<p><strong>Introduktion: </strong>Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. <strong>Syfte:</strong><em> </em>Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. <strong>Metod: </strong>En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet.<strong> </strong>I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  <strong>Resultat: </strong>En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling.<strong> </strong>En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. <strong>Konklusion:</strong> Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel.</p> / <p><strong>Introduction:</strong> Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.<strong>Purpose:</strong><em> </em>The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. <strong>Method: </strong>A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.<strong>Results: </strong>A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully. </p><p><strong>Conclusion:</strong> Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.</p>

<p>To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint.<em> </em>The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital.</p><p>Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation.</p><p>The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted.</p><p>Triage supports the assessment and prioritization of patients.<strong> </strong>A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.</p>

To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint. The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital. Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation. The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted. Triage supports the assessment and prioritization of patients. A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.

Introduktion: Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. Syfte: Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. Metod: En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet. I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  Resultat: En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling. En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. Konklusion: Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel. / Introduction: Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.Purpose: The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. Method: A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.Results: A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully.  Conclusion: Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.

Emergency response is a time critical work that needs team work from different organizations with various specialties. It also needs to integrate existing information system to collect and assemble necessary knowledge and resources for critical emerging tasks and use it to plan for collaborative problem solving In this study, we propose the methodology to automate the traditional emergency patient transfer process by connecting different organization¡¦s information systems through Web services with BPEL4WS. Via Web services, the medical resources information can be requested according to patient conditions, and resource reservation decision can be made online. Via BPEL4WS, heterogeneous information systems in different organizations can be connected and executed automatically in any predefined process without limit human intervention. The willingness of hospitals to share various levels of resource availability information to Emergency Operation Center (EOC) to coordinate regional medical resource distribution is critical to make Web service platform work. Therefore, this study examines the correlation of individual hospitals¡¦ performance in terms of resource utilization with hospital¡¦s information sharing with EOC. We investigate the effects from sharing information to EOC which adopts three policies of releasing hospital status information through simulation under different conditions in emergency occurrence and occupied hospital resources. Our findings from the simulations imply that the best policy for EOC to adopt in order to make Web services workable in handling medical emergency is to accord different conditions to adopt different suitable policies. For hospitals, if they want to get the maximum resources utilization, it had better to refer to different condition to adopt different information sharing strategies.

The main objective of this research is to devise a risk-based methodology for developing emergency operation schedules (EOS). EOS are decision tools that provide guidance to reservoir operators in charge of making real-time release decisions during major flood events. A computer program named REOS was created to perform the computations to develop risk-based EOS. The computational algorithm in REOS is divided in three major components: (1) synthetic streamflow generation, (2) mass balance computations, and (3) frequency analysis. The methodology computes the required releases to limit storage to the capacity available based on the probabilistic properties of future flows, conditional to current streamflow conditions. The final product is a series of alternative risk-based EOS in which releases, specified as a function of reservoir storage level, current and past inflows, and time of year, are associated with a certain risk of failing to attain the emergency operations objectives. The assumption is that once emergency operations are triggered by a flood event, the risk associated with a particular EOS reflects the probability of exceeding a pre-established critical storage level given that the same EOS is followed throughout the event. This provides reservoir operators with a mechanism for evaluating the tradeoffs and potential consequences of release decisions. The methodology was applied and tested using the Addicks and Barker Reservoir system in Houston, TX as a case study. Upstream flooding is also a major concern for these reservoirs. Modifications to the current emergency policies that would allow emergency releases based on the probability of upstream flooding are evaluated. Riskbased EOS were tested through a series of flood control simulations. The simulations were performed using the HEC-ResSim reservoir simulation model. Rainfall data recorded from Tropical Storm Allison was transposed over the Addicks and Barker watersheds to compute hypothetical hydrographs using HEC-HMS. Repeated runs of the HEC-ResSim model were made using different flooding and residual storage scenarios to compare regulation of the floods under alternative operating policies. An alternative application of the risk-based EOS in which their associated risk was used to help quantify the actual probability of upstream flooding in Addicks and Barker was also presented.

In recognition of the fact that communications commonly are considered to be essential to effective disaster preparedness and response, the present study addresses several related themes concerning the role of communications infrastructures--i.e., equipment facilities on the one hand, and established patterns of interpersonal relationships among government decision-makers and industry representatives on the other--in peacetime emergency communications planning and response processes. Its investigative tasks include the choice to apply the implicit guiding model in North American emergency management, namely, the "command-and-control" theoretical model, to a specific single-country peacetime disaster context: the Canadian case. That choice rests upon a recognition of the methodological difficulties and challenges in dealing with an emerging and highly dynamic configuration of multiple institutional players, new technologies and residual government policies respecting the telecommunications sector. / The study's findings suggest an appreciation of the complexity and nuanced context within which multiorganizational and especially multijurisdictional peacetime crisis management occurs, sometimes understood as the emergence of other frameworks. This investigation contributes to the disaster literature by providing the first exhaustive study of Canada's national emergency communications structure and capabilities. It therefore can perhaps best be seen as a prologue or preliminary discourse to a broader international comparative effort of addressing questions related to communications preparedness in regard to peacetime disasters.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xvii, 198 leaves. / The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.