Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

Lyginant su kitomis užsienio šalimis, Lietuvoje stuburo sužalojimai patiriami dažniau. Dažnai stuburo sužalojimą patyręs asmuo lieka neįgalus visą likusį gyvenimą. Valstybė ir artimieji patiria didelius nuostolius dėl prarastų pajamų, išlaidų gydymui ir išlaikymui. Paciento patyrusio stuburo sužalojimą tolimesnė gydymo ir sveikatos grąžinimo perspektyvos labai priklauso ir nuo pirmosios pagalbos teikimo ikistacionariniame etape. Tyrimo tikslas – įvertinti greitosios medicinos pagalbos tarnybų galimybes teikti pagalbą, kai yra stuburo sužalojimai. Tyrimą sudarė trys etapai. Tirta greitosios medicinos pagalbos tarnybų medikų teorinis ir praktinis pasiruošimas, materialinė techninė bazė ir procedūros taikomos pacientams patyrusiems didelės kinetinės energijos traumas. Tyrimo uždaviniai: 1. Įvertinti greitosios medicinos pagalbos darbuotojų teorinį ir praktinį pasirengimą teikti pagalbą pacientams, kuriems įtariamas stuburo sužalojimas po patirtos didelės kinetinės energijos traumos. 2. Įvertinti greitosios medicinos pagalbos materialinę ir techninę bazę, reikalingą teikiant pagalbą stuburo sužalojimų atvejais. 3. Nustatyti klinikinių procedūrų, atliekamų asmenims, patyrusiems stuburo sužalojimus, rūšį ir dažnį. 4. Nustatyti teikiamos pagalbos, asmenims su įtariamu stuburo sužalojimu, atitikimą pasaulio sveikatos organizacijų rekomendacijoms. / Spinal cord injuries incidence is higher in Lithuania than in other countries. Patient after experienced spinal cord injury often remains disabled for the rest of its life. Community and relatives have to suffer big losses for the lost incomes and expenses related to treatment and maintenance. Patient treatment and heath retain prognosis strongly depends on firs medical aid supplied at prehospital level. The aim of study – evaluate emergency medicine services abilities to provide first medical aid in cases of spinal injuries. The study consisted of three stages. We investigated the theoretical and skill readiness of emergency medicine services personnel, physical resources provision and procedures applied to the patients which have undergone high energy traumas. The objectives of the study: 1. To evaluate the theoretical knowledge level and skills required to provide first medical aid for patients which undergone high energy trauma and are suspected for spinal injury. 2. To evaluate physical resources of the emergency medicine institutions which are used for the first medical aid supplied to the patients with spinal injury. 3. To determine the availability of emergency medicine services and the kind and extent of clinical procedures applied to patients with spinal injury suspected. 4. To evaluate the conformance of the clinical procedures applied to patients with spinal injury to the recommendations of the world health institutions.

[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.

[Truncated abstract] This thesis describes the epidemiology and outcome of acute asthma managed by ambulance paramedics, in the metropolitan area of Perth, Western Australia, for the period of 1990 to 2001. The primary aim of this thesis was to determine demographic, socio-economic and clinical trends for ambulance transported patients with asthma, their outcomes and how they have changed over time. The Perth metropolitan area, located in the south-western corner of Western Australia (WA), accounts for 72% of the state’s population, which was approximately 1.3 million people at Census 2001. This thesis was structured around the analysis of twelve years of St John Ambulance (WA) data. Ambulance data was linked using probabilistic matching techniques to the Western Australian Data Linkage System, custodian of links to thirty five years of morbidity and mortality data of the state’s population . . . Unique geography, a monopolistic ambulance service and access to extensive linked data provided ideal conditions for this population-based epidemiological study of patients with asthma who were transported by ambulance. Observed trends in age and gender characteristics of patients, ambulance codes and temporal variables appear to be consistent over time. Monitoring trends in the use of ventilation procedures recorded in hospital data provided useful indicators for describing the epidemiology of severe, lifethreatening asthma in the prehospital setting. Findings from this study were found to be consistent with published literature.

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

This thesis is a case analysis of the nature of delays in emergency room admissions and the effects on ambulance dispatching and availability as it occurred in Southern California.

