. Given this result, EMT training program directors should consider using validated formative exams.

Next Steps
There is plenty of opportunity for further research in this area. Possible topics of research include: an examination of other valid test items used in place of/in addition to Fisdap Unit Exams, whether the length of program also has an effect on ERE success, whether Unit Exam exposure predicts success at the paramedic level, whether the timing of formative exam administration has an effect on the summative exam results, whether a student’s score on the first formative exam is predictive of attrition, and whether the administration of a valid entrance examination would positively impact summative exam results. There’s also an opportunity to examine whether exposure to formative exams specifically impacts performance on the critical thinking portion of the summative exams.

Is There a Relationship Between Empathy Levels and the Personality Traits of Entering Paramedic Students?

Ron Lawler, BUS, NRP; Elias Frick, BA, NRP; Ben Getsug, AAS; Brian Hendrickson, MS, EMT-P; Sara Houston, BS, NREMT-P; Evelyn Hunter, BS, MSW, LSW; Andy Lovell, NREMT-P; Luke Stanke, PhDc; Hanorah Vanni, BA; Mark Volker; Rachel Wasilewski, BS; Virginia Wilson, BSBA, BS, EMT-P

Introduction
Empathy is an essential affective competency that paramedic educational programs are encouraged to measure to meet accreditation requirements. Previous studies have suggested a link between empathy and personality traits in other professions.

Hypothesis
Empathy levels of matriculating paramedic students are associated with personality traits of agreeableness, conscientiousness,and neuroticism.

Methods
Paramedic students participating in Fisdap, a national online testing cooperative community, and completing the Fisdap Entrance Exam (EE), completed the previously validated Jefferson Scale of Empathy – Health Profession Student version (JSE-HPS – Williams 2015) and applicable sections of the M5-50 personality inventory (McCord 2002). To understand the relationship between empathy and other traits, three regression models were fit to empathy scores.

Results
A total of 604 consenting students from 61 geographically diverse programs in the United States completed both inventories between August 15, 2013, and March 27, 2015. Mean scores were obtained for empathy (110.00; SD=13.99), agreeableness (80.43; SD=11.09), conscientiousness (81.63; SD=11.66), and neuroticism (25.66; SD=17.09). Results were statistically significant for all three regression models (p < .01). See Table 1. Each trait accounted for the following variability in empathy scores: agreeableness 8% (R2 = .08), conscientiousness 5% (R2 = .08) and neuroticism 1%. Higher neuroticism scores were associated with decreased levels of empathy.

Table 1: Results of three regression models. Note: The relationships may not have practical significance.

For every 10 point increase on the agreeableness scale, we can expect a 3.6 point increase in empathy scores. For every 10 point increase on the conscientiousness scale, we can expect a 2.8 point increase in empathy scores. For every 10 point increase on the neuroticism scale, we can expect a 1 point decrease in empathy scores.

Table 2: Summary statistics for the four measures.

The first regression model used agreeableness as an independent variable and is written as: Y(x) = B0 + B1(Agreeableness Score).

The second regression model used conscientiousness scores as an independent variable and is written as: Y(x) = B0 + B1(Conscientiousness Score).

The third regression model model used neuroticism scores from the Fisdap Entrance Exam as an independent variable and is written as: Y(x) = B0 + B1(Neuroticism Score).

Conclusion
Empathy scores are positively correlated to agreeableness and conscientiousness while being negatively associated to neuroticism.

It appears empathy, unlike the other three traits, is a teachable “soft skill” and may vary with time. More evidence is needed to understand the practical significance and use of these relationships in EMS education.

Unrelated to this research project, David Page has a paid consultation relationship with Fisdap. Luke Stanke received financial compensation for work on this project from Fisdap. L. Michael Bowen is an employee of Fisdap.

Empathy Levels of Students Entering US Paramedic Education Programs

David I. Page, MS, NRP; L. Michael Bowen, NRP; Luke Stanke, PhDc; Brett Williams PhD

Introduction
Evaluation of the affective domain is an essential component of paramedic program accreditation in the United States. Empathy is an essential affective competency that graduating paramedic students are often required to display. Empathy has also been tied to patient satisfaction, greater diagnostic accuracy, and reduced rates of clinical errors. Previous studies have described empathy levels in Australian paramedic students and healthcare providers in general, using the previously validated Jefferson Scale of Empathy – Health Profession Student version (JSEHPS) by Williams, et al (2015).

