Objective: There is growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental. Methods: Data from OHCA patients treated in EMS systems that cover approximately 70% of Arizona's population were evaluated (October 2004-December 2006). We analyzed the association between transport interval (depart scene to ED arrival) and survival to hospital discharge in adult, non-traumatic OHCA patients and in the subgroup who achieved ROSC and remained comatose. Results: 1846 OHCA occurred prior to EMS arrival. Complete transport interval data were available for 1177 (63.8%) patients (study group). 253 patients (21.5%) achieved ROSC and remained comatose making them theoretically eligible for transport to specialized care. Overall, 70 patients (5.9%) survived and 43 (17.0%) comatose ROSC patients survived. Mean transport interval for the study group was 6.9 min (95% CI: 6.7, 7.1). Logistic regression revealed factors that were independently associated with survival: witnessed arrest, bystander CPR, method of CPR, initial rhythm of ventricular fibrillation, and shorter EMS response time interval. There was no significant association between transport interval and outcome in either the overall study group (OR = 1.2; 0.77, 1.8) or in the comatose, ROSC subgroup (OR 0.94; 0.51, 1.8). Conclusion: Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.

South African incidence of rape ranks amongst the highest worldwide. No direct policy exists for the emergency care provider management of rape victims in the pre-hospital setting. The pre-hospital exposure to rape cases is unknown as its health information system is not gender-based violence sensitive. In the absence of a clearly defined protocol, indiscretion in the emergency care treatment of rape victims remains undocumented. As a particularly vulnerable group globally, victims of rape are deserving of focused intervention. A qualitative, descriptive approach guided the research in which nine semi-structured voluntary interviews were held with emergency care providers, forensic medical practitioners and emergency consultants. Through a critical theory lens thematic content analysis was employed. University of Cape Town ethics approval was attained. The study found that pre-hospital providers lack knowledge and skills of rape victim identification and management but are desirous of evidence-informed guidelines for treatment and referral in a multidisciplinary approach. Educational and policy deficiencies are documented. The recommendations support a community of practice that is mutually inclusive of specialist rape-care centres, emergency department and pre-hospital providers in the interest of forensic emergency medicine. Due regard must be had for needs of practitioners at risk of vicarious traumatization from sexual assault management. Transformative curricula and responsive clinical guidelines are likely to redress any complicity of the health sector non-response to rape/sexual assault. This study is likely to benefit emergency care regulators, educators and researchers whose professional interest is to promote responsivity of the health system to rape.

Pain is the universal symptom of illness and trauma. It affects people of all ages, cultures, and backgrounds, causing distress and suffering. Appearing in a plethora of diagnoses, almost all patients will experience some type of pain as a related symptom during their lifetime. The ubiquitous nature of pain renders it likely that a wide variety of healthcare providers will treat patients reporting pain in both the acute care and longitudinal settings. Many institutions and governing bodies in the medical sphere have emphasized the duty of the medical field to treat pain and thereby alleviate suffering. It is common for Emergency Medicine (EM) physicians to manage patients presenting to the Emergency Department (ED) in pain. Although these patients’ etiologies for their pain may differ, most will be experiencing pain from an acute insult. Emergency Medical Services (EMS) is the extension of EM into the prehospital setting. As such, EMS providers interact with many of the same patients experiencing acute pain. Despite the prevalence of pain and the importance of alleviating it, acute pain management has often been inadequate. Improving pain management should continue to be a high priority. Opioid analgesics have long been the standard of care for acute pain management. The first opiate, morphine, was isolated in the early 1800’s. Opioids are potent analgesics and are titratable to effect. However, they have a significant adverse effect profile. Among other adverse effects, opioids can cause hypotension and respiratory depression. In addition, the United States opioid epidemic has placed increased pressures on EMS and the entire healthcare profession to utilize opioid alternatives while continuing to improve the quality of acute pain management provided to patients. As a result, non-opioid analgesics have gained increased attention and use in EMS. They generally have fewer adverse effects than opioids and are not typically associated with a potential for addiction and abuse. However, the individual and subjective nature of the pain experience increases the difficulty of achieving improved analgesia. EMS providers must weigh these various factors and the complexity of the pain experience when determining the most appropriate treatment for acute pain. This review seeks to determine if non-opioid analgesics have potential for use as first line treatment by EMS over opioid analgesics, the standard of care for acute pain management. The purpose of this review of the current literature, especially comparison studies, is to investigate the common EMS analgesics: morphine, fentanyl, acetaminophen, ketorolac, ibuprofen, nitrous oxide, methoxyflurane, and ketamine. The findings are discussed in relation to four important outcome measures identified: effect on pain severity, rescue analgesic use, patient satisfaction, and the consideration of risks. Due to the paucity of research on this important topic, a general recommendation cannot be made for the use of non-opioid analgesics as first line treatment for acute pain management by EMS. However, this review provides several specific suggestions regarding the use of non-opioid analgesics as first line treatment by EMS. Applicability concerns are addressed, and a protocol is presented that EMS could use to adapt the findings to existing protocols.

