Suicid och suicidförsök är ett folkhälsoproblem världen över och bara i Sverige tar ca 1500 människor sitt liv varje år, vilket blir ca fyra per dag. Suicidförsök är vanligare bland kvinnor, däremot fullföljer män oftare sin suicid. Att omhänderta en person med suicidnära tankar är bland det svåraste, mest emotionella och påfrestande arbetsuppgifterna som sjuksköterskan prehospitalt kan ställas inför. Personer med suicidnära tankar har ofta svårt att känna förtroende för andra människor och de har många negativa tankar om livet. Sjuksköterskan bör alltid sträva efter att förstå patientens livssituation samtidigt som de gör allt för att förhindra att patienten tar sitt liv. För att mötet med patienten ska bli så bra som möjligt krävs att sjuksköterskan fortlöpande ökar sin kompetens, bearbetar sina attityder och får den kunskap som behövs för att bemöta mångfalden i den problematik som omhändertagandet av personer med suicidnära tankar innebär.    Syftet var att belysa sjuksköterskornas upplevelser vid omhändertagandet av patienter med suicidnära tankar prehospitalt.    En kvalitativ ansats valdes med intervjuer som datainsamlingsmetod för att fånga sjuksköterskans upplevelser. Elva sjuksköterskor inom ambulanssjukvården intervjuades. Materialet spelades in med hjälp av en diktafon och transkriberades sedan av författarna. Analys av det insamlade intervjumaterialet gjordes genom en manifest, kvalitativ innehållsanalys.    I resultatet framkom fyra huvudkategorier: Beredskap för uppdraget, Det som skapar förutsättningarna, Mötet i en utsatt situation och Emotionella utmaningar – att gå vidare. Resultatet visade att sjuksköterskan inför uppdraget med en suicidnära patient inte förberedde sig på något speciellt sätt mer än att de diskuterade olika scenarion med sin kollega. Att sjuksköterskan var verbalt rustad och kände sig bekväm i sig själv som person, skapade goda förutsättningar för ett bra möte med patienten. Flera sjuksköterskor upplevde att de inte hade tillräcklig utbildning inom psykiatri, utan de arbetade utifrån sina egna och kollegans tidigare erfarenheter. Sjuksköterskorna upplevde att en stor del av omhändertagandet inte bara handlade om patienten utan även om dess närstående. Att omhänderta patienter med suicidnära tankar kunde väcka många starka känslor som kunde påverka sjuksköterskan negativt och vissa beskrev att de minns vissa uppdrag lång tid efter händelsen. Sjuksköterskorna uppgav att de inte var i behov av något stöd mer än att prata med sina kollegor efter en händelse.    Författarnas slutsats var att det fanns ett behov, för sjuksköterskan inom ambulanssjukvården, av kompletterande och återkommande utbildning i psykiatri som en viktig förutsättning för att bedriva patientsäker vård och omvårdnad i olika situationer. Kvaliteten och säkerheten inom vården minskade då sjuksköterskan själv upplevde en brist på kunskap inom detta område. / Suicide and suicide attempts are a public health problem all over the world. In Sweden 1500 people take their lives every year, which will be about four per day. Suicide attempts are more common among women. Men, however are more often succeed with their suicide. One of most challenging, most emotional and stressful tasks that the prehospital nurse can face, is to take care of a person with suicidal thoughts. Persons with suicidal thoughts often find it difficult to trust in other people and also have negative attitude towards life itself. A nurse should always strive to understand the patient's situation in life while doing what is possible to prevent the patient from committing suicide. In order for the patient meeting to be as successful as possible, the nurse need constantly to increase their skills, develop their attitudes and gain the required knowledge to deal with diversity that involves the treatment of people with suicidal thoughts.   The aim was to illuminate the nurses' experiences in the prehospital treatment, of patients with suicidal thoughts.   A qualitative approach was chosen to capture the nurse's experiences. Eleven nurses in the ambulance healthcare were interviewed. The interviews were recorded using a dictaphone, and then were transcribed verbatim. The analysis was carried out by a manifest, qualitative content analysis.   Four main categories emerged: Preparedness for the assignment, What creates the conditions, The meeting in an exposed situation and Emotional challenges - to move forward. The results demonstrate that the nurses did not prepare specifically before meeting a suicidal patient, other than discussed different possible scenarios with their colleague. To create optimal conditions for a good meeting with a patient, the nurse was well-prepared verbally, and felt confident. Several nurses experienced lack of adequate education in psychiatry and based their work on their own and colleagues' previous experiences. Nurses found that a great deal of care was not just about the patient but also of his or her relatives. To take care of patients with suicidal thoughts may cause many strong feelings that can negatively affect the nurse and some nurses described that they remember some of these assignments long after the event. Nurses stated that they were not in need of mental support, more than talking to their colleagues after an assignment.   The authors conclusion was that there is a need, for nurses in the ambulance care, supplementary and recurrent training in psychiatry as an important prerequisite for a patientsafe and nursing care in different situations. Quality and safety in healthcare decreased when the nurse experienced a lack of knowledge in this area.