Hypothesis
Matriculating US paramedic students will display similar levels of empathy to those of Australian paramedic students.

Methods
Students enrolling in paramedic programs participating in Fisdap, a national online testing cooperative community, and completing the Fisdap Entrance Exam (EE) were asked to participate in this prospective cross-sectional sample of convenience. Participating students completed the same JSE-HPS that has previously been used in Australia and by healthcare students in general. A t-test was used to compare US JSE-HPS values to those reported by Williams.

Results
A total of 606 consenting US paramedic students from 61 geographically diverse programs completed the JSE-HPS between August 15, 2013, and March 27, 2015. The mean score for the US cohort was 110.00 (SD=13.99), compared to a mean of 108.60 (SD=12.50) for the Australian cohort. Results of the t-test suggest a statistically significant difference in empathy scores between the two groups (t=2.46, p=.014).

Table 1: displays the JSE-HPS summary statistics for the Fisdap and Williams, et al studies.

Conclusion
US paramedic students in this sample displayed higher levels of empathy than previously reported levels from their Australian counterparts. While these levels appear similar to those in other healthcare professions, more research is needed to determine if they are representative of the population of practicing paramedics in general and what influence this may have on patient outcomes.

Agreeableness is Linked to Improved Communication During Paramedic Student Internships

David Page, MS, NREMT-P; L. Michael Bowen, NREMT-P; Luke Stanke, PhDc.

Introduction
Teamwork and cooperation are core paramedic competencies that depend on good communication. The Fisdap (Saint Paul, MN) Entrance Exam (EE) contains a portion of the previously validated M5-50 personality trait index (McCord 2002). It describes individual differences, such as being likeable, pleasant, and harmonious in relation with others. People with high instances of agreeableness are described as individuals who strive to maintain social harmony. These are people who might be described by others as "kind", "considerate" and "warm". We are postulating that individuals who score high in agreeableness will perceive providers to me more empathic due to a more positive outlook about social groups. It is also thought that these individuals have a decrease in social prejudices and as a result have more effective methods of conflict resolution.

Educators struggle to measure performance of the so-called “soft skills,” with agreeableness being one of the more difficult to define or teach. These affective behaviors are essential to good bedside manner or customer service, and effective teamwork. Potential employers describe these behaviors as the keys in avoiding patient complaint, and allowing for long term retention of high performing employees. While the M5-50 has been used in law enforcement candidates, little is known of how EMTs seeking paramedic certification will perform on this exam. In this project we postulated that entering paramedic students may already possess some of these helpful affective traits, as measured by the M5-50. We also postulated that having these traits would lead to a more successful completion of paramedic education, particularly during ambulance clinical performance in the field.

Hypothesis
Increased agreeableness scores in paramedic students result in improved communication ratings during patient contacts.

Methods
All paramedic students consenting to research and participating in both the National Registry of EMTs (NREMT) Psychomotor Competency Portfolio Project (PCPP) and the FISDAP(R) Entrance Exam (EE) were included in this study. The student’s ability to communicate was evaluated by using the NREMT-PCPP rating scale on the new PCPP shift evaluation form (www.nremt.org). The evaluation form was completed on each patient contact, first by student, then by preceptor. The evaluation ratings are: NA = Not Applicable; not needed/expected;  0 = Unsuccessful -required excessive or critical prompting; includes rating of “not attempted” when student was expected to try; 1 = Marginal - inconsistent - Not yet competent; 2 = Successful/Competent no prompting. An essay explaining these ratings to preceptors was also made available.

To improve inter-rater reliability directions on the use of this scale are included on the form itself.

The following note was included on the form:
NA = Not Applicable; not needed/expected – This is a neutral rating. (Example: Student expected to only observe, or the patient did not need intervention);
0 = Unsuccessful -required excessive or critical prompting; includes rating of “not attempted” when student was expected to try; This is an unsatisfactory rating;
1 = Marginal - inconsistent - Not yet competent; This includes partial attempts.
2 = Successful/Competent no prompting;
*NOTE: Ideally, students will progress their role from observation to participation in simple skills, to more complex assessments and team leadership. Students will progress at different rates and case difficulty will vary. Students should be active and ATTEMPT to perform skills, assess/treat patients and lead encounters early-on even if this results in frequent prompting and unsuccessful ratings. Unsuccessful ratings are normal and expected in the early stages of the clinical learning process when student needs prompting. Improvement plans MUST follow any unsuccessful or inconsistent ratings.

