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Emergency medical services (EMS) personnel experience direct traumatic exposure that can leave a lasting negative impact. However, little is known about the vicarious exposure that EMS personnel experience at challenging calls when family and loved ones are present at the scene. Additionally, there is minimal research that has looked at the experiences among paramedics and EMTs who arrive to mental disturbance calls or completed suicides. In order to add to the substantial body of literature on EMS personnel and traumatic exposure, this study explored their experiences of multifaceted traumatization; the lived experiences of paramedics and EMTs who have responded to completed suicides where loved ones of the deceased were present, and as a result, experienced both a negative psychological impact and posttraumatic growth. The study explored the risk factors and protective factors that paramedics and EMTs experience in their work. Additionally, this inquiry sought to explore the ways in which participants find meaning in providing emergency medical services and how they sustain their work. <br>This qualitative, phenomenological study was conducted through semi-structured individual interviews with 12 paramedics or EMTs who have been employed or volunteered for at least one year. Explication of data was completed using van Manen's (1990) four existential themes: spatiality, corporeality, temporality, and relationality. The results of this study identified themes that address van Manen's (1990) lived existentials, protective factors against posttraumatic symptoms through direct and vicarious traumatization, risk factors that contribute to these symptoms, and meaning making in their work. The implications of the study for the field of emergency medical services and suggestions for future research are provided. / School of Education; / Counselor Education and Supervision (ExCES) / PhD; / Dissertation;

Background Point-of-care blood gas analysis is considered a standard of care in modern air ambulance operations by many professional organisations for clinical assessment and monitoring of patients. Instances where point-of-care blood gas analysis has identified clinically significant abnormalities which then led to clinical intervention are well documented and have been quantified previously in the air ambulance environment. However, results obtained from point-of-care blood gas analysis are not always required for patient care, nor do they always result in any clinical action on the part of the medical crew. Our question therefore related to the data for a Johannesburg based jet air ambulance service. Methods By means of retrospective case reviews over a one year period, we reviewed the overall frequency of utilisation of point-of-care blood gas analysis on patient transportations within a Johannesburg based jet air ambulance service. We established how often point-of-care blood gas analysis yielded abnormal findings, and how frequently abnormalities detected by point-of-care blood gas analysis resulted in clinical interventions. Results Point-of-care blood gas analysis was undertaken in 266 of 334 patients transported (79.6%). Abnormal findings were noted in 203 of the 338 blood gas analyses undertaken (60.1%). Patient age (p=0.001) and intubation status (p=0.01) were significant influences on number of analyses performed, while flight time was not significant (p=0.07). Clinical intervention followed in 65.5% of instances where abnormalities on blood gas analysis were noted and in 87.6% where clinical corrective intervention was assessed as being possible under prevailing conditions. Of all patients transported, some form of clinical intervention was undertaken following 39.3% of all blood gas analyses undertaken. This therapeutic yield evidenced is equivalent to 2.54 samples analysed per corrective clinical action evidenced. A costing analysis further revealed that this testing is relatively inexpensive per positive finding yielded and subsequent clinical actions. Conclusions Abnormalities detected and subsequent clinical intervention using point-of-care blood gas analysis in this patient population was significant with a clinical yield of 39.3%. Since the costs are also not very high this modality is rightfully considered a minimum standard of care in air ambulance operations. These findings also support the notion that such testing should be carried out routinely on all patients irrespective of clinician interpretation of indication or need

To determine the level of self-assessed competence various registrars possessed in emergency skills as well as to identify any factors that may have contributed to their level of competence. Materials and Methods: Questionnaires were completed by registrars working in General Surgery, Internal Medicine, Psychiatry and Radiology in three academic hospitals in Johannesburg. Information regarding demographic data, educational background, work experience in emergency-related environments and resuscitation courses attended were collected. Registrars rated their level of perceived competence in a list of 25 emergency skills according to a ranking scale of 1 to 5. Results: A total number of 94 registrars participated in the study which amounted to an estimated response rate of 35%. General Surgery registrars had the highest mean competence scores of 3.7 and 3.9 for the respective basic and advanced skills groups. General Surgery and Internal Medicine registrars had the highest mean competence scores of 3.7 for the intermediate skills group. Psychiatry registrars had the lowest mean competence scores of 2.7, 2.4 and 1.5 in each of the skill groups. Registrars who had current certification in a PALS course had competence scores 0.6 units higher than others in both basic (p=0.027) and advanced (p=0.035) emergency skills. Conclusions: General Surgery and Internal Medicine registrars have a higher level of perceived competence in various emergency skills. The General Surgery group rated themselves the highest in levels of competence in the basic and advanced emergency skills groups. Current certification in BLS, ACLS, PALS and AMLS has a positive impact on registrars‟ self-perceived levels of competence in emergency skills. Registrars who had spent less time between community service and starting their specialist training had higher levels of self-perceived competence in intermediate and advanced emergency skills.

