Introduction: There are high demands on ambulance staff in relation to emergency assessments and treatment measures. In addition to this, staff are constantly exposed to potentially traumatic events. The experience of traumatic events is varied and depends on individual conditions. Aim: The aim of this literature study is to describe the ambulance staff's experiences of traumatic events in their profession. The purpose is also to review how the included articles have been selected. Method: A compilation has been made of ten scientific articles with qualitative, quantitative and mixed method. Systematic searches for articles were made in two different databases as well as manual searches. Result: Ambulance personnel’s experiences of traumatic events are based on mental and practical preparations. Feelings are described depending on the patient's condition, there are emotional differences in caring for children and adults regardless of whether the actions succeed or fail. The relatives' presence can be experienced both as suitable and unsuitable. Internal and external factors affect the experience of caring for the patient depending on circumstances. The need for processing occurs after traumatic events and is practiced in different ways. Care and guilt after an emergency situation is described in terms of different reactions. The need for necessary support is found to manifest itself after a traumatic event. Conclusion: The result shows that there is uncertainty regarding copingstrategies before, during and after traumatic events. Therefore, there is a need to improve working conditions for ambulance staff through future research.

This thesis deals with the knowledge of high school students in providing first aid in the Příbram region. Providing first aid to the injured and saving their lives or health is a legal and moral obligation of all of us. There are many incidents that can cause serious or light injury. We should know the possible dangers, know how to act, and be able to provide first aid both to ourselves, to our closest, but to others as well. It is therefore necessary that the public is sufficiently educated in first aid so as to be able to respond adequately. In the Czech Republic it is necessary to include the subject of first aid into the school curriculum. Currently, however, neither teacher training in first aid is conceptually solved though the current legislation and related regulations generally prescribe training in first aid as an obligation for schools. Yet there are no specific standards or recommendations. The theoretical part of this thesis deals with the topic of first aid, with the high school educational system and the education of teachers. Subsequently, we present the integrated rescue system, basic first aid terminology, sudden severe illnesses and the care for the injured. An integral part of the chapter is a brief description of selected statistical methods. Through basic mathematical operations, descriptive statistics, and the use of tables and graphs, the theoretical part gives an account and summary of large amounts of data. Descriptive statistics is followed by mathematical statistics. It includes a nonparametric and parametric testing. In this thesis we have set the objective of determining the degree of knowledge and skills of Příbram region high school students in providing first aid and of comparing the skills and knowledge of health students and students of different study programs. We have set two hypotheses: H1: "More than 2/3 of all surveyed high school students in Příbram region will score more than 50% of correct answers on the survey," and H2: "health profession students will achieve better results on this survey than students of other disciplines." In order to achieve the defined objectives and to verify the hypotheses we have compiled a questionnaire focusing on the area of first aid, carried out a questionnaire survey, and conducted statistical surveys using descriptive and mathematical statistics. The questionnaire consisted of closed questions. Three questions were of generally informative character and twenty questions focused particularly on the problems of first aid. There were four response options to the questions focused on first aid, only one of which was correct. By a random selection we picked out four out of fourteen secondary schools and the High School of Nursing and College of Health Příbram, hereinafter SZŠ. The project involved 295 students, a total of 154 girls and 141 boys, specifically 147 SZŠ students and 148 students from other high schools. The selective statistical sample consisted of 100 students of SZŠ and 100 students from other high schools. The questionnaire survey covered the period from March to May 2015. From the survey results it is clear that the surveyed knowledge is slightly above average in SZŠ students and reaches the average level in students of other high schools in Příbram region. The arithmetic average of the SZŠ students was 16 points out of 20 and only 13 of 20 points in students from other high schools. Only 13% of students achieved less than 50% of the correct answers. The results of the survey show that the objectives of the thesis were met and both hypotheses were confirmed. Nonetheless, a question arises: "Are the teachers adequately trained in first aid?" The answer follows from the incorrect answers of students. The results of the survey have been provided to the participating high schools which then could focus on potential problems in the area of first aid and their curriculum.

No description available.

