This thesis explores the potential of visual information and communication technologies (ICTs) for collaboration in emergency care. The thesis consists of four studies exploring future technology, 3D telepresence technology for medical consultation (3DMC), from several different methodological and analytical perspectives. Together the studies provide a broad view of the potential benefits, risks and implications of using visual technologies for collaboration in emergency care. The results show that paramedic-physician collaboration via 3DMC might have some benefits for patient care, both in the immediate patient care situation and beyond, for example, when coordinating transport and resources; improving understanding between different actors; and in developing paramedic competence and confidence in their skills. However, collaboration is heavily impacted by physicians’ and paramedics’ respective work practices which are situated in very different physical, professional and organizational contexts. Adding a visual dimension to this collaboration presents unique challenges for the overall design, development, implementation, and appropriation process. Thus, the thesis emphasizes the importance of understanding both the individual users as well as the complex overall image which, although often neglected or ignored, is crucial to understand when developing and introducing new technology that is successful and justified in the overall context while also being useful and meaningful for the individual users. / <p>Academic dissertation for the Degree of Doctor of Philosophy in Library and Information Science at the University of Gothenburg and the University of Borås to be publicly defended on Thursday 19 September 2013 at 13:15 in the auditorium at Simonsland, University of Borås, Skaraborgsvägen 3, Borås.</p>

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

Introdução: O transporte médico de crianças gravemente enfermas envolve particularidades que aumentam o risco de complicações, que podem contribuir para o aumento no tempo de internação e mortalidade. Objetivos: Avaliar a frequência e os tipos de complicações observadas durante o transporte pré- hospitalar e inter-hospitalar de crianças gravemente enfermas, assim como o impacto dessas complicações na mortalidade, no tempo de internação hospitalar e nos custos hospitalares. Pacientes e Métodos: Estudo realizado em duas etapas: a primeira foi um estudo transversal, no qual, por meio de entrevista padronizada com o médico que admitiu as crianças gravemente enfermas que necessitaram de transporte pré-hospitalar ou inter-hospitalar, foram identificadas e caracterizadas possíveis complicações ocorridas durante esse transporte. Estes dados foram auditados por três médicos independentes que definiram a presença ou ausência de complicações durante o transporte. A segunda etapa constituiu-se de uma coorte prospectiva, na qual os pacientes, divididos em dois grupos distintos (com e sem complicações durante o transporte), foram seguidos, prospectivamente, por 60 dias, observando-se a ocorrência de morte ou alta hospitalar. Resultados: Foram incluídas 143 crianças no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 pacientes (52%). As complicações mais frequentes foram relacionadas com as vias aéreas (69%), seguidas por distúrbios metabólicos (47%), alterações cardiovasculares (40%) e falhas relacionadas aos dispositivos e à monitorização (37%). Na análise univariada, os seguintes preditores para ocorrência de complicações durante o transporte foram observados: peso <10Kg (risco relativo - RR: 1,52; intervalo de confiança (IC 95%: 1,11-2,09); distância >100Km (RR: 1,67; IC 95%: 1,16-2,40); presença de doença respiratória (RR: 1,46; IC 95%: 1,06-1,95) e comorbidades (RR: 1,68; IC 95%: 1,23-2,30). Já na análise multivariada, não foram observados preditores independentes para ocorrência de complicações. A ocorrência de complicações durante o transporte foi associada com maior taxa de mortalidade hospitalar (hazard ratio - HR: 5,668; IC 95%: 1,26-26,65; p=0,0130) e menor taxa de alta hospitalar (HR: 0,48; IC 95%: 0,31-0,74; p=0,0007). Após a aplicação da regressão de Cox para ajuste de potenciais fatores de confusão, a presença de complicação durante o transporte permaneceu associada com o índice de mortalidade hospitalar (HR: 6,74; IC 95%: 1,40-32,34; p=0,017), contudo deixou de ser associada com o tempo para a alta hospitalar (HR: 0,76; IC 95%: 0,49- 