Os serviços de urgência/emergência apresentam-se como uma das portas de entrada do Sistema Único de Saúde (SUS), têm por objetivo atender de forma imediata indivíduos com risco iminente de vida. Nos últimos anos, a demanda por atendimento nestes serviços tem aumentado, dificultando a organização do trabalho e o acesso aos pacientes que realmente necessitam, comprometendo a qualidade do trabalho da equipe de saúde. As mudanças no perfil de morbi-mortalidade por doenças crônicas não transmissíveis trazem repercussão para o atendimento às urgências/emergências hospitalares. Este estudo teve por objetivo caracterizar os atendimentos clínicos de adultos segundo aspectos demográficos, organizacionais e de diagnóstico médico de alta em um Serviço de Urgência de um Hospital de Ensino do interior de São Paulo, no ano de 2007. Trata-se de uma pesquisa com desenho metodológico quantitativo, do tipo descritivo e transversal, utilizando dados secundários, obtidos através de um banco de dados do próprio hospital, os quais foram analisados segundo a estatística descritiva, apresentados na forma de freqüência e porcentagens, discutidos a partir de referencial teórico de reorganização do atendimento a urgências/emergências clínicas na perspectiva do SUS. No período ocorreram 5285 atendimentos clínicos que se caracterizaram em sua maior parte por usuários do sexo masculino (54,1%), com escolaridade de ensino fundamental (73,9%), na faixa etária de 18 à 59 anos (62,8%), procedentes do município de Ribeirão Preto (63,7%). No que se refere ao diagnóstico mais freqüente encontramos a hipertensão essencial (primária), correspondendo a 4,9% do total de atendimentos realizados. Quanto as variáveis organizacionais que o mês com maior número de atendimentos clínicos foi janeiro, 10%, enquanto o mês de novembro teve o menor número de atendimentos clínicos (7,3%), o dia da semana que apresentou maior demanda foi a segunda-feira (16%); quanto a variável horário de entrada do paciente no serviço, das 12 às 24h obtivemos um porcentual de 67,1% do total de atendimentos clínicos. O principal motivo de saída após atendimento foi a internação hospitalar e o tempo de permanência na unidade predominante foi inferior a seis horas. A caracterização dos atendimentos clínicos do serviço de urgência/emergência fornece subsídios para a organização do trabalho na unidade de estudo e no próprio hospital. / Emergency services are one of the entrances of the Unified Health System (SUS). They aim to delivery immediate care to people at eminent risk of death. The demand for care in these services has increased in the last years. This makes the organization of the work and the access of patients who really need care more difficult, compromising the quality of the health team work. Changes in the profile of morbimortality by nontransmissible chronic diseases reflect on the care provided in hospital emergency services. This quantitative, descriptive, cross-sectional study aimed to characterize the adult clinical care delivered in an Emergency Service in a Teaching Hospital in the interior of the state of São Paulo, in 2007. Secondary data, obtained in the hospital database, were used to characterize care according to demographic and organizational aspects and the discharge medical diagnosis. Data were analyzed using descriptive statistics and presented as frequency and percentage. Data are discussed through the theoretical framework of the reorganization of clinical emergency care in the perspective of SUS. During the analyzed period, 5285 clinical care sessions were delivered, most clients were men (54.1%), with primary educational level (73.9%), between 18 and 59 years of age (62.8%), and lived in the city of Ribeirão Preto (63.7%). The most frequent diagnosis observed was essential high blood pressure (primary), corresponding to 4.9% of the total care sessions delivered. Regarding the organizational variables, it was found that January was the month with the highest number of care sessions (10%), while November had the lowest (7.3%). Monday was the day of the week that presented highest demand (16%); the peak time of patient\'s entrance to emergency service was between 12 am and 12 pm, with 67.1% of the total clinical care sessions. The main reason of exit after the care session was hospitalization, and the prevailing length of stay at the service was less than six hours. The characterization of the clinical care delivered at the emergency service supports the organization of the work in the service under study and in the hospital itself.

