Introduction Air ambulances transport patients to their home country or to centres of medical excellence when they are critically ill or injured. From stranded hikers to cancer patients, individuals worldwide use air ambulance transport when they need care that cannot be provided in the country or area where they are situated. Aim The overall aim of this study was to explore the challenges experienced by health care professionals during air ambulance transport of patients in sub-Saharan Africa. Research method A quantitative, non-experimental, descriptive, exploratory design was used. The study was conducted in three phases. Phase 1 was the planning of the questionnaire, Phase 2 was the pre-testing of the questionnaire and Phase 3 was the execution phase in which the questionnaires were distributed, and data were captured and analysed. Results The researcher used the data generated from the questionnaires to indicate short falls within air ambulance transport services in sub-Saharan Africa. Conclusion The researcher made recommendations in order to increase the level of air ambulance services in sub-Saharan Africa. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

Bakgrund: Det prehospitala arbetet är utmanande i avseende att kombinera ett patientsäkert vårdarbete och yrkesmässig bilkörning. Vårdutrymmet i en ambulans är en riskfylld miljö både då bilen står parkerad på en olycksplats samt när den är i rullning. Trafiksäkerhet i ambulanssjukvård är därav en avgörande faktor för patientsäkerheten och ambulanssjuksköterskans arbetsmiljö. Brister denna säkerhet riskerar patienten att bli utsatt för ett vårdlidande och ambulanssjuksköterskan för en arbetsmiljöskada. Syfte: Syftet med studien är att beskriva ambulanssjuksköterskans upplevelser och uppfattningar av säkerhetsbältets användning på patienten under ambulanstransport och på så vis öka följsamheten gällande säkerhetsbältes användning. Metod: En kvalitativ intervjustudie genomfördes med enskilda intervjuer. Kvalitativ innehållsanalys med induktiv ansats användes som analysmetod. Resultat: Analysen resulterade i 5 kategorier som bildade resultatets rubriker “bältets betydelse”, “svagheter och brister”, “hinder för säkerhetsbälte”, “arbetsmiljö och säkerhet” samt “samverkan mellan förare och vårdare”. Slutsats: Av studiens resultat kunde slutsatsen dras att säkerhetsbältesanvändningen i ambulansen har stor förbättringspotential samt att upplevelse och uppfattning går i sär med hur verkligheten ser ut. Resultatet visar även vilka orsaker till en bristande bältesanvändning som är vanligast och förslag på hur man kan komma till rätta med dessa. Att säkerhetsbältesanvändningen för patienterna i ambulansen förs upp till diskussion är av stor vikt för att främja patientsäkerheten och ambulanssjuksköterskans Arbetsmiljö̈. För att öka följsamheten gällande säkerhetsbältesanvändningen är det av värde att flera studier utöver denna genomförs utifrån olika synvinklar, exempelvis patientens upplevelse / Background: The pre-hospital work is challenging in terms of combining apatient-safe care work and professional driving. The care room in an ambulance is a risky environment both when the car is parked on an accident site and when it is rolling. Traffic safety in ambulance care is therefore a crucial factor for patient safety and the ambulance nurse's work environment. If this safety fails, the patient risks being exposed to a suffering patient and the ambulance nurse for a work environment injury. Purpose: The purpose of the study is to describe the ambulance nurses experiences and perceptions of the safety belts use on the patient during ambulance transport and in this way increase compliance with seat belt use. Method: A qualitative interview study was conducted with individual interviews. Qualitative content analysis with inductive approach was used as analysis method. Result: The analysis resulted in 5 categories that formed the results headings “the importance of the belt”, “weaknesses and deficiencies”, “obstacles to safety belts”, “work environment and safety” and “collaboration between driver and carer”. Conclusion: From the results of the study, it could be concluded that the seat belt use in the ambulance has great improvement potential and that experience and perception go in particular with the reality. The result also shows the reasons for a lack of belt use that is most common and suggestions for how to deal with these. The fact that the safety belt use for the patients in the ambulance is brought up for discussion is of great importance for promoting patient safety and the ambulance nurses working environment. In order to increase adherence to seat belt use, it is of value that several studies in addition to this are carried out on the basis of different perspectives, forexample the

