Introduction Trauma and emergencies contribute to the quadruple burden of disease in South Africa and being prepared for an emergency requires rapid access to emergency equipment, drugs and emergency trolleys to optimally manage an emergency. This is the first descriptive study looking specifically at essential emergency equipment, drugs and the emergency trolley required for the provision of optimal emergency care at Community Health Centres (CHCs) in the Western Cape Metropole. Aims and Objectives The aim of the study was to evaluate whether eight 24 hour emergency units at CHCs in the Western Cape Metropole had the appropriate and essential emergency equipment, drugs and emergency trolleys necessary for the delivery of optimal emergency care, using the Emergency Medicine Society of South Africa (EMSSA) guidelines as the audit tool. Objectives included: 1. To assess availability of essential emergency equipment 2. To assess availability of essential emergency drugs 3. To assess the functionality of existing emergency trolleys Methodology EMSSA guidelines were used as the evaluation audit tool to perform a survey of emergency equipment, drugs and emergency trolleys at eight 24 hour CHCs in the Western Cape Metro pole. Data collection for the study was conducted at the eight 24 hour CHCs over a 3 month period during the months of June 2012 to August 2012. The data was analyzed using the Statistical Package for Health Sciences (Statistica, version 10 of 2012) and Microsoft Excel. Results A total of 81 emergency equipment items, 43 emergency drug items (37 emergency drugs, 6 intravenous fluids) and 78 emergency trolley items were required to be in each emergency unit. An average of 62% of all recommended emergency equipment items, 80% of all emergency drugs and 52.4% of all emergency trolley items were found to be present in this survey. Essential emergency paediatric equipment including bag ventilation devices, Magill’s forceps, masks, intraosseous needles and appropriate blood pressure cuffs were found to be absent at 2 CHCs. All CHCs had access to a defibrillator and ECG machine but these were found to be dysfunctional at 2 CHCs due to expired batteries and no tracing paper being available. Expired first line emergency drugs (adrenaline and atropine) were found at certain CHCs. The recording of emergency trolley checklists and stocking of essential emergency items were found to be incongruent, inconsistent and not up to the recommended standard. Conclusion Essential emergency equipment and drugs and the functionality of emergency trolleys were found to be generally inadequate. Considerable deficiencies of essential emergency items were found, particularly paediatric equipment and drugs and this may negatively impact on resuscitative efforts and outcome in both paediatric and adult emergency care at CHCs in the Western Cape Metropole.

Trata-se de um estudo descritivo exploratório que buscou identificar as competências críticas para o atendimento das urgências e emergências psiquiátricas em unidades de Pronto Atendimento, relatadas pela equipe de enfermagem. O estudo foi realizado em dois serviços de Pronto Atendimento do município de Ribeirão Preto. Participaram 31 profissionais de enfermagem entre enfermeiros, técnicos e auxiliares de enfermagem. A metodologia se constituiu na utilização da \"Técnica dos incidentes críticos\" com a utilização de duas questões que tratavam do atendimento às urgências e emergências psiquiátricas. Após a análise dos dados os profissionais indicaram 55 incidentes, sendo 26 com referencia positiva e 29 negativa. Categorizamos os elementos que compõem os incidentes críticos (situação, comportamento e conseqüência). Foram identificadas 55 situações e agrupadas em 5 categorias, sendo: Paciente agitado; Paciente calmo. Evasão e retorno à unidade; Ideação suicida/Tentativa de suicídio; Longa espera por atendimento. Em relação aos comportamentos, obtivemos 6 categorias: Abordagem Verbal; Restrição e isolamento; Avaliação e tomada de decisão; Interação da equipe e o trabalho multiprofissional; Reações diante a agressão física e verbal (sentimentos e ações); Interação do serviço de emergência com a Rede de saúde mental. Quanto às conseqüências obtivemos 3 categorias: o paciente se acalma, evasão da unidade e paciente recebe alta. A coleta e análise de incidentes críticos permitiu identificar um conjunto de competências para o atendimento de uma emergência psiquiátrica que fazem referencia à saber reconhecer as situações de urgência ou emergência e aos comportamentos necessários para manejar o paciente. Elas envolvem escolher como e de que forma realizar a abordagem verbal, as técnicas de contenção física e química, a avaliação da contenção, e a interação do PA com a rede de atenção psicossocial. O conjunto de as situações descritas e os comportamentos adotados para prestar assistência são as competências críticas para se prestar assistência de enfermagem. Neste sentido este estudo confirmou que os conhecimentos sobre o relacionamento interpessoal em enfermagem e o conhecimento sobre as alterações das funções mentais em situações de risco são essenciais para o bom desempenho da prática de enfermagem. A competência que este estudo acrescentou foi o conhecimento sobre a rede de atenção psicossocial que possibilita que os grandes objetivos estabelecidos nas