Introduktion: Sjuksköterskan inom ambulanssjukvården utsätts många gånger för det okända, de arbetar i utmanande miljöer och utför avancerad vård prehospitalt. Vid särskild händelse tilldelas första ambulans på plats rollen som sjukvårdsledning. Ofta tilldelas rollen utan möjlighet till förberedelser och med knapphändig information och en oro inför denna uppgift finns. Syfte: Att belysa sjuksköterskan i ambulans upplevelse av att vara i ledningsroll vid en särskild händelse. Metod: Studien har en kvalitativ design med induktiv ansats. Tolv sjuksköterskor verksamma i ambulanssjukvården i västra Sverige intervjuades via semistrukturerade intervjuer.  Innehållsanalys med manifest nivå användes som analysmetod. Resultat: Resultatet resulterade i fem teman: Att bli tilldelad utmaningen, Att ta sig an rollen, När känslorna tar över, Att uppnå kontroll och Erfarenhet skapar lugn. Slutsats: För sjuksköterskorna i studien var det en utmaning att ta sig an ledningsrollen vid särskild händelse. Ledningsrollen kunde leda till känslomässiga reaktioner och upplevdes påfrestande. Det fanns en strävan efter kontroll genom struktur, information och överblick.  Deltagarna i studien önskade att få öva mer och använda sin kunskap på de mindre skadehändelserna

Varje år drabbas tusentals patienter av skador inom vården på grund av felbehandlingar, stress och brister i kommunikation mellan vårdpersonal. Utöver detta dör över tusen patienter varje år till följd av vårdskador. Som en jämförelse kan nämnas att det är fler personer än vad som exempelvis dör i trafikolyckor. Arbetet med patientsäkerhet är därför ett mycket viktigt område. För att identifiera risker och tillbud är rapportering och utredning av avvikelser ett viktigt verktyg och för detta används digitala avvikelsesystem. Då det är tidigare känt att hälso- och sjukvården är en sektor som upplevt utmaningar inom digitala system ses behovet att undersöka vad den generella uppfattningen är kring de avvikelsesystem som används av Sveriges landsting. Specifikt syftar denna studie att undersöka uppfattningar kring användbarheten i dessa system och vart eventuella utmaningar ses. Genom resultatet kan det konstateras att det finns stora skillnader kring de generella uppfattningarna om avvikelsesystemen. Gällande de generella uppfattningarna om användbarheten i avvikelsesystemet ses mindre variationer och hos en tydlig majoritet av landstingen ses en negativ uppfattning. Dock krävs en fördjupad studie för säkerhet i resultatet. Specifika användbarhetsutmaningar har uppmärksammats på den nivå i systemet som hanterar och utreder avvikelser. En ytterligare utmaning tyder på att majoriteten av avvikelsesystemen är för komplexa i förhållande till verksamhetens behov vilket kan innebära en negativ påverkan på användbarheten i avvikelsesystemet. Sammanfattningsvis ger därför denna studie stöd för att vidare forskning kring användbarhetsaspekter inom avvikelsesystem kan vara av värde för hälso- och sjukvårdens avvikelsehanteringsprocesser och lärande. / Every year, thousands of patients suffer from injuries due to medical errors, a stressed working environment and miscommunication between health care professionals. In addition, over a thousand patients die each year due to medical injuries. As a comparison, this number is higher than, for example, deaths caused by traffic accidents. Therefore, the work on patient safety is a very important area. In order to identify risks and incidents, reporting and investigation of incidents is an important tool, and for this digital Incident Reporting Systems are used. Knowing that health care is a sector that has previously experienced challenges within digital systems this motivates a need to investigate general perceptions and challenges in Incident Reporting Systems used by Swedish County Councils. In particular, this study aims to investigate the perceptions of the usability in these systems and where potential challenges are seen. With support from the results, it can be concluded that there are significant differences on the general perceptions of the Incident Reporting Systems. In regards to the general perceptions on the usability in the Incident Reporting Systems less variation is seen, and by a clear majority of the County Councils a negative perception is seen. Although, an additional in-depth study is needed to attain reliability in the results. Specific usability challenges have been recognised at the advanced user level who are handling and investigating the reported incidents. Another challenge suggests that the majority of the Incident Reporting Systems are too complex in relation to the needs of the business which may have a negative impact on the usability of the Incident Reporting System. To summarize, this study supports that further research on the usability aspects of Incident Reporting Systems can be of value to health care’s incident reporting processes and learning.