Recruiting and retaining physicians to work in rural emergency departments (EDs) have reached a crisis level, threatening the availability of services to rural residents. In this study, a case study design was used to explore strategies that rural ED administrators use to recruit and retain physicians to work in their facilities. The study population consisted of 5 rural hospital administrators operating EDs in central Mississippi. These administrators were charged with the responsibility to recruit and retain ED physicians. The on-going staffing of ED physicians, with no lapses in coverage, was evidence that these administrators successfully recruited and retained ED physicians at their facilities. The conceptual framework that grounded this study was strategic human resource management. Semistructured interviews were used to collect data from participants, and the modified van Kaam method of data analysis was used to create and cluster themes, validate data, and to construct and describe textural meaning. One of the dominate themes that emerged from the study was the challenge of maintaining rural ED physician coverage. Deterrents to maintaining ED coverage included insufficient pools of available physicians, changing technological demands, and financial constraints. A second dominate theme permeating the study was the insufficient focus on retention of rural ED physicians. Study findings may contribute to social change by providing a replicable recruitment and retention model for recruiting and retaining rural ED physicians. The most successful strategies to recruit and retain ED physicians, as identified in this study, were provision of financial incentives and development of a sense of family and community.

This study examines the administration of emergency medical services (E.M.s.) in San Joaquin County. The analysis proposes to determine whether any serious inadequacies exist with the system as it is administered presently. There were three major sources for this research. The legislations on E.M.S. (federal, state and local), and the writer's personal working participation (as a staff member of the San Joaquin Comprehensive Health Planning Association) in the development of plans in this substantive area, and as a "participant observant at the San Joaquin County General Hospital, (with the Social Services Department). The rather limited bibliography on the subject Has consulted and adaptations are made to make this a scholarly exercise. However, because of the nature of the subject, this is an attempt to present a qualitative rather than a quantitative analysis. The discussion is divided in five parts. The first chapter lays out the basic concepts of an Emergency Medical Services System and discusses the most relevant aspects of the federal legislation on E.M.S. and its ramifications on state and local policies. In the second chapter, a policy model is developed, against which the existing system is later tested. This model is based mostly on state (of California) specifications and on the Federal Emergency Medical Service System Act of 1973. The third chapter describes the county from a geographic and socio-economic perspective, and points out emergency medical needs in the county. Chapter four evaluates E.M.S. resources and their use in San Joaquin County, measuring adequacy against the ideal system developed in Chapter two, and identifies problems and states recommendations in each area evaluated. Chapter five discusses methods for future evaluation of the System. The thesis concludes with the writer's personal observations about the system in the county.

Människor med hjärt- och kärlrelaterade åkommor är den främst förekommande patientgruppen att utredas och behandlas inom akutsjukvården. Behandlingsresultatet för dessa patienter har ett starkt samband med ett skyndsamt och korrekt omhändertagande, blir patienten inte korrekt prioriterad kan det leda till allvarliga vårdskador. Forskning visar att sjuksköterskor brister i att urskilja patienter med akuta hjärt- och kärlhändelser ur de stora patientflödena som akutsjukvården idag har. Syftet med studien var att belysa faktorer som påverkar identifiering av patienter med akut hjärt- och kärlsjukdom. Metoden som arbetet grundar sig på är en litteraturöversikt med systematiska artikelsökningar. Datainsamlingen har utförts i databaserna PubMed och CINAHL Complete. Femton vetenskapliga artiklar har granskats, sammanställts, analyserats och kritiskt utvärderats. Resultatet lyfter ett antal faktorer hos sjuksköterskan och patienten som påverkar sjuksköterskans möjligheter att identifiera de patienter som drabbats av en akut hjärt- och kärlhändelse. Sjuksköterskans kunskap, erfarenhet och individuella mål samt patientens demografi, symtombild och tidigare medicinska historia är alla faktorer som redovisas i resultatet. Även betydelsen av fortbildning och beslutsstöd för sjuksköterskan framhålls. Slutsatsen som baseras på studiens resultat understryker sjuksköterskans betydelse i det akuta omhändertagandet av de hjärt- och kärlsjuka patienterna. Sjuksköterskans förmåga att identifiera korrekt vårdbehov för enstaka patient leder till ökad vårdkvalitet för vårdtagarna och en minskad risk för vårdskador. Det är viktigt att ytterligare studera dessa faktorer så att adekvat och korrekt vård upprätthålls vid patientomhändertagande i det akuta skedet. / People suffering from cardiovascular diseases are the most common patient group that is examined and treated in emergency care. Treatment outcome for these patients has a strong connection with prompt and correct choice of therapy, if the patient is not prioritized correctly it can lead to serious healthcare injuries. Research shows that nurses fail to distinguish patients with acute cardiovascular events from the large patient flows in emergency care units. The aim of the study was to clarify factors that influence the nurse's ability to identify patients with acute cardiovascular disease. The method used in this study is a literature review where article searches and data collection have been carried out using the databases PubMed and CINAHL. Fifteen scientific articles have been reviewed, compiled, analysed and critically evaluated. The result highlights several factors in nurse and patient characteristics that affect the nurse's ability to identify patients suffering from an acute cardiovascular event. The nurse's knowledge, experience and individual goals as well as patient's demographics, symptom picture and previous medical history are all factors that are reported in the result. The importance of continuing education and decision support for the nurse is also emphasized. Conclusion based on the results of the study underlines the importance of the nurse’s role in urgent care of patients suffering from cardiovascular diseases. The ability to identify correct treatment for each individual patient leads to an increased quality of care and reduced risk of healthcare injury (for the patient). Further studies of these factors are needed in order to maintain adequate and correct patient care during the acute phase of cardiovascular events.