Bakgrund: Även om många patienter är nöjda med vården de får via ambulans och på akutmottagningar så finns det ett missnöje hos patienter avseende brist på bekräftelse, delaktighet och information. Syfte: Syftet med detta arbete är att beskriva hur patienter upplever bemötandet av vårdpersonal inom ambulansvård och på akutmottagningen. Metod: Denna studie använder sig av kvalitativa originalartiklar för att sammanställa patienters perspektiv av bemötande av ambulanspersonal och personal på akutmottagningen.   Resultat: Tre huvudteman framkom i resultatet: Patienternas behov av att inkluderas; vilket främst handlade om att bjudas in till dialog kring sin vårdsituation. Patienternas behov av att bekräftas; där det framförallt handlade om att bli tagna på allvar gällande oro och symtom samt bli behandlade som unika människor. Patienternas behov av information; vilket huvudsakligen var information kring väntetider, behandling och regler på akutmottagningen. Behoven varierar mycket från patient till patient. Då patienter inte upplevde att de blev bemötta på ett tillfredsställande sätt uppkom ett missnöje hos patienterna.   Slutsats: Sammanställningen visade liknande resultat för patienter som blivit omhändertagna av ambulanspersonal såväl som personalen på akutmottagningen. Bortsett från att det fanns ett ökat behov av information för patienterna på akutmottagningen. Med ett holistiskt perspektiv kan vårdpersonalen främja ett gott bemötande mellan patient och vårdgivare.

For emergency service providers, giving their service in least time shows their best performance. Emergency hospitals will be at their best if the ambulance reaches the site in Golden hour where life of injured persons can be saved. Ambulance uses the road network to reach the accident site. Today there are many GIS based systems being developed for routing of ambulance using GPS and other real-time technologies. These systems are useful and play a major role in solving the routing problem. But now roads are so congested that it difficult for the Ambulance drivers to travel and reach the accident. In this thesis present study area is studied and problems faced by emergency service providers on road network are identified. In this thesis GIS/GPS/GSM based prototype system has been developed for routing of ambulance on road network of Hyderabad city (AMS). This prototype is designed such that it finds the accident location on the road network and locates the nearest ambulance to incident site using the real-time technologies (GPS/GSM). AMS creates the fastest route from nearest ambulance to accident site, and from there to nearest hospital. Congestion on roads during peak hours is considered, and the fastest route on both major and minor roads is created. In this thesis AMS user interface has been developed using VBA, ArcGIS (network analyst). This Ambulance management system has been developed using software engineering model rapid prototyping model and has been evaluated by GIS users

SAMMANFATTNING Patienter söker vård på akutmottagningar via ambulans vilket är ett omtalat problem när de kunde behandlats på annan vårdnivå. När antalet besökare ökar på akutmottagningarna i Sverige kan allvarliga konsekvenser uppstå för både sjukvårdspersonal och patienter. Patienter får inte alltid den mest ändamålsenliga vård på en akutmottagning. I svensk sjukvård är det ovanligt att tillåta ambulanssjuksköterskor att förbise akutmottagningar för andra vårdnivåer. Detta resulterar i överbelastade akutmottagningar samt att ambulanser nyttjas i fel syfte. Kompetens och utrustning har utvecklat behandlingsmöjligheterna för ambulanssjuksköterskor vilket medfört att ytterligare kvalificerade insatser kunnat genomföras på plats hos patienten. Ambulanssjuksköterskor bedömer patientens vårdbehov och beslutar kring lämplig vårdinstans, för att effektivisera resurserna kan patienter med lindriga åkommor transporteras till primärvård. Syftet var att belysa vilka faktorer som inverkar på ambulanssjuksköterskors beslut att hänvisa patienten till primärvården. Studiens metod var deskriptiv och utgick från en kvalitativ samt induktiv ansats. Urvalet var ändamålsenligt och bestod av sju ambulanssjuksköterskor som arbetar i södra Sverige. Inklusionskriterier var att informanterna hade genomgått en specialistsjuksköterskeexamen inom ambulanssjukvård samt varit aktivt yrkesverksamma under minst ett års tid. Intervjuer har genomförts utifrån ett semistrukturerat frågeformulär med följdfrågor. Analysmetoden utgick från en kvalitativ innehållsanalys. Resultatet utgörs av fem kategorier: riktlinjer inom ambulansverksamhet, bedömning av patient, delaktighet kring beslut om vårdnivå, ambulanssjuksköterskans kompetens samt samarbete med primärvård. Det