En förutsättning för en lyckad utryckning är uppdaterad och tillförlitlig vägdata. Bristfällig data kan leda till en kostsam situation när utryckningstiden rinner iväg, där både liv och pengar riskerar att gå förlorade. Tidigare situationer under utryckningar där datan varit ofullständig har lett till sådana konsekvenser, detta har visat på hur viktigt det är att prioritera arbetet med att uppdatera nödvändig data.  För att säkerställa att datan till blåljusaktörer är uppdaterad och tillförlitlig, började Trafikverket och Lantmäteriet, tillsammans med blåljusaktörer och Botkyrka kommun, år 2015 ta fram checklistan Blåljuskollen som fungerar som ett stöd till kommuner när de ajourhåller den data som används av blåljusaktörer vid utryckningar. Däremot är det få kommuner som faktiskt har slutfört Blåljuskollen.  Det finns tecken på att Blåljuskollen kräver mycket resurser och tid av kommunerna och att detta är en anledning till att få har genomfört den. Därför ämnar detta arbete att utreda vad som är kritisk data för att blåljusaktörer snabbt ska hitta rätt vid utryckningar, samt att undersöka om den befintliga datan i Blåljuskollen uppfyller detta syfte. En uppdatering av den datan som ingår i Blåljuskollen skulle kunna leda till att det blir enklare och motivationshöjande för kommuner att genomföra denna. Under arbetets gång har intervjuer genomförts med involverade aktörer för att ta reda på vad som är kritisk data för att blåljusaktörer snabbt ska hitta rätt.  Resultatet av arbetet visar att det finns punkter i Blåljuskollen som bör finnas kvar men även punkter som bör tas bort, samt punkter där det råder delade meningar om de är relevanta för Blåljuskollen eller ej. Dessutom finns det punkter som bör läggas till i Blåljuskollen. Arbetet visar även att det finns mycket arbete kvar att göra med Blåljuskollen för att den ska uppfylla sitt verkliga syfte; att minska utryckningstider och således rädda liv. / A prerequisite for successful emergency responses is updated and reliable data. Deficient data can lead to situations where response times are extended, which can put both lives and money at a risk. Unfortunately, this has shown in previous emergency responses where a lack of data has led to such consequences. These situations have demonstrated how important it is to prioritize the work with updating the required data.  To ensure that the data that the first responders use is updated and reliable, Trafikverket and Lantmäteriet, in collaboration with first responders and Botkyrka municipality, started to create the checklist Blåljuskollen in 2015. This checklist functions as a support for Swedish municipalities when updating the data that is being used by the first responders during their emergency responses. However, few municipalities have completed Blåljuskollen.  There are signs that Blåljuskollen requires a lot of resources and effort from the Swedish municipalities and that this is a reason that very few have completed the checklist. Therefore, this study aims to examine what critical data first responders need to navigate, as well as an examination of whether the existing data in Blåljuskollen satisfies its purpose or not. An update of the existing data in Blåljuskollen could lead to it being easier for the municipalities to complete it. The motivation to complete the checklist could also rise. During this study, interviews have been conducted with the involved actors to find out what data is critical for the first responders to navigate. The result of this study shows that there are elements in Blåljuskollen that should remain, however there are also elements with differing opinions whether they are relevant for Blåljuskollen or not. Furthermore, there are also elements that should be added to Blåljuskollen. This study also shows that the checklist still requires work to fulfill its purpose; to decrease emergency response times and therefore save lives.

