Background Point-of-care blood gas analysis is considered a standard of care in modern air ambulance operations by many professional organisations for clinical assessment and monitoring of patients. Instances where point-of-care blood gas analysis has identified clinically significant abnormalities which then led to clinical intervention are well documented and have been quantified previously in the air ambulance environment. However, results obtained from point-of-care blood gas analysis are not always required for patient care, nor do they always result in any clinical action on the part of the medical crew. Our question therefore related to the data for a Johannesburg based jet air ambulance service. Methods By means of retrospective case reviews over a one year period, we reviewed the overall frequency of utilisation of point-of-care blood gas analysis on patient transportations within a Johannesburg based jet air ambulance service. We established how often point-of-care blood gas analysis yielded abnormal findings, and how frequently abnormalities detected by point-of-care blood gas analysis resulted in clinical interventions. Results Point-of-care blood gas analysis was undertaken in 266 of 334 patients transported (79.6%). Abnormal findings were noted in 203 of the 338 blood gas analyses undertaken (60.1%). Patient age (p=0.001) and intubation status (p=0.01) were significant influences on number of analyses performed, while flight time was not significant (p=0.07). Clinical intervention followed in 65.5% of instances where abnormalities on blood gas analysis were noted and in 87.6% where clinical corrective intervention was assessed as being possible under prevailing conditions. Of all patients transported, some form of clinical intervention was undertaken following 39.3% of all blood gas analyses undertaken. This therapeutic yield evidenced is equivalent to 2.54 samples analysed per corrective clinical action evidenced. A costing analysis further revealed that this testing is relatively inexpensive per positive finding yielded and subsequent clinical actions. Conclusions Abnormalities detected and subsequent clinical intervention using point-of-care blood gas analysis in this patient population was significant with a clinical yield of 39.3%. Since the costs are also not very high this modality is rightfully considered a minimum standard of care in air ambulance operations. These findings also support the notion that such testing should be carried out routinely on all patients irrespective of clinician interpretation of indication or need

To determine the level of self-assessed competence various registrars possessed in emergency skills as well as to identify any factors that may have contributed to their level of competence. Materials and Methods: Questionnaires were completed by registrars working in General Surgery, Internal Medicine, Psychiatry and Radiology in three academic hospitals in Johannesburg. Information regarding demographic data, educational background, work experience in emergency-related environments and resuscitation courses attended were collected. Registrars rated their level of perceived competence in a list of 25 emergency skills according to a ranking scale of 1 to 5. Results: A total number of 94 registrars participated in the study which amounted to an estimated response rate of 35%. General Surgery registrars had the highest mean competence scores of 3.7 and 3.9 for the respective basic and advanced skills groups. General Surgery and Internal Medicine registrars had the highest mean competence scores of 3.7 for the intermediate skills group. Psychiatry registrars had the lowest mean competence scores of 2.7, 2.4 and 1.5 in each of the skill groups. Registrars who had current certification in a PALS course had competence scores 0.6 units higher than others in both basic (p=0.027) and advanced (p=0.035) emergency skills. Conclusions: General Surgery and Internal Medicine registrars have a higher level of perceived competence in various emergency skills. The General Surgery group rated themselves the highest in levels of competence in the basic and advanced emergency skills groups. Current certification in BLS, ACLS, PALS and AMLS has a positive impact on registrars‟ self-perceived levels of competence in emergency skills. Registrars who had spent less time between community service and starting their specialist training had higher levels of self-perceived competence in intermediate and advanced emergency skills.

The purpose of this qualitative study was to investigate whether there were differences between the preconceived notions of emergency medical technicians and paramedics prior to entering the profession and their notions of the vocation after facing the realities of the job. The contribution of alignment or misalignment to job satisfaction and the intention to leave the profession was also further investigated. This research is important as there currently is a gap in the literature pertaining to the factors affecting career longevity of emergency medical service (EMS) professionals. The degree of fit between individual and occupational characteristics guided this phenomenological study according to Lowman's theoretical model of career assessment and counseling. Study participants (n = 10) were recruited from organizations providing EMS training courses and ambulance service providers in New York State. Data were collected from semistructured interviews and the information was coded into themes. Key findings indicated aligned expectations and experiences of altruism led to satisfaction, physical challenges not considered prior to employment were associated with intent to leave the profession, and a perception of EMS as a transient career. This study's implications for positive social change are that its results will likely aid organizations in developing strategies to retain prehospital service workers, resulting in improved responses to the medical emergencies of communities and improvements in the care provided to society's sick and injured.