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Rodrigo Jensen / Banca: Shirlene Pavelqueiras / Resumo: O objetivo geral do presente estudo foi analisar os chamados da população obstétrica usuária do SAMU 192 de Botucatu no ano de 2012 com relação à sua pertinência, considerando a paridade das mulheres. Trata-se de estudo observacional e analítico, realizado com população de mulheres no ciclo gravídico/puerperal e com profissionais da rede básica de saúde do município de Botucatu-SP. Os dados foram coletados a partir das fichas de atendimento do Serviço e chamados pertinentes foram todos os que resultaram em encaminhamento ao hospital e quando classificados nas cores vermelha, laranja e amarela, segundo critério de risco proposto pelo Ministério da Saúde. Quanto aos profissionais, a amostra foi composta por 67 pessoas, entre médicos, enfermeiros, auxiliares/técnicos de enfermagem e agentes comunitários de saúde. Nas análises estatísticas foram utilizados o teste qui-quadrado, Kruskal-Wallis e exato de Fisher, sendo que em todos os casos considerou-se p crítico <0,05. As análises foram feitas com o software SPSS v15.0. Este estudo foi aprovado por Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu - UNESP. Para ambos os critérios de classificação utilizados, a prevalência de demanda não pertinente foi baixa. Não houve diferença estatisticamente significativa na demanda não pertinente segundo a paridade. Quando se consideram as diferentes categorias profissionais que atuam na atenção básica, não houve diferença entre elas, quando se investigou se primíparas devem ser prioritárias para o SAMU, quando comparadas às multíparas. O escore de conhecimento sobre a pertinência da demanda ao SAMU obtido pelos profissionais variou entre 7 e 8 e pode ser considerado elevado. A excelente condição da mulher no atendimento, as queixas brandas e o registro de achados leves pelos profissionais sugerem que o encaminhamento ao serviço de referência pode estar sendo superestimado, indicando falta de... / Abstract: The general objective of the present study was to analyze the calls from the obstetric users of SAMU 192 in Botucatu, in 2012, as regards their pertinence and taking the women's parity into consideration. The present analytic and observational study included a population of women in the pregnancy-puerperium cycle as well as professionals of the primary healthcare network in the city of Botucatu, SP, Brazil. Data were collected from records of the Service and pertinent calls were all those resulting in referrals to hospitals and classified as red, orange and yellow according to the risk criteria proposed by the Brazilian Ministry of Health. As regards the involved professionals, the study sample comprised 67 peoples including physicians, nurses, nursing assistants/technicians and community healthcare agents. The chi-square, Kruskal-Wallis and exact Fisher's tests were utilized in the statistical analyses, and the critic p value was set at <0.05. The analyses were performed with the SPSS v15.0 software. The present study was approved by the Committee for Ethics in Research of Faculdade de Medicina de Botucatu - UNESP. A low prevalence of non pertinent demand was observed as both classification criteria were considered. No statistically significant difference was observed in relation to the non pertinent demand as the women's parity was considered. As the different professional categories involved in primary healthcare activities were considered, no difference was observed in the degree of priority given by SAMU to primiparae and multiparae. The scoring of the professionals' knowledge about demand pertinence ranged between 7 and 8 and may be considered high. The excellent health conditions of the women at their admission, their mild complaints and the reporting of mild findings by the professionals suggest that the index of referrals to the reference center might be overestimated, indicating lack of integration between primary ... / Mestre

Thesis. 1975. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning. / Bibliography: leaves 137-139. / M.C.P.

Thesis. 1975. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning. / Bibliography: leaves 186-189. / by Shelley F. Bernstein, E. Michael Paul Thomas. / M.C.P.