[ES] Según la Organización Mundial de la Salud, la esperanza de vida ha aumentado en seis años en las últimas dos décadas. Esto ha llevado a un aumento de las enfermedades crónicas entre la población. Como consecuencia, los sistemas de salud se han visto obligados a buscar medidas preventivas y de mejora de los procesos de atención para garantizar su sostenibilidad. Factores clave para esta mejora son la seguridad, la eficacia, la eficiencia, la atención centrada en el paciente, la puntualidad y la equidad, los cuales buscan minimizar riesgos y brindar una atención óptima. Asimismo, los Servicios de Urgencias se enfrentan a grandes desafíos debido a la alta demanda a la que están sometidos, lo que resulta en Servicios de Urgencias saturados y errores que pueden derivar en eventos adversos. Por lo tanto, mejorar la seguridad del paciente es crucial para obtener una mejor atención en el Servicio de Urgencias. Paradigmas como el Cuidado de la Salud Basado en el Valor abogan por medir la calidad de la atención, optimizar la asignación de recursos y lograr mejores resultados a través de una mejora continua. Siendo los indicadores de rendimiento tradicionales los que han desempeñado un papel crucial en este proceso, al alinear actividades y objetivos, brindar información sobre las experiencias del paciente y su estado de salud, así como contribuir en la evaluación del rendimiento, la eficacia clínica y la mejora de la calidad. Sin embargo, estos indicadores pueden presentar limitaciones debido a su naturaleza abstracta y la propia complejidad de los datos. Por lo tanto, es posible que el uso de indicadores clave no represente en su totalidad la complejidad de estos procesos. Además, la adaptación de estos indicadores a continuos cambios puede ser un desafío, lo que dificulta la comprensión de los sistemas. Técnicas como la Inteligencia Artificial pueden ofrecer una información valiosa al procesar grandes conjuntos de datos, que son de especialmente interés en el sector de la salud. De esta forma, la Minería de Procesos, un paradigma emergente y que está ganando popularidad en varios dominios incluido salud, ofrece la oportunidad de analizar y mejorar los procesos, contribuyendo a aliviar la crisis a la que se enfrentan los sistemas de salud hoy en día. Esta tesis doctoral introduce nuevos indicadores de proceso basados en técnicas de Minería de Procesos para el proceso de urgencias como solución a cuestiones no cubiertas por las técnicas de medición tradicionales o nuevas tecnologías como la Inteligencia Artificial. Además, esta tesis presenta un método novedoso para medir la Calidad de la Atención, así como comprender el proceso de atención del ictus en los Servicios de Urgencias. Este enfoque ofrece una forma más dinámica e interactiva de analizar los procesos de atención de la salud, lo que permite un mejor entendimiento, además de medir la cadena de valor, lo que ayuda a identificar especificidades en el proceso de atención en urgencias y así descubrir el comportamiento del proceso de la enfermedad de ictus. Por último, en esta tesis se presenta una aplicación basada en Minería de Procesos para soportar este método diseñada e implementada para tal fin. / [CA] Segons l'Organització Mundial de la Salut, l'esperança de vida ha augmentat en sis anys en les últimes dues dècades. Això ha portat a un augment de les malalties cròniques entre la població. Com a conseqüència, els sistemes de salut s'han vist obligats a buscar mesures preventives i de millora dels processos d'atenció per a garantir la seua sostenibilitat. Factors clau per a aquesta millora són la seguretat, l'eficàcia, l'eficiència, l'atenció centrada en el pacient, la puntualitat i l'equitat, els quals busquen minimitzar riscos i brindar una atenció òptima. Així mateix, els Serveis d'Urgències s'enfronten a grans desafiaments a causa de l'alta demanda a la qual estan sotmesos, la qual cosa resulta en Serveis d'Urgències saturats i errors que poden derivar en esdeveniments adversos. Per tant, millorar la seguretat del pacient és crucial per a obtindre una millor atenció en el Servei d'Urgències. Paradigmes com la Cura de la Salut Basat en el Valor advoquen per mesurar la qualitat de l'atenció, optimitzar l'assignació de recursos i aconseguir millors resultats a través d'una millora contínua. Sent els indicadors de rendiment tradicionals els que han exercit un paper crucial en aquest procés, en alinear activitats i objectius, brindar informació sobre les experiències del pacient i el seu estat de salut, així com contribuir en l'avaluació del rendiment, l'eficàcia clínica i la millora de la qualitat. No obstant això, aquests indicadors poden presentar limitacions a causa de la seua naturalesa abstracta i a la pròpia complexitat de les dades. Per tant, és possible que els indicadors clau no representen íntegrament la complexitat d'aquests processos. A més, l'adaptació d'aquests indicadors a canvis continus pot ser un desafiament, la qual cosa dificulta la comprensió dels sistemes. Tècniques com la Intel·ligència Artificial poden oferir una informació valuosa en processar grans conjunts de dades, que són d'especialment