Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients’ outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.

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Registered nurse (RN) insufficiency is both a major contributor to and effect of emergency department overcrowding (EDOC) in the United States and is implicated in increased patient mortality, ED wait times, and general congestion of the healthcare system. Licensed paramedics represent a viable solution to this crisis given their extensive training in emergency care by serving as RN adjuncts and alternatives in the ED setting. Paramedics utilize high-level clinical judgment and patient assessment skills to form detailed clinical impressions and employ a wide range of therapies to initiate treatment. Although they less frequently possess a college degree than their RN counterparts, paramedics complete a comparable study of medical science principles, patient assessment, and pathophysiology, and devote significantly more time to critical care and emergency medicine than RNs. Implementation of paramedics in U.S. EDs in the 1980s and 1990s highlighted their manual and technical skill prowess as well as their ability to rapidly assess emergency situations, including their unexpectedly widespread use in pediatric EDs. Modern implementation includes expansion of the psychomotor skills available to ED-based paramedics, with emphasis on medication administration and emergency procedures, but there is a significant lack of research into paramedic assessment and triage skills in the ED. Barriers to further implementation of ED paramedics include resistance from nursing advocacy organizations, regulatory and legal challenges, and public opinion and attitudes of nurses and paramedics. Nursing advocacy groups have historically opposed paramedic integration, fearing job encroachment and increased autonomy for non-nursing healthcare professionals. Regulatory challenges involve certification vs licensure discrepancies, limitations on paramedic scope of practice, and the wide-reaching effects of state Nurse Practice Acts. Societal resistance, cultural factors, and attitudes within the nursing and paramedic communities also impede further ED paramedic implementation. Practice recommendations are proposed, including the development of standardized ED orientation programs for paramedics, and redefining the minimum education for paramedics at the associate degree level. Legislative recommendations involve eliminating statutory restrictions on paramedic practice, reevaluating language in state Nurse Practice Acts, and clarifying the legal relationship between RNs and ED paramedics. The limitations of this literature-based thesis include a lack of large-scale studies, regional variability, and the absence of empirical examination of paramedic integration in reducing ED overcrowding. Future suggestions for study include randomized controlled trials comparing ED patient outcomes between RNs and paramedics, interrater reliability studies on assessment and triage skills, and comparisons of scope of practice and education between paramedics in different countries.

Introduktion: I den moderna prehospitala akutsjukvården kan ambulansens och ambulanshelikopterns samverkan ha stor betydelse för den svårt skadade eller sjuka patienten. Syfte: Syftet med studien var att undersöka vad sjuksköterskor inom ambulansen och sjuksköterska/läkare från helikoptern/akutbilen upplevde kunde påverka teamarbetet i den prehospitala miljön. Metod: En kvalitativ deskriptiv innehållsanalys med semistrukturerade intervjuer användes. 10 informanter från ett län i mellansverige inkluderades, fem kvinnor och fem män. Urvalet bestod i att informanterna skulle ha varit verksamma inom ambulansverksamheten i minst ett år samt ha erfarenhet av det prehospital samarbetet mellan ambulans och ambulanshelikopter. Intervjuerna spelades in, transkriberades till text och analyserades. Resultat: Studiens resultat presenterades i två teman med sju underkategorier. De två temana var: Ett dynamiskt teamarbete påverkas av tydliga roller och ett kontinuerligt förbättringsarbete och Teamarbete och kommunikation mellan kompetenserna i teamet. Konklusion: De olika rollerna vid teamarbetet har blivit tydligare med tiden och teamarbetet upplevdes ha blivit bättre med tiden. Hospitering och tid till övning beskrevs kunna optimera teamarbetet. Informanterna upplevde sig delaktiga i vården. Den prehospitala erfarenheten och bristen på den var av betydelse vid samverkan mellan enheterna. / Introduction: In the modern prehospital emergency care, ambulance and ambulance-helicopter's interactions play an important role for the severely injured or sick patients. Aim: The aim of the study is to examine what nurses in ambulance and nurse/doctor from the helicopter/emergency car experienced could affect the team work in the prehospital environment. Method: A qualitative descriptive content analysis of semi-structured interviews were used. 10 pieces of informants from a province in central Sweden were included five women and five men. The sample consisted of informants would have been active in the ambulance business for at least 1 year and have experience in the full spectrum of cooperation between ambulance and ambulance helicopter. The interviews were recorded, transcribed to text and analyzed. Results: The results of the study were presented in two themes with seven subcategories. The two themes were: A dynamic teamwork are influenced by clear roles and a continuous improvement and Team work and communication between the competencies of the team. Conclusion: The different roles in the cooperation has become clearer with time and team work was perceived to have become better with time. Site visits and time to exercise described to optimize teamwork. The informants perceived themselves involved in care. The prehospital experience and the lack of it was of importance to cooperation between units.

Source: Masters Abstracts International, Volume: 47-06, page: 3546. Adviser: Bahman S. Roudsari. Includes bibliographical references.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2641. Advisers: Arnold J. Schecter; Bahman S. Roudsari. Includes bibliographical references.

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.