Purpose: To evaluate the influence of physical fitness on the metabolic and perceptual responses to chest compression-only (CCO) CPR. Methods: In a counterbalanced design, forty-seven CPR-certified participants were randomized to perform: 1) a fitness assessment in which muscular (e.g., push-ups = PU) and cardiorespiratory endurance (e.g., step test recovery heart rate = RHR) were determined, and 2) a 10-minute CCO-CPR trial in which the heart rate (HR) response and ratings of perceived exertion (RPE) were determined. Results: Both PU and RHR were significantly correlated to the HR response to CCO-CPR (r = - 0.45, p < 0.01; r = 0.54, p < 0.001). PU were significantly correlated to RPE: local muscular (r = - 0.43; p < 0.01), central (r = - 0.45; p < 0.01), and over-all (r = - 0.39; p < 0.01). Conclusions: Greater physical fitness lessens the metabolic and perceptual strain to CCO-CPR. / by Adam J. Berrones. / Thesis (M.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Introdução Após mais de uma década de implantação do Serviço de Atendimento Móvel de Urgência (SAMU), torna-se importante lançar um olhar crítico a este serviço a fim de identificar as propostas da Política Nacional de Atenção às Urgências. Objetivo - Descrever e analisar criticamente o processo de trabalho da Central de Regulação do SAMU São Paulo (SAMU SP). Métodos Foi realizado um estudo de caso descritivo exploratório, com estratégia de métodos mistos, integrando as abordagens quantitativa (dados secundários referentes ao mês de outubro de 2012) e qualitativa (observação direta e entrevistas com três médicos reguladores). O banco de dados secundários permitiu descrever a demanda do SAMU SP e verificar a existência de padrões de associação entre as variáveis. Foi realizado o cálculo das frequências absolutas e relativas de todas as variáveis categóricas e cálculo dos tempos envolvidos no atendimento préhospitalar. As entrevistas foram transcritas e analisadas por meio da análise de conteúdo de Bardin com o objetivo identificar fatores subjetivos que não foram possíveis de serem mensurados na análise quantitativa. Foi realizada uma segunda análise estatística do banco de dados, com foco no processo de priorização das ocorrências, sendo investigadas as variáveis despacho e tempo de regulação, segundo determinante de prioridade e queixas principais. Foi utilizado o teste chi-quadrado para significância estatística. Resultados - A demanda é majoritariamente clínica (59,2 por cento ), masculina (52,2 por cento ), entre 20 e 59 anos (54,5 por cento ) e classificadas com Determinantes de alta prioridade (Echo e Delta) (52,5 por cento ). As transferências inter-hospitalares correspondem a 0,6 por cento da demanda. A frequência de despacho de ambulância é de 63,4 por cento e decresce conforme a prioridade diminui, chegando a 21,2 por cento no Determinante de menor prioridade (Ômega). O tempo resposta é inversamente proporcional ao Determinante de prioridade, e uma parte significativa de ocorrências de baixa prioridade (35,9 por cento ) são incluídas no sistema de saúde. Foram identificadas três dimensões que influenciam o processo de priorização das ocorrências: condições clínicas reportadas (parada cardiorrespiratória, problemas respiratórios, inconsciência) condições de vulnerabilidade e risco específicos (idosos e crianças abaixo de 3 anos, quedas, medo por parte do médico regulador de subestimar, presença de violência, interação com outros serviços) e condições intrínsecas ao processo de trabalho da central de operações SAMU SP (alta demanda e poucos recursos, trabalho colaborativo com outros profissionais). Conclusões A descrição e análise crítica da demanda e do processo de trabalho do SAMU SP traz elementos para a discussão sobre seu papel dentro do sistema de saúde do município. É possível afirmar que o SAMU SP tem cumprido a missão de salvar vidas, provendo assistência qualificada para pacientes classificados de altíssima prioridade que necessitam de atendimento fora do ambiente hospitalar. Ordenar a demanda de urgência e se configurar como um observatório de saúde passam pela necessidade do reconhecimento técnico e político de que se trata de um serviço integrado a rede de atenção à saúde e não apenas a rede temática da urgência / Introduction After more than a decade of Brazilian Mobile Emergency Services (SAMU) implementation, it becomes importante to launch a critical look at this service in order to identify the proposals of the National Policy for Emergency Care. Objective To critically describe and analyze the work process of SAMU Regulation Center of the city of São Paulo (SAMU SP). Methods A descriptive exploratory case study with mixed methods strategy, integrating the quantitative (secondary data for October 2012) and qualitative (direct observation and interviews with three regulatory physicians) approaches. The secondary database was used to describe SAMU SP demand and to verify the existence of patterns of association between the variables. Absolute and relative frequencies of all categorical variables and the times involved in prehospital care were calculated. The interviews were transcribed and analyzed through Bardin content analysis with the objective of identifying subjective factors that were not possible to be measured in the quantitative analysis. A second statistical analysis of the database was carried out, focusing on the prioritization of emergency incidentes. The frequency of dispatch and regulation time were investigated, according to the Priority Determinant and main complaint. The chi-square test was used for statistical significance. Results - The demand is composed mainly by clinical chief complaints (59.2 per cent ), male patients (52.2 per cent ), between 20 and 59 years old (54.5 per cent ) and classified with high priority determinants (Echo and Delta) (52.5 per cent ). Interhospital transfers correspond to 0.6 per cent of the demand. Ambulance dispatch frequency is 63.4 per cent and decreases as the priority decreases, reaching 21.2 per cent in the lowest Priority Determinant (Omega). The response time is inversely proportional to the Priority Determinant, and a significant portion of low priority occurrences (35.9 per cent ) are included in the health system. Three dimensions have been identified that influence the prioritization of emergency incidents: reported clinical conditions (cardiorespiratory