Background. In South Africa violence related crimes are frequent, and interpersonal violence is one of the most common causes of injury and death. Violence can be related to social structures, poverty and income inequality. In South Africa 25% of the population live in extreme poverty, and 16% of households in Western Cape live in Informal dwellings. Drug and alcohol miss-use is a big problem. EMS personnel all over the world are exposed to violence. The last couple of years the rate of incidents of violence against the ambulances and EMS personnel in Western Cape and Cape Town has escalated, and a protocol to protect the personnel has been established. The protocol of Red Zones requires an armed escort for the ambulance and EMS personnel when working in certain areas. The red zones are often in low income areas, which makes United Nations’ Sustainable Development Goal of Reduced inequality relevant. The Purpose of this study is to describe how red zones affect patient waiting times and mission times for the ambulance in the Western Cape province of South Africa. Method. Quantitative analysis of priority 1 assignments in one month periods in 2016, 2017 and 2018 to Hanover Park, a suburb of Cape Town. Hanover Park has been considered a red zone since September 2016. Result. Seven different time periods in the missions were analyzed, comparing the City of Cape Town and Hanover park in 2016, 2017 and 2018. Conclusion. The result shows an increase in waiting times for EMS in Hanover Park, even though the precise response time could not be described. Call times and mission times for the entire City of Cape Town seem to have increased, indicating a problem beyond the red zones, potentially affecting everyone in need of an ambulance in the city. Further studies are encouraged. / Bakgrund. I Sydafrika är våldsrelaterade brott vanligt förekommande, och interpersonellt våld är en av de vanligaste orsakerna till skada och död. Våldet kan relateras till sociala strukturer, fattigdom och inkomstskillnad. I Sydafrika lever 25% av befolkningen i extrem fattigdom och 16% av hushållen i Western Cape lever i informella bostäder. Missbruk av droger och alkohol är ett stort problem. Ambulanspersonal över hela världen utsätts för våld. De senaste åren har graden av våldshändelser mot ambulanser och dess personal i Western Cape och Kapstaden eskalerats och ett protokoll för att skydda personalen etablerats. Protokollet för Röda Zoner kräver en beväpnad eskort för ambulans och personal vid arbete i vissa områden. De röda zonerna är ofta i låginkomstområden, vilket gör FN: s hållbara utvecklingsmål för minskad ojämlikhet relevant. Syftet med denna studie är att beskriva hur röda zoner påverkar patienters väntetid och uppdragstider för ambulansen i Western Cape i Sydafrika. Metod. Kvantitativ analys av prio 1-uppdrag under en månadsperiod i 2016, 2017 och 2018 till Hanover Park, en förort till Kapstaden. Hanover Park har ansetts vara en röd zon sedan september 2016. Resultat. Sju olika tidsperioder i uppdragen analyserades, och jämfördes mellan hela Kapstaden och Hanover Park 2016, 2017 och 2018. Slutsats. Resultatet visar ökad väntetid för ambulansvård i Hanover Park, även om den exakta framkörningstiden inte kunde beskrivas. Uppdragstider för hela staden Cape Town verkar ha ökat, vilket indikerar ett problem bortom de röda zonerna, vilket potentiellt kan påverka alla som behöver en ambulans i staden. Ytterligare studier rekommenderas.

The theme of my diploma is the Logistic indemnity of medical interference within the area of multiple victim accidents. The world was struck by natural disasters during its long history. As well as the strengthening of natural disasters, the appearance of the disasters caused by human activity has been increasing in recent times, and at present and their after-affects are more destructive. This diploma is taken as a overall cross {--} sectional study of the topic of logistic indemnity of medical interference within the area of multiple victim accidents. After a brief approach of the history of prehospital care the diploma is focused on legislative regulation of this theme including processing of emergency plans and traumatological plans, financing of crisis set-ups, special training, procedure of salvage and liquidation operations of the units of integrated rescue systems and logistic indemnity of medical interference in the form of material and technical special equipment including human sources and psychological support. This diploma also includes some special problems of this topic (e.g. processing of traumatological plans, financing of crisis set-ups, labels of multiple victim accidents).

