A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the degree of Bachelor of Arts (Masters). / As the past decade has witnessed a growing interest in the nature, causes and management of stress reactions in emergency workers, the present study examined emergency workers' reactions to traumatic work related incidents. Furthermore, although Job Dissatisfaction and Increased levels of Turnover have been identified in literature and research on emergency workers as being behavioural manifestations of the traumatic stress associated with emergency work, the effect of occupational trauma on these variables has not been documented extensively in trauma literature or research. A second aim of the study was therefore to provide further insight into the effects of work related trauma on these constructs. Moreover, although literature on emergency workers has not documented the impact of occasional trauma on Job Involvement, the present study undertook to examine the effects of trauma on tnis construct. The study was considered to be exploratory in this regard. By examining how exposure to occupational trauma impacts on Job Satisfaction, Job involvement and Propensity to Leave, it was hoped that this will lead to a better understanding of the effects of occupational trauma and its implications for employees and organisations alike. One hundred full-time paramedics completed a self-report questionnaire. The questionnaire also included questions to obtain demographic variables as it has been documented that the relationship between exposure to traumatic events and the expression of distress is constructed by personal factors. In addition, qualitative data pertaining to the constructs under investigation was obtained from 30 paramedics. The reported symptoms revealed that 17% of the sample was suffering from rrso. Correlational analyses using a non-experimental, cross-sectional design, revealed a significant relationship between PTSD and Job Satisfaction. A non-significant relationship was found between PTSD and both Job Involvement and Propensity to Leave, Of the demographic variables measured, stepwise regression analysis. revealed that gender and previous exposure to trauma were the most efficient predictors of PTSD Content Analyses performed on the qualitative data indicated that paramedics were subjected to numerous job stressors which seemed to associated to Job Involvement and Propensity to Leave. The results of the study are discussed with respect of the literature reviewed and limitations and implications of these findings are discussed thereafter. Lastly implications of the present study for future research are presented. / Andrew Chakane 2018

CHDS State/Local / The analysis of domestic incidents of terrorism has revealed many gaps in our Nation's capability to effectively manage the multi-jurisdictional response. Although many gaps have been addressed through implementation of measures based on lessons learned, the most pervasive unresolved issue remains the ability to properly identify first response personnel on incident scenes. The nature of incidents of terrorism requires force protection to be a priority because of the threat of a secondary attack. Identity must be established and authenticated to protect responders and prevent infiltration to perpetrate a secondary attack. This thesis examines and evaluates several options for closing this pervasive identity management capability gap. The current decentralized identity system, a defined and typed response resource for identity management, and the federal identity project initiated under HSPD-12 are examined and evaluated as mechanisms for improving on-scene identity management in the response to incidents of terrorism. The thesis argues the development of a standardized nationwide responder identity token that can be rapidly authenticated and establishing dedicated identity management response resources are essential to improving the response multi-jurisdictional and catastrophic incidents of terrorism. / Corporal, Frederick County Sheriff’s Office, Frederick, Maryland

Submitted in fulfillment of the requirements for the Degree of Master of Health Sciences in Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2016. / Purpose Emergency care education and training in South Africa is experiencing an important transformation period, involving migration from short course based training to a newly proposed, formalised, three-tier qualification system, aligned with the Higher Education Sub-framework. Many existing and experienced holders of short course emergency care certificates face the challenge of gaining access to formal emergency care programmes without meeting the minimum entry requirements. Recognition of Prior Learning (RPL) will therefore become one of the key strategies for planned migration of short course graduates into professional learning programmes. However, the research reports on RPL practice in the field of emergency care are scarce. Hence, valuable lessons about RPL in emergency care programmes are missed. The purpose of this study is to explore the efficacy of RPL practice within the National Certificate: Emergency Care (NCEC) Programme in the Western Cape, through the experience of ambulance emergency assistants, who applied for RPL on the Programme and the paramedic educators involved in the facilitation and RPL assessment on the NCEC Programme. Methodology The design of this descriptive exploratory study was qualitative, and was set in the interpretative paradigm using a case study mode of inquiry. The qualitative data was collected through semi-structured focus groups, individual interviews, and document analysis. The participants were from Cape Peninsula University of Technology (CPUT), Department of Emergency Medical Sciences, and the Western Cape Government College of Emergency Care (WCCEC). Collected data was interpreted by means of thematic analysis, set against the context of the study objectives and the theoretical framework. Finding The study revealed three main themes related to RPL efficacy in the NCEC Programme. These included the need for RPL training for educators involved in RPL, lack of support and guidance for RPL assessors and participants, and the need for careful selection of RPL assessment methods. The document analysis highlighted the gap between a comprehensive and sound RPL policy document and the practical implementation of these policies. Conclusion and Recommendations The emergency care field requires greater awareness and information on RPL processes, principles, assessments, and requirements. The higher education institutions, as the sole providers of the newly proposed formal emergency care programmes need to consider building capacity for RPL by means of training and dedicating academic staff to RPL, and developing comprehensive RPL policies, in collaboration with relevant stakeholders in the field. RPL assessment methods need to be more diverse and tailored to the individual RPL claimants. Further research on RPL will ensure a fair, social inclusive and redressing process during the planned migration of emergency care education and training. / M

This dissertation examines factors with influence on the organizational cultural competence of Emergency Medical Services (EMS) systems. The purpose of this study was to draw on theories of representative bureaucracy and transformational leadership to assess cultural competence in Emergency Medical Services systems from the perspective of EMS leadership, within careful consideration of the external environment in which EMS systems operate. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015 / FAU Electronic Theses and Dissertations Collection

This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.