SAMMANFATTNING Bakgrund Definitionen av missfall är ett spontant avslut av graviditeten utan att aktiva åtgärder vidtas. Ett missfall innebär att graviditeten avslutas innan vecka 22 och 80–85 procent av samtliga missfall inträffar i tidigt stadie. Varför en kvinna drabbas av missfall kan ha flera orsaker. Vid ett missfall står kvinnan inför fysiska såväl som psykiska utmaningar och vänder sig därför till akutsjukvården där ett personcentrerat bemötande är önskvärt. Syfte Syftet var att lyfta kvinnors upplevelser i mötet med sjuksköterskan inom akutsjukvården vid missfall. Metod Resultatet i litteraturöversikten baserades på 16 vetenskapliga artiklar där kvinnors upplevelse av akutsjukvården vid missfall presenterades. För att finna de vetenskapliga artiklarna hade författarna databaserna PubMed och CINAHL till hjälp. I litteraturöversikten beskrevs ett tydligt urval. En kvalitetsgranskning utfördes med stöd av Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering. Data analyserades stegvis. Resultat Resultatet beskriver att kvinnor upplevde brister vid besöket med sjuksköterskan inom akutsjukvården. Kvinnorna kunde uppfatta kommunikationen och informationen som oärlig och otillräcklig samt brister i kontinuiteten som gjorde dem förvirrade. De påpekade brister i det emotionella stödet och respekten till deras integritet, vilket för kvinnorna inte främjade förlusthanteringen. I resultatet framhävs fyra kategorier som författarna genom analys lyfte som grundpelare i kvinnornas upplevelse av akutsjukvården. Dessa var information och kommunikation, emotionellt stöd, hotad integritet i den akuta miljön samt uppföljning och framtid. Slutsats Kvinnans upplevelse av akutsjukvården var ett resultat av olika faktorer. Att drabbas ett missfall kunde vara en traumatisk upplevelse. Denna litteraturöversikt visar att kvinnorna önskade ett empatiskt bemötande, tydlig information och att sjuksköterskan i omvårdnaden inom akutsjukvården behövde ett helhetsperspektiv. Vid ett missfall, en förlust, framträdde känslor som sjuksköterskan behöver ha kompetens, respekt och visa emotionellt stöd för. Detta för att kvinnorna skulle uppleva mindre lidande och förbättra deras upplevelse som i dagsläget innefattar betydande brister. Nyckelord: Akutsjukvård, empati, kommunikation, känslor, missfall / ABSTRACT Background Definition of miscarriage is a spontaneous termination of pregnancy without any action being taken. A miscarriage means that the pregnancy ends within week 22, 80–85 percent of all miscarriages occur at an early stage. Why a woman suffer from miscarriage can have several causes. In case of miscarriage, the women face physical and mental challenges and therefore seek care at emergency departments, were a person-centered care is useful. Aim Women’s experiences encountering nurses in the emergency care of miscarriage. Method This literature review was based on 16 scientific articles presenting women's experience with nurses of emergency care in case of miscarriage. To find the scientific articles, the authors used the databases PubMed and CINAHL. A clear selection was described. A quality examination was performed with the support of Sophiahemmet Högskola's assessment basis for scientific classification. Data were analyzed step by step. Results The result describes that women experienced deficiencies of various kinds during their visit with nurses at the emergency department. The women could perceive communication and information as dishonest and insufficient. They pointed out deficiencies in the emotional support and respect for their integrity, which for women did not promoted the management of the loss. The result highlights four categories that lifted as mainstays of women's experience of emergency care. These were information and communication, emotional support, threatened integrity in the emergency environment, and follow-up and future. Conclusions A miscarriage can be a traumatic experience. This literature review shows that women want empathic care, evident information, and a nurse with a holistic perspective. In case of miscarriage, women will show emotions that requires the nurse to have necessary skills, respect and be able to support emotionally. This was helpful for the women so that they shall suffer less and also improve their experience that have great flaws. Keywords: Abortion spontaneous, communication, emergency medical services, emotions, empathy