arrest, respiratory problems, unconsciousness), vulnerable conditions and specific risk of the emergency incident (elderly and children under 3 years, falls, medical doctor fear of underestimation, presence of violence, interaction with other services) and work process intrinsic conditions of SAMU SP operations center (high demand and few resources, collaborative work with other professionals). Conclusions The description and critical analysis of the demand and work process of the SAMU SP brings elements to the discussion about its role within the health system of the city of São Paulo. It is possible to affirm that SAMU SP has fulfilled the mission of saving lives, providing qualified assistance to patients classified as high priority who need care outside the hospital environment. In order to SAMU SP organize the demand for urgent care and to be a health observatory, there is the need of technical and political re-recognition that it is a service integrated to the health care network and not just a thematic network of urgency

abstract: Emergency Medical Services (EMS) first response personnel treat urgent and immediate illnesses and injuries in prehospital settings, and transport patients to definitive care if needed. EMS originated during warfare. The practice of rescuing wounded soldiers started during the Byzantine Empire, and developed along with other medical advances to the present day. Civilian EMS in the United States grew rapidly starting in the 1960s. Following the landmark National Research Council white paper of “Accidental Death and Disability: The Neglected Disease of Modern Society”, the nation addressed the key issues and problems faced in delivering emergency medical services. Today, colleges and universities often sponsor EMS organizations to serve populations concentrated in complex campuses. These are collectively known as Collegiate-Based Emergency Medical Services (CBEMS). By September 2018, there were 252 registered CBEMS organizations in the United States. Most are affiliated with the National Collegiate Emergency Medical Services Foundation (NCEMSF), which advocates, encourages, and provides support for CBEMS organizations. A survey repeating prior work (1996 and 2005) was sent to all NCEMSF registered CBEMS organizations, and 24 responded. The survey included questions on demographics, response capacities, coverage, organization, and logistics information. Locally, Arizona State University Student Emergency Medical Services (SEMS at ASU) began as an all-student-run volunteer organization in 2008. In 2018, SEMS at ASU became ASU EMS, as an official subdivision of the ASU Environmental Health Safety (EH&S) Department. This study summarizes the history of EMS, investigates the current status of CBEMS organizations and traces the history of ASU EMS from a volunteer group to an official department. / Dissertation/Thesis / Masters Thesis Biology 2019

Agriculture is a hazardous industry with high rates of occupational industry. Due to a variety of occupation-related factors, farmers may also be at risk for delays in reaching trauma services. Though the state of Iowa has a comprehensive trauma system implemented to provide an efficient response to traumatic injuries, it is unknown how farmers fare in this system. The aims of this study were to determine if the use of emergency medical services (EMS), the occurrence of interfacility transfers, the time to definitive care in severely injured patients, and the length of prehospital intervals for those using EMS differs between farmers and other workers. A population-based, retrospective observational study was performed using data from the Iowa State Trauma Registry for the years 2005-2011. Eligible entries included adults (≥15 year old) sustaining an occupational injury within the state of Iowa and treated in an Iowa trauma center. Multiple imputation was performed to replace values for missing covariates. Logistic regression modeling was performed to examine the use of EMS and the occurrence of interfacility transfers among farmers compared to non-farmers. Survival analysis was performed to determine the time to definitive care for severely injured farmers compared to severely injured non-farmers; similarly, a survival-based multi-state model was performed to compare the prehospital time intervals for farmers to non-farmers among EMS users. The study demonstrated that the likelihood of EMS use was dependent on injury severity. For lower severity injuries, farmers were less likely to use EMS, but there was no difference in EMS use for high severity injuries. The occurrence of interfacility transfers was also dependent on injury severity as well as rurality. Farmers tended to be less likely to receive an interfacility transfer in more rural areas; in large town and urban areas, farmers tended to be more likely to receive an interfacility transfer, particularly for moderate and severe injuries. These trends were slightly stronger for EMS non-users than EMS users; however, the results did not reach statistical significance for most levels. The median time to definitive care for farmers was nearly an hour longer for farmers compared to non-farmers (1h48m vs. 2h46m, respectively). In the survival analysis, time to definitive care for severely injured farmers compared to severely injured non-farmers was found to be time-dependent, and was only significant in the first hour after injury. When the prehospital time intervals for farmers using EMS (included all severities) were compared to non-farmers, farmers took longer to complete the discovery, response, and transport intervals; the scene interval was the only interval that did not reach statistical significance. The results obtained from this study provide useful information about the operation of the Iowa State Trauma System. While EMS use was lower for minor injuries, farmers with severe injuries had no significant difference in EMS use compared to non-farmers, suggesting comparable access. Likewise, the probability of transfer was only higher in specific instances when the patient did not use EMS. However, the fact that both time to definitive care and several prehospital intervals were longer suggest that occupation-specific factors may contribute to delay. Further research is needed to identify these barriers and develop new strategies to improve the response to traumatic agricultural injury.