<p dir="ltr">Traffic Incident Management (TIM) is an important tool for agencies to reduce secondary crashes, improve travel reliability, and ensure safety of first responders. Having “eyes” on the scene from roadside traffic cameras can assist operators to dispatch appropriate personnel, provide situational awareness, and allow for quick response when incident conditions change. Many intelligent traffic systems (ITS) centers deploy pan-tilt-zoom (PTZ) cameras that provide broad coverage but require operators to position. When incidents occur or a public safety vehicle stops for roadside assistance, Traffic Management Center (TMC) operators need to reposition cameras to monitor the event. The camera positioning time depends on operator experience, accuracy of 911 call, location, public safety radio reports, and in some cases, GPS positions. This research outlines the methodology to use GPS data sources to automate camera position to a scene for event nature verification. In general, this GPS information can come from either connected vehicles or public safety vehicles, such as Indiana Department of Transportation (INDOT) Hoosier Helpers. Implementing this research into INDOT daily operations has increased the number of events that cameras verify, while decreasing the time from event occurrence to camera verification from a median of 5 minutes to a median of approximately 90 seconds. The time is driven by the accuracy and frequency of GPS data from devices. With increased telematics polling rates and availability of enhanced vehicle data such as door open/close and seatbelt latch events, this latency is expected to further decline. </p>

CHDS State/Local / Approved for public release, distribution is unlimited / Threatened with the loss of federal funding for Homeland Security and emergency management preparedness programs, state and local entities must implement the National Response Plan and the National Incident Management System, which includes the Incident Command System, Unified Command, and the Multiagency Coordination System. Although mandated by Congress and implemented by Homeland Security Presidential Directive 5, underdeveloped areas of Indian country and small towns, especially farming and ranching communities and agriculturally-based counties are likely to find that they do not have the capacity to fully implement these mandated federal response programs. A theoretical terrorist-induced multistate Foot and Mouth Disease (FMD) outbreak is used to examine the impact of implementing newly established federally mandated response management programs on rural and tribal communities in agrarian states. Recovering from such an agroterrorism bioattack would require a coordinated multi-disciplinary response that is heavily dependent on local, tribal, state, and private sector personnel. However, because the United States has not experienced an outbreak of FMD since 1929, many of the skills required to quickly diagnose and respond may no longer exist. This thesis identifies potential methods for obtaining and deploying the FMD virus in a coordinated bioattack on the U.S. economy. / Director, Idaho Bureau of Disaster Services

Every year, tens of thousands of patients in North America die from preventable errors. Incident learning can decrease this number, but is not currently reaching its full potential in health care. The goal of this research was to propose strategies to effectively report and learn from incidents to drive quality improvement. A detailed literature review, focus groups, in-depth interviews, and thematic analysis were used to identify potential process improvement strategies from aviation and nuclear power and assess these strategies for feasibility and desirability in health care. This work was guided by World Health Organization recommendations and Rasmussen’s risk management framework. An extensive list of strategies to address existing shortcomings was ultimately proposed for consideration in health care. These strategies can serve as guidelines to proactively improve incident learning processes. This should help create more effective systems and in turn, improve patient safety.

