doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. ‫ا‬ ‫ر‬ ‫ا‬ ‫ت‬.is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. was not certified by peer review)

BackgroundThe use of case-based learning (CBL) in the paramedic curriculum has been reported to be a valuable learning tool. Despite this, the use of CBL in distance or online education is not well researched, in particular, identifying the motivation for students to use CBL using a theoretical approach to eliciting and reviewing student paramedics’ beliefs. AimsThis study aimed to explore the wide range of students' beliefs when it comes to CBL (elicitation of beliefs) and to develop a tool for assessing beliefs in the setting of the theory of planned behaviour (TPB) (development of an assessment instrument).MethodsA sequential exploratory study design was used to explore the methodological challenges associated with eliciting beliefs and forming reliable belief scales. The standard components of developing a questionnaire in the context of the theory of planned behaviour were undertaken. Finally, a cross-sectional non-experimental survey design was used to determine the capability of the TPB to predict students’ perceptions to CBL in their third year of study.ResultsIn order to learn about the factorial structure of the TPB questionnaire on CBL, a 40–50% response rate was required; this study had 12 of 25 students (48%) respond. Using CBL as a focus in paramedic education is subjectively comparable with previous studies in nursing, medicine and allied health professions. It was viewed positively as a linking exercise for consolidation of previously covered work in a paramedic bachelor degree but its true worth not only as a learning tool but for students studying via distance education requires further study and refinement as a model on its own.ConclusionThis study was devoted to eliciting students' beliefs about CBL in their education and developing an instrument to assess students' beliefs in the context of the TPB. A pilot study utilising the constructs of the TPB is required to be undertaken in predicting students’ behaviour towards CBL within their degree.

Introduction Even with paramedicine's evolution, clinical decision-making will always be a crucial learning and teaching requirement. As part of their learning, paramedic students need to develop critical thinking and collaborative approaches with others. The aim was to review the literature around escape room activity as a pedagogical approach for paramedic education. The intent is to contribute to the discussion around authentic and engaging approaches to teaching clinical thinking and decision making in paramedicine. Methods A systematic review was undertaken to review existing literature on using this approach in higher education. EBSCO, Medline, CINAHL, ScienceDirect, ProQuest and PubMed were used to review paramedic and health education strategies using a list of keywords. Results There were 23 scholarly papers examining the use of escape rooms in an educational context found. There was no reference to using this teaching methodology in paramedicine, but some health contexts were identified for nursing, pharmacy, radiology and medicine. Conclusion With an instructional design that addresses logistical requirements, educational escape rooms can be used effectively in paramedic higher education. This review highlights a longitudinal study is needed to assess an educational escape room's implementation into the paramedic higher education curriculum. A longitudinal, multi-university study can further explore the feasibility of using a blended online/offline escape room activity in large enrolment paramedic programs.

Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infarction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016–August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48–124), and 81% of patients had a D2B time < 90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of < 90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events.

Background Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality worldwide. Recent studies demonstrated low survival rates in Middle Eastern countries. Anecdotally there are unique demographic, cultural and logistical challenges in this region. However, there remains a paucity of data published on OHCA in the Middle East. In order to address OHCA in a meaningful manner in the region, we first need to quantify the issue. Methods We conducted a scoping review of published and grey literature on OHCA in the Gulf Cooperative Council region that utilised Arksey and O'Malley's framework. Electronic databases and grey literature sources were identified and searched. Subject matter experts in the region were consulted. All types of studies in English and Arabic were included. Results A total of 24 studies were included from Saudi Arabia, the UAE, Oman, Kuwait, and Qatar. No literature was identified from the state of Bahrain. OHCA victims in the region are younger, predominantly male, and more co-morbid than those in Western studies. We observed low Emergency Medical Service utilisation, low bystander cardiopulmonary resuscitation, return of spontaneous circulation, and survival to discharge rates across the region. There are differences in characteristics of OHCA among ethnic groups. Discussion and conclusions We identified unique characteristics associated with OHCA in the region, variances in processes and outcomes when compared to Western studies, and a lack of coordinated effort to research and address OHCA. We recommend creating lead agencies responsible for coordinating and developing strategies such as community response, public education, and reporting databases.