Notaufnahmen und Rettungsdienste bilden ein in sich geschlossenes System. Die Schnittstelle beeinflusst maßgeblich den Arbeitsverlauf des Rettungsdienstes. Außerdem führen die steigenden Patientenzahlen zur Überlastung von Notaufnahmen, wodurch auch Rettungsdienste in ihrer Funktionalität eingeschränkt werden. Bei überlasteten Notaufnahmen kommt es zu einer verzögerten Behandlung aller Patient:innen, auch derer, die durch den Rettungsdienst angeliefert wurden. In der vorliegenden Arbeit wird analysiert, inwiefern die Architektur das Problem einer überlasteten Notaufnahme beeinflusst. Dazu wurde ein Fragebogen erstellt, welcher online vom medizinischen Personal ausgefüllt wurde. Die Ergebnisse aus dem Fragebogen zeigen, dass Patient:innen und Rettungsdienstpersonal mehrmals täglich zwischen 5 bis 30 Minuten warten müssen, bis die Übergabe zum Notaufnahmepersonal stattfindet. Dies geschieht meistens in einem nicht zum Warten vorgesehenen Flur, welcher von Patient:innen und Personal als schlecht gestalteter Raum betrachtet wird. Spezielle Räumlichkeiten für das überwachte Warten und die Übergabe von Rettungsdienstpatient:innen verbessern die Wartezeit für Patient:innen und Personal.

Thesis (M. Nursing) -- University of Limpopo, 2022 / Background: Emergency departments (EDs) as the hospitals' front door have a critical role in ensuring access to and efficient care of acute illness and injuries in the healthcare system. The environment in EDs is physically and emotionally demanding and burdened by complex patient loads, long shifts, and administrative challenges resulting in high pressure and high volume workloads amongst the staff members. Purpose: The study aimed to develop support strategies for the resuscitation team in EDs of Mankweng and Pietersburg public hospitals in Limpopo Province, South Africa. Study method: A descriptive, phenomenological, and explorative research design was used to explore the resuscitation team's experiences and the available strategies to support them. Purposive and convenience sampling methods were used to select five Medical doctors and twelve Professional nurses to participate in the study. The sample size was determined by the depth of the information obtained from the participants.Data was collected through semi-structured individual interviews. Interview guide was developed to guide with organised line of questioning and thinking. Qualitative data analysis using Tesch's approach was then followed. The quality of data was ensured by applying four elements; credibility, transferability, dependability, and confirmability. Turfloop Research Ethics Committee, the Limpopo Department of Health, and the Mankweng/Pietersburg Ethics Committee permitted the study. The study's details were explained to potential participants, who then agreed to be part of the study and signed consent forms. Results: The following themes emerged: Challenges related to the shortage of resources in the ED, challenges related to lack of standardized procedures and policies for handling the resuscitation process, psychological challenges of resuscitation failure, leadership, and managerial support challenges, and challenges related to education and training of the resuscitation team. Conclusion: This study's results indicated that the resuscitation teams of EDs from Mankweng and Pietersburg Public Hospitals face challenges that cause them stress and burnout. The challenges result from an increased overload of work with no personnel and material resources. They become demoralized by being engaged in failed resuscitation with no psychological support from the management. They don't receive any debriefing or counseling post failed resuscitation and no educational backing of the management. The study's findings guided the researcher in developing strategies to support the resuscitation teams in the EDs of Mankweng and Pietersburg Public Hospitals.

Text in Afrikaans / Die studie fokus op die effek van krisiswerk op die helper in terme van stres, die uitbrandingsindroom en posttraumatiese stresversteuring (PTSV). Salutogeniese konstrukte as moderatorveranderlikes in die stres-siekte-verhouding word ook ondersoek. 'n Beskikbaarheidsteekproef van 52 ambulansmanne en 52 kontrolegroepwerkers is verkry. Biografiese, koherensie-, uitbrandings-, PTSV- en stresvraelyste is ingevul en statisties verwerk. Resultate dui daarop dat ambulansmanne hul werk as buitengewoon stresvol beleef en dat meer ambulansmanne diagnoseerbare PTSV vertoon. Daar blyk geen verskil tussen die twee groepe te wees nie met betrekking tot die voorkoms van uitbranding en streservaring. 'n Negatiewe verband tussen koherensiebelewing en die voorkoms van stressimptome en uitbranding is verkry. Ambulansmanne het 'n buitengewoon stresvolle werk en vertoon meer simptome van stresversteurings as mense in ander beroepe. Aanbevelings word gedoen oor hoe om die negatiewe konsekwensies van stres te verminder. / The study focuses on the effect of crisis work on the assistant in terms of stress, the burnout syndrome and post-traumatic stress disorder (PTSD). Salutogenic constructs as moderator variables in the stress-illness relationship are also investigated. An availability sample of 52 ambulancemen and 52 control group workers was obtained. Biographic, coherence, burnout, PTSD and stress questionnaires were completed and statistically processed. Results indicate that ambulancemen experience their work as exceptionally stressful and that more Ambulancemen display diagnosable PTSD. There appears to be no difference between the two groups in respect of the incidence of burnout and experience of stress. A negative connection between the experience of coherence and the incidence of stress symptoms and burnout was obtained. Ambulancemen have an exceptionally stressful job and display more symptoms of stress disorders. Recommendations are made on how to reduce the negative consequences of stress. / Industrial and Organisational Psychology / M. Com. (Bedryfsielkunde)