Every year, tens of thousands of patients in North America die from preventable errors. Incident learning can decrease this number, but is not currently reaching its full potential in health care. The goal of this research was to propose strategies to effectively report and learn from incidents to drive quality improvement. A detailed literature review, focus groups, in-depth interviews, and thematic analysis were used to identify potential process improvement strategies from aviation and nuclear power and assess these strategies for feasibility and desirability in health care. This work was guided by World Health Organization recommendations and Rasmussen’s risk management framework. An extensive list of strategies to address existing shortcomings was ultimately proposed for consideration in health care. These strategies can serve as guidelines to proactively improve incident learning processes. This should help create more effective systems and in turn, improve patient safety.

<p dir="ltr"><a href="" target="_blank">ABSTRACT</a></p><p dir="ltr">A literature review was conducted, to determine and gain a better understanding of the environmental, technological, physiological, and psychological issues that lone agricultural workers potentially face in the event they are involved in an emergency. An investigation was conducted of communication devices used in other industries where working alone was common, to monitor for and detect incident occurrences. An assessment of currently available emergency alert software and sensing technology for <a href="" target="_blank">communication </a><a href="#_msocom_1" target="_blank">[AE1]</a> devices was also undertaken in this review.</p><p dir="ltr">Three hundred and sixty-eight U.S. cases of fatalities or injuries were analyzed in which working alone was identified as a contributing factor. Cases included lone agricultural workers, between the ages 15-64, who were identified from a convenient sample of incident reports from <a href="" target="_blank">2016-2021</a><a href="#_msocom_2" target="_blank">[AE2]</a> . Of the 368 lone agricultural worker incidents analyzed, 38% (140) were caused by tractor rollover or tractor runover, and ATV/ UTV rollovers. Grain bin entrapments accounted for 13% (48) of all identified cases, of which 86% (42) were fatal. Thirty-three percent (121) of the identified incidents involved equipment roll over (not including runovers), and 50% of identified victims, when age was known, were 57 years of age or older. In 11 cases (3%), the victim was under 15 years old and active in agricultural-related tasks at the time of incident occurrence.</p><p dir="ltr">Geospatial Information Systems (GIS) tools were used to identify the proximity of Emergency Medical Service (EMS) facilities and cellular towers from a convenient sample of 29 fatal and serious agricultural related injuries from 2016-2021, occurring in the state of Indiana. This analysis found that there were substantially fewer EMS facilities within close proximity to documented rural incident locations compared to injuries or fatalities occurring closer to a populated area. There were also fewer cellular towers within close proximity of incidents located primarily on or near rural agricultural land. More densely populated areas tended to have a greater density of EMS and cellular tower locations, with, most likely, more favorable outcomes from injuries due to shorter <a href="" target="_blank">response times.</a><a href="#_msocom_3" target="_blank">[AE3]</a></p><p dir="ltr">An investigation of the physical and operational impact that agricultural equipment would have on the efficacy of commercially available wearable technologies was undertaken, to detect the potential injury-causing agricultural incident. Five experiments were conducted to test the feasibility of these selected wearable devices in detecting agricultural-related incidents with the potential of causing serious injuries. Only one <a href="" target="_blank">simulated agricultural incident</a> <a href="#_msocom_4" target="_blank">[AE4]</a> successfully triggered incident detection. <a href="" target="_blank">Incidents successfully triggered incident detection on one wearable device, the Garmin Vivoactive 4 smartwatch. </a><a href="#_msocom_5" target="_blank">[AE5]</a></p><p dir="ltr">Recommendations included greater emphasis on the hazards associated with lone workers assigned agricultural workplaces, development of new, evidence-based educational resources to incorporate in current prevention strategies directed at farmers, ranchers, and agricultural workers, enhanced supervision of young agricultural workers and compliance with existing child labor regulations, equipping lone workers with appropriate cellphones and/ or wearable technologies to be carried in their vehicles, agricultural equipment, or on their person, use of electronic surveillance or monitoring equipment, written policies and procedures that enhance awareness of worker locations and conditions on a regular basis, and adherence to existing federal and state workplace safety and health regulations related to lone workers.</p><p><br></p><p dir="ltr"><a href="#_msoanchor_1" target="_blank">[AE1]</a>Changed</p><p dir="ltr"><a href="#_msoanchor_2" target="_blank">[AE2]</a>Fixed</p><p dir="ltr"><a href="#_msoanchor_3" target="_blank">[AE3]</a>I’m not sure how to address that more rural people are dying, given the limited scope and criteria for selection of the incidents selected in this study.</p><p dir="ltr"><a href="#_msoanchor_4" target="_blank">[AE4]</a>Not sure if this Is the best way to say it. I may end up cutting this part. I’ll pair the abstract down to ~250 words. For whatever reason, I thought the intro chapter abstract needed to be longer for a dissertation.</p><p dir="ltr"><a href="#_msoanchor_5" target="_blank">[AE5]</a>Shortened this paragraph and removed unnecessary detail, for clarity.</p>