políticas de saúde mental brasileira possam avançar e se concretizar / This research is characterized as qualitative study, descriptive exploratory aimed identifying the critical competencies to meet psychiatric emergencies in emergency care units, reported by the nursing staff. The study was conducted in two emergency cares in Ribeirão Preto. Were interviewed 31 professionals, including nurses, technicians and nursing assistants. The methodology consisted in used the \"critical incident technique\" with two questions about the psychiatric emergencies in emergency cares unit. After data analysis we found 55 incidents, with 26 positive references and 29 negative references. The elements were classified like described in literature (situation, behavior and consequence).The situations were grouped into 5 categories, as follows: Agitated Patient; Quiet Patient; Evasion and return to unity; Suicidal ideation / suicide attempt; Long waits for care. Regarding behavior, we obtained 6 categories: Verbal Approach; Restraint and seclusion; Assessment and decision making; Team interaction and multidisciplinary work; Reactions to physical and verbal aggression; Interaction of emergency services to mental health network. About the consequences we found 3 categories: Quiet Patient, evasion of the unit and patient is discharged. The analysis of critical incidents identified a set of critical skills for the care of a psychiatric emergency. These skills make reference to how to recognize the urgent or emergency situations and behaviors necessary to manage the patient. These behaviors involve how to choose and how to use verbal approach, the techniques of physical and chemical restraint, evaluation of restraint, and the interaction of Emergency unit with the network of psychosocial care. We checked the interpersonal relationship as central to the development of skills, because it is through this relationship that the professional knows the needs of the patient and can assess the mental functions. The set of situations described as psychiatric emergencies and behaviors adopted to assist the demands of critical skills to provide nursing care in the emergency service. In this sense this study confirmed that knowledge on the interpersonal relationship in nursing and knowledge of the changes of mental functions in situations of risk are essential for the proper performance of nursing practice. A competency that this study was added knowledge about the network of psychosocial care. This competency enables to achieve the goals established in Brazilian mental health policies to advance

Trata-se de um estudo descritivo exploratório que buscou identificar as competências críticas para o atendimento das urgências e emergências psiquiátricas em unidades de Pronto Atendimento, relatadas pela equipe de enfermagem. O estudo foi realizado em dois serviços de Pronto Atendimento do município de Ribeirão Preto. Participaram 31 profissionais de enfermagem entre enfermeiros, técnicos e auxiliares de enfermagem. A metodologia se constituiu na utilização da \"Técnica dos incidentes críticos\" com a utilização de duas questões que tratavam do atendimento às urgências e emergências psiquiátricas. Após a análise dos dados os profissionais indicaram 55 incidentes, sendo 26 com referencia positiva e 29 negativa. Categorizamos os elementos que compõem os incidentes críticos (situação, comportamento e conseqüência). Foram identificadas 55 situações e agrupadas em 5 categorias, sendo: Paciente agitado; Paciente calmo. Evasão e retorno à unidade; Ideação suicida/Tentativa de suicídio; Longa espera por atendimento. Em relação aos comportamentos, obtivemos 6 categorias: Abordagem Verbal; Restrição e isolamento; Avaliação e tomada de decisão; Interação da equipe e o trabalho multiprofissional; Reações diante a agressão física e verbal (sentimentos e ações); Interação do serviço de emergência com a Rede de saúde mental. Quanto às conseqüências obtivemos 3 categorias: o paciente se acalma, evasão da unidade e paciente recebe alta. A coleta e análise de incidentes críticos permitiu identificar um conjunto de competências para o atendimento de uma emergência psiquiátrica que fazem referencia à saber reconhecer as situações de urgência ou emergência e aos comportamentos necessários para manejar o paciente. Elas envolvem escolher como e de que forma realizar a abordagem verbal, as técnicas de contenção física e química, a avaliação da contenção, e a interação do PA com a rede de atenção psicossocial. O conjunto de as situações descritas e os comportamentos adotados para prestar assistência são as competências críticas para se prestar assistência de enfermagem. Neste sentido este estudo confirmou que os conhecimentos sobre o relacionamento interpessoal em enfermagem e o conhecimento sobre as alterações das funções mentais em situações de risco são essenciais para o bom desempenho da prática de enfermagem. A competência que este estudo acrescentou foi o conhecimento sobre a rede de atenção psicossocial que possibilita que os grandes objetivos estabelecidos nas políticas de saúde mental brasileira possam avançar e se concretizar / This research is characterized as qualitative study, descriptive exploratory aimed identifying the critical competencies to meet psychiatric emergencies in emergency care units, reported by the nursing staff. The