interés en el sector de la salut. D'aquesta manera, la Mineria de Processos, un paradigma emergent i que està guanyant popularitat en diversos dominis inclòs salut, ofereix l'oportunitat d'analitzar i millorar els processos, contribuint a alleujar la crisi a la qual s'enfronten els sistemes de salut hui dia. Aquesta tesi doctoral introdueix nous indicadors de procés basats en tècniques de Mineria de Processos per al procés d'urgències com a solució a qüestions no cobertes per les tècniques de mesurament tradicionals o noves tecnologies com la Intel·ligència Artificial. A més, aquesta tesi presenta un mètode nou per a mesurar la Qualitat de l'Atenció, així com comprendre el procés d'atenció del ictus en els Serveis d'Urgències. Aquest enfocament ofereix una forma més dinàmica i interactiva d'analitzar els processos d'atenció de la salut, la qual cosa permet un millor enteniment, a més de mesurar la cadena de valor, la qual cosa ajuda a identificar especificitats en el procés d'atenció en urgències i així descobrir el comportament del procés de la malaltia de ictus. Finalment, en aquesta tesi es presenta una aplicació basada en Mineria de Processos per a suportar aquest mètode dissenyada i implementada per a tal fi. / [EN] According to the World Health Organization, life expectancy has increased by six years in the last two decades. This has led to an increase in chronic diseases among the population. Consequently, health systems have been forced to look for preventive measures and improvement of care processes to guarantee sustainability. Key factors for this improvement are safety, efficacy, efficiency, patient-centred care, timeliness, and equity, all of which pursue to minimize risks and provide optimal care. Likewise, Emergency Services face significant challenges due to the high demand to which they are subjected, which results in saturated Emergency Departments and errors that can lead to adverse events. Therefore, improving patient safety is crucial to obtain better care in the Emergency Department. Paradigms such as Value-Based Healthcare advocate measuring the Quality of Care, optimizing the allocation of resources, and achieving better results through continuous improvement being the traditional performance indicators, those that have played a crucial role in this process by aligning activities and objectives, providing information on the patient's experiences and their state of health, as well as contributing to the evaluation of performance, clinical efficacy and quality improvement. However, these indicators may present limitations due to their abstract nature and the complexity of the data. Therefore, the key indicators may not fully represent the complexity of these processes. Furthermore, adapting these indicators to continuous changes can be challenging, making it difficult to understand the systems. Techniques such as Artificial Intelligence can offer valuable information when processing large data sets, which are particularly interesting in the health sector. In this way, Process Mining, an emerging paradigm gaining popularity in several domains, including health, offers the opportunity to analyze and improve processes, contributing to alleviating the crisis that health systems face today. This doctoral thesis presents a new way to measure the value of the emergency process with interactive process indicators based on Process Mining techniques as a solution to issues not covered by traditional measurement techniques or new technologies such as Artificial Intelligence. In addition, this thesis proposes a novel method to measure the Quality of Care in addition to understanding the stroke care process in Emergency Services. This approach offers a more dynamic and interactive way of analyzing healthcare processes, which allows for a better understanding and measuring of the value chain, which helps identify specificities in the emergency care process and thus discover the behaviour of the stroke disease process. Finally, this thesis presents an application based on Process Mining to support this method, designed and implemented for this purpose. / Ibáñez Sánchez, G. (2023). Interactive Process Mining Techniques to Co-create Interactive Process Indicators to Evaluate and Characterize the Clinical Practice in Emergency Departments [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/202611

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Fire fighters are involved in critical decision making situations, and under-performance and lack of job satisfaction due to burnout could adversely affect the welfare of the people that are being provided with the service. This study thus investigated the relationship between burnout and job satisfaction amongst operational fire fighters. Two measuring instruments were used: the Pines, Aronson & Kafry (1981) Burnout Index, and the Smith, Hulin and Kendall (1969) Job Descriptive Index. This study was conducted amongst 102 fire fighters working for a local authority. Through a literature review, burnout and job satisfaction were defined, and a link between the two constructs outlined. Through an empirical study, the relationship between burnout and job satisfaction was determined. Supporting evidence indicates a negative correlation between burnout and job satisfaction, as well as revealing social support amongst co-workers as being an important buffer against the effects of burnout. / Industrial and Organisational Psychology / M.A. (Industrial Psychology)

