One of the long-standing debates in disaster science and practice is the tension between planning and structure on the one hand and flexibility and adaptation on the other in maximizing the effectiveness of response operations. This research aims to reconcile the divide that currently exists among scholars and practitioners and present a continuum that bridges the above models and ties planning, improvisation, and spontaneous planning together. The main questions that were examined with this research are: First, what role did spontaneous planning and improvisation play in responding to the two disasters. Second, in what ways do hazard characteristics (e.g. speed of onset and scope of impact) influence the roles played by spontaneous planning and improvisation? This is a qualitative study that employed a comparative case study to examine the characteristics of spontaneous planning. The major findings are that spontaneous planning does occur and that variables such as speed of onset, scope, magnitude, and number of organizations involved impact the visibility of spontaneous planning characteristics.

Ghana is highly vulnerable and threatened by several hazards and has sought ways of minimizing impacts of hazards events over time including demonstrating an interest in developing an emergency management training and an higher education degree program. Yet, as of 2013, the country has not developed a disaster management training program or a degree program. This study investigated Ghana’s efforts to see these programs develop with a particular focus on identifying the factors involved in explaining the current status of Ghana’s efforts. Purposive and snowball sampling were used to select 19 emergency management scholars and practitioners who have been involved with Ghana’s efforts. An additional 6 faculty members who have been involved with development of other new degree programs in 4 Ghanaian universities were selected through snowball sampling for the purposes of comparison with the data collected from those involved in efforts to initiate an emergency management higher education degree program. The data collection was done through in-depth semi-structured face-to-face and telephone interviews. Both the data collection and analysis were guided by Rubin and Rubin’s (2005) Responsive Interviewing Model. The data show that although Ghana intends to develop an emergency management degree program in the future, its efforts, to date, have been geared towards developing a training program. The results suggest that six main factors explain why Ghana has not yet established the emergency management training program it intends to first develop. The factors include institutional support, partnership, advocacy, funding, program marketing, and cultural factors. Further, the results show that there are likely to be six other factors to address if, and when Ghana decides to pursue an emergency management degree program. These factors include faculty issues, student issues, supporting learning materials, professional legitimacy, accreditation and curriculum development, and autonomy and administrative location.

There exists a lack of consensus around the definition of “sustainability” and numerous of applications of the concept in the disaster literature. Reviewing the disaster literature on sustainability, its intended audience, and the disciplines that inform it, a disconnect between the strategies proposed and the current role of county emergency managers in the U.S is evident. This study qualitatively explored how sustainability is conceptualized and perceived to be applicable at the local level by interviewing county emergency managers in the states of Florida and North Dakota. The study demonstrated that the lack of definitional clarity evidenced in the disaster literature is also reflected in emergency manager conceptualizations of sustainability. However, themes related to meaning were identified in the interviewed managers’ conceptualizations of sustainability, contextual factors influencing these conceptualizations offered, and implications of these findings for the development of the profession and discipline of emergency management discussed.

This study attempted to explore how nonprofit and government organizations conceptualize disaster response effectiveness using an internet survey. Unfortunately, the data collected through this method was insufficient for meaningful data analysis, and, therefore this study was unable to generate significant findings with respect to its research question. Thus, rather than focusing on a presentation of results from data collection and interpreting the significance of those results, this thesis focuses on justification of the need for research on this topic, review of the literature that suggests it is likely that nonprofits and government perceive disaster response effectiveness differently, recounting of the initial data collection efforts undertaken and the problems encountered, offering of hypotheses for future testing based on analysis of the flawed data, and recommendation of an alternate data collection method that should be used in the future.

Introduction: Out of Hospital Cardiac Arrest (OHCA) is a time-sensitive emergency which requires prompt identification and emergency care in order to reduce morbidity and mortality. The first step in recognising OHCA is rapid identification by the emergency dispatch centre. Identification of such patients remains challenging in South Africa due to multiple languages and widely differing levels of education. This study aimed to identify the key descriptors (words and phrases) of OHCA used by callers speaking Afrikaans when contacting the emergency dispatch centre of the Western Cape Provincial Emergency Medical Services (WC-EMS). Methodology: Computer-aided dispatch (CAD) data with a corresponding “patient unresponsive” incident type were drawn for a 12 month period (January – December 2018). Corresponding patient care records were extracted to verify OHCA. The original voice recordings between the caller and emergency call taker at the time of the emergency were extracted and transcribed verbatim. Transcriptions were subjected to inductive, qualitative content analysis to the manifest level. Descriptors of OHCA in Afrikaans calls were coded, categorised and quantified. Results: A total of 729 confirmed OHCA cases were identified, of which 36 (5%) were in Afrikaans and eligible for analysis. Following content analysis, 83 distinct codes in six categories were identified. The most prevalent categories were descriptors related to Respiratory Effort (apnoea and difficulty in breathing; 30.1%) (30.1%), Clinical Features (related to the eyes, mouth and body temperature; 20.4%) and Cardiac Activity (pulselessness; 16.8%). Conclusion Afrikaans Callers within the Western Cape province of South Africa use consistent descriptors when requesting and ambulance for OHCA. Future studies should focus on describing descriptors for other languages commonly spoken in the province, and to develop and validate telephonic OHCA recognition algorithms.