Background: Protection against cold is vitally important in prehospital trauma care to reduce heat loss and prevent body core cooling. Objectives: Evaluate the effect on cold stress and thermoregulation in volunteer subjects byutilising additional insulation on a spineboard (I). Determine thermal insulation properties of blankets and rescue bags in different wind conditions (II). Establish the utility of wet clothing removal or the addition of a vapour barrier by determining the effect on heat loss within different levels of insulation in cold and warm ambient temperatures (III) and evaluating the effect on cold stress and thermoregulation in volunteer subjects (IV). Methods: Aural canal temperature, sensation of shivering and cold discomfort was evaluated in volunteer subjects, immobilised on non-insulated (n=10) or insulated (n=9) spineboards in cold outdoor conditions (I). A thermal manikin was setup inside a climatic chamber and total resultant thermal insulation for the selected ensembles was determined in low, moderate and high wind conditions (II). Dry and wet heat loss and the effect of wet clothing removal or the addition of a vapour barrier was determined with the thermal manikin dressed in either dry, wet or no clothing; with or without a vapour barrier; and with three different levels of insulation in warm and cold ambient conditions (III). The effect on metabolic rate, oesophageal temperature, skin temperature, body heat storage, heart rate, and cold discomfort by wet clothing removal or the addition of a vapour barrier was evaluated in volunteer subjects (n=8), wearing wet clothing in a cold climatic chamber during four different insulation protocols in a cross-over design (IV). Results: Additional insulation on a spine board rendered a significant reduction of estimated shivering but there was no significant difference in aural canal temperature or cold discomfort (I). In low wind conditions, thermal insulation correlated to thickness of the insulation ensemble. In greater air velocities, thermal insulation was better preserved for ensembles that were windproof and resistant to the compressive effect of the wind (II). Wet clothing removal or the use of a vapour barrier reduced total heat loss by about one fourth in the cold environment and about one third in the warm environment (III). In cold stressed wet subjects, with limited insulation applied, wet clothing removal or the addition of a vapour barrier significantly reduced metabolic rate, increased skin rewarming rate, and improved total body heat storage but there was no significant difference in heart rate or oesophageal temperature cooling rate (IV). Similar effects on heat loss and cold stress was also achieved by increasing the insulation. Cold discomfort was significantly reduced with the addition of a vapour barrier and with an increased insulation but not with wet clothing removal. Conclusions: Additional insulation on a spine board might aid in reducing cold stress inprolonged transportations in a cold environment. In extended on scene durations, the use of a windproof and compression resistant outer cover is crucial to maintain adequate thermal insulation. In a sustained cold environment in which sufficient insulation is not available, wet clothing removal or the use of a vapour barrier might be considerably important reducing heat loss and relieving cold stress.

This thesis investigated whether or not the parents of children seen in emergency treatment department could learn the child's medical regime better if reinstructed on the regime in a quiet place after the child has been discharged from the department. An experimental group reinstructed under the above conditions was compared with a control group.The investigation revealed that there was better learning of medical instructions by those parents reinstructed on the medical regime under the ideal conditions in the emergency treatment department.Ball State UniversityMuncie, IN 47306