Introdução: O estrato da população com 60 anos ou mais está crescendo mais rapidamente do que grupos etários mais jovens em todo o mundo. Há um aumento desproporcional nas visitas de idosos aos serviços médicos de emergência (SME), com taxas mais altas de resultados adversos. Objetivos: Descrever as características sociodemográficas do usuário do SME de um hospital terciário e investigar diferenças nos desfechos por sexo e idade. Desenho: Estudo analítico observacional transversal. Fonte de dados: Dados administrativos eletrônicos de saúde (2009 a 2013). Local do estudo: Pronto-Socorro do Instituto Central do Hospital das Clínicas, São Paulo, Brasil. Participantes: 222.387 adultos que visitaram o serviço de emergência terciária uma ou mais vezes durante o período. Métodos: As principais variáveis categóricas foram sexo, ano e faixa etária, que incluiu \"adultos jovens\": 18 a 39 anos; \"adultos maduros\": 40-59; \"idosos jovens\": 60-79; e \"muito idosos\": 80- 109. As variáveis contínuas foram idade, tempo de internação e tempo de permanência na UTI. Os desfechos foram hospitalização, estadia na Unidade de Terapia Intensiva (UTI) e óbito. Análise estatística: Calculamos a estatística descritiva; em seguida, construímos modelos lineares mistos generalizados (GLMM) para cada desfecho e estimamos as razões de chances (odds ratios - OR) com intervalo de confiança de 95% para as variáveis categóricas independentes. O nível de significância foi estabelecido em 5%, com correção de Bonferroni. Resultados: Analisamos 333.028 atendimentos consecutivos não programados no SME. A proporção dos atendimentos atribuídos aos adultos jovens diminuiu anualmente (44,4% para 38,2%), enquanto a de pessoas com 60 anos ou mais aumentou (24,1% para 29,9%). Os OR para internação, internação em UTI e mortalidade associada a idosos foram 3,49 (IC 95% = 3,15-3,87), 1,27 (1,15-1,39) e 5,93 (5,29-6,66) respectivamente, tendo como referência adultos jovens. O sexo masculino foi discretamente associado a hospitalização (OR= 1.37, IC 95%=1,30-1,44) e a mortalidade (OR=1.14, IC 95%=1,07-1,21). O tempo de permanência na UTI e o tempo de internação não diferiram entre os grupos etários. Conclusões: Entre 2009 e 2013, diminuiu a proporção de visitas dos adultos jovens no SME, enquanto a das pessoas com 60 anos ou mais cresceu. As taxas de hospitalização e de mortalidade aumentaram com a idade em ambos os sexos. A idade é um fator de risco relevante para hospitalização e mortalidade, mas não para internação em UTI. Os muito idosos correm maior risco e demandam estratificação adicional em subgrupos / Background: The stratum of the population aged 60 years or over is growing faster than younger age-groups worldwide. There is a disproportional increase in Emergency Department (ED) visits by older people, with higher rates of adverse outcomes. Objectives: To describe the sociodemographic characteristics of ED users in a tertiary hospital and to investigate differences in outcomes by sex and age. Design: Observational cross-sectional analytic study. Data source: Administrative electronic health data (2009 to 2013). Setting: The ED of the Instituto Central do Hospital das Clínicas, São Paulo, Brazil. Participants: 222,387 adults who visited the tertiary ED one or more times during the period. Measurements: The main categorical variables were sex, year and age-group, which included \'young adults\': 18-39 years; \'adults\': 40-59; \'young-older adults\': 60-79; and \'old-older adults\': 80- 109. The continuous variables were age, length of hospital stay (LOS) and length of Intensive Care Unit stay (LIS). Outcomes were hospitalization, use of intensive care unit (ICU) and mortality. Statistical analysis: We calculated descriptive statistics; then, built generalized linear mixed models for each outcome to produce estimated Odds Ratios (95% confidence interval) for independent categorical variables. The significance level was 5% with Bonferroni correction. Results: We analyzed 333,028 consecutive unscheduled ED visits. The proportion of visits attributed to young adults decreased annually (44.4% to 38.2%), while those of people aged 60 or over increased (24.1% to 29.9%). ORs for hospitalization, intensive care use and mortality associated with old-older adults were 3.49 (95% CI= 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. Male sex was weakly associated with hospitalization (OR= 1.37, 95%CI=1,30-1,44) and mortality (OR=1.14, 95%CI=1,07-1,21). LOS and LIS did not differ among age groups. Conclusions: Between 2009 and 2013, the proportion of \'young adults\' ED visits reduced while those of people aged 60 or over increased. Hospitalization, ICU stay and mortality rates increased with age. Age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification

No description available.