Bakgrund: Enligt statistiken har ambulansutryckningarna ökat men ambulanstätheten minskat. Det behövs därför en väl fungerande prioritering av patienterna som söker akut vård från larmcentralen. De som inte är i akut behov av ambulanstransport till sjukhus ska kunna omdirigeras till att söka annan vård som vårdcentral eller stanna hemma med egenvård.   Syfte: är att jämföra patienter med samma ESS kod i ambulansjournalerna som endera transporterades till sjukhus eller kvarstannande med egenvård vid prio ett larm. Metod: En retrospektiv fallkontroll studie med en kvantitativ ansats. En journalgranskning med 139 inkluderade ambulansjournaler från södra Sverige.   Resultat: Andelen prio ett uppdrag där patienten lämnades hemma med egenvård i föreliggande studie var 193 stycken, 7,2 procent. Utifrån resultatet fanns det inga skillnader i åldern mellan patienter som stannade kvar respektive transporterades med ambulans till akuten på respektive sjukhus. Det fanns heller inga signifikanta skillnader mellan könen utifrån tid på dygnet. Dock fanns det en signifikant skillnad då det gällde avstånd till sjukhus. För patienterna som bodde ≤ 8 km radie från ett sjukhus stannade 83st (59,7%) kvar i hemmet med egenvård. För patienter med ≥ 8 km ifrån ett sjukhus stannade 106 (76,3 %) kvar i hemmet med egenvård. Totalt för patienter som transporterades överensstämde larmcentralens index med ambulanssjuksköterskans ESS-kod vid 52%. För patienter som kunde kvarstanna i hemmet var överensstämmelsen 42% mellan larmcentralens index och ambulanssjuksköterskans ESS.   Slutsats: Studien kunde inte påvisa någon skillnad mellan kön och tidpunkt av de som transporterades mot de som kunde stanna hemma, dock fanns det en signifikant skillnad på antal patienter som transporterades och kunde stanna hemma beroende på avstånd mellan deras boende och sjukhus. Även fanns det en förbättringspotential mellan SOS index och ambulanssjuksköterskans ESS kod, att denna skulle stämma mer överens. För ambulanssjuksköterskan är det viktigt att behandla alla patienter lika oberoende på yttre faktorer, i denna studie framkom att avståndet hade en betydelse. Detta får vi som ambulanssjuksköterskor ta till oss och inte låta ha en avgörande betydelse för den vård vi beslutar oss för att ge patienten. / Background: According to statistics, ambulance emergency were increased but the density decreases, which requires a well-functioning prioritization of patients seeking emergency care from the central station. Those who are not in need of urgent ambulance transport to the hospital to be redirected to seek other care medical center or stay at home with self-care.   Purpose: is to compare patients with the same ESS Code of ambulance records that are either transported to a hospital or keeping people with self-care at priority alarm. Method: A retrospective case-control study with a quantitative approach. A medical record review of 139 included ambulance records from southern Sweden.   Results: The proportion of priority a mission in which the patient was at home with self-care in this study were 193 pieces, 7.2 per cent. Based on the results, there were no differences in age between patients who remained and was transported by ambulance to the emergency room and hospital. There were also no significant differences between the sexes based on time of day. However, there was a significant difference as regards the distance to the hospital. For patients who lived ≤ 8 km radius of a hospital stayed 83st (59.7%) remain in the home with self-care. For patients with ≥ 8 km from the hospital stayed 106 (76.3%) remain in the home with self-care. Total of patients transported consistent monitoring center index with the ambulance nurse ESS Code at 52%. For patients who were able to remain in the home was the consistency 42% between the central station's index and the ambulance nurse ESS. Conclusion: The study did not demonstrate a difference between gender and time of the transported toward those who could stay at home, however, there was a significant difference in the number of patients who were transported and could stay home, depending on the distance between their accommodation and hospitals. Although there was an improvement in potential between SOS Index and the ambulance nurse ESS code. For ambulance nurse, it is important to treat all patients equally regardless of external factors, in this study revealed that the distance had a meaning. This we get that ambulance nurses bring to us and not let be crucial for the care we decide to give.