This form is an adaptation of the state of California shift evaluation form. It was modified in 2008 by the NREMT PCPP committee. The NREMT convened a group of subject matter experts representing a wide range of community stakeholders. This group sought to evaluate the feasibility of using a “prompting” evaluation methodology previously described in the literature (Nepon/Eberly 2008). This form was piloted by 8, then 24 paramedic programs and found to provide high inter-rater reliability and better evaluation validity.

For the purposes of this study, ratings of 0 and 1 were merged as unsuccessful, “NA” ratings were excluded, and 2 was counted as successful. Communication was defined as the ability of the student to effectively communicate with the team, provide an adequate verbal report and thorough written patient narrative. Agreeableness scores from the EE were then compared the PCPP rating, a dichotomous preceptor rating, acceptable or unacceptable, that evaluated their communication skills after each patient encounter using a generalized linear multilevel model (GLMM), a type of regression model. The GLMM included random effects for student and preceptor, and fixed effects for the square root of the total number of patient encounters completed prior to the rating and affective domain scores. The coefficients of the model are discussed in the results section.

Results
A total of 75 students meeting inclusion criteria were drawn from 7 different programs. These 75 students received ratings from 363 preceptors over a total run volume of 12,375 total patient encounters in the hospital clinical setting and the field setting (mean = 165 encounters). Of those encounters, 9,480 were completed in the field (mean = 126.4 encounters). The mean logit score for agreeableness was 1.33 (SD 1.03; Range -1.33 to 5.25). The results from the model fitting suggested a statistically significant relationship between agreeableness logit scores and ability to communicate ratings received from preceptors (p=.02). The results produced an odds ratio suggesting that for every 1 logit increase in agreeableness, a student was 1.6 times more likely to obtain a positive rating on communication from a preceptor, controlling for student ability, preceptor rating harshness, and total number of encounters prior to the rating.

Regression Results – Agreeableness and Communication

Conclusion
A positive relationship exists between preceptor ratings of communication skills and a student's level of agreeableness. Student’s with increased scores of agreeableness tend to communicate more efficaciously than those with decreased scores. Agreeableness was the focus because this temperament is associated with motives to maintain positive interpersonal relations. To our knowledge no other studies exist linking affective personality traits to paramedic field performance. More research is needed to determine if agreeableness and improved communication can be increased with targeted interventions during paramedic education.

Are You There Doc? Paramedic Student Team Lead Utilization of MD Consultation

Tristan Pennella, BS; Scott Craig, CCEMT-P, I/C; Luke Stanke, BS; Marilee Vosper, M.Ed., EMT-P; Rachel Walberg, BA; A.C. Cook, NREMT-P; Sandi Wewerka, MPH, CCRC, EMT-B

Background
Current EMS guidelines indicate that if a patient’s condition does not conform to standard protocol, the paramedic should always contact medical control for instruction. However, a recent publication investigating cardiac patient encounters found that protocol based care is equivalent and perhaps slightly better than online medical control. Therefore, the purpose of this study was to examine the frequency of paramedic student team leads decision to access physician consultation from the field during cardiac patient encounters. Additionally, we sought to determine predictors in identifying the likelihood of physician consultation as well as identify any changes in patient care.

Hypotheses
HA1: Paramedic student team leads who consult physicians leads to increased use of cardiac interventions and medications in the field.

HA2: Paramedic student demographics and patient characteristics can predict utilization of physician consultation during a cardiac patient encounter.

Methods
A retrospective review of data was collected using Fisdap™, an internship skills tracking system for EMS students. Inclusion criteria included: Field data inputted by paramedic students in contexts between 01-01-2011 and 12-31-2014; patients with a primary and secondary impression of “cardiac” (n= 8,800) whether or not physician consultation occurred. Paramedic student demographics included age and gender. Patient characteristics included age, gender, and initial cardiac rhythm. Patient care was analyzed based on interventions performed (cardioverysion, pacing, 12-lead, thrombolytic screen, nasotracheal intubation, and pericardiocentesis) and medications given (acetylsalicylic acid, nitroglycerin, paralytics, amiodarone, dopamine, epinephrine (1:10,000), and all other IV drip medications).

