The United States is experiencing a severe shortage of Emergency Medical Service (EMS) paramedics. The job outlook for paramedics (EMT-P) for the years 2012-2022 is predicted to increase by 23%-33%, which is much faster than the 4% average increase of other first-response professions. The average tenure of paramedics is less than 4 years. There is a significant gap in the literature concerning paramedic personality traits and tenure. The primary objective of the current study is to provide empirical data on the personality traits possessed by long-term paramedics (5+ years), and compare them to those with shorter tenure (< 5 years). Using Allport's Trait Theory, I predicted that personality would affect paramedic longevity. The 6 personality traits tested were warmth, reasoning, emotional stability, liveliness, social boldness and openness to change. A socio-demographic questionnaire, determined the length of their EMS career, while the 16PF® Assessment, tested their personality traits. Using t tests, Mann-Whitney U tests, and a set of regression analyses, data were examined to determine if length of career and personality traits predicted paramedic tenure. The research sample consisted of long term paramedics and former paramedics. The results showed that of the 6 personality traits, only warmth was a significant predictor of paramedic tenure. A logistic regression showed for every additional point in warmth, the odds of leaving EMS prior to 5 years increased by a factor of 2.77. This study provides support for positive social change by helping EMS to learn how to increase recruitment and tenure. It also helps by advising EMS agencies to attend to the mental and emotional health of their paramedics by being aware of the level of their warmth personality trait.

The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.

<p>Sammanfattning</p><p>Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre.</p><p>Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal.</p> / <p>Abstract</p><p>The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada.</p><p>The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients.</p><p>Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.</p>

Sammanfattning Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre. Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal. / Abstract The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada. The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients. Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.

No description available.

No description available.

The KwaZulu-Natal Department of Health highlighted in the 2005-2009/2010 Strategic Plan many challenges. One of the major challenges was an inadequate management information system at Emergency Medical Rescue Services (EMRS). It was further stated that decision-making becomes risky in the absence of reliable and accurate information. EMRS provides an ambulance service to the citizens of KwaZulu-Natal. This research will focus on EMRS in eThekwini District. In order to provide the best possible service to the citizens there has to be effective information management. The questionnaire survey used in this research project attempted to reach a broad cross-section of the various groups of people (management, operations and administrative staff) who take part in information work, and hence develop a broad sense of their perceptions and beliefs about how information is managed and used at eThekwini EMRS. The answering of questions varied between the groups. This showed that managers, operational staff and administrative staff have different perceptions on information management. Some of the recommendations included: EMRS has to adopt information as a strategic resource; information must be used in addressing problem areas; staff must have access to information that EMRS gathers; and further research has to be conducted at EMRS to address the challenges the organisation faces. / Thesis (MPA)-University of KwaZulu-Natal, Westville, 2010.

[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.