Introdução: O transporte médico de crianças gravemente enfermas envolve particularidades que aumentam o risco de complicações, que podem contribuir para o aumento no tempo de internação e mortalidade. Objetivos: Avaliar a frequência e os tipos de complicações observadas durante o transporte pré- hospitalar e inter-hospitalar de crianças gravemente enfermas, assim como o impacto dessas complicações na mortalidade, no tempo de internação hospitalar e nos custos hospitalares. Pacientes e Métodos: Estudo realizado em duas etapas: a primeira foi um estudo transversal, no qual, por meio de entrevista padronizada com o médico que admitiu as crianças gravemente enfermas que necessitaram de transporte pré-hospitalar ou inter-hospitalar, foram identificadas e caracterizadas possíveis complicações ocorridas durante esse transporte. Estes dados foram auditados por três médicos independentes que definiram a presença ou ausência de complicações durante o transporte. A segunda etapa constituiu-se de uma coorte prospectiva, na qual os pacientes, divididos em dois grupos distintos (com e sem complicações durante o transporte), foram seguidos, prospectivamente, por 60 dias, observando-se a ocorrência de morte ou alta hospitalar. Resultados: Foram incluídas 143 crianças no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 pacientes (52%). As complicações mais frequentes foram relacionadas com as vias aéreas (69%), seguidas por distúrbios metabólicos (47%), alterações cardiovasculares (40%) e falhas relacionadas aos dispositivos e à monitorização (37%). Na análise univariada, os seguintes preditores para ocorrência de complicações durante o transporte foram observados: peso <10Kg (risco relativo - RR: 1,52; intervalo de confiança (IC 95%: 1,11-2,09); distância >100Km (RR: 1,67; IC 95%: 1,16-2,40); presença de doença respiratória (RR: 1,46; IC 95%: 1,06-1,95) e comorbidades (RR: 1,68; IC 95%: 1,23-2,30). Já na análise multivariada, não foram observados preditores independentes para ocorrência de complicações. A ocorrência de complicações durante o transporte foi associada com maior taxa de mortalidade hospitalar (hazard ratio - HR: 5,668; IC 95%: 1,26-26,65; p=0,0130) e menor taxa de alta hospitalar (HR: 0,48; IC 95%: 0,31-0,74; p=0,0007). Após a aplicação da regressão de Cox para ajuste de potenciais fatores de confusão, a presença de complicação durante o transporte permaneceu associada com o índice de mortalidade hospitalar (HR: 6,74; IC 95%: 1,40-32,34; p=0,017), contudo deixou de ser associada com o tempo para a alta hospitalar (HR: 0,76; IC 95%: 0,49- 1,16; p=0,213). Conclusões: As complicações foram frequentes durante o transporte pediátrico. A presença de doenças respiratórias, peso <10Kg, presença de comorbidades e a distância >100 Km foram preditores de risco para a ocorrência dessas complicações. As complicações ocorridas durante o transporte foram associadas com o aumento nas taxas de mortalidade hospitalar. / Introduction: The medical transport of critically ill children involves characteristics that increase the risk of complications, which can contribute to an increase in length of stay and mortality. Objectives: To evaluate the frequency and type of complications observed during the pre-hospital and inter-hospital transport of critically ill children, as well as the impact of these complications on mortality, length of hospital stay and hospital costs. Patients and Methods: A study carried out in two stages: the first was a cross-sectional study where through a standardized interview with the doctor who admitted the critically ill children requiring pre-hospital or inter-hospital transport identified and characterized possible complications during this transport. These data were audited by three independent doctors who defined the presence or absence of complications during transport. The second stage consists of a prospective cohort study, where patients divided into two groups (with and without complications during transportation) were followed prospectively for 60 days observing the occurrence of death or hospital discharge. Results: We included 143 children in the study. At least one complication during transportation was observed in 74 patients (52%). The most frequent complications have been associated with airway (69%), followed by metabolic disorders (47%), cardiovascular disorders (40%) and failure in the device and monitoring (37%). In the uni-variate analysis, the following predictors for the occurrence of complications during transport were observed: weight <10 kg (relative risk - RR: 1.52; 95% confidence interval - CI: 1.11-2.09); distance greater than 100 km (RR: 1.67; 95% CI: 1.16-2.40); presence of respiratory disease (RR: 1.46; 95% CI: 1.06-1.95) and associated comorbidity (RR: 1.68; 95% CI: 1.23- 2.30). In the multivariate analysis, no independent predictors were observed for the occurrence of complications. The occurrence of complications during transport was associated with higher hospital mortality (hazard ratio - HR: 5.668; 95% CI: 1.26-26.65; p=0.0130) and a lower hospital discharge rate (HR: 0.48; 95% CI: 0.31-0.74; p=0.0007). After Cox regression to adjust for potential confounding factors, the presence of complications during transport remained associated with hospital mortality (HR: 6.74; IC 95%: 1.40-32.34; p=0.017), however, was not associated with hospital discharge rates (HR: 0.76; 95% CI: 0.49-1.16; p=0.213). Conclusions: The complications were common during pediatric transport. Distance greater than 100 km, presence of respiratory disease, associated comorbidity and weight <10 kg were risk predictors for occurrence of complications. Complications during pediatric transport were associated with increased hospital mortality rates.

