Svensk ambulanssjukvård har under de senaste decennierna utvecklats och anses idag bedriva kvalificerad akutsjukvård. Men ambulanssjukvården har en utsatt arbetsmiljö som allt mer utsätts för hot och våld i det vårdande arbetet. Varje patient förtjänar en trygg och säker vård. Syftet var att beskriva hur ambulanspersonal upplever att vårdandet kan påverkas vid hot och våld i ambulanssjukvården. Metoden som användes var en litteraturöversikt. I denna litteraturöversikt har 15 vetenskapliga artiklar inkluderats. Artiklarna hämtades från databaserna Pubmed och Cinahl. Varje artikel är kvalitetsgranskad och bedömd enligt bedömningsmall från Sophiahemmet Högskola. Resultatet visar att ambulanspersonal som drabbas av våld upplevde att våldet stundtals kunde leda till försämrad vårdkvalité då situationen upplevdes som stressande. Ambulanspersonalen kände också oro för våld på arbetsplatsen vilket kunde påverka vårdandet. Dessutom upplevde ambulanspersonalen att korrekt träning och utbildning skulle kunna stärka säkerheten och samtidigt resultera i en bättre vårdkontakt. Ambulanspersonal som har utsatts för hot och våld har förändrat sitt beteende och känner sig alltmer rädd och oroad på arbetsplatsen samt arbetar med en ökad försiktighet och misstänksamhet. Effekterna av detta kan leda till en minskad empati mot patienten. Vid situationer där hot och våld är förekommande är det vanligt att vårdandet hamnar i bakgrunden. Slutsatsen visar att situationer där hot och våld förekommer i ambulanssjukvård ökar risken för konsekvenser för vårdandet. Ambulanspersonalens känslor och bemötande påverkas i negativ riktning vilket i sin tur kan leda till att vården påverkas. Ambulanspersonal behöver mer utbildning i hur de ska agera i en hotfull situation där risken för påverkan på vården finns. Avslutningsvis är det av stor vikt att ambulanspersonalen erhåller önskat stöd och eventuell rehabilitering efter en situation där hot och våld utspelats. / Swedish ambulance care has developed during the last decades and today it is considered to provide qualified emergency care. But the ambulance care has an exposed work environment that more often receives threats and violence in the work of care. Every patient deserves safe and secure care. Furthermore, it is important that ambulance staff gets to work in a safe and healthy environment. The purpose was to describe the ambulance staff´s experiences how the caring may be affected by threats and violence in ambulance care. The used method was a literature review. In this literature review 15 scientific articles were included. The articles were collected from the databases Pubmed and Cinahl. Each article was quality reviewed and assessed according to an assessment template from Sophiahemmet University. The result shows that ambulance staff affected by violence experienced that violence sometimes could lead to impaired quality of care when the situation was perceived as stressful. The ambulance staff were also concerned about violence in the workplace, which could affect the caring. In addition, the ambulance staff felt that proper training and education could strengthen safety and at the same time result in better care. Ambulance staff that have been exposed to threat and violence have changed their behavior and feel more scared and concerned at work, they also work with increased caution and suspicion. The effects of violence may lead to reduced empathy towards the patient. In situations where threats and violence occur it is common that the caring ends up in the background. In conclusion, situations where threat and violence occur in ambulance environments increases the risk of negative consequences for the caring. The ambulance staff's feelings and treatment are affected in a negative direction which may lead to influence in the caring. The ambulance staff need more education in how they are supposed to act in a threatening situation when there is a risk of consequences of the caring. Finally, it is important that ambulance staff receives support and possible rehabilitation after a situation that contains threat and violence.