1,16; p=0,213). Conclusões: As complicações foram frequentes durante o transporte pediátrico. A presença de doenças respiratórias, peso <10Kg, presença de comorbidades e a distância >100 Km foram preditores de risco para a ocorrência dessas complicações. As complicações ocorridas durante o transporte foram associadas com o aumento nas taxas de mortalidade hospitalar. / Introduction: The medical transport of critically ill children involves characteristics that increase the risk of complications, which can contribute to an increase in length of stay and mortality. Objectives: To evaluate the frequency and type of complications observed during the pre-hospital and inter-hospital transport of critically ill children, as well as the impact of these complications on mortality, length of hospital stay and hospital costs. Patients and Methods: A study carried out in two stages: the first was a cross-sectional study where through a standardized interview with the doctor who admitted the critically ill children requiring pre-hospital or inter-hospital transport identified and characterized possible complications during this transport. These data were audited by three independent doctors who defined the presence or absence of complications during transport. The second stage consists of a prospective cohort study, where patients divided into two groups (with and without complications during transportation) were followed prospectively for 60 days observing the occurrence of death or hospital discharge. Results: We included 143 children in the study. At least one complication during transportation was observed in 74 patients (52%). The most frequent complications have been associated with airway (69%), followed by metabolic disorders (47%), cardiovascular disorders (40%) and failure in the device and monitoring (37%). In the uni-variate analysis, the following predictors for the occurrence of complications during transport were observed: weight <10 kg (relative risk - RR: 1.52; 95% confidence interval - CI: 1.11-2.09); distance greater than 100 km (RR: 1.67; 95% CI: 1.16-2.40); presence of respiratory disease (RR: 1.46; 95% CI: 1.06-1.95) and associated comorbidity (RR: 1.68; 95% CI: 1.23- 2.30). In the multivariate analysis, no independent predictors were observed for the occurrence of complications. The occurrence of complications during transport was associated with higher hospital mortality (hazard ratio - HR: 5.668; 95% CI: 1.26-26.65; p=0.0130) and a lower hospital discharge rate (HR: 0.48; 95% CI: 0.31-0.74; p=0.0007). After Cox regression to adjust for potential confounding factors, the presence of complications during transport remained associated with hospital mortality (HR: 6.74; IC 95%: 1.40-32.34; p=0.017), however, was not associated with hospital discharge rates (HR: 0.76; 95% CI: 0.49-1.16; p=0.213). Conclusions: The complications were common during pediatric transport. Distance greater than 100 km, presence of respiratory disease, associated comorbidity and weight <10 kg were risk predictors for occurrence of complications. Complications during pediatric transport were associated with increased hospital mortality rates.

Introdução: O transporte médico de crianças gravemente enfermas envolve particularidades que aumentam o risco de complicações, que podem contribuir para o aumento no tempo de internação e mortalidade. Objetivos: Avaliar a frequência e os tipos de complicações observadas durante o transporte pré- hospitalar e inter-hospitalar de crianças gravemente enfermas, assim como o impacto dessas complicações na mortalidade, no tempo de internação hospitalar e nos custos hospitalares. Pacientes e Métodos: Estudo realizado em duas etapas: a primeira foi um estudo transversal, no qual, por meio de entrevista padronizada com o médico que admitiu as crianças gravemente enfermas que necessitaram de transporte pré-hospitalar ou inter-hospitalar, foram identificadas e caracterizadas possíveis complicações ocorridas durante esse transporte. Estes dados foram auditados por três médicos independentes que definiram a presença ou ausência de complicações durante o transporte. A segunda etapa constituiu-se de uma coorte prospectiva, na qual os pacientes, divididos em dois grupos distintos (com e sem complicações durante o transporte), foram seguidos, prospectivamente, por 60 dias, observando-se a ocorrência de morte ou alta hospitalar. Resultados: Foram incluídas 143 crianças