framkom en osäkerhet hos ambulanssjuksköterskor om vilka patienter primärvården kunde behandla. Vid bedömning av patienten utgick ambulanssjuksköterskor från verksamhetens behandlingsriktlinjer. Ur intervjuerna med ambulanssjuksköterskorna framkom att de såg till hela patienten i sin bedömning vilken grundades i patientens allmäntillstånd, vitalparametrar och uppvisande symtom. Hänvisning till primärvården förekom endast för patienter med lindriga besvär. Dialogen med patienten angående ändamålsenlig vårdnivå upplystes vara essentiell och vikten av att komma överens med patienten samt anhöriga. I resultatet framkom att specialistutbildade ambulanssjuksköterskor betonade betydelsen av att få nyttja sina kunskaper och färdigheter i beslut om hänvisning till lämplig vårdnivå. En önskan om bättre tillgänglighet hos primärvården framkom från ambulanssjuksköterskorna. Slutsatsen blev att ambulanssjuksköterskorna under intervjuerna beskrev att de tog hänsyn till en mängd olika faktorer vid beslut om hänvisning av patienten till primärvården. Ambulanssjuksköterskorna belyste komplexiteten i beslutet och uttryckte vikten av att se till patientsäkerheten. Patienter transporterades till akutmottagning trots att vårdcentralen kunde varit en lämplig vårdnivå. Detta på grund av att svårigheter framkom kring patienter samt anhörigas påtryckningar men även primärvårdens tillgänglighet. Ambulanssjuksköterskorna önskade att bidra till att minska akutmottagningens belastning och ge patienten råd kring ändamålsenlig vårdnivå.  Nyckelord: ambulanssjuksköterska, vårdnivå, primärvård och riktlinjer. / ABSTRACT Patients seek care at emergency departments through ambulance, which is a reported problem when their condition could be treated at another level of care. As the number of visitors increases in emergency departments in Sweden causing overcrowding, serious consequences can occur in healthcare professionals and patients. Patients do not always receive the most appropriate care in emergency departments. In swedish healthcare it is unusual to allow ambulance nurses to disregard emergency departments for other levels of care. This results in overcrowded emergency departments and ambulances being used for the wrong purpose. Skills and equipment have developed treatment options for ambulance nurses, which result in further qualified interventions being carried out at the location. Ambulance nurses assess the patients need of care and decide on appropriate care facilities, in order to streamline resources, patients with mild disorders can be transported to primary care. The aim was to highlight the factors that affect the ambulance nurses decision to referral the patient to primary care. The method of the study was descriptive and was based on a qualitative and inductive approach. The sample was purposeful and consisted of seven ambulance nurses working in southern Sweden. Inclusion criteria were that the informants had a specialist nursing degree in ambulance care and had worked for at least one year. Interviews have been conducted based on a semi-structured questionnaire with follow-up questions. The analysis method was based on a qualitative content analysis. The result consists of five categories: guidelines in ambulance organisation, patient assessment, participation in decision-making on health care, ambulance nurses skills and cooperation with primary care. There was an uncertainty among ambulance nurses about which patients the primary care could treat. Ambulance nurses included the full complexity of the patient in their assessments, which was based on the patients general condition, vital signs and exhibited symptoms. Referral to primary care only occurred in patients with mild disorders. The dialogue with the patient and relatives regarding the appropriate level of care was stated to be essential. Ambulance nurses emphasized the importance of using their skills in decision making on the appropriate level of care. A wish for better accessibility to primary care was highlighted among ambulance nurses. The conclusion was that ambulance nurses took a variety of factors into account when deciding the patient referral to primary care. Ambulance nurses highlighted the complexity of the decision and expressed the importance of ensure the patients safety. Patients were transported to emergency departments even though the health center could have been an appropriate level of care. This was because of the difficulties encountered between patients and their relatives, but also the availability of primary care. Ambulance nurses wanted to help reduce the load in emergency deparments and advise patients to the appropriate care level.  Keywords: ambulance nurse, care level, primary care and guidelines.