L’actualité de l’affaire de la Caroline en droit international public.<p>La doctrine de la légitime défense préventive en procès.<p><p><p>La principale préoccupation au centre de cette recherche a consisté à trancher la controverse qui divise les spécialistes au sujet de la légalité de la doctrine de la légitime défense préventive, spécialement du point de vue du système juridique international institué au lendemain de la deuxième Guerre mondiale. La doctrine en cause préconise clairement qu’un gouvernement d’un Etat, qui éprouverait des craintes ou des soupçons d’une menace d’attaque contre son intégrité territoriale, et dans une certaine mesure, ses intérêts éparpillés à travers le monde, serait autorisé à frapper militairement l’Etat dont le territoire est susceptible de constituer le point de départ de telles menaces :soit, parce qu’un tel Etat détient les armes de destruction massive, notamment l’arme nucléaire et les armes chimiques ;ou soit parce qu’il hébergerait des bandes hostiles, en l’occurrence, les groupes terroristes, à l’origine de ses craintes. Les partisans de cette thèse soutiennent qu’il s’agit là d’une norme de nature coutumière élaborée à l’issue du règlement de l’affaire de la Caroline survenue en 1837, entre la Grande Bretagne et les Etats-Unis d’Amérique. <p><p>En effet, un petit navire battant pavillon américain, dénommé la Caroline, avait l’habitude d’effectuer des navettes entre les territoires de Buffalo, aux Etats-Unis, et Navy Island, au Canada. Et dans cet ordre d’idées, il entama comme à l’accoutumée, la traversée du fleuve Niagara en embarquant à son bord des passagers, vers le Canada, en date du 29 décembre 1837. Mais il fut, dans ce contexte, accusé de transporter des rebelles qui étaient sur le point d’envahir le territoire canadien. C’est ainsi qu’à l’issue de ses voyages opérés durant la journée du 29 décembre 1837, alors qu’il se trouvait déjà accosté dans un port situé dans les eaux intérieures américaines, une intervention armée, décidée par le gouvernement anglais, avait eu lieu sur le territoire des Etats-Unis durant cette nuit là. Elle s’est soldée par la destruction de nombreux biens américains, dont le navire en question, qui fut au final coulé dans le fleuve Niagara. <p><p>Cet incident va du coup provoquer une grande controverse diplomatique entre les deux Etats précités. La Grande-Bretagne prétendit notamment que ce navire était engagé dans des opérations pirates, et que par ailleurs, sa destruction par ses forces armées relevait de l’exercice du droit d’autoconservation et de légitime défense. Mais au termes de nombreux rebondissements, le Secrétaire d’Etat américain, du nom de Daniel Webster, adressa en date du 24 avril 1841, une note diplomatique à l’Ambassadeur britannique basé à Washington, M. Henry Fox, dans laquelle il contestait l’ensemble de motifs avancés par la Grande-Bretagne, mais en insistant spécialement sur le fait que la destruction de la Caroline, aurait été acceptée comme relevant de la légitime défense, si et seulement si, les forces britanniques ayant agi militairement au cours de cette nuit là étaient en présence « d’une situation de nécessité absolue de légitime défense, pressante, écrasante, ne permettant pas le choix des moyens, et ne laissant pas de temps pour délibérer ». Un consensus de principe se serait donc, semble-t-il, formé autour de ce dictum, mais non de son application aux faits d’espèce. <p><p>C’est en prenant en compte les considérations historiques qui précèdent que beaucoup d’auteurs, essentiellement anglo-saxons, se permettent d’affirmer que l’affaire de la Caroline est un précédent fondateur de la légitime défense en droit international public. Et dans cette même optique, considérant par ailleurs que la singularité de cette note consiste dans le fait de subordonner la validité de telles actions armées anticipatives, à l’existence d’une menace imminente d’attaque du territoire canadien par des insurgés, la célèbre formule de Webster précitée aurait également consacré de ce fait même, la doctrine de la légitime défense préventive en droit international coutumier.