The purpose of this qualitative study was to investigate whether there were differences between the preconceived notions of emergency medical technicians and paramedics prior to entering the profession and their notions of the vocation after facing the realities of the job. The contribution of alignment or misalignment to job satisfaction and the intention to leave the profession was also further investigated. This research is important as there currently is a gap in the literature pertaining to the factors affecting career longevity of emergency medical service (EMS) professionals. The degree of fit between individual and occupational characteristics guided this phenomenological study according to Lowman's theoretical model of career assessment and counseling. Study participants (n = 10) were recruited from organizations providing EMS training courses and ambulance service providers in New York State. Data were collected from semistructured interviews and the information was coded into themes. Key findings indicated aligned expectations and experiences of altruism led to satisfaction, physical challenges not considered prior to employment were associated with intent to leave the profession, and a perception of EMS as a transient career. This study's implications for positive social change are that its results will likely aid organizations in developing strategies to retain prehospital service workers, resulting in improved responses to the medical emergencies of communities and improvements in the care provided to society's sick and injured.

The major purpose of this study was to develop an Adaptation Model for emergency departments in urban and suburban Health Maintenance Organizations. Questions explored which provided data for the Model were: 1) are there significant differences in the demographic, sociologic, and decision-making characteristics of clients seeking services in emergency rooms and after-hour clinics?, and 2) are there significant differences in perceptions of access-related problems and stated preferences for personal physicians among clients seeking such services? A pilot study was completed, critiqued, and analyzed. Final research instruments were developed for adults and children. Questionnaires were completed by 1,031 clients in an urban and suburban facility of the Kaiser-Permanente Medical Care Program in Portland, Oregon. Data analysis was completed using the Statistical Package for the Social Sciences sub-program FREQUENCIES, CROSSTABULATION, AND DISCRIMINANT. Major findings of this study were: 1) no significant differences existed in the demographic and sociologic characteristics of clients, 2) significant differences were found in perceived problems of access, in decision-making characteristics, and in preferences for personal physicians. Significant items were: 1) convenience of the facility location, 2) immediacy and availability of care, 3) contact prior to arrival, 4) instruction by "nurse" to seek care, 5) clients reporting they did not have a personal physician, and 6) repeated use of the emergency department during the previous year. Different profiles of decision-making characteristics of urban and suburban clients resulted from the analyses. The overall pattern of care for children varied less between urban and suburban settings than did the pattern of care for adults. Findings were discussed in terms of the traditional model of emergency department care. Conflicts arising from system "controls" provided the basis for suggesting changes incorporated into the Adaptation Model. The basic premise for the Adaptation Model advances the point at which triage occurs, eliminates conflicts of control, and thus modifies both consumer behavior and the emergency department system. / Graduation date: 1982

This study takes the medical service as an example to discuss the evaluation and choice models of professional services. The main purpose of the study is to see whether consumers¡¦ involvement and knowledge of medical services as well as their personal difference will affect their evaluation and choice models. In this study, the common cold, stomach ulcer and cancer are chosen to represent medical services with low, median and high involvement. Convenience sampling is conducted in Taipei, Hsinchu and Kaohsiung and a total of 407 valid questionnaires have been collected. About the data analysis, factor analysis, ANOVA and chi-square test are used as statistical analysis methods. The results are presented below. 1. Consumers¡¦ involvement and knowledge of medical services have different effects on their evaluation criteria. 2. Consumers¡¦ involvement of medical services makes difference to their evaluation and choice models. 3. Consumers¡¦ knowledge of medical services makes difference to their evaluation and choice models. 4. There is interaction between consumers¡¦ involvement and knowledge of medical services, and they together affect the choice models. When consumers face medical services with ¡§low involvement, high knowledge¡¨ and ¡§high involvement, low knowledge¡¨, obvious difference is found between the choice models they use. 5. Consumers¡¦ personal factors make difference to their evaluation and choice models. 6. Consumers¡¦ personal factors make difference to their involvement and knowledge of medical services.

This study explores the medical services based on the ICT technologies such as the wireless network and positioning. The related history of internet and recently developed technologies of localization will be introduced. The literature review and case study approaches will be applied to explore the medical services using high technologies. Combining new technologies and medical industry requires an integrated platform. How to design such a platform and what functionalities required in that are investigated in this thesis. Our data is mainly from Industrial Technology Research Institute (ITRI), including the platform for homecare and eldercare. Moreover, we also study the product samples available on numerous web sites. The services provided in Taiwan are inspected as well. Due to the increasing aging population worldwide, the medical services incorporating high-tech such as homecare and eldercare have attracted interests from both academics and industry. Once a well developed platform can be integrated, there are many advantages can be expected such as saving the medical resource, enhancing the service quality, and so on. Therefore, the government puts emphasis on such medical integrated scheme such as the U-care project in order to meet the future requirements. We will report the platform constructed by ITRI and analyze the problems encountered in the advanced country such as Japan and America. Finally, how the technologies are developed from the engineer perspective will be clarified. The networking and positioning services from Intel and Microsoft are studied in this work and the evolvements are also illustrated

published_or_final_version / Community Medicine / Master / Master of Public Health