Thesis (M.Tech.: Emergency Medical Care)-Durban University of Technology, 2007 xiv, 116 leaves / The Professional Board for Emergency Care Practitioners (PBECP), a division of the Health Professions Council of South Africa, regulates the scope of practice and publishes guidelines and protocols that advanced life support (ALS) practitioners are required to follow. These define an acceptable, standardised approach to each commonly encountered emergency. Non compliance with the guidelines and protocols regularly occurs, which could impact on the quality of care delivered and may result in further injury or death of the patient. This study investigated the reasons for non-compliance by ALS practitioners and explored how compliance could be improved.

Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The rate of technology expansion is rapidly covering even the most remote parts of the globe and in the lowest resource settings. With globalization however, low and middle income areas are facing emerging health issues such as injuries and chronic medical conditions. With these illnesses, there are inevitable demands on emergency services. It has been thought that technology be utilized to augment emergency medical care in such settings where formal Emergency Medical Services. To aggregate and analyze the existing literature on the topic a systematic literature review was conducted. This study analyzed the existing literature on prehospital emergency care in settings in which no formal EMS services were utilized. Four databases were searched with inclusion and exclusion criteria, yielding 1782 results. The initial screening excluded all but 21 articles. Of the 21 articles in full review, 15 were included in the final review. Studies included in the final review were grouped into those reporting outcomes from five categories: Feasibility, Quality of Care, Response Time, Patient Outcomes, and Cost Effectiveness. Only one study was identified to be of high quality. There was a lack of studies with adequate statistical analysis to conduct statistical aggregation. Most studies however reported prehospital telemedicine in settings without EMS to be feasible, provide quality care, are be cost effective. However, the lack of statistical analysis makes it difficult to make conclusions. Also, several studies did show response time of a trained basic life support volunteer to be faster than EMS in many of the settings. But no positive health outcomes were observed in patients treated with projects utilizing technology in the prehospital setting. The prehospital emergency medicine setting is a young field of study that may have significant hurdles in application. The studies conducted have shown promise in the use of technology in prehospital settings without formal EMS services, but are not robust enough to make strong conclusions or recommendations that could be put into practice. Thus, more robust, statistically oriented research is imperative in the field so that we can fully explore the potential of technology in the prehospital setting, especially in low resource and rural settings without formal EMS services. With more robust studies, we can hope to integrate new technologies into practice and better serve the populations without adequate EMS coverage to provide more timely emergency care.

Since 1999 when the report To Err is Human: Building a Safer Health System was released, medical errors have come into focus (Kohn, 2000). In an effort to reduce medication administration errors in prehospital emergency care, an android-based smartphone application simulation was created. The app has components including QR barcode scanning, text to speech for medication cross-checking, weight-based medication dose calculations, and time stamped medication data wirelessly transferring to a database in real-time. Color standard identification was implemented, aiding to a designed systematic process for patient treatment to reduce medication errors. Direct observation was performed of emergency patient calls with Richmond Ambulance Authority’s providers for a preliminary assessment. Device testing was assessed with emergency medical interns and functionally tested in different light environments. Results showed how similar different pharmaceutical vendors created medication labeling and that 58.3% of medical experts would say this device served to reduce medication administration errors.

Objective—To explore the experience of psychological distress and wellbeing in emergency medicine (EM) consultants. Methods— A qualitative, Interpretative Phenomenological Analysis (IPA) study based on interviews with EM consultants working in emergency departments (EDs) across South West England. 18 EM consultants were interviewed, representing a response rate of 54.55% across 5 EDs. The mean (SD) age of participants was 43.17 (5.8) years. All participants worked full-time as EM consultants, with the average years-in-role being 7.64 (5.76). The personal meanings that participants attached to their experiences were inductively analysed and explored alongside their perceived psychological health. Results— The analysis formed three super-ordinate themes: systemic pressures, physical and mental strain, and managing the challenges. Pressures within the ED and healthcare system contributed to participants feeling undervalued and unsatisfied when working in an increasingly uncontrollable environment. Participants described working intensely to meet systemic demands, which inadvertently contributed to a diminishing sense of achievement and self-worth. Consultants perceived their experience of physical and emotional strain as unsustainable, as it negatively impacted: functioning at work, relationships, personal wellbeing and the EM profession. Sustainability was promoted by the presence of social support and through evolving with the consultant role. Conclusions— EM consultants experience considerable physical and mental strain. This strain is dynamically related to consultants' experiences of diminishing self-worth and satisfaction, alongside current socio-political demands on EM services. Recognising the psychological experience and needs of EM consultants through promoting a sustainable EM consultant role could have wide-reaching benefits for the delivery of emergency care and physician wellbeing.

Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018. / For emergency medical care (EMC), clinical mentorship can be thought of as the relationship between the EMC students and qualified emergency care personnel. Through this relationship, students may be guided, supported and provided with information to develop knowledge, skills, and professional attributes needed for delivering quality clinical emergency care. However, this relationship is poorly understood and the focus of this research was to explore how this relationship enabled or constrained learning. Through having experienced mentorship, first as a student in EMC, then as an operational paramedic, mentoring students, I was privy to an insider perspective of clinical mentorship, and the experiences of fellow students‘. Through this experience the practices I observed may not have promoted learning. This is when my interest in pre-hospital clinical mentorship in relation to learning began. The aim of this research was to present a qualitative analysis of the clinical mentorship relationship in pre-hospital EMC involving the qualified pre-hospital emergency care practitioner (ECP) and the EMC student. The objectives included gaining an understanding of what enabled and/or constrained learning EMC, exploring clinical mentorship and learning in the pre-hospital EMC context, and gaining understanding of the role and scope of community members in the clinical mentorship activity system. The purpose of this study was to qualitatively document, by means of a thematic analysis, the pre-hospital clinical mentorship relationship, as well as document, by means of a Cultural Historical Activity Theory (CHAT) analysis, the clinical mentorship activity system. The focus of this qualitative documentation was the enablements and constraints to learning during clinical mentorship. This research also made possible recommendations for EMC clinical mentorship and education and may also inform (PBEC) policy, as well as work integrated learning (WIL) policy. Data collection included the use of diaries and focus group interviews. Analysis involved a two-part analysis, where data was reduced and understood with thematic analysis guided by Braun and Clarke (2006) six phase thematic analysis process (explained in Chapter three, Section 3.6). Thereafter, a CHAT analysis was conducted to uncover contradictions within the clinical mentorship activity system that made working on the object of activity difficult, thereby also uncovering constraints to learning. Inductive reasoning was applied to the thematic analysis to reduce data and identify themes and subthemes which provided insight into the enablements and constraints to learning in the pre-hospital EMC clinical mentorship relationship. The CHAT analysis of the data collected and analysed brought to surface the affordances, tensions as well as the primary-level and secondary-level contradictions of the clinical mentorship activity system. The thematic analysis of the clinical mentorship relationship provided limited understanding of the enablements and constraints to learning, and thus further motivated deeper analysis with CHAT. The results of this research included primary and secondary-level contradictions for almost all elements of the clinical mentorship activity system. Contradictions amongst the Division of Labour (DoL), the rules of the activity system, and the tools/resources of the activity system existed in that it constrained the interaction and activity of the subject and the community while working on the object of the activity system possibly achieving a lesser or undesired outcome of clinical mentorship.

The purpose of this study is to gain information about the social service needs and demographic characteristics of patients admitted to Providence Hospital's emergency room during the hours a social worker is not available. The emergency room staff requested the information in order to utilize it in planning emergency room services

This dissertation presents a comprehensive qualitative study of the decision-making aspects of emergency department (ED) triage at a large urban Trauma I hospital in the Southeast. Specifically, this study addresses the following research questions: (1) What do triage nurses perceive as the primary role of the triage process? (2) How do triage nurses interpret patient performances? These questions are explored through illuminating the intricacies of triage decision-making by the use of semi-structured interviews and observations. The findings of this study indicate: (1) a better understanding of the triage decision- making process yielding more practical insights related to the informal, emergent, and often improvisational ways patients are received, categorized, and treated was needed, and (2) providing a clearer understanding of the processes involved in sorting patients may provide much-needed insight regarding clinical concerns and/or issues regarding patient categorization, adverse clinical events, and excessive patient wait times. These findings are of particular importance due to the widespread overuse of EDs for nonemergent care. Essentially, EDs are designed for patients to visit due to an alteration in their physical and/or mental state. Once a patient enters the ED, a medical professional is tasked with the responsibility of interpreting the physical and/or mental state of the patient, which is generally achieved by interpreting the patient story - the precipitating event that brought them into the ED. What this study contributes to the literature is a deeper understanding of the communicative processes that ED triage nurses leverage to make sense of patient stories.

Compared with the population at-large, the Emergency Department (ED) population sees a high percentage of people with alcohol use and abuse problems. Therefore, the ED is well suited for the implementation of alcohol screening and interventions. It is important to be able to identify at risk drinkers who come to the ED for treatment for injury or other medical problems so that interventions may occur. Project ED Health conducted intensive interviews with harmful and hazardous drinkers presenting to the ED for treatment of injury or medical problem. The data was entered into a database and analyzed to find differences between injured and non-injured at risk drinkers. We found that 2/3 of at risk drinkers presented without injury. Compared to participants without injuries, injured individuals were significantly younger and more likely to be male. Injured and non-injured individuals had similar drinking patterns and health behaviors. Individuals at risk for alcohol-associated problems are similar in terms of drinking patterns and consequences and health status. Any screening tactic that is less than comprehensive, (i.e. that targets only injured individuals), will miss a significant number of at risk drinkers.

Thesis (Ph.D.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Medical Sciences - Pediatrics. Title from pdf file main screen (viewed on January 24, 2010). Includes bibliographical references.