O presente estudo teve como objetivo geral investigar os riscos ocupacionais, os acidentes de trabalho e doenças que acometem motoristas de uma central de ambulância de Marília (São Paulo). Para o alcance do objetivo, utilizou-se como metodologia o estudo de caso, sendo a coleta de dados realizada por entrevista estruturada, com o auxílio de um formulário. Constituíram-se sujeitos do estudo 22 motoristas socorristas. Obteve-se a categorização dos dados direcionados pela literatura sobre riscos, acidentes de trabalho e doenças relatadas pelos motoristas socorristas. Todos os entrevistados eram do sexo masculino; 81,82% eram casados; 40,90% dos trabalhadores não concluíram o primeiro grau; 54,54% exerciam outra ocupação remunerada e 81,81% referiram ter o hábito de ingerir bebidas alcoólicas toda a semana em quantidades variadas. Os riscos encontrados foram os ergonômicos e suas subcategorias fisiológicas, psicológicas e organizacionais, riscos de acidentes, riscos biológicos e riscos físicos. Constatou-se que 13 (59,09%) dos motoristas relataram ter sofrido 19 acidentes de trabalho (AT). Dentre estes destacaram-se aqueles ocorridos em decorrência do excesso de exercícios e movimentos vigorosos e repetitivos, agressão, impacto, quedas e penetração de corpo estranho no olho. Dos 19 AT, 15 (78,94%) referem-se a traumatismos, 10,53% a dorsalgias inespecíficas, 5,26% a fratura de ossos do metatarso e 5,26% à presença de corpo estranho no olho. Quatro motoristas referiram ter adoecido, sendo que dois apresentaram traumatismos não especificados do abdome, dorso e pelve; um relatou transtorno de disco intervertebral e outro, afecção ocular devida ao vírus do herpes. No contexto estudado, pôde-se observar que se trata de profissionais que estão expostos a outros riscos alheios a sua categoria, além daqueles próprios por executarem trabalho de atendimento aos pacientes, não específico daquele prescrito para a referida profissão. Estratégias foram propostas no sentido de minimizar os riscos ocupacionais, os acidentes de trabalho e as doenças encontradas entre estes trabalhadores. / The present study has the general goal of investigating the occupational risks, accidents and diseases which drivers of an ambulance center in Marilia (São Paulo) suffer from. To achieve the goal, it was used the study of case methodology, being the data collection done by structured interview, with the support of a form. Twenty-two professionally qualified first aid drivers took part of the study. It was obtained the categorization of the data directed by the literature about risks, occupation accidents and diseases related by professionally qualified first aid drivers. All drivers interviewed were male; 81.82% were married; 40.90% did not finish elementary school; 54.54% used to have another paid occupation and 81.81% said to have the habit of having alcoholic drinks all the week in various amount. The risks found were the ergonomics and their physiological, psychological e organizational subcategories, risks of accidents, biological risks and physical risks. It was found out that thirteen (59.09%) of the drivers said to have had nineteen occupation accidents (AT). Among them, it was emphasized the ones occurred because of the excess of physical exercises and tough and repetitive movements, aggression, impact, falling downs and penetration of strange body into the eye. From 19 AT, 15 (78.94%) were about traumatisms, 10.53% about non-specific backaches, 5.26% about bone breakage of metatarsus and 5.26% about presence of strange body in the eye. Four drivers said to have came down, being that two showed non-specific traumatisms of abdomen, dorsum and pelvis; one related problem of intervertebral disc and another, ocular affection due to herpes virus. In the context studied, it was showed that it’s about professionals who are exposed to other risks out of their category, beside the ones by attending the patients, not specific of the one prescribed to the referred occupation. Strategies were proposed to minimize the occupational risks, accidents and diseases found among these workers.

