Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 144. Thesis director: P. J. Maddox. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 129-143). Also issued in print.

A dissertation submitted in fulfilment of the requirements for the degree of Master in Technology: Emergency Medical Care in the Department of Emergency Medical Care and Rescue, Durban University of Technology / Strong earthquakes are frequent catastrophic disasters occurring worldwide and often lead to structural collapse of buildings. Urban Search and Rescue (USAR) is the specialised process of locating, extricating and providing immediate medical treatment to victims trapped in collapsed structures. This research project aimed to identify the key preparedness efforts necessary by an earthquake affected country to ensure best coordinated use of international USAR assistance. / M

The purpose of this research is to determine an appropriate nurse staffing strategy for the Intermediate Care Unit (ICU) and the Critical Care Unit (CCU) of the Emergency Department at York Hospital in York, Pennsylvania. This strategy must adhere to certain administrative policies while keeping patient waiting times within allowable limits. Determining the proper number of resources in an emergency department is a difficult problem because while assistance must be provided without delay at any time, the available resources are restricted by the hospital budget. This research involves simulating the operations of the Emergency Department at York Hospital using the software package Arena 7.0 to evaluate how the system is impacted by various nurse staffing strategies. A microcomputer-based decision support system (DSS) for nurse scheduling that was first developed by Sitompul in 1991 has been implemented using Turbo Pascal 6.0 to generate twenty possible nurse staffing plans. The best alternative staffing plan has been evaluated by the simulation model to determine its effect on waiting times for patients. Specifically, patients are divided into five ESI levels, where ESI-1 patients are the most serious and ESI-5 patients are the least serious, and waiting times are provided for each patient type. While the DSS approach is useful in generating specific working schedules that are acceptable to the nurses' requirements, it is limited when developing an overall staffing plan. Specifically, the DSS requires a user-defined ratio of nurses working the various shifts, and this ratio must remain constant throughout each month even if patient arrival rates are known to be time dependent. As an alternative approach, OptQuest for Arena was employed to search for an overall nurse staffing plan. After providing Arena with 50 DSS-generated schedules that satisfy the nurses' requirements, OptQuest was used to determine the best schedule for each nurse to follow in order to minimize the average waiting time in the system for patients. Although the average waiting time obtained by the OptQuest staffing plan decreased from the current staffing plan for all patient types, a paired-t comparison determined using Arena's Output Analyzer indicated no statistical difference (at the 95% confidence level) between the DSS and OptQuest scenarios, in terms of the average waiting time for ESI-1 and ESI-2 patients. Further analysis indicated that a system bottleneck occurred in the triage area of the emergency department during evening hours. After adding one additional triage nurse in the evening shift, the OptQuest-generated staffing plan was re-evaluated. The results indicate that the suggested staffing plan reduced the average waiting time in the current staffing plan by 34.33%, 32.73%, 47.87%, 54.92%, and 52.41% for ESI-1, ESI-2, ESI-3, ESI-4, and ESI-5 patients, respectively. In addition, the average waiting time of ESI-1, ESI-2, ESI-3, ESI-4, and ESI-5 patients for the suggested staffing plan was 19.27%, 19.36%, 39.37%, 48.55%, and 46.64%, respectively, less than for the staffing plan determined when using the DSS approach alone. / Master of Science

Antalet besökare på akutmottagningar ökar runt om i landet och arbetsförhållandena för vårdpersonalen blir allt sämre. Triagesystemet används för att kunna sortera och prioritera akut sjuka patienter som är i behov av att omedelbart träffa läkare för bedömning. Den stora majoriteten av patienter som söker vård på en akutmottagning har dock inte livshotande tillstånd. De har således en lägre prioritering och står på så sätt inför en komplicerad situation med bristande information, okunskap och långa väntetider. Syftet med studien är att beskriva hur patienten upplever vården på en akutmottagning. Metoden författarna har valt att använda är litteraturstudie enligt Axelsons modell. Studien behandlar nio artiklar. De valda artiklarnas resultat sammanställs och bildar tillsammans teman och subteman i syfte att skapa en ny helhetsbild. I Resultat framkommer det att patienter upplever triageringen som positiv men att den efterföljande vården, med bland annat långa väntetider, bristande information och avsaknad av delaktighet, bidrar till en otrygg och frustrerande upplevelse för patienter av vården på en akutmottagning. Diskussionen belyser patientens upplevelse av triageringen och hur det kommer sig att just detta möte beskrivs som positivt av patienter. Vidare diskuteras den bristande informationen patienter upplever på akutmottagningar och hur detta påverkar patienten.

Thesis (PhD)--University of South Australia, 1999

The ubiquitous use of mobile devices and smartphones in the United States presents an interesting opportunity for application developers with respect to emergency management. Software engineers from the federal government to individuals have recognized the unique prospect of utilizing always-connected devices to assist in emergency notification, preparedness, and response. The federal government has instituted and ratified multiple acts and mandates with respect to mobile communications during a crisis such as the Commercial Mobile Alert System. Likewise, individual organizations and developers have created mobile applications that access weather alerts from the National Weather Service. Many of these applications utilize push notification architectures to notify users and stakeholders about impeding emergency situations. While most of these applications are geared towards a national audience, there are a few that are highly granular with a focus on the local community. This thesis presents a universal iOS application running on all iOS mobile devices: iPhone, iPad, iPad Mini, and iPod Touch for the Virginia Tech community. The application is highly granular with respect to emergency response guidance and notification by providing clear, concise, and supportive information to citizens during a crisis. Additionally, the application provides another medium of delivery for the Office of Emergency Management at Virginia Tech to potentially mitigate the extent of collateral damage and secondary incidents while saving lives. / Master of Science