Data were analyzed using descriptive statistics to describe the demographics of paramedic students and patients. Frequency counts and generalized linear modeling was utilized to determine the number of cardiac interventions and medications given and describe any differences between treatment groups.

Results
1,008 student paramedic team leads treated a total of 8,800 cardiac patients during the retrospective study time frame. There were 288 physician consultations performed on 277 different patients. Of these 1,008 paramedic students, only 8.7% (n=88) called for physician consultation. The number of cardiac medications given increased significantly (p

Consultation
Even with the advancement of telecommunications, physician consultations from the field remain low. Interestingly, the paramedic student team leads who made a physician consultation averaged 3.3 consults compared to the other 91.3% of paramedic student team leads who had no physician consultations during the study time frame.

Although this finding warrants further investigation, it is possible that once student paramedics make their first physician consultation they become more comfortable with seeking additional instruction, and thus become increasingly likely to pursue a consultation from the field. This population of paramedic student team leads was significantly more likely to administer more medications compared to team leads who did not consult physicians when treating cardiac patients. We suspect that this is due to the advanced medical decision making of the physician relaying care onto the paramedic team. It is also likely that the patients who require physician consultation are more acutely ill, and therefore require higher level of care and management.

We also discovered that the more patient contacts a medic had and the older they are, the less likely they were to give cardiac medications compared to their young counterparts. It is unclear if this is because the paramedics become desensitized to patient complaints, or because they are seasoned and better able to assess treatment. Together, this review illustrates some thought provoking findings as they relate to the decision of paramedic student team leads to access physician consultation.

Our study is limited by the design of only including cardiac encounters, however future directions could and should involve other aspects of EMS care to identify if these findings hold true. Future prospective approaches could also help to accurately identify the reasons for physician consultations and any change in patient care.

References

1. Pozen, MW, D’Agostino, RB, Sytkowski, PA, Schneider, RJ, Berezin, MM, Bremer, LH, Riggen, RJ. Effectiveness of a Prehospital Medical Control System: An Analysis of the Interaction Between Emergency Room Physician and Paramedic. Circulation; 63, No. 2, 1981
2. Greer, S., Williams, I., Valderrama, AL., Bolton, P., Patterson, DG., Zhang, Z. EMS Medical Direction and Prehospital Practice for Acute Cardiovascular Events. Prehospital Emergency Care; 2013; 17:38-45.
3. Bergrath, S., Czaplik, M., Rossaint, R., Hirsch, F., Beckers, SK., Valentin, B. Implementation phase of a multicenter prehospital telemedicine system to support paramedics: feasibility and possible limitations. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:54
4. Thompson, SJ. & Schriver, JA. A Survey of Prehospital Care Paramedic/Physician Communication for Multnomah County (Portland), Oregon. Journal of Emergency Medicine, Vol. 1, pp 421-428, 1984.
5. Erder, MH., Davidson, SJ., Cheney, RA. On Line Medical Command in Theory and Practice. Annals of Emergency Medicine; 18:3 March 1989

Entrance Exam Prediction on Paramedic Student Terminal Performance

David I. Page, MS, NRP; L. Michael Bowen, NRP; Luke Stanke, PhDc

Introduction
Paramedic education can be costly and time consuming. Previous allied health entrance screening tools have been shown to have little predictive value to overall paramedic student success. Employers, students, and educators could benefit from accurate pre-paramedic program assessment tools to guide admission and remediation of key abilities.

Hypothesis
Fisdap’s entrance exam scores can positively predict passing the NREMT-CE on first attempt.

Methods
Paramedic programs using Fisdap, a national online testing cooperative community that measures paramedic student progress and summative competency, administered Fisdap’s Entrance Exam (EE) to matriculating paramedic students. The EE is designed to measure cognitive ability with breakdowns in math, reading comprehension, anatomy & physiology, and EMT-level critical thinking. Program directors from participating institutions reported attrition and National Registry of Emergency Medical Technician Paramedic Cognitive Exam (NREMT-CE) performance results. A logistic regression model was fit to the data to determine if there was association with EE score and first time pass rates on the NREMT-CE.