Bakgrund: Vårdmötet mellan ambulanspersonal och patient påverkar patientens upplevelse och behandlingsresultat. Empati, kommunikation och respekt är nyckelfaktorer. Förståelse och uppfyllande av patientens behov är viktigt för en kvalitativ vårdrelation. Tidigare forskning visar att patientens fysiska behov ofta prioriteras över de psykosociala, vilket kan leda till bristande respekt och medkänsla. Ambulanspersonalen måste balansera fysiska och psykosociala aspekter för en respektfull vårdrelation. Att identifiera och förstå faktorer som främjar eller hindrar vårdmötet är avgörande för att förbättra vården och säkerställa att varje patient känner sig sedd och lyssnad till. Syfte:Att beskriva patienters upplevelser av faktorer som främjar eller hindrar vårdmötetmed ambulanspersonal. Metod: En litteraturöversikt med systematisk ansats och integrerad analys genomfördes. Resultat: Litteraturöversikten mynnade ut i två teman: Patientens upplevelse och interaktion ivårdmötet samt ambulanspersonalens professionella kompetens och förhållningssätt. Patienterna kände sig ibland förbisedda av ambulanspersonal och betonade sin beroendeställning. Deltagande i vårdbeslut och respektfull behandling främjade positiva vårdupplevelser. Kommunikationens kvalitet och förståelse för patienternas behov var viktiga. Bristande kommunikation ledde till ogynnsamma utfall och känslor av maktlöshet. Ambulanspersonalens empati och lugnande närvaro påverkade välbefinnandet och känslan av trygghet hos patienterna. Deras professionalism och omsorg skapade förtroende och lugn vilket främjade en positiv vårdupplevelse. Slutsats: Resultatet ger en viktig insikt i både främjande och hindrande faktorer iinteraktionen mellan ambulanspersonal och patienter, med betoning på att bli tagen på allvarsom en avgörande främjande faktor. Det understryker behovet av utbildning för att ambulanspersonal ska kunna lyssna på och respektera patienternas upplevelser, samt anpassa sin kommunikation för att möta individuella behov. Dessa insikter kan användas för att förbättra kommunikationsstrategier och tillämpa omvårdnadsprinciper för att skapa en trygg vårdmiljö, vilket kan leda till förbättringar inom utbildning och vårdutförande inom ambulanssjukvården. / Background: The interaction between ambulance staff and patients influences the patient's experience and treatment outcomes. Empathy, communication, and respect are pivotal factors. Understanding and meeting the patient's needs are crucial for a qualitative care relationship. Previous research indicates that the patient's physical needs are often prioritized over thepsychosocial ones, potentially leading to a lack of respect and compassion. Ambulancepersonnel must balance physical and psychosocial aspects for a respectful care relationship. Identifying and understanding factors that promote or hinder the care encounter are crucial for improving healthcare and ensuring that every patient feels seen and heard. Aim: To describe patients' experiences of factors that facilitate or hinder the care encounterwith ambulance personnel. Method: A literature review with a systematic approach and integrated analysis wasconducted. Results: The literature review resulted in two themes: the patient's experience and interactionin the care encounter and the ambulance personnel's professional competence and attitude. Patients sometimes felt overlooked by ambulance personnel, emphasizing their dependency. Participating in healthcare decisions and receiving respectful treatment promoted positive care experiences. The quality of communication and understanding of patients' needs were crucial. Poor communication led to unfavorable outcomes and feelings of powerlessness. The empathy and calming presence of ambulance personnel influenced patients' well-being and sense of security. Their professionalism and care instilled trust and calmness, promoting apositive care experience. Conclusion: The results provide valuable insights into both facilitating and hindering factors in the interaction between ambulance personnel and patients, with emphasis on being taken seriously as a crucial facilitating factor. It underscores the need for education to enable ambulance personnel to listen to and respect patients' experiences and adapt their communication to meet individual needs. These insights can be used to improve communication strategies and apply nursing principles to create a safe care environment, leading to enhancements in education and care delivery within ambulance healthcare.

No description available.