Ambulanssjuksköterskor exponeras regelbundet för traumatiska händelser i sitt arbete, vilket utgör en risk för psykisk ohälsa i olika former. Trots kännedom om riskerna och vikten av stöd består brister i det befintliga stödsystemet. Bristerna påverkar inte bara sjuksköterskornas välbefinnande och arbetsprestation, utan även patientsäkerheten. Syftet med examensarbetet var att beskriva ambulanssjuksköterskors upplevelser av stöd efter traumatiska händelser för att öka kunskapen om stödets betydelse efter traumatiska händelser. Examensarbetet har genomförts som en kvalitativ semistrukturerad intervjustudie med induktiv ansats. Datainsamlingen och analysprocessen genererade tre kategorier; Organisatoriska brister, organisatoriska tillgångar och betydande faktorer utanför organisationens stödstrukturer följt av åtta subkategorier som genererade en struktur. Resultatet påvisar organisatoriska brister, brister i befintliga handlingsplaner och brist på tid till bearbetning. Samtidigt framkom organisatoriska tillgångar, såsom värdet av stödjande samtal och en stödjande chef. Betydande faktorer utanför organisationen stödstrukturer beskrevs i form av kollegialt stöd och egenansvar. Informanterna betonade vikten av proaktivt och långsiktigt stöd. Examensarbetet understryker vikten av ett strukturerat och anpassat stödsystem för ambulanssjuksköterskor efter traumatiska händelser. Förbättringar krävs för att säkerställa deras psykiska hälsa och förmågan att leverera högkvalitativ vård. / Ambulance nurses are regularly exposed to traumatic events in their work which poses a risk for various forms of mental illness. Despite awareness of the risks and the importance of support, weaknesses in the existing support system persist. These weaknesses affect not only the well-being and work performance of the nurses but also patient safety. The purpose of this thesis was to describe ambulance nurses’ experiences of support following traumatic events to increase the knowledge about the significance of support after such events. The thesis was conducted as a qualitative semi-structured interview study with an inductive approach. Data collection and analysis generated three categories: organizational deficiencies, organizational assets and meaningful factors outside the organizational support structures, followed by eight subcategories that formed a structure. The results show organizational deficiencies, a lack of structured action plan and lack of time for processing. Meanwhile, organizational assets such as the value of supportive counselling and supportive manager. Meaningful factors outside the organizational support structures were described in the form of collegial support and personal responsibility. The interviewed ambulance nurses emphasized the importance of proactive and long-term support. The thesis highlights the importance of a structured and tailored support system for ambulance nurses after traumatic events. Improvements are required to ensure their mental health and ability to deliver high quality care.