O objetivo da presente investigação foi identificar os diagnósticos de enfermagem em vítimas de trauma no Atendimento Pré-hospitalar (APH) Móvel Avançado.Trata-se de um estudo qualitativo descritivo, em que se utilizou o método de estudo de caso.Como referencial teórico utilizamos o Modelo Conceitual de Horta e o método sistematizado do ATLS (Advanced Trauma Life Support). Os dados foram coletados pela pesquisadora na Unidade de Suporte Avançado (USA) do SAMU (Serviço de Atendimento Móvel de Urgência) da Secretaria da Saúde de Ribeirão Preto (São Paulo), no período de janeiro a junho de 2004, utilizando um instrumento previamente validado. A amostra se constituiu de 23 pessoas vítimas de trauma maiores de 18 anos atendidas pela pesquisadora na USA. Após a coleta de dados, procedemos à identificação dos diagnósticos de enfermagem, utilizando um processo raciocínio diagnóstico e a construção das categorias diagnósticas teve como referência as Taxonomias I e II da NANDA (North American Nursing Diagnosis). Os dados coletados e os diagnósticos de enfermagem estabelecidos pela pesquisadora foram analisados por cinco enfermeiras com experiência na assistência a vítima de trauma e com conhecimento específico em diagnóstico de enfermagem e, posteriormente, com a análise das sugestões foram revisados pela pesquisadora que acatou as opiniões. No Atendimento Pré-hospitalar (APH) Móvel Avançado foram identificados 24 diagnósticos de enfermagem sendo 15 do tipo real e nove de risco. Com percentual igual ou superior a 50% identificamos Risco para infecção, Risco para trauma, Dor aguda e Integridade tissular prejudicada. Os demais diagnósticos identificados foram: Desobstrução ineficaz de vias aéreas (17%), Padrão respiratório ineficaz (30%), Risco para aspiração (17%), Risco para disfunção neurovascular periférica (39%), Risco para função respiratória alterada (13%), Volume de líquidos deficiente (43%), Risco para volume de líquidos deficiente (43%), Perfusão ineficaz periférica (13%),cerebral (30%), gastrintestinal (8%),. Percepção sensorial perturbada visual (4%), cinestésica e tátil (22%), Confusão aguda (17%), Risco para temperatura corporal alterada (34%), Integridade da pele prejudicada (21%), Mobilidade física prejudicada (21%), Risco para queda (17%), Ansiedade (43%), Medo (4%) e Violência direcionada para si (4%).Verificamos que o grupo de diagnósticos representam a gravidade da vítima por identificarem alterações em sistemas orgânicos vitais. / The aim of this study was to identify the nursing diagnoses of adult trauma victims in the pre-hospital attendance. The research methodology used was a descriptive, qualitative, case study strategy. It was based on Horta’s Conceptual Model and the ATLS (Advanced Trauma Life Support) theoretical framework. The researcher collected data in the SAMU-192 pre-hospital intensive care ambulance, from the Advanced Vital Support Unit, in Ribeirão Preto (SP), Brazil during the period of January to June 2004, using a previously validated instrument for data collection. The sampling was made up of 23 adult trauma victims, of 18 years or older. After data collection the nursing diagnostics were identified through a rational thought process and forming of diagnostic categories based on the NANDA (North American Nursing Diagnosis) taxonomy II. Both the collected data and nursing diagnoses elaborated by the researcher were analyzed by five other nurses with experience in trauma care and specific Knowledge of nursing diagnosis and afterwards, the suggestions made were reviewed and accepted. During the advanced mobile prehospital assistance 24 nursing diagnoses were identified, 15 of which were actual problems and 9 were at risk of occurring. Of the latter, the factors with a 50% or higher at risk status were infection, trauma, acute pain and tissue integrity damage. The other diagnoses that were established included: ineffective airway clearance (17%), ineffective breathing pattern(30%), risk for aspiration (22%), risk for altered breath pattern (13%), fluid volume deficit (43%), risk for fluid volume deficit (43%), altered peripheral tissue perfusion (13%),. altered cerebral tissue perfusion (30%), altered gastrointestinal tissue perfusion (8%), risk for peripheral neurovascular dysfunction (39%), visual sensory/perceptual alterations (4%), tactile and kinesthetic sensory/perceptual alterations (22%), acute confusion (17%),risk for altered corporal temperature (34%), damaged skin integrity (22%), impaired physical mobility (22%),risk for falling, anxiety (43%), fear (4%) and risk for self directed violence (4%). We verify that the group of disgnostic represents the gravity of the victim for identifying alterations in vital organic systems.