The growing worldwide use of clinician-performed ultrasound (CPU) marks a dramatic change in bedside medicine and patient care. With steadily improving portability, accessibility and technology, ultrasound use continues to grow amongst many medical specialties. Likewise, the application of CPU in emergency medicine is increasing. Emergency Medicine (EM) is a medical specialty “based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury…” (International Federation for Emergency Medicine, 1991). Increasingly, emergency physicians are using emergency department ultrasound (ED U/S) to enhance their assessment of critically-ill patients (American College of Emergency Physicians, 2008). The purpose of this study was to evaluate and describe those aspects of ultrasound simulation (during HFS) that contribute to the development of critical care ED U/S skills. Secondly, it was of interest to assess how a novel ultrasound simulator (edus2) compared to video playback on a laptop in terms of the above-mentioned aspects. The population of interest included both EM trainees and faculty. This investigation was a randomized, prospective, crossover study with two intervention treatments for all participants. In Phase I, EM trainees and faculty from London, UK, were invited to participate in one of four day-long critical-care HFS sessions during which they participated in four critical-care scenarios. Faculty were involved in assisting with session debriefing and feedback. All participants completed two cases with each intervention. In Phase II, faculty in Saskatoon, SK, Canada, were invited to review video recordings of the sessions from Phase I and evaluate the educational merits of the two ED U/S simulation interventions. iii This study produced both quantitative and qualitative data. As this study looked at two interventions and how they could contribute to the development of ED U/S skills, pre- and postintervention changes were analysed for statistically significant differences between them. T-test analyses were used for comparisons. Effect sizes (Cohen’s d) were calculated where statistically significant findings were observed. Qualitative data was assessed through emergent thematic analysis and triangulation. The findings of the study support the integration of ED U/S simulation into HFS. Integration was found to be of value to both trainees and faculty by allowing trainees to demonstrate knowledge of indications as well as correct image interpretation and general integration of ED U/S into critical care (p<0.05). Trainees described an increased motivation to develop their ED U/S skills as well as greater desire to use ED U/S in everyday practice. Furthermore, the edus2 was identified as being the preferred training intervention. The edus2 met functional fidelity through its real time and hands-on applicability. Faculty preferred the edus2 as it allowed for better assessment of trainee skills that then influenced session debriefing and formative feedback. Faculty in Phase II found the edus2 intervention sufficient in offering basic insights into trainee ED U/S skills and mastery (p<0.05). Implications of the study include support for the use of ultrasound simulation during HFS for the development of critical care ED U/S skills amongst EM trainees. Further study on the effects of such hybrid simulation on clinical performance is warranted.

The need to have evacuation plans in place for readily implementation for special need populations has become evident after catastrophic events such as Hurricane Katrina. For the purpose of this research special need populations will include, but are not limited to, people with physical disabilities, senior citizens, non-English speaking populations, residents and employees without vehicles, and tourists. The main objective of this research is to evaluate different evacuation procedures for special need populations from large urban areas utilizing current public transit systems. A microscopic simulation model was constructed to analyze real life scenarios for evacuation methodologies. A linear programming optimization model was developed to find the optimum locations for evacuation bus stops for the case study area. The results from this research were very interesting and can aid evacuation planners in the future. / by Linda S. Hess. / Thesis (M.S.C.S.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

Thesis (M.S.)--Marshall University, 2001. / Title from document title page. Document formatted into pages; contains vi, 78 p. Includes bibliographical references (p. 56-61).

Background: The last 30 years have seen considerable growth in the scope of emergency medicine and the size, scale and expectations of emergency departments (EDs) in the USA and other countries, including Australia. The emphasis has changed from direct referral to departments in the hospital to treatment in and disposition from the ED. At the same time, emergency clinicians face increasing pressure to address patient needs with greater efficiency. Within this context, this project describes the character of the unique domain of work and collective identity that emergency clinicians carve out in their interactions with other emergency clinicians and with clinicians from other departments. Methods: Fieldwork was conducted over 10 months in the EDs of two tertiary referral hospitals in Sydney, Australia. It comprised approximately 535 hours of unstructured and structured observation, as well as 56 field interviews. Results: Emergency clinicians have a unique role as "gatekeepers" of the hospital. This ensures that their clinical work is inherently organisational - that is, interdepartmental and bureaucratic work. Emergency clinicians explicitly and implicitly negotiate the "patient pathway" through the hospital which is organised according to the "fragmented" body. This role demands previously under-recognised and complex immaterial work. Emergency clinicians seek to reconcile the individual trajectories of patients present in the ED with the ED?s broader function as a "carousel" in order to seek to provide the greatest good for the greatest number of future patients. The research uniquely charts the socialisation processes and informal education that produce tacit organisational expertise with which emergency nurses and doctors, both separately and jointly, negotiate the bureaucracy of the hospital. Conclusion: EDs are destined to struggle to provide the greatest good for the greatest number, reconciling shortcomings in the structure and provision of public and community health care. However, recognition and support for the unique clinical-organisational domain of ED care presents an opportunity for improved holistic care at the front door of the hospital. Our ageing population and its promise of more patients with complex health issues demand further research on the interdepartmental work of other whole-body specialties, such as Aged Care.