study was conducted in two emergency cares in Ribeirão Preto. Were interviewed 31 professionals, including nurses, technicians and nursing assistants. The methodology consisted in used the \"critical incident technique\" with two questions about the psychiatric emergencies in emergency cares unit. After data analysis we found 55 incidents, with 26 positive references and 29 negative references. The elements were classified like described in literature (situation, behavior and consequence).The situations were grouped into 5 categories, as follows: Agitated Patient; Quiet Patient; Evasion and return to unity; Suicidal ideation / suicide attempt; Long waits for care. Regarding behavior, we obtained 6 categories: Verbal Approach; Restraint and seclusion; Assessment and decision making; Team interaction and multidisciplinary work; Reactions to physical and verbal aggression; Interaction of emergency services to mental health network. About the consequences we found 3 categories: Quiet Patient, evasion of the unit and patient is discharged. The analysis of critical incidents identified a set of critical skills for the care of a psychiatric emergency. These skills make reference to how to recognize the urgent or emergency situations and behaviors necessary to manage the patient. These behaviors involve how to choose and how to use verbal approach, the techniques of physical and chemical restraint, evaluation of restraint, and the interaction of Emergency unit with the network of psychosocial care. We checked the interpersonal relationship as central to the development of skills, because it is through this relationship that the professional knows the needs of the patient and can assess the mental functions. The set of situations described as psychiatric emergencies and behaviors adopted to assist the demands of critical skills to provide nursing care in the emergency service. In this sense this study confirmed that knowledge on the interpersonal relationship in nursing and knowledge of the changes of mental functions in situations of risk are essential for the proper performance of nursing practice. A competency that this study was added knowledge about the network of psychosocial care. This competency enables to achieve the goals established in Brazilian mental health policies to advance

Vid omhändertagande av en svårt sjuk eller allvarligt skadad människa är det essentiellt att samarbetet mellan den prehospitala personalen på plats fungerar. Frågor så som vem som har högst medicinsk kompetens och vem som leder arbetet spelar också en stor roll för att ett bra teamarbete skall komma till stånd. I en sådan situation i Stockholms Läns Landsting möts två sjuksköterskekompetenser, specialistsjuksköterskan i ambulanssjukvård och specialistsjuksköterskan i anestesisjukvård. Den ena i ambulans och den andra i förstärkningsenhet så som akutbil eller helikopter. I de medicinska riktlinjerna för ambulanssjukvården i Stockholm står att högst formell medicinsk kompetens innehar det medicinska ansvaret. I de fall då två specialistsjuksköterskor med olika specialistutbildning men med samma formella medicinska kompetens samverkar kring patienten innehas det medicinska ansvaret av sjuksköterskan med mest lämpad kompetens. Detta ger utrymme för tolkningar och kan ge upphov till oklarheter om vem som har det medicinska ansvaret baserat på olika kompetensfokus. Syftet med studien var att beskriva ambulanssjuksköterskans och anestesisjuksköterskans upplevelse av samarbetet vid prio1-larm avseende vem som innehar det medicinska ansvaret och identifiera faktorer som påverkar samarbetet. Som metod användes en kvalitativ intervjustudie med innehållsanalys. Utifrån en intervjuguide baserad på Critical Incident Technique (CIT) genomfördes tre fokusgruppsintervjuer. Sex ambulanssjuksköterskor och fyra anestesisjuksköterskor deltog i studien vilket resulterade i att 31 kritiska incidenter beskrevs. Insamlat material analyserades genom en kvalitativ innehållsanalys med en induktiv ansats. Ur resultatet framkommer två huvudområden av betydelse för specialistsjuksköterskornas upplevelse av samarbetet. Hantering genom situationsanpassning utifrån kategorierna uppfattning om kompetensnivå, uppfattning om ansvarsfördelning och uppfattning om trygghetsgenererande faktorer samt Hantering genom resursoptimering utifrån kategorierna att leda och samarbete. De slutsatser som kan dras från resultatet är att specialistsjuksköterskorna genom att visa kollegial respekt för varandras kompetens, anpassa sig utifrån förutsättningar och använda befintliga resurser på rätt sätt skapar ett fungerande samarbete kring patienten. Genom detta undviker de att hamna i en konflikt med kollegan orsakad av oenighet om vilken specialistkompetens som är mest lämpad att inneha det medicinska ansvaret under det aktuella omhändertagandet. / When assessing and caring for a critically ill or injured patient, it is essential that the cooperation and interaction within the group of pre-hospital providers functions at its best. Questions about competencies and who will be medically in charge of the case plays an important role. In Stockholm County Council (SCC) emergency medical services (EMS) two specialist nurse competencies meet, the nurse anesthetist in the rapid response unit and the ambulance nurse in the ambulance. Both specialist nurses are formally