Para dar resposta às necessidades de saúde de uma população o sistema de saúde requer um nível de organização suficiente para acolher o usuário em suas unidades e dar conta de suas necessidades conforme rezam os princípios do Sistema Único de Saúde (SUS). Neste sentido destaca-se a importância da implantação do Serviço de Atendimento Móvel de Urgência (SAMU) preenchendo este vazio assistencial dentro da área de Urgência e Emergência. O presente estudo teve como Objetivo Geral: Analisar o processo de tomada de decisão dos profissionais de saúde no SAMU e sua relação com a produção de cuidado. Como Objetivos Específicos 1 - Analisar os elementos que concorrem para a tomada de decisão dos profissionais do SAMU no ato da cena; 2 - Analisar o processo de tomada de decisão na regulação do atendimento às urgências pelos médicos reguladores. O estudo é do tipo descritivo e exploratório de abordagem qualitativa. Foram sujeitos desta pesquisa os profissionais do SAMU que atuam no campo prestando assistência presencial ou por regulação ao usuário. Os instrumentos de coleta de dados utilizados foram a entrevista semi-estruturada e a observação participante. A pesquisa foi desenvolvida em consonância com a Resolução 466/2012 do Conselho Nacional de Saúde que trata da pesquisa com seres humanos. A tese que sustenta esse estudo é que as decisões tomadas que geram o trabalho vivo em ato dos profissionais do SAMU tem relação com o desenho do Sistema de Saúde local. Os dados dos depoimentos foram organizados em categorias e subcategorias com o software Atlas Ti 7.0. Com base na Análise de Conteúdo de Bardin (2009) foram determinadas três categorias principais que respondem ao problema do estudo: Urgência e Emergência, Educação Permanente e Tomada de Decisões e relação com a Produção do Cuidado. O estudo revelou que os profissionais do SAMU utilizam-se do seu núcleo de saberes e práticas profissionais e do Atendimento Pré-Hospitalar, seus valores e conhecimentos empíricos para tomar decisões no ato da prestação da assistência ao usuário gravemente enfermo e que, essas decisões, são compartilhadas entre os membros das equipes. Foi possível apreender ainda que os princípios da Educação Permanente e Educação Popular em Saúde podem melhor qualificar o processo de tomada de decisões dos profissionais do SAMU. O Acolhimento e Classificação de Risco pode conferir uma linguagem padronizada para o adequado encaminhamento do usuário e suas demandas dentro do sistema de saúde. As tomadas de decisões dos profissionais do SAMU no ato da cena produzem resultados que podem ajudar na reorientação do modelo assistencial ou favorecer a manutenção de um modelo centrado no enfrentamento das situações agudas, quando implantado num Sistema de Saúde com problemas organizacionais e estruturais, além de colaborar na construção da Rede de Atenção as Urgências e da Rede de Atenção a Saúde como um todo / To fullfill the needs of a population, the Healthcare system requires a level of organization that is good enough to take care of the users in its facilities and cope with their needs, according to the principles of SUS, which stands for \"Sistema Único de Saúde\" (Brazil Healthcare system). In this way, we highlight the importance of SAMU, which fills the assistance gap in the area of Medical Emergencies. This paper had the general goal of analyzing the SAMU professionals\' process of decision- making and their relation to Healthcare production. As specific goals: 1- analyzing the elements that contribute to the decision-making of SAMU professionals at the place of occurrence; 2- analyzing the process of decision-making according to the regulation of the Medical Prority Dispatch System. This is a descriptive explanatory study of qualitative approach. The subjects of this study were the professionals of SAMU who act outdoors, dealing with emergencies or users regulation. The tools of data collection were semi-structured interview and observation in loco. The research was developed in consonance with Resolution 466/2012 from \"Conselho Nacional de Sáude\" (Healthcare regulator), which is responsible for research with human beings. The supporting thesis of this study is the course of action taken by SAMU professionals at dealing with emergencies has a relation to the local Healthcare System model. The interview data was organized in categories and sub-categories with software Atlas Ti 7.0. Having the \"Bardin Content Analysis\" (2009) as basis, we determined 3 main categories which solve the problem of this study. Medical Emergency, Permanent Education and Decision Making and its relation to Healthcare Production. The study has shown that SAMU professionals make use of their knowlegde and professional practice and Prehospital Treatment, their values and empirical knowlegde to make decisions at the site of the emergency and that, those decisions are shared among team members. We were also able to learn that the principles of Permanent Education and Popular Education in Health can improve the decision making process of SAMU professionals. The Risk Assesment can determine a standarazied language to an accurate plan of action to be performed. SAMU professionals\' decision making in loco produces results that can help in reorientating the Aid model or favor the maintence of a model centered in facing severe situations, when deployed in a Healthcare System with structural and organization problems, besides it can cooperate in contructing the Emergency Care Network and Healthcare Network as a whole