In the essay, the view of mistakes and disciplinary sanctions within the military aviation and health and medical service, are compared. The comparison shows that military aviation and health and medical service could have several points in common on how mistakes may occur, but that the present view of mistakes is different betwen the sectors. The view of mistakes and disciplinary sanctions is explicit within military aviation, and is based on a clear ideology on how mistakes occur, which is characterised of a systematic approach. Within health and medical service, an explicit and unequivocal ideology on how mistakes occur is missing, but, however, there are implicit ideas about infallibility and perfection. The comparison indicates that the view of mistakes is also, possibly directed by a bureaucratic model (instead of an ideology on mistakes), which aims to legitimacy, but that this may happen on the expense of not taking surrounding circumstances into consideration. In that way there may be a certain contrast in the health and medical service’s present system between rule of law and medical service safety.

THE ABSTRACT It has been shown recently that workload, stress, and burnout syndrome among the staff of the medical rescue service may be major risk factors in terms of triggering the use of psychoactive substances. Representing what is understandably a delicate issue, substance use among emergency medical staff has not been thoroughly studied in our country. Emergency medical workers' difficult working conditions and the chronic stress they are exposed to, in combination with a lack of support and care on the part of their employers, result in exhaustion and general distress, accompanied by the development of symptoms associated with both physical and mental disorders. This condition may lead to the use of psychoactive substances as a negative coping strategy. Consisting of both theoretical background and case studies, the paper points out the relationship between the chronic effect of stressors pertaining to the job of emergency medical workers and the use of psychoactive substances as a way of coping with and compensating for the implications of work-related stress and fatigue. Thorough case studies are presented to demonstrate the onset and development of addictive behaviour within a wider context, with special emphasis being placed on its association with coping with both acute and chronic occupational...

This paper brings critical sociological analysis of contemporary situation on the EMS field in Czech Republic and discovers several topics which seemed to be less emphasized at that time. The result of the study is complex description of the EMT's personality, particular types, the population as a whole, specific relationships between variables and a few problems identified during the survey. Using mixed design research methods, the author deals with the emergency medical services in Czech Republic and it's employees. Based on the narrative data collected in speeches with the EMS staff, the typology of EMT's was created, considering their work attitudes, and a set of hypothesis was created as well. On this basis the continuing quantitative research was designed, verifying the validity of previous findings. The paper offers possible directions, how to continue in forthcoming research.

This thesis engages in its theoretical part description of the process of pursuance and assurance of quality in emergency medical dispatch centre. There is also a comprehensive description of key quality parameters used in this environment in this part. The content of the empiric section is an organizational case study, which aim was to evaluate an extensive organizational change in emergency medical dispatch centre of the Emergency Medical Service of the Central Bohemian region and its impacts on the quality of care. The first phase of centralization of emergency medical dispatch centres in the Central Bohemian region went through during the first half of 2011. Four local emergency medical dispatch centres were gradually brought together into one entity. The aim of the research was to evaluate impacts of the organizational change on key quality parameters. The observational retrospective study consists of two groups of data, collected from identical area during two equivalent periods. Group A contains data from the period of six months before and group B contains data from the period of six months after the centralization. Key quality indicators were compared in both groups: response time; call processing times; safety of classification and indication of calls; use of dispatch life support and...

This thesis explores and evaluates the educational system of certain ambulance service. It's aim is to suggest the recommendations leading to higher efficiency and individualization of the system. This is the way how to address the educational needs of individual employees and help their professional development. Theoretical part of the thesis pays attention to employee's education and describes the specifics of educational cycle in more detail. So far there was no functional educational system in place in explored organization. This is the reason why to make it happen. The change I talk about needs to be prepared, planned and realized. Therefore another theme of theoretical part is devoted to implementation of change in organization. The practical part initially summarizes the attitude of Czech and some foreign ambulance services towards to employee's education, as it appears from their web sides. It also describes the current system of education in explored organization and evaluates it from the change implementation point of view. The attention is also paid to the fulfillment of different parts of educational cycle. Last part of this section is dedicated to research focused on realization of the first phase of cycle - identification of employees' educational needs. The closing part contains all...