The major purpose of this study was to develop an Adaptation Model for emergency departments in urban and suburban Health Maintenance Organizations. Questions explored which provided data for the Model were: 1) are there significant differences in the demographic, sociologic, and decision-making characteristics of clients seeking services in emergency rooms and after-hour clinics?, and 2) are there significant differences in perceptions of access-related problems and stated preferences for personal physicians among clients seeking such services? A pilot study was completed, critiqued, and analyzed. Final research instruments were developed for adults and children. Questionnaires were completed by 1,031 clients in an urban and suburban facility of the Kaiser-Permanente Medical Care Program in Portland, Oregon. Data analysis was completed using the Statistical Package for the Social Sciences sub-program FREQUENCIES, CROSSTABULATION, AND DISCRIMINANT. Major findings of this study were: 1) no significant differences existed in the demographic and sociologic characteristics of clients, 2) significant differences were found in perceived problems of access, in decision-making characteristics, and in preferences for personal physicians. Significant items were: 1) convenience of the facility location, 2) immediacy and availability of care, 3) contact prior to arrival, 4) instruction by "nurse" to seek care, 5) clients reporting they did not have a personal physician, and 6) repeated use of the emergency department during the previous year. Different profiles of decision-making characteristics of urban and suburban clients resulted from the analyses. The overall pattern of care for children varied less between urban and suburban settings than did the pattern of care for adults. Findings were discussed in terms of the traditional model of emergency department care. Conflicts arising from system "controls" provided the basis for suggesting changes incorporated into the Adaptation Model. The basic premise for the Adaptation Model advances the point at which triage occurs, eliminates conflicts of control, and thus modifies both consumer behavior and the emergency department system. / Graduation date: 1982

published_or_final_version / Community Medicine / Master / Master of Public Health

Background Emergency department (ED) overcrowding has become a worldwide problem over the past few years, which has been reported in USA, Canada, New Zealand and Australia. For the past two decades, ED overcrowding has also become a controversial issue in Hong Kong, due to high demand for emergency service and misuse of emergency services. In 2002, although there was a charge for emergency department visit which led to a markedly decrease (19.1%) of total attendance, but now the rising trend of ED overcrowding seems to resurface during past few years. This paper aims to review and synthesis causes of ED overcrowding and possible interventions so as to provide possible recommendations for emergency care in Hong Kong. Methods Literatures on ED overcrowding and potential interventions were searched from PubMed, Google Scholar and Google to locate all relevant articles in English up to May 2013. Through PubMed, ED was described using “Emergency Medicine [MeSH]” OR “emergency department” OR “emergency”, and overcrowding was described using “Crowding [MeSH]” OR “crowded” OR “overcrowding” OR “overcrowded” OR “congestion”, and interventions was described using “interventions” OR “solutions”. Besides, relevant emergency medicine literatures published from the Hong Kong Journal of Emergency Medicine were also reviewed. Results I identified and reviewed relevant articles and found that ED attendance has been steadily rising during the past decades in Hong Kong. Although the causes may be somewhat different between different countries, causes of ED overcrowding could be related to easy access to emergency services, barriers to primary care as well as specialist care, and the rising aging population which might be an important underlying cause. As the problem of ED overcrowding will have significant negative impact on patient outcomes, such as unnecessary death, two common interventions to the problem are increasing the resources and demand management. Apart from increasing resources within emergency departments to cater for the increasing demand, it is of highly significance to improve community and primary care for the needs of older people who will contribute a great proportion to ED overcrowding in the future. Conclusion Semi-urgent and non-urgent visits do account for a great proportion among the total attendance, so it is important triage these patients to alleviate the overcrowding. What’s more, pressure on EDs can be related to a significant increase in the number of elderly patients who may require more investigation or admissions, and need much longer time to manage. As a result, future health policies should focus more on the aging population to improve emergency care. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

No description available.

Strong earthquakes are frequent catastrophic disasters occurring worldwide and often lead to structural collapse of buildings. Urban Search and Rescue (USAR) is the specialised process of locating, extricating and providing immediate medical treatment to victims trapped in collapsed structures. This research project aimed to identify the key preparedness efforts necessary by an earthquake affected country to ensure best coordinated use of international USAR assistance.

Thesis (Ph. D.)--University of New South Wales, 2002. / Also available online.