Background: The overuse of the emergency department (ED) for non- critical patients has been associated with overcrowding and a rise in healthcare cost. Green Valley Fire Department (GVFD) has created a program, Fire-Based Urgent Medicals Service (FBUMS) with a nurse practitioner (NP). Patients can call 9-1-1 or the ""NP hotline"" and request to be seen by the NP instead of being immediately transported to the hospital via ambulance. Purpose: The purpose of this project is to evaluate the impact of the nurse practitioner led FBUMS, on ED visits and ambulance transports. Methods: A survey was mailed to all persons, age 18 and older, who were seen by the NP with FBUMS between February 2017 and March 2017. The survey asked about the reasons for contacting GVFD, the type of treatment received, and whether they went to ED after treatment. Data analysis: Descriptive statistics including frequencies, percentages, means and standard deviations were used to analyze each of the answered survey questions in Microsoft Excel©. Results: Surveys completed (n=42). The majority, 39 (92.9%) stated they did not receive care at the ED within 72 hours following their appointment with the NP, three (7.1%) stated they did. By dramatically decreasing transport to the hospital and associated ED treatment, it is estimated to have saved approximately $53,425 in ambulance costs and $54,210 in ED treatment for a total savings of $99,632.52. Conclusion: A Fire-Based Urgent Medical Service led by a nurse practitioner decreased emergency room visits and ambulance transports.

Antalet barn som anhöriga till patienter som erhåller vård och transport till sjukhus är okänt. Barn under 18 år kan ibland vara närvarande på hämtplatsen när ambulanssjukvården hämtar barnets anhörig. Hur många barn som anhöriga som är närvarande är okänt inom ett västsvenskt ambulansområde. Triagesystemet RETTS används vid triagering och bedömning av anhöriga till barnen. Syftet med studien är att kartlägga hur många barn som är närvarande då deras anhöriga ges vård, behandling och transport till en vårdinrättning vid prioritet 1 och 2 larm. En enkät skapades för att samla in data till studien. Barn som anhöriga finns även inom ambulanssjukvård. I denna studie identifierades 155 barn vid 95 ambulansuppdrag. Barn som anhörig ses till både vuxna, vanligen en förälder, som till barn. Ett flertal barn som anhöriga är närvarande när en anhörig påvisar svåra, kanske livshotande symptom. Sammanfattningsvis visade studien att stödet till barn och kunskapen om stöd fanns inte inom det ambulansområde där studien är genomförd. / Children as next of kin to patients who are treated by an ambulance nurse in Swedish ambulance service in unknown. Children under 18 years of age may sometimes be present when their parent or other next of kin, has to call the ambulance service due to illness or accident. How many children who experience their next of kin transported to hospital within a Western Swedish ambulance service district is unknown. The purpose of this survey is to identify how many children actually are present when their next of kin may need care and treatment from an ambulance service. Purpose: Survey how many children are present when an ambulance nurse cares and treats a next of kin due to illness or an accident, prioritized as priority 1 or 2. Method: a survey conducted by ambulance nurses in a western Swedish ambulance service. The survey has a quantitative design. Children as next of kin are present within a Swedish ambulance service district, in this survey 155 children was identified in a total of 95 ambulance missions. Children as next of kin are seen as adults, in most cases, a parent as well as children usually a sibling. Many children are present when their relative shows sign and symptoms of severe illness.