Thesis (Ph.D. (Social Work)) -- University of Limpopo, 2021 / An Emergency Medical Service (EMS) is considered one of the most stressful work environments. Copious literature has demonstrated that emergency service work has an undesirable impact on the health and wellbeing of personnel. In South Africa, research findings described that emergency services personnel are among the highest group of professionals at risk of suffering from job-related stress. In spite of the fact, previous studies have examined the association between critical incidents and Post Traumatic Stress Disorder (PTSD) symptoms including the psychological influence of trauma, a minority studies have explored the EMS personnel’s traumatic experiences and the subsequent coping strategies applied. This study sought to explore and describe the lived experiences of Emergency Medical Personnel in Capricorn District and to develop a user led model for mitigating occupational stress among EMS personnel. The principal aim of this study was achieved through the following objectives; to profile work related stress and the lived experiences of EMS personnel in Capricorn District, to Identify and appraise coping strategies employed by EMS personnel, to establish how accessible and user friendly EAP services are to EMS personnel, to determine the nature of social support (colleagues and supervisors) EMS personnel receive and to develop a user-led model for EMS personnel. This study was rooted in three theories, namely; trauma theory, resilience theory and the strengths perspective theory. The three theories were appropriate in this study to offer a perspective of situation and to analyse the situation under study to provide an understanding into the way in which EMS personnel make sense of their situation of the challenges they come across and make use of the available resources. The three theories interlaced together played a critical role in this study as they both align with building resilience, recognise individual’s innate strengths and coping in the face of hardship. Owing to the inimitability role of the emergency personnel and the services’ work context, the study adopted a qualitative approach. The purpose of the study was exploratory descriptive in nature. Exploring both their experience of critical incidents and the coping strategies employed by them to mitigate work-related stress and traumatic incidents from this qualitative perspective allowed the researcher to employ phenomenological research design for this study. A sample size of 21 emergency employees comprising 7 station managers and 14 EMS personnel) was obtained through purposive sampling technique. Thematic analysis was used to analyse data.  The findings suggest that life in the emergency field can possibly have an undesirable long-term effect on employees’ overall health and welfare and higher risk of PTSD. The distressing incidents were those in which the participants experienced feelings of vulnerability and had no control of the situations. The study established that emergency personnel find it most hard to deal with incidents involving children and colleagues. Emergency personnel suffer from emotional and physical stress owing to high job demands and repeated exposure to traumatic incidents. Regardless of the traumatic nature of emergency work and the inimitable role of emergency personnel, this study discovered that fact several stressors originate from organisational failure such lack of involvement in decision-making process, lack of training and shortage of staff. Unsupportive work environment, Lack of personal and job resources were found to be the extensive contributory factors to the job pressure experienced by which lead to compassion fatigue and exhaustion. It was also discovered the current EAP programme in the Department of Health (DoH) is not known and inaccessible to EMS personnel. The coping strategies utilised by emergency personnel were not adequate to prevent the aftermath of critical incidents. However collegial and social support from supervisors were found helpful in dealing with work-related stress. The study findings revealed that emergency personnel were unaware of the available support services within the DoH in Capricorn District. Collectively, the findings confirm that there is a need for an extensive marketing strategy of the EAP services and the user-led model which will be implemented by the organisation. The researcher recommends that EAP policies should form part of package given to new recruits during induction or orientation programme and diverse marketing strategies should be adopted to familiarise employees with EAP services available to them. The DoH should consider decentralisation of EAP services to enhance accessibility.