O tempo resposta é um indicador usado para avaliação da qualidade de serviços de atendimento pré-hospitalar (APH). Consiste no intervalo de tempo entre a expressão do pedido de socorro até a chegada da equipe à cena do evento. Assim, o objetivo do estudo foi analisar o tempo resposta de um SAMU, referente aos chamados para atendimentos clínicos e traumáticos demandados à Central de Regulação de Urgências. Os agravos clínicos foram compostos pelas síndromes neurológicas, cardiovasculares e respiratórias, por serem considerados agravos tempo dependentes; os agravos traumáticos foram constituídos pelos acidentes de trânsito e quedas, por serem os mais prevalentes no serviço. Trata-se de um estudo transversal retrospectivo. A amostra foi constituída por 1.580 atendimentos realizados em 2013, sendo 793 atendimentos clínicos e 787 atendimentos traumáticos. Os dados foram extraídos do sistema informatizado da central de regulação do SAMU de Porto Alegre (SAPH True), transpostos para o programa Microsoft Excel e analisados através do Programa Statistical Package for the Social Sciences (SPSS), versão 21.0. Os resultados evidenciam que o tempo resposta total foi de mediana de 19 minutos e os fatores que permaneceram associados estatisticamente com maior tempo de resposta total, após o ajuste pelo modelo multivariado, foram: tipo de socorro clínico (p<0,001), turno da noite (p<0,001), equipe básica (p=0,016), dias úteis da semana (p<0,001) e ocorrência de incidente no local do chamado (p=0,001). Em relação à faixa etária e gravidade presumida, não há diferenças significativas de tempo resposta. O tempo resposta total, formado pelas parcelas de tempo de cada etapa do atendimento, é influenciado pelo desempenho dos profissionais na comunicação e na avaliação das demandas do usuário e pelo tempo de mobilização da equipe para a partida para os atendimentos. O tempo resposta poderá ser reduzido através de processos de educação permanente com os profissionais do serviço para discussão e reorganização de práticas e com medidas de planejamento na organização estrutural do SAMU. / Response time (RT) is an indicator used to assess the quality of prehospital emergency care (PHEC). It is defined as the interval of time between a call for help and the arrival of the response team at the scene of the incident. In light of this, the objective of this study was to analyze the response time of the Brazilian Mobile Emergency Service (SAMU) to calls regarding clinical conditions and traumas made by the emergency control center. Clinical conditions comprised cardiovascular affections, neurological syndromes, and respiratory failure, due to their time-sensitive nature; traumatic injuries consisted of those caused by automobile accidents and falls, as they were the most prevalent in the service. This was a cross-sectional retrospective study with a sample of 1,580 cases from 2013, of which 739 were clinical conditions and 787 were traumatic injuries. Data were extracted from the SAMU call center’s computer system of the city of Porto Alegre (SAPH True), and then transposed to Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0. The results showed that median total response time was 19 minutes and the factors that were statistically associated with greater total response time, after adjustment by the multivariate model, were: type of clinical assistance (p<0.001), night shift (p<0.001), basic team (p=0.016), week business days (p<0.001), and the occurrence of an incident at the call location (p=0.001). There were no significant differences in RT in terms of age range and emergency severity. Total response time, defined as the sum of the time elapsed in each phase of emergency care, was influenced by the performance of health professionals in communicating and assessing user demands and team mobilization for departure. Response time can be reduced by means of continuing education processes with the service professionals to discuss and reorganize the practices, implementing measures to plan the service’s structural organization. / El tiempo de respuesta es un indicador usado para evaluación de calidad de atención de emergencias prehospitalarias (AEP). Es el intervalo temporal entre la solicitud del pedido de socorro hasta la llegada del equipo al lugar del evento. Se objetivó entonces analizar el indicador de tiempo-respuesta de un Servicio de Atención Móvil de Urgencias (SAMU) respecto de llamadas para urgencias clínicas y traumáticas realizadas a la Central de Regulación de Urgencias. Las urgencias clínicas consistieron en afecciones cardiovasculares, síndromes neurológicos y disfunciones respiratorias, consideradas urgencias tiempo-dependientes; las urgencias traumáticas constituyeron accidentes de tránsito y caídas, las más prevalentes en el servicio. Estudio retrospectivo transversal, con muestra constituida por 1580 atenciones realizadas en 2013, 793 clínicas y 787 traumáticas. Los datos se tomaron del sistema informático de la central de regulación del SAMU de Porto Alegre (SAPH True), fueron volcados a planilla de Microsoft Excel y analizados con Statistical Package for the Social Sciences (SPSS), versión 21.0. Los resultados evidencian que el tiempo de respuesta total tiene una mediana de 19 minutos, y los factores que permanecieron estadísticamente asociados al mayor tiempo de respuesta total luego del ajuste por modelo multivariado fueron: tipo de socorro clínico (p<0,001), turno nocturno (p<0,001), equipo básico (p=0,016), días hábiles (p<0,001) y acontecimiento de incidente en el lugar del llamado (p=0,001). Respecto a la faja etaria y gravedad presumida, no hay diferencias significativas de TR. El TR total, integrado por la sumatoria de lapsos de tiempo de cada etapa de atención, resulta influido por el desempeño de los profesionales en comunicación y evaluación de solicitudes del usuario, y preparación del equipo para salida de atención. El tiempo de respuesta podrá ser reducido a través de procesos de educación permanente con los profesionales actuantes en el servicio para discusión y reorganización de prácticas y con medidas de planificación en la organización estructural del SAMU.

In the diploma work, we familiarised the reader with the basic theoretical starting points concerning emergency medical services and preparedness for emergencies. First of all, in this part, we elaborated a basic overview of the organisational structure of the emergency medical services of the Ústecký kraj region, and of its subdivisions. Next, we outlined the educational system of the paramedical staff of the emergency medical services of the Ústecký kraj region, focused on the area of crisis management. The crisis management competence of paramedical staff involved in emergency medical services was the subject of a separate sub-chapter. We linked these chapters with the issue of the formation of the department of disaster medicine. Here, we defined the tasks and aims of disaster medicine. To create a better understanding of the issue, a part of the chapter consists of the basic terminology used in disaster medicine. The main aim of the diploma work is the analysis of the knowledge of the paramedical staff of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies. The sub-objectives of the thesis are the analysis of the knowledge of the medical rescue workers of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies, and the analysis of general nurses' knowledge of, and qualifications in, the specialist anaesthesiological-resuscitative care of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies. The methodology of the work lay in the quantitative analysis of statistical data that we gathered from questionnaires that were filled in by randomly selected respondents among the paramedical staff of the emergency medical services of the Ústecký kraj region. We prepared the content of the questionnaire in the context of the issues studied. The respondents chose from a number of pre-defined answers to a total of 20 questions. The data obtained underwent statistical analysis with the use of statistical research methods, scaling, measurement in descriptive statistics, elementary statistical processing, non-parametric testing, estimation theory, and parametric testing. From the results of the practical part of the diploma work, it is evident that the knowledge of the medical rescue workers of the emergency medical services in terms of the preparedness for emergencies of the Ústecký kraj region is close to the normal frequency distribution N (mi and sigma). Also the general nurses' knowledge of, and qualification in, the specialist anaesthesiological-resuscitative care of the emergency medical services of the Ústecký kraj region, in terms of preparedness for emergencies, is close to the normal frequency distribution N (mi and sigma).