Akutsjukvården är en högriskmiljö som karaktäriseras av flera parallellt pågående arbetsprocesser som måste samverkas och korta vårdtider. Patienten flyttas flera gånger mellan olika enheter och rapporteras mellan personal. En säker kommunikation är korrekt, fullständig, avgränsad och kommuniceras på ett tydligt sätt och i rätt tid. Det finns standardiserade kommunikationsverktyg som underlättar en säker informationsöverföring, de härstammar ifrån flygindustrin. Patienten har rätt till en säker vård, där vårdpersonalen kan kommunicera med varandra på ett säkert sätt och samarbeta i team för att uppnå en patientsäker vård. Syftet var att utifrån ett sjuksköterskeperspektiv beskriva informationsöverföringen vid patientöverlämningar i akutsjukvård. Metoden som användes var en litteraturöversikt där 17 artiklar inkluderades. Artiklarna hämtades från databaserna PubMed, Cinahl och PsycINFO. Artiklarna kvalitetsgranskades med hjälp av en bedömningsmall och en integrerad analys utfördes utifrån artiklarnas resultat. Artiklarna var peer reviewed och etiskt godkända. Resultatet visade att det fanns olika metoder för patientöverlämning, muntligt både bedside och på sjuksköterskeexpeditionen, samt med hjälp av elektroniska verktyg. Sjuksköterskorna presenterade både för och nackdelar med de olika metoderna. Att använda ett standardiserat kommunikationsverktyg visade sig förbättra kvaliteten på patientöverlämningen. Ostrukturerade rapporter, extrem arbetsbelastning och stressfylld miljö försvårade en patientöverlämning, samt att bli avbruten mitt i rapporten. Sjuksköterskorna efterfrågade en ostörd miljö att ge rapport i och att rapporten skulle genomföras utifrån ett standardiserat kommunikationsverktyg. Slutsatsen är att sjuksköterskan behöver vara medveten om vilka risker som en patientöverlämning innebär, samt förmedla informationen utifrån ett standardiserat kommunikationsverktyg för att bidra till en säker vård för patienten.

Emergency medical services personnel work in a fast-paced, stressful environment requiring rapid, efficient response to critical situations, creating unique safety considerations within the workforce. With an occupational fatality rate notably higher than average, most of which are attributed to vehicular crashes, compounded by risks faced on rural roadways, rural EMS personnel face unique driving challenges that may be exacerbated by the very traits, self-efficacy and risk propensity, that may have initially drawn them to the profession. The purpose of this study was to identify the extent to which rural EMS personnel engage in off-duty, risky driving behaviors and to examine the relationship between these behaviors and their levels of risk propensity as well as their self-efficacy relative to driving. A cross-sectional, quantitative study was conducted to explore the relationship between the variables. A 63-item survey was completed by 227 rural EMS personnel. The statistical model resulting from this study identifies risky-driving self-efficacy and risk propensity as significant predictors of engaging in risky driving behaviors, with self-efficacy emerging as the strongest predictor. The predictive model fit well within the Social Cognitive Theory construct of triadic reciprocity, providing a platform from which to develop mitigating strategies to foster systemic as well as behavioral changes, while tailoring interventions to highly self-efficacious, risk-taking individuals who gravitate toward risky professions, including rural EMS personnel.

The health sector is evolving at a rapid pace with a growing task force of health workers ready to defend us from various diseases. Emergency Medical Services(EMS) have therefore become extremely important to empower the health workers. In order to facilitate them to deliver the fast treatment to patients the fast transit of patients to the hospital and access to the right equipment is extremely crucial to save lives. UAV (Unmanned Aerial Vehicle) or drone is a promising candidate for the current problem. However, these drones are prone to be attacked by intruders with a few lines of code. This literature review will shed light on the security threat in the EMS to analyze the risk to UAVs.