Abstrakt Bakgrund: Patienter hänvisas idag i större utsträckning till egenvård av sjuksköterskor i ambulanssjukvården och beslutstöd finns för att hjälpa till med hänvisningen. Arbetet innebär att prioritera och bedöma vilken vårdnivå som är optimal för patienterna, vilka patienter som behöver följa med i ambulansen för ytterligare vård på vårdinrättning och vilka som kan hänvisas till egenvård. Att bedöma vad som är optimal vårdnivå ställer krav på att sjuksköterskorna besitter medicinska kunskaper vid olika tillstånd, men också kunskap om helheten i hänvisningsprocessen.Syfte: Syftet var att undersöka sjuksköterskors erfarenheter av ett beslutstöd för hänvisning av patienter från ambulanssjukvård till egenvård. Metod: En kvantitativ tvärsnittsstudie har utförts med hjälp av enkäter. Designen var deskriptiv och explorativ. En totalundersökning av populationen har utförts som innefattade 123 sjuksköterskor i ambulanssjukvården i en region i södra Sverige, fördelat på två länsdelar. Slutligen inkom 95 enkätsvar (77,2 %). Data har analyserats med deskriptiv statistisk och tematisk innehållsanalys. Resultat: Det var 68 (71,5 %) av sjuksköterskorna som höll med om att de alltid använde beslutsstödet och 54 (56,9 %) upplevde att beslutsstödet gav det stöd som behövdes. Det var 84 (88,5 %) som hade uppfattningen att patienter var nöjda med hänvisning till egenvård. Av sjuksköterskorna svarade 77 (81,1 %) att läkare fanns att tillgå vid behov. Dock fanns en önskan om att akutläkare alltid skulle vara tillgängliga vid frågor. Tid på dygnet och geografisk hämtplats påverkade beslutet att lämna patienter hemma. Beslutstödet fokuserade allt för mycket på vitala parametrar och täckte därmed inte andra viktiga aspekter. Konklusion: Resultatet visade att beslutstödet är i behov av förändring. Akutläkare eller läkare med hög kompetens bör finnas tillgängliga vid frågor. Genom att använda sin kliniska blick, hög medicinsk kompetens och erfarenhet, tillsammans med ett väl fungerande beslutsstöd kan sjuksköterskorna i ambulanssjukvården uppleva ökad trygghet när patienter hänvisas till egenvård. / Abstract Background: Today, more and more nurses in the prehospital care are referring patients to self-treatment and there is certain support to help make this decision. The work nurses in the ambulance care do means that assess which level of care that is optimal for the patients. Which patients who need to come along in the ambulance and which patients who can be referred to self-care. To decide what is optimal care requires nurses to possess medical knowledge in different conditions, but also knowledge about the whole process of referring patients. Purpose: The purpose was to examine nurses´ experiences of a decision support for referring patients from ambulance care to self-care. Method: A quantitative study has been made, where the writers used a survey to fulfill the purpose. The design of the survey was descriptive and explorative. A total examination of the population has been done, which was 123 nurses in the Ambulance service in a region in south of Sweden, divided into two counties. Finally, there was 95 replies of the survey (77,2 %). Statistical analysis and thematic analysis of the content were used to present the result. Result: There was 68 (71,5 %) of the nurses who agreed to that they always used the decision support and 54 (56,9 %) experienced that the decision support gave the support that was needed. A bigger part, 84 (88,5 %), had the opinion that patients were satisfied being referred to self-care. Of all nurses, 77 (81,1 %) answered that doctors were available if necessary. However, there was a desire that emergency doctors were always available on questions. Time of day and geographical place of pick up affected the decision to leave the patient in his or her home. There were 84 (88,5%) nurses who had experiences from satisfied patients being referred by the ambulance care to self-care. Decision support focused too much on vital parameters and thus did not cover other important aspects. Conclusion: The result showed that the decision support is in need of change. Emergency doctors or doctors with high competence should be available when needed. By using their clinical eye, with high medical competence and experience, together with a well-functioning decision support - the nurses in the ambulance care can experience increased confidence in referring patients to self-care.