A superlotação de serviços de emergência é problema sério e de grande relevância do sistema de saúde, não sendo restrito ao nosso meio. Os estudos que enfocam esse tema vêm tomando proporções na literatura internacional. O que se vem vivenciando há mais de uma década são prontos socorros lotados devido a um deslocamento da população em direção a estes serviços, configurando-os como prestadores de atenção primária de assistência à saúde e, não de fato, destinados ao atendimento de emergências. O principal objetivo do estudo foi recompor a trajetória do usuário do serviço de saúde até a chegada à unidade de emergência de um hospital terciário do município, qualificando-o segundo as razões de escolha de atendimento e caracterizando seu perfil socioeconômico e demográfico. Este estudo de corte transversal se restringiu à análise da demanda espontânea do Pronto Socorro de Emergências Clínicas do Hospital das Clínicas da Universidade de São Paulo. Foram entrevistados todos os usuários que procuraram este serviço durante uma semana típica. Dos pacientes entrevistados, foram incluídos no estudo 881 pacientes, o que representou 93,1% do total. Realizada a análise estatística univariada, seguida pela construção de um modelo de regressão logística, para estudo das variáveis associadas à vinda direta ao pronto socorro. Os resultados demonstraram que a demanda era constituída predominantemente de mulheres, brancas, com idade média de 44 anos, baixo grau de instrução, com rendimento per capita mensal de até uns salários mínimos e residentes no município de São Paulo (81,3%). Cinco por cento tinham direito à assistência médica privada. Quanto ao acesso a serviços de saúde, 72,5% residiam próximo a serviços de saúde de atenção primária e 53,4% a hospitais e/ou prontos socorros. Quanto à trajetória percorrida antes da chegada ao pronto socorro, 56,2% procuraram diretamente o pronto socorro. Dos pacientes que procuraram outros serviços previamente, 26,4% passaram por unidades básicas de saúde e 73,6% por outros hospitais/prontos socorros. Dos 881 pacientes entrevistados, 771 foram dispensados após consulta médica. As características associadas à vinda direta ao pronto socorro foram: nível superior de escolaridade, não ser casado, não ter diagnóstico médico, possuir cartão do Hospital das Clínicas, ter idade entre 25 e 39 anos e contribuir para a Previdência Social. Por outro lado, quanto maior a duração da queixa e quanto mais distante o local de residência, menor a probabilidade de procurar este serviço diretamente. As razões do uso dos serviços de emergência envolvem mecanismos complexos, além da credibilidade e confiança na instituição, facilidade de acesso e baixa resolutividade dos outros serviços da rede pública de saúde. Contrariamente ao senso comum e a visão corrente de vários gestores do sistema de saúde, a problemática de superlotação dos serviços de emergência não reside apenas na atenção primária, mas sim no baixo poder de resolução da rede hospitalar. / Overcrowding in Emergency Department is a Public Health problem not only in Brazil. However, information about the population that search for emergency medical care at tertiary hospitals in Brazil is incomplete. Therefore, the main objective of this work was to reconstruct the pathway of these patients until their arrival to the Clinical Emergency Department of a tertiary Hospital. During a typical week, 1121 patients were attended at the Hospital das Clínicas Clinical Emergency Department, São Paulo, Brazil. From this total, 946 were interviewed and 881 (93,1%) were selected to the study. The selected patients were questioned by health care professionals before the medical consult, regarding their demographic characterization, as well as questions about the reasons why they choose this specific health service. Variables associated to the patients coming to the hospital were studied by univariate analysis followed by construction of a logistic regression model. The emergency service demand is composed predominantly by white women, 44 years old (mean age), living in São Paulo City (81,3%), low instruction grade, monthly income around US$ 80. Only 5% of them have private health care plan. Usually they have a primary medical service (72,5%) or a hospital/emergency service (53,4%)in their home neighborhoods. More than half of the patients (56,2%) came directly to the Clinical Emergency Department, without searching for a less complex service. The most frequent diagnosis was upper airways infections. More than 92% of the patients attended were discharged after a simple medical consultation, suggesting that they could have been seen in a less complex health care facility. Patients not married, aged between 25 and 39 years old, with higher level of instruction, without clinical disease and that had been attended at Hospital das Clínicas any time were more likely to search this emergency service before to go to other health services. In other hand, patients living far from the service and with symptoms during several days were less likely to search this service directly. Asked the reasons they search this specific Emergency Service, patients cited credibility and trust are major factors, along with lack of confidence and solving ability of the others services. Factors priming the patients to have this specific service as a first choice were living close to the Hospital, higher education level, symptoms lasting less than one day and fever as a presenting symptom. From the patients attended in other services, prior to their arrival at this Emergency Department, 26,4% were seen at primary care facilities and 73,6% at other hospitals. In this study we have shown that the reasons why patients search for a Clinical Emergency Department in a tertiary Hospital is very complex, including easy access, credibility and lack of trust in other services. These results are contrary to the common sense, and the current view of Health Care directors. Overcrowding in Emergency Departments is due not only to inefficiency Primary Care services, but also to low solving ability of hospital services.