Introdução: O estrato da população com 60 anos ou mais está crescendo mais rapidamente do que grupos etários mais jovens em todo o mundo. Há um aumento desproporcional nas visitas de idosos aos serviços médicos de emergência (SME), com taxas mais altas de resultados adversos. Objetivos: Descrever as características sociodemográficas do usuário do SME de um hospital terciário e investigar diferenças nos desfechos por sexo e idade. Desenho: Estudo analítico observacional transversal. Fonte de dados: Dados administrativos eletrônicos de saúde (2009 a 2013). Local do estudo: Pronto-Socorro do Instituto Central do Hospital das Clínicas, São Paulo, Brasil. Participantes: 222.387 adultos que visitaram o serviço de emergência terciária uma ou mais vezes durante o período. Métodos: As principais variáveis categóricas foram sexo, ano e faixa etária, que incluiu \"adultos jovens\": 18 a 39 anos; \"adultos maduros\": 40-59; \"idosos jovens\": 60-79; e \"muito idosos\": 80- 109. As variáveis contínuas foram idade, tempo de internação e tempo de permanência na UTI. Os desfechos foram hospitalização, estadia na Unidade de Terapia Intensiva (UTI) e óbito. Análise estatística: Calculamos a estatística descritiva; em seguida, construímos modelos lineares mistos generalizados (GLMM) para cada desfecho e estimamos as razões de chances (odds ratios - OR) com intervalo de confiança de 95% para as variáveis categóricas independentes. O nível de significância foi estabelecido em 5%, com correção de Bonferroni. Resultados: Analisamos 333.028 atendimentos consecutivos não programados no SME. A proporção dos atendimentos atribuídos aos adultos jovens diminuiu anualmente (44,4% para 38,2%), enquanto a de pessoas com 60 anos ou mais aumentou (24,1% para 29,9%). Os OR para internação, internação em UTI e mortalidade associada a idosos foram 3,49 (IC 95% = 3,15-3,87), 1,27 (1,15-1,39) e 5,93 (5,29-6,66) respectivamente, tendo como referência adultos jovens. O sexo masculino foi discretamente associado a hospitalização (OR= 1.37, IC 95%=1,30-1,44) e a mortalidade (OR=1.14, IC 95%=1,07-1,21). O tempo de permanência na UTI e o tempo de internação não diferiram entre os grupos etários. Conclusões: Entre 2009 e 2013, diminuiu a proporção de visitas dos adultos jovens no SME, enquanto a das pessoas com 60 anos ou mais cresceu. As taxas de hospitalização e de mortalidade aumentaram com a idade em ambos os sexos. A idade é um fator de risco relevante para hospitalização e mortalidade, mas não para internação em UTI. Os muito idosos correm maior risco e demandam estratificação adicional em subgrupos / Background: The stratum of the population aged 60 years or over is growing faster than younger age-groups worldwide. There is a disproportional increase in Emergency Department (ED) visits by older people, with higher rates of adverse outcomes. Objectives: To describe the sociodemographic characteristics of ED users in a tertiary hospital and to investigate differences in outcomes by sex and age. Design: Observational cross-sectional analytic study. Data source: Administrative electronic health data (2009 to 2013). Setting: The ED of the Instituto Central do Hospital das Clínicas, São Paulo, Brazil. Participants: 222,387 adults who visited the tertiary ED one or more times during the period. Measurements: The main categorical variables were sex, year and age-group, which included \'young adults\': 18-39 years; \'adults\': 40-59; \'young-older adults\': 60-79; and \'old-older adults\': 80- 109. The continuous variables were age, length of hospital stay (LOS) and length of Intensive Care Unit stay (LIS). Outcomes were hospitalization, use of intensive care unit (ICU) and mortality. Statistical analysis: We calculated descriptive statistics; then, built generalized linear mixed models for each outcome to produce estimated Odds Ratios (95% confidence interval) for independent categorical variables. The significance level was 5% with Bonferroni correction. Results: We analyzed 333,028 consecutive unscheduled ED visits. The proportion of visits attributed to young adults decreased annually (44.4% to 38.2%), while those of people aged 60 or over increased (24.1% to 29.9%). ORs for hospitalization, intensive care use and mortality associated with old-older adults were 3.49 (95% CI= 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. Male sex was weakly associated with hospitalization (OR= 1.37, 95%CI=1,30-1,44) and mortality (OR=1.14, 95%CI=1,07-1,21). LOS and LIS did not differ among age groups. Conclusions: Between 2009 and 2013, the proportion of \'young adults\' ED visits reduced while those of people aged 60 or over increased. Hospitalization, ICU stay and mortality rates increased with age. Age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification

International mass sports gatherings like the FIFA (Federation Internationale de Football Association) World Cup Soccer and Olympics can cause great challenges to local healthcare systems and emergency medical services. History has shown that disasters do occur during these events, whether on a small or large scale. Disaster Management Practitioners from the public health perspective widely recognize that poor planning and a range of other underlying factors, create conditions of vulnerability. These result in insufficient capacity or measures to reduce hazards’ potentially negative consequences. The eThekwini District has to be prepared in the event of a mass disaster. Pre-empting and planning for disasters will lead to the safety and security of our citizens. The aim of this study was to undertake a baseline survey (in a total number of eleven public sector hospitals) to assess the state of hospital readiness, medical preparedness, and emergency care in preparation for the 2010 FIFA World Cup Soccer in the eThekwini District. A general assessment tool in the form of a standard questionnaire, and a walkthrough visit with a checklist, was used to collect data. There is no previous study conducted at the eThekwini District to assess requirements for an international event in terms of a mass disaster. South Africa is a developing country, and this was the first time any developing country had hosted a sporting event on such a large magnitude thus there are no international standards on sports disaster management by any other developing countries to generalise to eThekwini District. The current disaster management operational plan that is being used for the World Cup is based on a United Kingdom integrated management philosophy tool. The study herein adopted a public health approach and incorporates the Yokohama Strategy within its tool along with the use of HMIMMS and MIMMS in the assessment of the clinical criteria. The perceived minimum requirements suggested by the hospitals and a Provincial Task Team, from the Provincial Health Disaster Management office, was used as a guideline. The study showed that although disaster plans and policies are in situ, there still exists a need for resources to be directed toward skills training, attraction and retention of healthcare professionals, revitalisation of emergency and theatre areas and the commissioning of more isolation units. The results of the study would enable the District Office to note any shortcomings and lack of resources in public sector hospitals. The study outcome would be important for the implementation of any strategic planning to aid the hospitals in preparation for mass disasters that may occur during the 2010 FIFA World Cup Soccer. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

Critical Incident Stress (CIS) in emergency workers and in victims of crises is widely held to be the possible precursor to Post Traumatic Stress Disorder (PTSD) if left unattended. Indeed, the symptoms for CIS and PTSD overlap in all category areas. Today, the commonly used treatment for trauma in emergency workers is Critical Incident Stress Management (CISM). This system of interventions includes a debriefing session which facilitates people to fully remember the trauma events and their own reactions to it. CISM models were conceived and designed within and from a typically white, western viewpoint. However, one agency in Vancouver, First Nations Emergency Services Society (FNESS), provides CISM debriefing interventions and training to Native emergency workers and Native victims of crises. The purpose of this study was to document how Native participants perceived the CISM model as FNESS presented it and to understand whether the intervention was culturally meaningful for the First Nations participants in the CISM sessions. This study examined whether the mainstream CISM model, which is currently used by this agency, is culturally meaningful for populations of another culture receiving it. Narrative interviews were conducted with participants to determine their reactions to the session, their feelings regarding information presented, and their ability to make cultural meaning of the experience. Narrative analysis was used to determine themes across individuals. Theoretical implications of this research include addressing the gap in the literature of the subjective experiences of participants in CISM; no studies have used a purely qualitative methodology to study this topic. Also, this study looked at the important issue of the cross-cultural application of a mainstream intervention, particularly for a population with a history of complex traumas. Practical implications include providing information into the perceived effectiveness of the FNESS approach to a CISM framework and providing an opportunity for recipients' opinions to be heard.