equal concerning the highest medical competence. The medical guidelines in SCC states that the highest formal medical competence is also in charge of the case. When two formally equal, but clinically different nurse competencies collaborate, the nurse most suited for the task is also considered to be in charge. There is room for interpretation, which can lead to unclarity in who should be in charge, based on different competencies. The aim of the study was to describe the experiences of the two specialist nurse competencies on cooperation and interaction when attending the same priority 1 case, concerning who is in charge and to identify factors influencing the cooperation and interaction. The method used was qualitative interview. Using an interview guide based on critical incident technique (CIT) three focus group interviews were conducted. Six ambulance nurses and four nurse anesthetists participated. The interviews resulted in 31 critical incidents. The data were analyzed with qualitative inductive content analysis. In the results two themes emerged. Situational management from the categories; perception of competence, perception of the division of responsibility and the perception of confidence generating factors. Also, management by resource optimization from the categories leadership and cooperation. The conclusions that can be drawn from the results are that the specialist nurses can create a functioning cooperation and interaction through collegial respect for each other’s competencies, situational adaption and the use of resources available at the time being. This way a conflict is avoided in the question on who should be in charge.

As especificidades inerentes ao perfil do paciente, nos seus aspectos físicos (estado grave) e emocionais (dor, risco de vida, angústia, sofrimento, medo, insegurança etc.) no atendimento das unidades de Urgência e Emergência de alta complexidade, proporcionam a particularidade que a referida unidade requer como estudo mais aprofundado. Com o objetivo de buscar este entendimento sobre os diversos aspectos envolvidos na assistência ao paciente em estado crítico é que o seguinte trabalho de pesquisa se concretiza. Aspectos que envolvam desde a compreensão do sistema operacional médico-enfermagem, apoio logístico-administrativo, técnico-construtivo, como suporte ao processo de concepção da arquitetura e reconhecer, principalmente, os aspectos humanoemocionais que se relacionam com o ambiente hospitalar. Com a análise sobre três Unidades de Urgência e Emergência de realidades totalmente distintas, no que se refere à abrangência populacional, socioeconômica e histórico-cultural, foi possível estabelecer parâmetros mais criteriosos sobre as tipologias estudadas. O presente trabalho objetiva abarcar os diversos aspectos envolvidos no processo projetual, os quais substanciarão as decisões para a geração da arquitetura, que consequentemente poderá contribuir para atingir a qualidade desejada. A arquitetura comportar-se-á como mais um instrumento do processo para que se obtenham Unidades de Urgência e Emergência eficientes, alta qualidade - espacial e operacional -, resolutividade, produtividade e principalmente mais humana. Além das considerações abordadas, a proposta deste trabalho também visa contribuir como fonte de pesquisa e abertura de discussão sobre o assunto, ainda pouco explorado e desenvolvido, nos seus diversos aspectos envolvidos com a geração do ambiente dos edifícios de saúde. / The special needs required to each different patient profile are related to several aspects such as physical and emotional aspects as physical condition pain, life-threaten, distress, suffering, fear, insecurity etc. The duty of the Urgency and Emergency units is of highly complexity and to provide a particular care it is required a deeper study. Therefore, having the objective of understand more about the varied aspects involved in the aid of patients in critic state, which is the aim of the following research. Aspects which involve the comprehension of the medical-nursing operational system, technician-constructivist and logistic-administrative support, are used to maintain the architectural concept process and recognize, mainly, the human-emotional aspects that are related within the hospital environment. Analyzing three Urgency and Emergency Units of entirely distinct realities taking into consideration their cultural history, socioeconomic context, and population scope, it was possible to establish criterion parameters about the typologies studied. The objective of this dissertation is gather the varied aspects involved in the project process, which will consolidate the decisions taken for the architectural planning, which may consequently contribute to reach the desired quality. The architecture will behave as another instrument in the process to obtain high quality efficient Urgency and Emergency Units with regards to spatial and operational aspects. Which will provide to those centers resoluteness, productivity and mainly turning them more human. Besides the considerations brought up, the proposal of this dissertation is also to contribute as research source and open discussions about the subject, even though, little was explored and developed with regards to the varied aspects involved with the planning of the health centers buildings environment.