Introdução: O transporte médico de crianças gravemente enfermas envolve particularidades que aumentam o risco de complicações, que podem contribuir para o aumento no tempo de internação e mortalidade. Objetivos: Avaliar a frequência e os tipos de complicações observadas durante o transporte pré- hospitalar e inter-hospitalar de crianças gravemente enfermas, assim como o impacto dessas complicações na mortalidade, no tempo de internação hospitalar e nos custos hospitalares. Pacientes e Métodos: Estudo realizado em duas etapas: a primeira foi um estudo transversal, no qual, por meio de entrevista padronizada com o médico que admitiu as crianças gravemente enfermas que necessitaram de transporte pré-hospitalar ou inter-hospitalar, foram identificadas e caracterizadas possíveis complicações ocorridas durante esse transporte. Estes dados foram auditados por três médicos independentes que definiram a presença ou ausência de complicações durante o transporte. A segunda etapa constituiu-se de uma coorte prospectiva, na qual os pacientes, divididos em dois grupos distintos (com e sem complicações durante o transporte), foram seguidos, prospectivamente, por 60 dias, observando-se a ocorrência de morte ou alta hospitalar. Resultados: Foram incluídas 143 crianças no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 pacientes (52%). As complicações mais frequentes foram relacionadas com as vias aéreas (69%), seguidas por distúrbios metabólicos (47%), alterações cardiovasculares (40%) e falhas relacionadas aos dispositivos e à monitorização (37%). Na análise univariada, os seguintes preditores para ocorrência de complicações durante o transporte foram observados: peso <10Kg (risco relativo - RR: 1,52; intervalo de confiança (IC 95%: 1,11-2,09); distância >100Km (RR: 1,67; IC 95%: 1,16-2,40); presença de doença respiratória (RR: 1,46; IC 95%: 1,06-1,95) e comorbidades (RR: 1,68; IC 95%: 1,23-2,30). Já na análise multivariada, não foram observados preditores independentes para ocorrência de complicações. A ocorrência de complicações durante o transporte foi associada com maior taxa de mortalidade hospitalar (hazard ratio - HR: 5,668; IC 95%: 1,26-26,65; p=0,0130) e menor taxa de alta hospitalar (HR: 0,48; IC 95%: 0,31-0,74; p=0,0007). Após a aplicação da regressão de Cox para ajuste de potenciais fatores de confusão, a presença de complicação durante o transporte permaneceu associada com o índice de mortalidade hospitalar (HR: 6,74; IC 95%: 1,40-32,34; p=0,017), contudo deixou de ser associada com o tempo para a alta hospitalar (HR: 0,76; IC 95%: 0,49- 1,16; p=0,213). Conclusões: As complicações foram frequentes durante o transporte pediátrico. A presença de doenças respiratórias, peso <10Kg, presença de comorbidades e a distância >100 Km foram preditores de risco para a ocorrência dessas complicações. As complicações ocorridas durante o transporte foram associadas com o aumento nas taxas de mortalidade hospitalar. / Introduction: The medical transport of critically ill children involves characteristics that increase the risk of complications, which can contribute to an increase in length of stay and mortality. Objectives: To evaluate the frequency and type of complications observed during the pre-hospital and inter-hospital transport of critically ill children, as well as the impact of these complications on mortality, length of hospital stay and hospital costs. Patients and Methods: A study carried out in two stages: the first was a cross-sectional study where through a standardized interview with the doctor who admitted the critically ill children requiring pre-hospital or inter-hospital transport identified and characterized possible complications during this transport. These data were audited by three independent doctors who defined the presence or absence of complications during transport. The second stage consists of a prospective cohort study, where patients divided into two groups (with and without complications during transportation) were followed prospectively for 60 days observing the occurrence of death or hospital discharge. Results: We included 143 children in the study. At least one complication during transportation was observed in 74 patients (52%). The most frequent complications have been associated with airway (69%), followed by metabolic disorders (47%), cardiovascular disorders (40%) and failure in the device and monitoring (37%). In the uni-variate analysis, the following predictors for the occurrence of complications during transport were observed: weight <10 kg (relative risk - RR: 1.52; 95% confidence interval - CI: 1.11-2.09); distance greater than 100 km (RR: 1.67; 95% CI: 1.16-2.40); presence of respiratory disease (RR: 1.46; 95% CI: 1.06-1.95) and associated comorbidity (RR: 1.68; 95% CI: 1.23- 2.30). In the multivariate analysis, no independent predictors were observed for the occurrence of complications. The occurrence of complications during transport was associated with higher hospital mortality (hazard ratio - HR: 5.668; 95% CI: 1.26-26.65; p=0.0130) and a lower hospital discharge rate (HR: 0.48; 95% CI: 0.31-0.74; p=0.0007). After Cox regression to adjust for potential confounding factors, the presence of complications during transport remained associated with hospital mortality (HR: 6.74; IC 95%: 1.40-32.34; p=0.017), however, was not associated with hospital discharge rates (HR: 0.76; 95% CI: 0.49-1.16; p=0.213). Conclusions: The complications were common during pediatric transport. Distance greater than 100 km, presence of respiratory disease, associated comorbidity and weight <10 kg were risk predictors for occurrence of complications. Complications during pediatric transport were associated with increased hospital mortality rates.