La création d'un centre d'appel d'urgence pour les sourds et malentendants a nécessité la conception et la mise en place d'un dispositif sociotechnique ad hoc respectant la diversité de leurs pratiques de communication. Ancrée dans ce projet technique mené afin de rendre accessible une institution organisée autour de l'interaction téléphonique, cette recherche fut l'occasion de conduire une réflexion croisée sur les dispositifs techniques de communication appréhendés comme outil de travail et outil d'accessibilité. À partir de matériaux issus d'une enquête ethnographique réalisée dans les centres d'appel d'urgence que nous faisons dialoguer avec des traces de l'activité de conception, nous interrogeons, dans un même élan, le rôle que tiennent ces dispositifs dans l'écologie des situations ainsi que la manière dont ils définissent en actes la dynamique contemporaine de prise en compte environnementale du handicap. Au travers de ce questionnement deux grandes thématiques sont explorées : le travail en situation de communication médiatisée et le processus reformulation des pratiques engagé par la conception et la mise en service d'un dispositif technique d'accessibilité. Pour ce faire, nous nous appuyons sur des travaux de recherche ancrés dans la théorie de l'action située et en sociologie de la science et des techniques que nous articulons à la littérature scientifique portant sur le handicap et, plus spécifiquement, sur la surdité. Détaillant finement les multiples cours d'action en nous attachant notamment à rematérialiser les pratiques interactionnelles, nous démontrons en quoi les dispositifs techniques de communication participent d'une armature invisible qui fait système et contribue à organiser et pérenniser les pratiques ; armature que nous appréhendons à travers la notion d'infrastructure communicationnelle. Ainsi, nous proposons cette dernière notion comme outil conceptuel pour appréhender l'introduction de nouveaux dispositifs dans les organisations et pour accompagner une réflexion sur l'accessibilité-en-pratiques. / Creating an emergency call centre dedicated to deaf and hard of hearing users has required the design and implementation of a specific socio-technical system in order to take into account the diversity of their communication practices. Our research is grounded on such technical project specifically oriented towards the accessibility to an organization acting mainly through telephonic interactions and therefrom emerged for us the opportunity to conduct a cross-reflection on socio-technical devices apprehended as a working tool and an accessibility tool. Based on elements obtained through an ethnographic study conducted in emergency call centres which has given empirical material that we are bringing into discussion with traces of the process of the product design, we are questioning the place and status of communication devices in the local environment. Along with this questioning, we are also observing how communication devices practically achieve accessibility within the social model of disability. Two main themes are therefore explored: the organization of work activities in situations of mediated communication and the process, engaged by the design and implementation of an accessibility device, by which conventional practices are reformulated. To do so, we draw on conceptual tools and works from Situated action theory and Sociology of science and technology. We also mobilize Disability and Deaf Studies literature. Through a refined description of the multiple courses of action and a subtle attention to the materiality of interactional practices, we demonstrate that communication technical devices are a piece of an heterogeneous assembly, that make sense in situation, and act as an invisible scaffolding that organize and stabilize communication practices. We propose to designate this form of stabilization under the name of communicational infrastructure and to use it as a conceptual tool for approaching the introduction of new communication devices in organizations and to support a reflection on accessibility-in-practices