No description available.

Hundreds of Canadians die each year while awaiting a vital organ transplant. Consistent with several countries in the world, the demand for organs for transplantation outweighs the supply. In Canada, citizens must actively register to enlist themselves as organ donors after death occurs. The aim of this thesis was to examine and evaluate the acceptability of an emergency department-based organ donation registration strategy. Secondarily, we identified the proportion of emergency physicians, nurses and clerks who are personally registered as organ donors. We conducted three self-administered surveys as well as an a priori sub-study to evaluate the effect of a prenotification letter on postal surveys of physicians. We discovered that key stakeholders in emergency departments are engaged in organ donation and feel that the emergency department is an acceptable place to promote organ donation registration. In addition, we identified several barriers to such a potential intervention which largely revolve around time and resource limitations.

Introduction: Emergency Medical Services (EMS) are ideally placed to provide relief of acute pain and discomfort. EMS frequently follow locally prescribed guidelines and have a variety of qualifications each with differing capabilities and scopes of practice. The objectives of this study are to describe prehospital pain management practices by EMS in the Western Cape, South Africa. Methods: A retrospective descriptive survey was undertaken of analgesic drug administration by advanced life support (ALS) paramedics. Patient care records (PCRs) generated in t he City of Cape Town during an 11 month period containing administrations of Morphine, Ketamine, Nitrates and 50% Nitrous Oxide/Oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 PCRs were included (N=530). Morphine was administered in 70% (95% CI 66 - 74, n=371) of cases, Nitrates in 37 %(95% CI 33 - 41, n=197) and Ketamine in 1.7% (95% CI 1 - 3, n=9) of cases. A total of 5mg or less of Morphine was administered in 75% (95% CI 70 - 79, n=278), with the mean dose being 4mg (IQR 3 - 6). Single doses were administered in 72.2% (95% CI, 67 - 77, n=268) of Morphine administrations, 56% (95% CI, 21 - 86, n=5) of Ketamine administrations and 82% (95% CI, 76 - 87, n=161) of Nitrate administrations. Chest pain was the reason for pain management in 43% (n=226) of cases. ALS providers have a median experience level of 2 years (IQR2 - 4). Conclusion: ALS providers in the Western Cape appear to use low doses of Morphine, with most analgesia administered as a single dose. Chest pain is an important reason for drug administration in acute prehospital pain. Paramedics do not appear to be using a weight based nor a titration based strategy.

Nurses are at an increased risk for violence from patients compared to other healthcare professionals working in hospital emergency departments. In this setting, there are multiple factors contributing to patient violence including long wait-times, overcrowding, insufficient staffing, and lack of security personnel. This violence can be verbal, physical, or sexual in nature, and may result in psychological, emotional, cognitive, and social consequences. While there is an abundance of literature that explores how nurses working in the emergency department experience patient violence, less is known about how patient violence affects their day-to-day nursing practice. The purpose of this study was to explore how nurses working in Ontario emergency departments who have experienced patient violence enact their nursing care. This was an interpretive description qualitative study using semi-structured, conversation-style telephone interviews, set in Ontario, Canada. Data were analyzed using conventional content analysis. The participants’ experiences with patient violence and its effect on their nursing care were described using four categories and seven subcategories: ‘Violent Context’ (Leadership), (Wait-Times), (Security Measures), ‘Being Responsible’ (Work Family), ‘Violent Patients’ (Patient for Whom we Anticipate Violence), (Patients who Surprise Us), and ‘Adapting their Practice’ (Engaging with Patients). Nurses working in the emergency department describe frequent occurances of physical and verbal violence as part of their daily practice. This violence leads to emotional and psychological consequences, as well as changes to their nursing care and interactions with future patients. Inconsistencies in hospital policies, resources, and supports create an environment where nurses are often left to manage both the violent encounter and their personal and professional responses.

Background: Acute respiratory failure is becoming a frequent phenomenon in the emergency department due to increasing life expectancy, and in the last two decades the number of presentations has more than doubled. Non-invasive ventilation has become the treatment modality of choice in selected patients, with a significant reduction of mortality in these cases. However, adequate monitoring of clinical and blood gas parameters is crucial to ensure treatment targets are met. Objective: This study aims to evaluate monitoring of respiratory physiological parameters in patients treated with non-invasive ventilation (NIV) in the ED in Sligo University Hospital. As a secondary objective, the study aims to evaluate how monitoring data influence treatment modification. Methodology: This was a retrospective chart review of 50 patients who presented to the ED in acute respiratory failure and were treated with non-invasive ventilation between September 2017 and March 2019. Results: A total of 50 charts were analysed, 62% female and 38% male. The average age for both genders was 76 years. Results showed that initial and ongoing monitoring of vital signs remained guideline compliant throughout the entire duration of NIV in the ED. All but one patient out of 50 had an initial blood gas analysis done prior to initiation of NIV treatment, while repeat blood gas analysis was inconsistent with 38% (n= 19) who did not have blood gas repeated. Conclusion: The study highlights the discrepancy between monitoring of vital signs and arterial blood gas during treatment of acute respiratory failure patients with non-invasive ventilation in the emergency department. A proforma may help bridge this gap to ensure a standardised care in order to improve treatment outcomes.