Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 74-75).

This study was designed to determine if a need exists to teach decision making skills to paramedic students in San Bernardino County.

Dissertation submitted in fulfillment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2012. / Background In the emergency setting, the onus is on the individual practitioner’s ability to make critical decisions at critical moments in order to provide the best level of care to their patient. In order to ensure that these decisions fall in line with the best interests of the patient, the South African paramedic requires a better understanding of how to arrive at such a decision; they need to understand the clinical decision making process. This study focused on South African paramedic clinical decision making with specific reference to acute traumatic pain management, with the aim of determining the factors which influence South African paramedic clinical decision making by revealing the current method of pain management employed by South African paramedics, how they view the priority of pain management in the continuum of care and if there were any context specific factors influencing their clinical decision making. Methods A mixed method design was used to determine the factors contributing to the clinical decision making process of South African paramedics in the acute pain management of patients with acute traumatic pain. A mixture of qualitative and quantitative approaches was utilized by means of a research questionnaire as well as in-depth interviews. The questionnaires were targeted at all South African paramedics while the in-depth interviews were conducted with five participants who had been purposefully selected from the questionnaire respondents. The data analysis was conducted in a descriptive manner in order to inform the explanatory nature of the answers to the research questions and objective. Results The results provided insight into the current methods and clinical decision making processes employed by South African paramedics in the management of patients’ experiencing acute traumatic pain. The study determined that the South African paramedic’s clinical decision making process involves three key phases in the acute traumatic pain management setting, the assessment phase, the initiation/pain management phase and the conclusion/re-evaluation phase, with each phase utilizing different decision making models, the intuitive/humanist model, the hypothetico- deductive model and a model which combined both of the aforementioned models. In addition to this, numerous factors such as the provision of care in order to facilitate further management and transportation to an appropriate facility, which influenced clinical decision making, were identified. Amongst South African paramedics, pain management was identified as coming second only to the interventions required to manage immediately life threatening conditions in terms of the prioritization of treatment. Recommendations A variety of recommendations which included the need to further the development of clinical decision making and pain management through research and education as well as considerations for investigation into the potential expansion of South African paramedic scope of practice in the pain management environment were made.

Bakgrund: Ambulanspersonal är en yrkesgrupp som i sitt yrkesutövanden riskerar att utsättas för traumatiska händelser som kan vara mycket påfrestande och stressfulla. Trots erfarenhet och träning blir vissa trauman stundtals övermäktiga och kan ge reaktioner som posttraumatiskt stressyndrom. Risken att utveckla PTSD ökar med antalet upplevda trauman och prevalensen i yrkesgruppen är hög. Syfte: Syftet var att beskriva vilka traumatiska händelser ambulanspersonalen upplevde som mest stressfulla. Syftet var även att beskriva ambulanspersonalens upplevelser och hantering av posttraumatiskt stressyndrom i relation till traumatiska händelser i sitt yrkesutövande. Syftet var dessutom att granska artiklarnas kvalitet utifrån den metodologiska aspekten undersökningsgrupp. Metod: Beskrivande litteraturstudie innefattande elva vetenskapliga artiklar av både kvalitativ och kvantitativ ansats sökta i medicinsk och omvårdnadsorienterade databas. Huvudresultat: Traumatiska händelser som upplevdes mest stressfulla innefattade händelser som involverade akut sjuka och allvarligt skadade barn, vilka väckte en emotionell respons och där ambulanspersonalen identifierade sig med nödställda. Upplevelser av PTSD kännetecknades av överspändhet, sämre prestation, mental avstängning och återupplevande av minnesbilder. Hantering av PTSD utmärktes av copingstrategier som känslomässig distans, fokusering, stöd, återhämtning, kontroll och förberedelse. Slutsats: Ambulanspersonal upplever i sitt yrkesutövande traumatiska händelser som kan vara mycket stressfulla och som kan leda till posttraumatiskt stressyndrom. Upplevelserna kan ge psykiska och fysiska symtom som påverkar hälsa och funktionsförmåga. Ambulanspersonalen behöver utbildning i copingstrategier för att hantera kritiska incidenter på ett gynnsamt sätt, speciellt händelser som involverar barn. Strategier behövs för att stärka känslan av kontroll och förmågan till fokusering, där förberedelse, socialt stöd och återhämtningstid är betydelsefullt.

