Emergency departments (ED) provide access to care for large numbers of patients who have nonemergent medical needs. More than half of the patients presenting to the ED at Salem Hospital in Salem, Oregon, were found to be seeking care for nonemergent medical needs. In an effort to provide an alternative location for receiving this medical care, the hospital opened an Urgent Care Center (UCC) a few blocks from the ED. The purpose of this study was to determine who uses the ED, why, and what effect the UCC had on providing an alternative to the ED. My anthropological methodology uses both quantitative and qualitative techniques. Included in the study is a random retrospective chart review of 462 patients who utilized the ED and 183 patients who utilized the UCC. The collected data were analyzed and compared with information found in the literature review. Interviews with hospital staff and patients using the two facilities are integrated into the analysis. My own experience as a nurse allows me a certain insider's perspective which was useful in interpreting data, while doing observation, and during the interview process. Findings from my research show that the Urgent Care Clinic does provide an alternative source of health care to the ED for many people. This is particularly true for those whose usual source of care is unavailable and for those who are unable to find a primary care provider to accept them. The emergency department provides nonemergent care for large numbers of patients, some of whom have psycho-social problems which differ as compared to the general population. Some of these patients have moderate psychiatric dysfunction and/or addiction problems or homelessness as well as underlying medical problems, all of which are barriers to obtaining care in a regular office setting. In some cases, the emergency department provides the best option of available care. / Graduation date: 1999

This research study represents a personalized account of my experiences as a San Antonio Fire Department (SAFD) paramedic. In this study I bring the reader closer to the subculture of the Emergency Medical Services (EMS) through the research methodology of autoethnography. This qualitative method allows me to be researcher, subject, and narrator of the study. Autoethnography requires considerable attention to reflection, introspection, and self-analysis through the use of the narrative. Written in first person voice, I am positioned in the narrative in a manner that allows me to communicate directly with the audience. Through an insider’s perspective, I have traced the time I spent in EMS by reflecting, interpreting, and analyzing a collection of epochal events that significantly impacted my life both personally and professionally. There are five themes that I have identified as salient to the meaning-making process of the study: (a) death and dying, (b) faith and spirituality, (c) job burnout, (d) dealing and coping with job-related stress, and (e) alcohol abuse. The events that I have selected for this study may be read and interpreted as a prelude to what is a much broader narrative of my tenure in EMS and of other emergency responders’ experiences as well. The study explores how my life was impacted beyond the immediate experience and how the story continues to evolve to the present day. The study establishes a foundation for designing training programs to be used by public safety educators. Three theoretical elements of adult learning that help inform professional education strategies for emergency responders have been identified: (a) experiential, (b) narrative, and (c) transformative learning. The study also sensitizes the general public to the physical, social, and psychological demands that are placed on paramedics. It is important for the reader to know that these public servants are ordinary human beings doing extraordinary work in one of the most stressful and hazardous professions in the world.

Objectives: 1. To describe variations in major trauma between rural and urban residents of Ontario in terms of external causes, severities, prehospital care and clinical outcomes. 2. To determine whether prehospital intubation improves survival to hospital discharge among victims of major trauma. Methods: The study involved secondary analyses of data from the Ontario Prehospital Advanced Life Support Study (OPALS). OPALS is the largest study of prehospital emergency medical services conducted worldwide. 1. Rural-urban status of trauma patients was determined using modified Beale Codes. Differences in trauma characteristics and patient care were compared among four geographic groups (Large Metro, Medium Metro, Small Metro, Rural). 2. Patients who were intubated in the field were individually matched with non-intubated patients by patient age, injury severity score category, abbreviated head injury score category, and exact Glasgow coma scores. Cox regression was used to estimate the effect of prehospital intubation on patients' survival to hospital discharge, stratifying on patient matching. Results: 1. Patients in the large metro and rural groups had higher injury severity scores (medial 25, 24, respectively) than the other two groups (median=22). Paramedics generally spent more time in rural and large metro areas (median=37.4, 36.6 minutes respectively) than in medium and small metro (median=32.0, 30.7 minutes respectively) areas. Response times and transport times in rural groups were significantly longer than the other three groups, while scene times in the large metro group were significantly longer compared with the other geographic groups. There were no significant differences in survival rates by geographic group. 2. There were no significantly differences between the intubated and the non-intubated groups by age, sex, Glasgow coma scores, injury severity score, and systolic blood pressure category. Prehospital intubated patients exprienced a 3-fold risk of mortality after adjustment for potential confounders (HR2.9; 95% CI 1.4 to 5.8). Conclusions: 1. While response and transport times for major trauma were longer in rural areas, there were no significant differences in mortality in patients with different rural urban status. 2. Prehosptial intubation showed a negative association with survival among major trauma patients. Further randomized trials are required to invesitigate this clinical issue. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-10-24 11:58:53.955

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xvii, 198 leaves. / The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 149 leaves, Appendices A-I. / Prehospital emergency medical service (EMS) data is essential for understanding the functioning of the services as well as the community's health. Being able to clearly and accurately define the patient population in terms of demographics and clinical condition may guide the EMS in resource management, clinical governance, research, education and political decisions. However, such data is limited in South Africa. This research, therefore, aimed to develop a data collection tool to determine the population of prehospital emergency medical care patients in South Africa. The objectives were: (i) determination of what data needed to be collected, (ii) development of a tool to collect the data, and (iii) testing the tool for ease and appropriateness of use and completeness of data collection in an authentic environment. A mixed-method, predominantly qualitative methodological design was used, with some elements of grounded theory. There were three phases corresponding to the objectives. The first two were qualitative and the third was both qualitative and quantitative. In the first phase expert consensus was sought, using a focus group discussion and Delphi study, to develop a minimum data set (MDS) to describe the patient population. The resultant MDS consisted of 18 data elements which could be categorised into demographics, time and location of EMS use, the clinical reasons for EMS use, and the actual use of the EMS. A tool and associated user instructions, based on the findings of Phase One, were developed and refined during Phase Two. Phase Three was used for testing the tool in an authentic environment. The tool was found to be acceptable and user-friendly. Further testing of the tool for accuracy and reliability is recommended.

Thesis (M.S.H.I.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Oct. 31, 2007). Includes bibliographical references (p. 106-123).

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Örebro : Örebro universitet, 2006. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.