緊急醫療救護法自從民國84年8月9日公布迄今，已歷經四次修正，最後ㄧ次修正為民國96年7月。公布後迄今的十多年間，緊急醫療救護之環境丕變，從原本消防局救護人員擔任從家裡送到醫院，單純的「運送」角色，然後轉交於醫院醫護人員為急診醫療處置的情況，驟然變成了由指導醫師教育、訓練、督導、考核之下，得由救護技術員於現場實行不等的醫療救護行為，有問題時得詢問線上醫療指導醫師。除此之外，在需救護車送到醫院情況下，民眾現在得自由選擇民間救護車機構或是消防局救護車。換句話說，緊急救護場景即從原本的三角當事人關係，演變成了複雜五角甚至六角當事人關係。當事人間的權利義務關係為何？查詢最近的論文，多為醫師與病患間醫療行為的刑事與民事關係，卻鮮少論及到院前救護時，地方政府、救護技術員、醫療指導醫師與緊急傷病患間之權利義務關係。 本論文之研究目的，就在於了解並釐清緊急救護系統內各當事人間之權利義務，待損害發生時可得適當之救濟途徑；並嘗試藉由美國與我國已有之到院前救護相關爭訟判決，來了解未來我國到院前救護可能發生之紛爭，進而提出改善建議，來達到預防爭訟之效果。本研究之範圍將限於緊急醫療系統中之到院前救護階段，著重於緊急傷病患之現場緊急救護及醫療處理，與送醫途中之緊急救護。而大量傷病患、重大傷病患或離島、偏遠地區難以診治之傷病患之轉診與醫療機構內之緊急醫療，以及災難醫療救護部分則不在本論文之討論範圍內。 本文共分五章，分別為第一章緒論、第二章我國緊急醫療系統的介紹與現狀、第三章派遣與反應階段損害賠償責任之成立、第四章現場救護與送往醫院階段損害賠償責任之成立、第五章結論。 第一章為緒論，在於闡述本研究之動機與目的，與進行本研究之範圍及研究方法，最後作架構性的介紹與各章節的簡介，祈能使讀者對本論文架構有一初步的認識。 第二章首先對於緊急醫療救護的定義與目的作一概要之介紹，再來介紹我國現行到院前緊急救護系統中各個當事人於現行法規規定下所扮演的身分、角色與工作內容。之後對於我國到院前緊急醫療系統資源現況、缺失與運作流程作一清楚之描述。 第三章首先介紹到院前救護損害賠償責任之態樣，分「國家賠償責任」與「民法損害賠償責任」兩種為說明。本文認為「救災救護指揮中心啟動之到院前救護」為具公法性質之行政事實行為，因而如該當國家賠償之要件時，自有國家賠償請求權。而「非救災救護指揮中心啟動之到院前救護」則為民法之範疇，並將之類型化可分為「民眾直接聯絡民間救護車營業機構」、「負保護義務之人聯絡簽約之救護車設置機構」及「救護車設置機構自行啟動」三種類型，並對其中當事人間之法律關係作一描述與釐清相對之權利義務。 再來論及緊急救護中借名醫療院所的連帶責任，並搜集學說與實務判決以了解目前通說與實務之見解。隨後介紹派遣與反應階段可能發生的問題，及美國與我國之實務判決。 第四章介紹現場救護階段與送往醫院階段所可能發生的法律問題。首先釐清救護技術員執行緊急醫療救護是否違反醫師法之密醫罪。接著探討現場救護人員之注意義務標準與共同侵權責任判定之實務見解。再來討論線上醫療指導制度所可能引發之問題與解決方案。另外亦分析如非緊急醫療系統的醫師於救護現場時可能發生的情況與相關問題。之後對於現場救護時所可能遭遇的說明義務履行困境及相關建議。本章的最後，則再探討送往醫院的路程中可能發生的問題，包括送往醫院的決定者為誰，與救護車發生車禍時，對於緊急情況判定的法院見解與本文建議。 第五章為結論。