Thesis (M.Sc.)--Edith Cowan University, 2007. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.

Thesis (M.S.M.)--Regis University, Denver, Colo., 2006. / Title from PDF title page (viewed on Aug. 29, 2006). Includes bibliographical references.

No description available.

Ambulanspersonal möter patienter i alla åldrar i flera tänkbara miljöer. Det finns en hel del skillnader vid omhändertagandet av barn prehospitalt jämfört med omhändertagandet av vuxna. Det skiljer sig i utrustning i ambulanserna och det skiljer sig anatomiskt och fysiologiskt hur barn ser ut jämfört med vuxna. Dessutom innebär vården av barn ofta även vård av föräldrar eller närstående. Lagen betonar alla människors lika värde och rätt till en jämlik vård. Syftet med studien var att beskriva vilka faktorer som påverkar ambulanspersonalens omhändertagande av sjuka barn prehospitalt. Metoden som användes var en allmän deskriptiv litteraturstudie innehållandes både kvantitativa och kvalitativa vetenskapliga artiklar. Artiklarna söktes fram i databaserna CINAHL och PubMed. 15 vetenskapliga artiklar analyserades och kvalitetsgranskades och ligger till grund för resultatet i studien. Det övergripande resultatet som framkom visade att de faktorer som främst påverkade ambulanspersonalens omhändertagande av att vårda barn prehospitalt var känslomässiga reaktioner och att larm gällande barn var sällsynta händelser. Vidare framkom underkategorierna stress, interaktion och kommunikation samt utbildning till känslomässiga reaktioner och erfarenhet och patientsäkerhet till sällsynta händelser. Slutsatsen i studien var att det är av betydelse att ambulanspersonal får utrymme i utbildningen, men även fortlöpande i yrkeslivet, att utveckla och upprätthålla de kunskaper som krävs för att vårda sjuka barn. Studien visade dessutom på att det finns en kongruens mellan verklighet och lagtext, författningar och barnkonventionen då vården i nuläget inte ges på lika villkor för alla människor. / Ambulance staff meet patients of all ages in several conceivable environments. There are a lot of differences in the care of children pre-hospital compared to the care of adults. It differs in equipment in the ambulances and it differs anatomically and physiologically how children are formed compared to adults. In addition, the care of children often also involves the care of parents or relatives. The law emphasizes the equal value and right of equal care for all people. The aim of this study was to describe factors affecting the ambulance staff's care of sick children in the prehospital care. The method used was a general descriptive literature study containing both quantitative and qualitative scientific articles. The articles were searched in the databases CINAHL and PubMed. 15 scientific articles were analyzed and quality checked and form the basis of the result in the present study. The overall result that emerged showed that the main factors affecting the ambulance staff's care of sick children in the prehospital care were emotional reactions and that alarms concerning children were rare events. Furthermore, the subcategories stress, interaction and communication and education emerged within the category emotional reaction and experience and patient safety within rare events. The conclusion of the study was that it is important that ambulance staff are given the training to care for sick children, both in the education and in the professional life. This in order to maintain and develop the knowledge that is required. The study also showed a congruence between reality and law, regulations and the convention of the children's rights. Currently the care is not provided on equal terms for all people.