<p><p>Notre hypothèse de travail est simple. En effet, nous partons du point de vue selon lequel, le raisonnement des partisans de la doctrine de la légitime défense préventive, fondée spécialement sur le précédent de la Caroline, soulève de vrais problèmes d’équilibre et de cohérence du système international élaboré après la deuxième Guerre mondiale, dans la mesure où, il aboutit dans ses applications, à cautionner, au sujet de l’interdiction de la force, l’existence d’un ordre juridique ambivalent. Autrement dit, si l’on transpose les enseignements tirés de l’affaire de la Caroline, dans le droit international positif, on aurait immanquablement, d’un côté, un régime conventionnel restrictif de la Charte, qui limite la possibilité de riposter militairement à la seule condition où un Etat a déjà effectivement subi une attaque armée. Tandis que de l’autre côté, on aurait parallèlement un régime coutumier plus permissif, qui laisserait à l’Etat un pouvoir discrétionnaire d’appréciation des circonstances de temps et de lieux, dans lesquelles il peut se permettre de frapper militairement un autre Etat, en invoquant la légitime défense.<p><p>Le travail de déconstruction auquel nous avons procédé pendant nos recherches, nous a amené à constater, au bout de cette thèse, que tous les arguments qui sont généralement invoqués par les partisans du précédent de la Caroline présentent des limites et des excès, dans leur prétention à fonder juridiquement, une règle de légitime défense préventive en droit international public, et du coup, ils doivent être relativisés dans leur teneur respective. Pour cette raison, nous soutenons en ce qui nous concerne l’hypothèse selon laquelle, le droit international public en vigueur, ne permet pas encore en son état actuel, l’extension du champ opératoire du concept de légitime défense, tel que stipulé à l’article 51 de la Charte, de manière à justifier l’emploi de la force dans les rapports entre les Etats, en cas d’une simple menace, peu importe son intensité et sa nature, tant qu’il n’y a pas encore eu véritablement une attaque armée de la part de l’Etat envers qui on agit militairement. En conséquence, la tentative doctrinale qui consiste à justifier l’existence d’une règle coutumière, autorisant la légitime défense préventive, en se fondant sur l’autorité de l’affaire de la Caroline, procède en quelque sorte d’un malentendu doublé d’un anachronisme évident. <p><p><p><p>Bruxelles, le mardi 6 mai 2008<p>Ivon Mingashang / Doctorat en droit / info:eu-repo/semantics/nonPublished

The aim of this study was to investigate how air traffic controllers cope with stress and also to determine whether there were statistically significant differences in the coping behaviour of air traffic control staff from different groups. The study was conducted on a sample of Air Traffic Controllers who control civilian aircraft in the South African airspace. The coping resources inventory (CRI) assessment was used to collect data and analysed to determine how controllers cope with stress and whether there are differences in the coping behaviour of air traffic control staff from different groups. The results showed that air traffic controllers use emotional coping resources to cope with stressful work situations and make less use of cognitive coping resources. The results also showed that there were no statistically significant differences in the coping behaviour of air traffic control staff from different groups. / Industrial and organisational psychology / M.A. (Industrial and Organisational Psychology)

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective. The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews. The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV). The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.