Dissertation submitted in fulfilment of the requirements for the Degree of Master in Technology: Emergency Medical Care, Durban University of Technology, 2010. / South Africa currently has 1631 registered Advanced Life Support (ALS) paramedics to tend to the pre-hospital advanced life support needs of just under 50 million people. Compared to the globally accepted ratio of 1:10 000, the number of ALS paramedics in South Africa is grossly inadequate. The current shortage of South African ALS paramedics may be ascribed to migration. However, although literature on health worker migration in general abounds, there is a marked lack of national or international statistics and information on migration of ALS paramedics and their migration. Current measures to manage migration appear to be ineffective. The success of future strategies is dependent on an understanding of the migration of South African ALS paramedics - an understanding that presently does not exist. Purpose The purpose of this study was to describe the migration of South African undergraduate Advanced Life Support paramedics who qualified between 2001 and 2006, and to then develop a framework of retention strategies. In particular, it determined the extent and nature of their migration, identified the factors that have contributed to their decision to work outside South Africa and identified strategies to retain or encourage the return of ALS paramedics to practice exclusively in South Africa. Methods The study consisted of a two-phase mixed method descriptive survey. Paramedics with ALS undergraduate diplomas who qualified in South Africa between 2001 and 2006 made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N=97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n=10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were Page vi integrated to obtain an in-depth understanding of South African ALS paramedic migration. Results Significant differences existed in the distribution of age (p=0.035), and years of experience post-graduation (p=0.007) and the ALS paramedic deemed most likely to migrate were individuals between the ages of 21 – 30. 15 (55%) of the participants working outside the country were engaged in short term contracts while all 24 (100%) of participants working inside South Africa were permanently employed. 18 (75%) of respondents working inside South Africa intended migrating, 12 (67%) of which intended to do so within 0 to 2 years. Nine major factors or reasons for migration were identified by participants. Working conditions, physical security and economic considerations were ranked as the top three major factors most likely to contribute to the decision or intended decision to migrate. This study also found five primary decisions that likely emerge during the life of a South African ALS Paramedic. The outcome of each decision is a result of facilitators weighted against barriers. Facilitators are factors that supported each of the primary decisions while barriers weakened or rejected them. Findings indicated that many barriers existed which rejected or weakened the decision of ALS paramedics to work inside South Africa, return to South Africa or remain in South Africa. On the converse, a vast number of facilitators existed which spurred continued migration. Conclusions As the decision to migrate may be conceptualised as early on as when individuals decide to become ALS paramedics, the constructs of return and retention strategies have to extend as far as revising recruitment policies. Preference or places into training programmes should be given to individuals who are less inclined to migrate, these include: military personnel; those already employed in the EMS, older mature candidates; candidates with families that have already settled in SA; and recognition of prior learning (RPL) candidates who are predominately obligated by contract to remain in South African EMSs.

<p>Sammanfattning</p><p>Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre.</p><p>Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal.</p> / <p>Abstract</p><p>The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada.</p><p>The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients.</p><p>Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.</p>

Sammanfattning Syftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada. Den motsatta situationen existerade också, där ambulanspersonalen påbörjade HLR av hänsyn till anhörigas vilja i frågan. I helhet visade ambulanspersonalen en vilja att respektera patientens autonomi i HLR frågan. Ambulanspersonalen i Nordamerika stödde antagandet av lagar som möjliggjorde prehospital Ej HLR, när det gällde terminalt sjuka och terminalt sjuka äldre. Sökord : Etik, ambulanssjukvård, HLR, HLR- Riktlinjer och ambulanspersonal. / Abstract The aim of this study was to describe exsisting research about the ethical conflicts, faced by paramedics surrounding the decision makeing in CPR and to determine the influence that prehospital CPR guidelines have on ethical issues regarding CPR. A litterature rewiew was conducted by analyzing thirteen scientific articles.The result showed that ethical conflicts appeared whithin paramedics decision, wheter to start or whithheld CPR in situations described by the litterature as patients that have a terminal illness or in elderly terminally ill patients. Sometimes paramedics violated the patients autonomi, when performing CPR despite the precense of a DNR wish from the patient and the patients family. The main reason that such situations occured was indistinct legalisation in prehospital CPR guidelines in USA and Canada. The opposite situation also occured,were the paramedics initiated CPR in order to honour the wishes from the patients relatives. Overall paramedics showed a will to respect the patients autonomi in the CPR question. Paramedics in the Northen America supported prehospital guidlines statues allowing them to withheld CPR,under cirumstances initiating CPR in terminally ill and elder terminally ill patients. Keywords : Ethics, Emergency medical services, CPR, CPR guidelines and Emergency medical technicians.