The 2001 anthrax attacks heightened awareness of the possibility of weaponizing biological agents such as Ebola, anthrax, and smallpox and hence, the Bioterrorism Act of 2002 to prevent biological attacks and reduce bioterrorism threats and vulnerabilities. However, the 2014 Ebola epidemic raised concerns about unpreparedness for bioterrorism within the healthcare community and about secondary infections from healthcare workers. Using Kingdon's conceptualization of multiple streams as the foundation, the purpose of this case study was to explore the nature of bioterrorism threats and the level of preparedness of Emergency Medical Technicians (EMTs) who were involved in the 2014 Ebola epidemic in a New Jersey County for biological attacks and avoidance or reduction of secondary infections. Data were collected from 18 individuals through interviews and from emergency response documents. The data were inductively coded and subjected to thematic analysis. The emergent themes indicated that although there was an abundance of bioterrorism preparedness policies and programs dating back to the 2001 anthrax attacks, the response to the 2014 Ebola epidemic revealed inadequate bioterrorism preparedness practices. The study participants identified insufficient knowledge of bioagents and lack of regular training as factors that prevented enhanced preparedness practices. Participants suggested that improved training opportunities, interagency collaborations, and better funding would improve bioterrorism preparedness practices. The social change implications of this study include increased funding for bioterrorism preparedness to harden EMTs and the creation of public awareness of bioagents for improved 911 calls and emergency response practices.

Ambulanspersonal möter i sitt arbete många olika patienter, patienternas ålder varierar och så också de olika sjukdomstillstånden. En oro hos ambulanspersonal är att vårda sjuka och skadade barn. En känsla av otillräcklighet och att vårda två patienter samtidigt - barnet och dess anhöriga. En svårighet inom ambulanssjukvården är även att den medicintekniska utrustningen är anpassad för vuxna och inte alltid passar barn vilket gör att risker inom patientsäkerheten uppstår. Syftet med studien var att belysa ambulanspersonalens upplevelser av att vårda barn ur ett personcentrerat omvårdnadsperspektiv. Metoden som valdes är en litteraturstudie där 11 vetenskapliga artiklar från år 2007 till 2017 inkluderades från databaserna Pubmed, Cinahl och manuella sökningar i referenslistor. Både kvantitativa och kvalitativa artiklar har inkluderats. De inkluderade artiklarna har kvalitetsgranskats och därefter analyserats utifrån integrerad analys. I resultatet framkom tre kategorier som svarar på studiens syfte. Dessa var Känslomässiga upplevelser, Vård av två patienter - barnet och anhörig samt Behov av utbildning. Det framkom i resultatet att ambulanspersonalen upplevde känslor som stress och ångest vid larm gällande barn. Det framkom även att ambulanspersonalen upplevde svårigheter då de hade en känsla av att vårda två patienter, både barnet och deras anhöriga. Ambulanspersonalen upplevde att mer utbildning inom ämnet behövs. Slutsatsen var att mer utbildning behövs för ambulanspersonalen för att förbereda sig på att vårda barn. Med mer utbildning inom ämnet kan kompetensen förbättras och de känslor som ambulanspersonalen upplever vid dessa larm som exempelvis ångest och stress kan minskas. / Ambulance staff experiences many different patient meetings, different ages of patients and various conditions of illness. One anxiety of the ambulance staff is to care for sick and injured children. A sense of insufficiency to care for two patients simultaneously - the child and their relatives is always present. One challenge in ambulance care for children is also that the medical devices are designed for adults and do not always fit children, which means that risk for patient safety may occur. The aim was to describe ambulance staffs experiences of treating children from a patientcentred view. A literature review was chosen as a method in which the relevant articles were collected from the databases PubMed, CINAHL and from manual searches in reference lists. 11 articles published between 2007 and 2017 were included, including both quantitative and qualitative methodologies. The included articles were quality-reviewed and then analyzed based on integrated analysis. The results demonstrated three categories in relation to the aim. These were emotional experiences, to care for two patients - the child and the relative and educational needs. Results indicated that ambulance staff experienced feelings such as stress and anxiety in the case of children's alarms. It was also found that ambulance staff experienced difficulty as they had a feeling of caring for two patients, both the child and their relatives. The ambulance staffs also expressed the need for more education in the subject. The conclusion suggests that more training is needed for the ambulance staff to prepare to care for children. With more education in the subject, competence can be improved and the feelings that ambulance staff experience in these alarms, such as anxiety and stress could be reduced.