no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 pacientes (52%). As complicações mais frequentes foram relacionadas com as vias aéreas (69%), seguidas por distúrbios metabólicos (47%), alterações cardiovasculares (40%) e falhas relacionadas aos dispositivos e à monitorização (37%). Na análise univariada, os seguintes preditores para ocorrência de complicações durante o transporte foram observados: peso <10Kg (risco relativo - RR: 1,52; intervalo de confiança (IC 95%: 1,11-2,09); distância >100Km (RR: 1,67; IC 95%: 1,16-2,40); presença de doença respiratória (RR: 1,46; IC 95%: 1,06-1,95) e comorbidades (RR: 1,68; IC 95%: 1,23-2,30). Já na análise multivariada, não foram observados preditores independentes para ocorrência de complicações. A ocorrência de complicações durante o transporte foi associada com maior taxa de mortalidade hospitalar (hazard ratio - HR: 5,668; IC 95%: 1,26-26,65; p=0,0130) e menor taxa de alta hospitalar (HR: 0,48; IC 95%: 0,31-0,74; p=0,0007). Após a aplicação da regressão de Cox para ajuste de potenciais fatores de confusão, a presença de complicação durante o transporte permaneceu associada com o índice de mortalidade hospitalar (HR: 6,74; IC 95%: 1,40-32,34; p=0,017), contudo deixou de ser associada com o tempo para a alta hospitalar (HR: 0,76; IC 95%: 0,49- 1,16; p=0,213). Conclusões: As complicações foram frequentes durante o transporte pediátrico. A presença de doenças respiratórias, peso <10Kg, presença de comorbidades e a distância >100 Km foram preditores de risco para a ocorrência dessas complicações. As complicações ocorridas durante o transporte foram associadas com o aumento nas taxas de mortalidade hospitalar. / Introduction: The medical transport of critically ill children involves characteristics that increase the risk of complications, which can contribute to an increase in length of stay and mortality. Objectives: To evaluate the frequency and type of complications observed during the pre-hospital and inter-hospital transport of critically ill children, as well as the impact of these complications on mortality, length of hospital stay and hospital costs. Patients and Methods: A study carried out in two stages: the first was a cross-sectional study where through a standardized interview with the doctor who admitted the critically ill children requiring pre-hospital or inter-hospital transport identified and characterized possible complications during this transport. These data were audited by three independent doctors who defined the presence or absence of complications during transport. The second stage consists of a prospective cohort study, where patients divided into two groups (with and without complications during transportation) were followed prospectively for 60 days observing the occurrence of death or hospital discharge. Results: We included 143 children in the study. At least one complication during transportation was observed in 74 patients (52%). The most frequent complications have been associated with airway (69%), followed by metabolic disorders (47%), cardiovascular disorders (40%) and failure in the device and monitoring (37%). In the uni-variate analysis, the following predictors for the occurrence of complications during transport were observed: weight <10 kg (relative risk - RR: 1.52; 95% confidence interval - CI: 1.11-2.09); distance greater than 100 km (RR: 1.67; 95% CI: 1.16-2.40); presence of respiratory disease (RR: 1.46; 95% CI: 1.06-1.95) and associated comorbidity (RR: 1.68; 95% CI: 1.23- 2.30). In the multivariate analysis, no independent predictors were observed for the occurrence of complications. The occurrence of complications during transport was associated with higher hospital mortality (hazard ratio - HR: 5.668; 95% CI: 1.26-26.65; p=0.0130) and a lower hospital discharge rate (HR: 0.48; 95% CI: 0.31-0.74; p=0.0007). After Cox regression to adjust for potential confounding factors, the presence of complications during transport remained associated with hospital mortality (HR: 6.74; IC 95%: 1.40-32.34; p=0.017), however, was not associated with hospital discharge rates (HR: 0.76; 95% CI: 0.49-1.16; p=0.213). Conclusions: The complications were common during pediatric transport. Distance greater than 100 km, presence of respiratory disease, associated comorbidity and weight <10 kg were risk predictors for occurrence of complications. Complications during pediatric transport were associated with increased hospital mortality rates.

