Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, June 2009. / Thesis Advisor(s): Richter, Anke. "June 2009." Description based on title screen as viewed on July 13, 2009. Author(s) subject terms: Critical mortality, triage accuracy, definitive care, damage control, regional preparedness, standard of care, mass casualty event, trauma medicine, rationing, Spain, Israel, United Kingdom, Tactical Combat Casualty Care, TCCC. Includes bibliographical references (p. 73-78). Also available in print.

No description available.

Aim and objectives: To describe the ideal doctors' shift handover process in a systematic fashion, and to identify tasks that should be performed, but are not consistently done. To understand the types of communication problems that may occur during the handover process, their causes, their likelihood of occurrence and their effect on patient safety. Method: Three studies were conducted in two, Scottish Acute Medical Units. A Hierarchical Task Analysis was performed and data was collected by means of interviews and focus groups. Observations of doctors' actual shift handover process were compared against the description of doctors' ideal handover process. To examine potential failures modes, a Healthcare Failure Modes and Effects Analysis was performed using focus group interviews. Results: The handover process entailed the pre-handover, the handover, and the post- handover phases. Multiple critical steps in the process were omitted by outgoing shift doctors. The pre-handover was particularly vulnerable to information omission, with over 50% of its critical tasks not being performed across a total of 62 observations. Nonetheless, most of these omissions were typically caught during the handover meeting, especially if incoming doctors participated in pre-handover activities. Post-handover activities involved prioritizing and delegating clinical tasks. However these were observed not to happen consistently due to multiple interruptions. Thirty-four failure modes were identified, with eight of them posing a significant risk to patient safety. The studies found that interruptions, patient workload, and a lack of standardised procedures were the biggest causes for information loss during the handover process. Conclusions: There are key critical tasks necessary for an ideal doctors' shift handover process. A simple, handover process checklist may ensure critical handover tasks have been achieved prior to any shift change. Interruptions, patient workload, peer trust, and a lack of standard operating procedures are areas that future handover research should examine.

This study seeks to serve as a baseline survey of the knowledge, attitudes and practices (KAP) of surgical registrars concerning hospital disaster preparedness across 3 tertiary hospitals in Gauteng. This is owing to the fact that a perusal of the relevant literature reveals that while considerable research exists for the assessment of hospital disaster preparedness within an international context, there was a lack of information pertaining to the South African setting. A stratified random sampling process was applied to 30 surgical registrars who were asked to complete a self-administered questionnaire. Thus the study design was a cross sectional descriptive study of the surgical registrars working across 3 tertiary hospitals in Gauteng. A response rate of 83% was achieved. The study concluded that while 80% of surgical registrars surveyed had an excellent level of knowledge about hospital disaster preparedness, only 52% of the respondents have positive attitudes towards hospital disaster preparedness. An overwhelming majority of the surgical registrars (84%) reported poor practices concerning hospital disaster preparedness. The findings of this study has lead to the following key recommendations being made: a) the need for a dedicated national hospital disaster preparedness fund, b) the provision of regular in-service training on hospital disaster preparedness with special attention being given to registrars with greater than 11 years of clinical experience c) need for hospital disaster preparedness training to adhere to some form of quality control d) setting up of a task team to conduct regular audits on the practices of hospitals in terms of disaster preparedness.

Thesis (MCur (Nursing Science))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Thesis (MCur (Nursing Science))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

No description available.

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2014. / Introduction: The Emergency Medical Service (EMS) is required to respond to cases of life threatening illness or injury which may later be found to be non-emergent thus creating a mismatch between the dispatch of limited EMS resources and actual patient need. This study proposed that such a mismatch presently exists among South African urban EMS systems resulting in unacceptably high levels of inappropriate emergency responses. The purpose of this study therefore, was to evaluate the appropriateness of EMS responses in comparison to patient needs in a South African urban EMS system. Methods: All emergency cases dispatched over a 72 hour period at the Emergency Medical Communication Centre (EMCC) of the eThekwini Emergency Medical and Rescue Service (EMRS), a public sector urban EMS system, were prospectively enrolled in a quantitative study employing a descriptive, comparative design. Computer generated Vehicle Control Forms (VCF) containing dispatch data were matched and compared with Patient Report Forms (PRF) containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis and comparisons were analysed with correlations and chi-square. The Pearson's г and Spearman's rho were used to establish significance between more than two variables. Results : A total of 1689 cases were enrolled in the study of which 1385 met the inclusion criteria; 304 cases were excluded due to incomplete or duplicated data. The demand for EMS resources fluctuated widely throughout the day with levels peaking at midday and declining sharply after midnight. The median response time across all priorities was 56 minutes (IQR 59min) with just under half (46.4%) of all cases having a response time of more than an hour and almost one in ten (9.5%) exceeding 2½ hours. Significant variations existed between dispatch and on-scene priority settings and category descriptors most notable of which was seen in the highest priority ‘red code’ category which constituted more than 56% of all cases dispatched yet accounted for less than 2% on-scene (p <0.001). Conversely, over 80% of ‘red code’ responses actually required a lower priority response. Similarly, significant discrepancies were seen in the allocation of resources compared to the interventional needs of patients where it was shown that more than 58% of all cases required no interventions and just under 36% required only basic life support (BLS) level interventions (p <0.001). Of those patients triaged as ‘red code’ on-scene, less than 12% were initially allocated an appropriate Advanced Life Support (ALS) level of response and, of particular concern, only 7% of patients found to be dead or ‘blue code’ on-scene were initially dedicated a ‘red code’ response. Conclusion: South African urban EMS systems are presently unable to meet the needs of patients in terms of demand and matching resources to patient needs with evidently high levels of inconsistent and inappropriate responses resulting in sub-optimal use of limited resources.