The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.

Thesis (Ph. D.)--Indiana University of Pennsylvania. / Includes bibliographical references.

PURPOSE. Domestic violence has a significant prevalence in the world, and certainly in South Africa, yet Emergency Care Practitioner (ECP) training and practice does not have any particular focus on domestic violence intervention. The absence of any clear response protocol to domestic violence in a Health Professions Council of South Africa (HPCSA) regulated profession, suggests the reliance on health practitioner discretion in this regard. This is problematic as the profession is male dominated and focused on tertiary levels of care. ECP's may be positioned to screen for abuse early, yet there is no evidence of success or failure in this endeavour. This study aimed to ascertain what the prevailing ECP knowledge, attitudes and beliefs around domestic violence in the Western Cape are, so that any factors preventing or nurturing early identification and appropriate treatment of domestic violence may be mitigated or supported respectively. METHODS. Health Professions Council of South Africa (HPCSA) registered ECP's in the Provincial Government- Western Cape (PGWC)- Emergency Medical Service (EMS) Metropole region voluntarily completed a questionnaire. MAJOR RESULTS. Only 49% of respondents could correctly define domestic violence. ECP qualification was associated with domestic violence definition in that Basic ECP's were more likely to incorrectly define domestic violence than the advanced ECP's. Eighty-one percent of respondents recognized less than thirty domestic violence calls in the preceding six months. The majority of ECP's (89%) experienced no special handling of domestic violence victims. No significant association could be found (Chi-Square: p = 0.2298) between qualification and knowledge of domestic violence laws. An ECP's qualification is no predictor of his/her legal knowledge about abuse. Qualification could also not be positively associated with the referral of victims, although the majority of practitioners of all qualifications (78%), had only sometimes referred victims or not at all. The majority of respondents expressed inadequate assessment and management of domestic violence patients. The majority also indicated that their ECP training was inadequate in preparing them for domestic violence intervention. CONCLUSIONS DRAWN. The attitudes and beliefs of Emergency Care Practitioners elicited from this study suggest a poor level of understanding of the extent and nature of domestic violence. There is a probable low detection rate amongst the majority of ECP's. There exists harbouring of myths that may confound the implementation of a pre-hospital protocol for domestic violence management. There is an inadequacy of current ECP practice with respect to domestic violence crisis intervention with regards screening, management and referral. The EMS response to domestic violence should be congruent with an appropriate health sector response and should include universal screening (asking about domestic violence routinely); comprehensive physical and psychological care for those patients who disclose abuse; a safety assessment and safety plan; the documentation of past and present incidents of abuse; the provision of information about patients rights and the domestic violence act; and referral to appropriate resources. The ECP curriculum should emphasise the particular nature and treatment of domestic violence. The study supports the need for the introduction of a comprehensive ECP protocol, in training and in practice. This information should prove useful to all who attempt to design educational programmes and clinical strategies to address this public health issue. / Thesis (M.PH.)-University of KwaZulu-Natal, 2006.

Aim: The aim of this study was to explore the attitudes and practices of the emergency staff working in the level one emergency departments in the province of KwaZulu-Natal, with regard to witnessed resuscitation. Methodology: A qualitative approach was used to explore the attitudes and practices of the staff. Two semi - structured interviews were conducted with each participant, an initial and a verifying interview, with each interview lasting between 15 - 30 minutes long. The researcher applied the principle oftheoretical saturation and a total ofsix participants from two of the four level one emergency departments were included in this study. One provincial and one private emergency department were chosen. All of the interviews were taped and transcribed prior to manual analysis, in which categories and themes were identified from the data. Findings: The emergency staff disliked the idea of witnessed resuscitation. They believed it to be a harmful experience for the witnesses, a threat to the resuscitation process, threatening for the emergency staff, and impossible to implement in their emergency departments that are already short of staff and space. Although these were their dominant feelings, there were subtle references made during the interviews that revealed that there were some aspects of witnessed resuscitation that they liked once they had considered the practice. There were no written policies to dictate how the relatives were handled, but all the staff agreed that the relatives were asked to wait outside-of the resuscitation area, they were kept informed and then brought in when the patient was stable or had died. A number of recommendations are suggested for education, practice and further research in an attempt to introduce witnessed resuscitation as an option in KwaZulu-Natal's emergency departments. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.