Results
A total of 550 consenting students from 33 geographically diverse programs completed the EE between July 1, 2012 and August 30, 2013. Of these, 177 (32%) attrited or were dismissed for poor academic performance (n=47;9%), poor affect (n=11;2%), or other reasons, including personal circumstances (N=31; 6%). Of the 340 graduating students, 293 (53%) passed the NREMT-CE on first attempt and 47 failed (9%).

First-time Pass Rates

The results of the logistic regression show a statistically significant, positive relationship between the EE anatomy & physiology, mathematics, and reading comprehension sections and NREMT-CE first-time pass rate (p < .001). The results suggest that for every 10 point increase on the Entrance Exam anatomy & physiology section, a student is 3.8 times more likely to pass the NREMT-CE. Odds of passing for the average composite score on the Entrance Exam, 79, is 92%.

Conclusion
Fisdap’s Entrance Exam scores positively predict first-time pass rate on the NREMT-CE. Further research is needed to understand the best use of this data to increase retention and improve pass rates.

Table 1 displays the coefficients and standard errors of the model.

Table 1: Results from the logistic regression.

Unrelated to this research project, David Page has a paid consultation relationship with Fisdap. Luke Stanke received financial compensation for work on this project from Fisdap. L. Michael Bowen is an employee of Fisdap.

Impact of the NAEMSP Guidelines for Spinal Immobilization and Long Backboard Application on Usage Rates between 2010 and 2014

Lauren MacNeill, BA, NREMT; Tom Dobrzynski, BS, NRP; Mark Cromer, MS, MBA, NRP; Gina Riggs, MS, NRP; Mike Mayne, BA; Joshua Salzman, MA, EMT-B

Background
Previous research has demonstrated that use of the long backboard for spinal immobilization in trauma patients may cause more harm than good, prompting the release of the 2013 NAEMSP/ACS Committee on Trauma joint position statement on long backboard and cspine immobilization usage. This study evaluated whether the release of this position statement impacted the rates of long backboard and ccollar usage.

Methods
This study was a retrospective review of prospectively collected data from paramedic, AEMT, and EMT students entering data into Fisdap, a database of prospectively reported clinical field experiences. Inclusion criteria included student consent to research, data validated by preceptor as good data, and patient encounter dates between 2010 and 2014. Change in the rate of long backboard and ccollar use per year was analyzed using logistic regression.

Results

A total of 1,105, 818 runs (2010 = 202, 858, 2011 = 216,980, 2012 = 265,403, 2013 = 253,718, 2014 = 166,859) met inclusion criteria. Rate of long backboard use decreased from 7.90% in 2010 to 1.73% in 2014, resulting in a 30% decrease in long backboard use year over year (OR = 0.70, 95% CI = 0.690.70). Rate of ccollar use decreased from 8.25% in 2010 to 3.95% in 2014, which was an 18% year over year decrease. When the years were grouped into pre (2010-2012) and post (2013-2014) position statement time periods, there was a much faster year over year reduction in usage rates for long backboards (OR = 0.5899; 95% CI: 0.56480.6161) and ccollar spinal immobilization (OR: 0.7871; 95% CI: 0.76350.8114) in the post position statement time period.

Conclusion
The rate of long backboard and ccollar spinal immobilization has been declining since 2010, which included time prior to the release of the 2013 position statement paper. Release of the position statement appears to have accelerated the decrease in rates of long backboard and ccollar immobilization compared to the preposition paper period.

Factors Associated with Appropriate Spinal Immobilization and Long Backboard Use

Tom Dobrzynski, BS, NRP; Lauren MacNeill, BA, NREMT; Marc Cromer, MS, MBA, NRP; Gina Riggs, MS, NRP; Mike Mayne, BA; Joshua Salzman, MA, EMT-

Background
The 2013 NAEMSP/ACS Committee on Trauma joint position statement on long backboard and cspine immobilization included criteria defining appropriate use of these treatments. This study sought to identify factors associated with the appropriate use of long backboard immobilization following release of these guidelines.