Made available in DSpace on 2014-12-17T14:46:49Z (GMT). No. of bitstreams: 1 IsabelKFC_DISSERT.pdf: 2842147 bytes, checksum: 5940c197670eef58d4b127c85880497a (MD5) Previous issue date: 2011-12-02 / Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service. / Estudo explorat?rio, descritivo, quantitativo e dados prospectivos, realizado no Servi?o de Atendimento M?vel de Urg?ncia da Regi?o Metropolitana de Natal/RN, com vistas a identificar o conhecimento da equipe multiprofissional acerca das normas de precau??es padr?o e seguran?a do trabalhador; identificar os riscos ocupacionais peculiares ?s atividades desenvolvidas nesse servi?o; caracterizar os acidentes de trabalho (AT) e conhecer os procedimentos adotados ap?s cada AT. A popula??o constou de 162 profissionais e os dados foram coletados entre os meses de novembro e dezembro de 2010. Quanto ? caracteriza??o pessoal e profissional, dos 162 profissionais, 12,96% eram m?dicos; 6,79%, enfermeiros; 33,95%, t?cnicos de enfermagem; 46,29%, condutores; 74,70% do sexo masculino; 43,21% tinham entre 31 e 40 anos; 69,33% residiam em Natal/RN; 50,00% possu?am o ensino m?dio completo; 58,64% casados; 69,75% tinham filhos; 46,91% tinham entre 1 e 4 anos de forma??o; 61,73% possu?am cursos de atualiza??o; 59,25% estavam com 3 a 4 anos de servi?o; 54,32%, com 1 a 4 anos de experi?ncia na urg?ncia; 44,44% recebiam de 1 a 2 sal?rios; 78,40% recebiam insalubridade; 67,28% atuavam na USB; 83,95% tinham jornada no SAMU Metropolitano de 31 a 40 horas semanais; 52,47% possu?am outro v?nculo empregat?cio. Quanto ao conhecimento sobre normas de precau??es padr?o, seguran?a e riscos ocupacionais, 99,38% sabiam o que era AT; 62,96% deram respostas incompletas; 74,07% conheciam as normas de AT; 46,67% adquiriram esse conhecimento em palestras; 53,09% conheciam os EPIs; 71,60% deram respostas incorretas sobre a import?ncia das PPs; 45,06% nunca receberam interven??o educativa sobre essa tem?tica; 89,51% disseram serem muito importante as interven??es educativas na preven??o de ATs; 90,12%, apontaram como muito importante este tema no ambiente de trabalho; 27,00% sugeriram a orienta??o sobre o tema no pr?prio local de trabalho; dentre os riscos f?sicos, 34,57% consideraram os ru?dos como o mais importante; dos riscos qu?micos, 78,40% referiram os gases e fuma?a; dos riscos biol?gicos, 48,77% citaram o contato com o sangue; dos riscos mec?nicos, 80,86% disseram que eram os acidentes de transporte; dos riscos ergon?micos, 40,12% afirmaram ser a tens?o/estresse no atendimento aos pacientes graves, psiqui?tricos e agressivos; e houve uma m?dia de 4,5 para o sentimento de seguran?a no ambiente de trabalho. Em rela??o aos dados sobre os ATs ocorridos, 31,48% sofreram pelo menos um evento acident?rio; 72,55% n?o notificaram; 60,98% responderam que n?o existia rotina para notifica??o; 56,86% estavam realizando o transporte de pacientes; 49,02% se acidentaram na USB/UR; 60,78% aconteceram durante o dia; 96,08% dos profissionais estavam em escala de trabalho normal (plant?o 24hs); 31,37% sofreram contus?o; 58,82% les?es nos membros/cintura p?lvica; 43,14% foram acidentes de transporte. Quanto ? evolu??o do AT, 62,75% n?o precisaram de afastamento do trabalho; 76,47% n?o tiveram sequelas; 88,24% n?o precisaram de reabilita??o; nenhum profissional precisou mudar de ocupa??o. E, por meio da regress?o log?stica univariada, evidenciou-se que os enfermeiros e o sexo masculino eram fatores de risco para a ocorr?ncia de AT. Conclu?mos que havia lacunas no conhecimento da equipe no que concerne aos AT, enfatizando-se a necessidade da educa??o permanente em biosseguran?a no servi?o.