Το Τ.Ε.Π ( Τμήμα Επειγόντων Περιστατικών ) ενός νοσοκομειακού συγκροτήματος είναι Αυτόνομο Τμήμα στελεχωμένο από ιατρικό , νοσηλευτικό και παραϊατρικό προσωπικό και που καλείται να αντιμετωπίσει επείγοντα περιστατικά σε καθημερινή 24ωρη βάση. Αποτελεί το μοναδικό ίσως φορέα παροχής επείγουσας φροντίδας σε ολόκληρους πληθυσμούς νομών, δεδομένης της παντελούς έλλειψης ή ανεπάρκειας στη χώρα μας, υπηρεσιών πρωτοβάθμιας φροντίδας υγείας. Οι ανάγκες για παροχή υπηρεσιών υγείας αυξάνονται με ρυθμούς δυσανάλογους σε σχέση με τους διαθέσιμους πόρους για υγειονομική φροντίδα, γεγονός που δυσχεραίνει την εξασφάλιση της αποδοτικής λειτουργίας των Τ.Ε.Π και κατά συνέπεια δεν διασφαλίζεται η παροχή υψηλού επιπέδου υπηρεσιών. Για να επιτευχθεί η αποδοτική λειτουργία των Τ.Ε.Π θα πρέπει να εξευρεθούν τρόποι και λύσεις που θα αξιοποιούν και τις τεχνολογίες πληροφορικής και επικοινωνίας (Τ.Π.Ε) για την επιτάχυνση των λειτουργικών διεργασιών του Τ.Ε.Π και για την αποτελεσματική αντιμετώπιση των περιστατικών, διατηρώντας υψηλά το επίπεδο ικανοποίησης από τις παρεχόμενες υπηρεσίες όλων των ασθενών. / -

As especificidades inerentes ao perfil do paciente, nos seus aspectos físicos (estado grave) e emocionais (dor, risco de vida, angústia, sofrimento, medo, insegurança etc.) no atendimento das unidades de Urgência e Emergência de alta complexidade, proporcionam a particularidade que a referida unidade requer como estudo mais aprofundado. Com o objetivo de buscar este entendimento sobre os diversos aspectos envolvidos na assistência ao paciente em estado crítico é que o seguinte trabalho de pesquisa se concretiza. Aspectos que envolvam desde a compreensão do sistema operacional médico-enfermagem, apoio logístico-administrativo, técnico-construtivo, como suporte ao processo de concepção da arquitetura e reconhecer, principalmente, os aspectos humanoemocionais que se relacionam com o ambiente hospitalar. Com a análise sobre três Unidades de Urgência e Emergência de realidades totalmente distintas, no que se refere à abrangência populacional, socioeconômica e histórico-cultural, foi possível estabelecer parâmetros mais criteriosos sobre as tipologias estudadas. O presente trabalho objetiva abarcar os diversos aspectos envolvidos no processo projetual, os quais substanciarão as decisões para a geração da arquitetura, que consequentemente poderá contribuir para atingir a qualidade desejada. A arquitetura comportar-se-á como mais um instrumento do processo para que se obtenham Unidades de Urgência e Emergência eficientes, alta qualidade - espacial e operacional -, resolutividade, produtividade e principalmente mais humana. Além das considerações abordadas, a proposta deste trabalho também visa contribuir como fonte de pesquisa e abertura de discussão sobre o assunto, ainda pouco explorado e desenvolvido, nos seus diversos aspectos envolvidos com a geração do ambiente dos edifícios de saúde. / The special needs required to each different patient profile are related to several aspects such as physical and emotional aspects as physical condition pain, life-threaten, distress, suffering, fear, insecurity etc. The duty of the Urgency and Emergency units is of highly complexity and to provide a particular care it is required a deeper study. Therefore, having the objective of understand more about the varied aspects involved in the aid of patients in critic state, which is the aim of the following research. Aspects which involve the comprehension of the medical-nursing operational system, technician-constructivist and logistic-administrative support, are used to maintain the architectural concept process and recognize, mainly, the human-emotional aspects that are related within the hospital environment. Analyzing three Urgency and Emergency Units of entirely distinct realities taking into consideration their cultural history, socioeconomic context, and population scope, it was possible to establish criterion parameters about the typologies studied. The objective of this dissertation is gather the varied aspects involved in the project process, which will consolidate the decisions taken for the architectural planning, which may consequently contribute to reach the desired quality. The architecture will behave as another instrument in the process to obtain high quality efficient Urgency and Emergency Units with regards to spatial and operational aspects. Which will provide to those centers resoluteness, productivity and mainly turning them more human. Besides the considerations brought up, the proposal of this dissertation is also to contribute as research source and open discussions about the subject, even though, little was explored and developed with regards to the varied aspects involved with the planning of the health centers buildings environment.