Methods
This was a retrospective review of collected data from Fisdap, a database of prospectively reported clinical field experiences for paramedic, AEMT, and EMT students. Inclusion criteria included student consent to research, data validated by preceptor as good data, and patient encounter date of 2013 and 2014. The association of US geographic region where the encounter ocurred (West, North, South, East), student training level (EMT/AMET vs. paramedic), patient race/ethnicity (African American, Caucasian, Other, Hispanic), patient gender (male vs. female), and patient age (≤ 18; 1964; ≥65) with appropriate backboard use was evaluated using logistic regression. Appropriate use was defined according to the 2013 position statement criteria and derived from data elements from Fisdap.

Results
A total of 24,020 runs (2013 = 15,417; 2014 = 8,603) met inclusion criteria and were analyzed (Table 1). Overall, 82.4% of patients were appropriately long backboarded, 13.9% had inappropriate placement, and appropriateness could not be determined in 3.7% of patients (Table 2).

Encounter year (2013 = 77.9%; 2014 = 90.3%), geographic location [Midwest (OR = 1.54; 95% CI 1.31.8); South (OR = 1.24; 95% CI 1.101.40); reference = West], and race (African American; OR = 1.22; 95% CI = 1.101.36; reference = Caucasian) were all significant factors associated with higher levels of appropriate placement. Encounters with an AEMT student (OR = 0.81; 85% CI 0.710.92) and encounters with a patient ≤ 18 (OR = 0.74; 95% CI 0.66 0.82) or ≥65 (OR = 0.75; 95% CI 0.69 0.82) were associated with a lower likelihood of appropriate placement.

Conclusion
Factors associated with higher likelihood of appropriate long backboard use include patient encounter in 2014, encounters in the Midwest or South, and African American patient race. Encounters with an AEMT students and encounters with patients ≤ 18 or ≥65 were associated with a lower likelihood of appropriate long backboard use.

Examining the Role of Experience and Affective Personality Traits in Paramedic Students’ Success

Wayne Perry, BS, NRP, NCEE; Kelly Wanzek, AAS, NRP; Michael Hunter, BS, NRP; Ben Hejkal, BA; Ginger Burke, AAS, MICP; Katie Cicolello, BA; Todd Cage, M.Ed, NREMT-P

Introduction
Paramedic programs are evaluated on course completion rates and National Registry of EMT’s pass rates by accrediting bodies and regulatory agencies. Like other health professions, EMS educators are interested in methods that predict student success as entrance exams and background evaluations. The connection between affective personality traits and paramedic success has also been of recent interest to EMS educators. Many paramedic programs require varying levels of EMT experience for admission, because experience is believed to offer enhanced understanding. Although these predictive variables have been discussed, limited research on this subject has been completed.

Methods
Scores on a validated summative exam (PRE) [Table 1] were compared to sub-scores on a validated entrance exam (EE) and self-reported prior EMT experience [Table 2]. The EE consists of four content areas: Math, Reading, Anatomy/Physiology, and EMT Basics; and three noncognitive sections: Agreeableness, Conscientiousness, and Neuroticism. Scores for the PRE and the EE were converted from total scores to logit scores, and the data was fit into a series of linear regression models [Table 3].

Table 1: Fisdap Entrance Exam Scores

Table 2: Self Reported EMT Experience

Table 3: Results of Linear Regression

Results
The total number of students who completed both the EE and PRE was 291. The average PRE score was 74% (range 47–89%). The corresponding average logit score was 1.02 (range -0.10–2.09). The coefficients from the model suggest that four variables explain the differences in PRE logit scores with statistical significance. These factors were Experience of 2–5 years, EE Anatomy/Physiology scores, EE EMT Basic scores, and EE Conscientiousness scores.

Examinees with 2–5 years of experience score, on average, 0.13 logits higher on the PRE (t=0.03).

On average, students with higher scores on the EE Anatomy/ Physiology and EMT Basics subsections obtained higher scores on the PRE. Every 10-scale point increase in Anatomy/ Physiology raises the PRE by 0.17 logits (t < 0.001). Likewise, every 10-scale point increase in EE EMT Basics raises the PRE by score 0.11 logits (t=0.01).

Finally, every 10-scale point increase in Conscientiousness scale scores, decreases the PRE by 0.06 logits (t=0.03). Although significant, the result is a statistical artifact due to multicollinearity, and this negative result should be ignored.