Made available in DSpace on 2014-12-17T14:46:58Z (GMT). No. of bitstreams: 1 GrayceLTC_DISSERT.pdf: 1835806 bytes, checksum: f4f84109098e5cafa4fd9ac77f73ad99 (MD5) Previous issue date: 2013-02-07 / The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death / A aten??o com a seguran?a dos pacientes ? importante na qualidade da assist?ncia de enfermagem e dos cuidados de sa?de. No atendimento pr?-hospitalar, estes cuidados s?o essenciais no local do evento, com prop?sito de minimizar poss?veis consequ?ncias ao indiv?duo, garantindo um atendimento precoce e adequado, com melhoria da morbidade e diminui??o da mortalidade. Estes atendimentos igualmente associam-se a riscos significativos de eventos adversos e erros graves, que podem ser diminu?dos com a conscientiza??o dos profissionais, organiza??o e qualidade da gest?o. Trata-se de estudo descritivo, transversal, de abordagem quantitativa, com o objetivo de identificar os riscos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel sob a ?tica dos enfermeiros, em uma cidade do Nordeste Brasileiro. A amostra da pesquisa foi formada por 23 enfermeiros. Os crit?rios de inclus?o foram: ter no m?nimo dois anos de experi?ncia e aceitarem participar da pesquisa. A coleta de dados foi realizada em duas etapas: primeiramente coleta de fotos atrav?s do m?todo adaptado de an?lise fotogr?fica, e a segunda com a aplica??o de question?rio, dividido em duas partes: dados s?cio-profissionais e instrumento de pontua??o de fotografia digital sobre a seguran?a do paciente. Encontrou-se a predomin?ncia de enfermeiros com tempo m?dio de trabalho no atendimento pr?-hospitalar m?vel de seis anos e seis meses, na faixa et?ria de 38 a 53 anos (69,56%) e com especializa??o Lato sensu (73,91%), sendo (29,41%) em urg?ncia e emerg?ncia e (29,41%) em terapia intensiva. Possuem o Advanced Cardicologic Life Support (ACLS) (74%) e o Pre Hospital Trauma Life Support (PHTLS) (100%); conhecem a tem?tica seguran?a do paciente (91,30%). Nas fotos observou-se uma maior variabilidade de categorias (riscos) onde 44% de vari?ncia emergiu na foto 01 do estudo. As fotografias 4 e 9, com m?dias abaixo de 5, foram classificadas como muito inseguras, enquanto que as fotos 7 e 3 com m?dias acima de 7, muito seguras. Dos resultados de riscos observados para a seguran?a do paciente no atendimento pr?-hospitalar m?vel emergiram cinco categorias: organiza??o e acondicionamento de equipamentos e materiais, rotinas e especificidades no atendimento pr?-hospitalar m?vel, riscos para a administra??o de medicamentos, para traumas e para infec??o. Partindo da an?lise desses riscos foram propostos dez passos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel: 1- Identificar o paciente; 2- Seguran?a relacionada ? preven??o de infec??o; 3- Seguran?a na administra??o de medicamentos; 4- Seguran?a e padroniza??o do acondicionamento de equipamentos e materiais; 5- Aten??o para as especificidades do atendimento pr?-hospitalar m?vel; 6- Incentivar e valorizar a participa??o do paciente e fam?lia; 7- Promover a comunica??o com a central de regula??o; 8- Preven??o de traumas e quedas; 9- Proteger a pele de les?es adicionais; 10- Compreender o benef?cio de todos os equipamentos da ambul?ncia. Os m?ltiplos riscos e suas combina??es emergidas no estudo indicam a multifatoriedade de a??es a serem desenvolvidas e estimuladas, como a utiliza??o de passos para a seguran?a do paciente no atendimento pr?-hospitalar m?vel que contribui como subs?dio no gerenciamento de riscos, diminui??o de erros, incapacidades e morte