Magister Public Health - MPH / In response to the increasing burden with regard to treatment of HIV/AIDS in Mozambique, the Ministry of Health has developed a national strategic plan for HIV and AIDS. This provided for broader access to Antiretroviral Therapy (ART) by decentralizing and integrating ART services into the essential services provided at the primary care level. In keeping with this initiative,medical technicians are now responsible for first-line ART prescription and management at primary-level care health centres in the country. The ART programme was introduced in Mozambique in 2003 alongside other health services offered in hospitals; it was decentralized to PHC health centres in 2006.This study aimed to explore the experiences and perceptions of medical technicians regarding the decentralization and integration of ART services into PHC health centres in Beira. An exploratory qualitative study was conducted using in-depth interviews, key informant interviews and focus group discussions. A sample of 15 medical technicians was distributed across two focus groups for the purpose of discussion. In addition there were four in-depth individual follow-up interviews with four medical technicians, drawn from the two focus groups. Three key informant interviews were also held to collect data. The data was analysed using content analysis.The study revealed that the decentralization process was viewed by many of the medical technicians as a very positive initiative for the country. However a number of operational and managerial issues need to be addressed to ensure the effectiveness of the comprehensive approach that was institutionalized and adopted by all PHC health centres. Key amongst the issues that needed to be addressed were the workloads of the health care personnel, and of medical technicians in particular. Their workloads have increased without any corresponding increase in the health workforce needed to manage the patient load. The medical technicians felt that this adversely affected the quality of care they were able to provide to patients, and specifically to those requiring ART medication. The recommendations that emerge from the study are intended to promote the development of policy that will improve of working conditions and assist medical technicians to provide a better service to their patients.

Submitted in fulfillment of the requirements for the Degree Masters of Health Sciences in Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2016. / Clinical practicum remains an integral part of training and a vital component of the emergency medical care curriculum that takes place in a realistic and complex emergency care environment. Clinical practicum should provide students with the opportunity to combine cognitive, psychomotor and affective skills to develop competencies to prepare the qualifying practitioner for demands of pre-hospital emergency care in the real world. The aim of this study was to explore the multidimensional aspects of the clinical practicum experience of ALS paramedic students in the Western Cape through the lens of a qualitative research design. The study involved exploring the experience of paramedic students in the clinical practice placement. In addition, the views of paramedic graduates were also explored, to ascertain whether the placement experience adequately prepared them for practice. An analysis of the clinical practice documents utilised in the training of ALS paramedic students was conducted with particular reference to identify correlations with relevant literature. In addition, it was necessary to identify how clinical practice manifested itself, not only in what students and graduates express but also how it was coordinated and conveyed in a professional work related context, against the backdrop of the work integrated learning framework. Using a case study design, focus group interviews were conducted with final year EMC students from CPUT and CCA students from the Western Cape CEC. This was followed with one on one interview with paramedic graduates. Further to this, clinical practice documents were analysed to triangulate the data. This study revealed that the clinical practice learning objectives for paramedic students were not adequately achieved and paramedic graduates felt ill prepared for independent practice. These discrepancies were attributed to the complex issues both in theory and practice. The study provided a number of recommendations for improving the clinical training experience, such that paramedic graduates who enter the complex and challenging world of EMC are better prepared. / M

[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.