Bakgrund:Ambulanssjukvård är ett område som blir allt mer avancerat. Prehospital akutsjukvård karakteriseras av snabb bedömning, beslutsfattande och utvärdering i både säkra och osäkra miljöer. Ett korrekt omhändertagandeav patientenförutsätter en fungerande kommunikation. Risken ökar annars för missförstånd, minskad patientsäkerhet, vårdskadorochökat lidande. Språkbarriär är ett merstuderat fenomen inom intrahospital vård men forskningen kring fenomenet inom ambulanssjukvårdenärytterst sparsmakad.Syfte: Syftet var att utforska ambulanspersonalens uppfattningar av språkbarriär i mötet med patienten.Metod: Studien har genomförts med en kvalitativ, induktiv ansats. Data inhämtades genom semistrukturerade intervjuer med 18 deltagare med olika professionell bakgrund, erfarenheter, kön och åldrar. Fenomenografisk metod användes i analys av de transkriberade intervjuerna.Resultat: De variationer av uppfattningar som författarna identifierat fördelades i fyrabeskrivningskategorier.Ett positivt synsätt, Inverkan på patientmötet,Strategier för att överbrygga språkliga hinderoch En del av ett komplext förhållande.Slutsatser:Studien belyser att ett samband mellan språkbarriär och försämrad vård finns. Bristfällig kommunikation innebär att patienten riskerar att inte få lika vård på lika villkor. Ambulanspersonal agerar pragmatiskt och lösningsorienterat, i tidskritiska situationer, för att tillvarata patientens intressen och leverera säker vård. Tillgängliga hjälpmedel uppfattas varaotillfredsställande och behöver ses över. / Background: Ambulance care is a field which is becoming more and more advanced. Prehospital emergency care is characterized by quick assessments, decision making and evaluation in safe as well as unsafe environments. Correct management of the patient demands a functioning communication. Otherwise there is an increased risk of misunderstandings, diminished patient safety, adverse events and increased suffering. Language barriers have been studied extensively within intra-hospital care but research regarding the phenomenon in the ambulance care setting is utterly sparse.Aim: The aim of this studywas to explore the ambulance personnel’s perceptions of language barrier in the encounter with the patient.Methods: The study was conducted using a qualitative, inductive approach. Data was collected through semi structured interviews with 18 participants from different professions, of varying experience, sex and age. Phenomenographic method was used when analysing the transcribed interviews. Results:The variations of perceptions that the authors have identified were distributed in four categories of description: A positive outlook, Effects on the encounter, Strategies to overcome language barriersand Part of a complex relationship.Conclusions:This study highlights the presence of a relationship between language barrier and insufficient care. When communication is unsatisfactory the patient runs the risk of not receiving equal careon equal terms. Ambulance personnel’s actions are pragmatic and solution orientedin time critical situations in order to secure the patient’s interests and deliver safe care.Available tools are perceivedas inadequate and need to be re-evaluated.

Orientador: Alessandro Lia Mondelli / Resumo: Introdução: O Acidente Vascular Cerebral (AVC) é uma das principais causas de morte e sequelas neurológicas no mundo. O reconhecimento precoce e a pré-notificação hospitalar por serviços de atendimento pré-hospitalar têm sido relacionados com o aumento nas taxas de tratamento adequado. Sendo assim, a American Heart Association e a European Stroke Organisation recomendam o uso de escalas de avaliação pelas equipes do atendimento pré-hospitalar. Objetivo: Traduzir para o idioma português do Brasil, realizar a adaptação transcultural das escalas Cincinnati Prehospital Stroke Scale e Los Angeles Prehospital Stroke Screen e avaliar a confiabilidade e validade na população brasileira. Material e Métodos: Trata-se de um estudo metodológico, transversal e prospectivo realizado em 2 etapas: a primeira constituída pelos processos de tradução e adaptação transcultural das escalas e a segunda pela aplicação das mesmas, que ocorreu entre julho de 2016 e dezembro de 2017. Resultados e Discussão: A Cincinnati Prehospital Stroke Scale ficou denominada de “Escala de Avaliação pré-hospitalar do AVC – Cincinnati”. Os resultados mostraram um Coeficiente de alpha de Cronbach foi de 0,39 e uma alta confiabilidade interobservador do instrumento final, evidenciada pelo alto valor do índice de Kappa, principalmente nos itens “queda do braço” e “fala” que obtiveram o valor máximo. A escala apresentou acurácia de 93% (IC 95% 87,76, – 98,24%), sensibilidade de 92,42% (IC 95%, 86,03 – 98,80% / VPP = 71,7... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Strokes are one of the leading causes of death and neurological disability in the world. Early recognition and prehospital notification may increase rates of thrombolysis with recombinant tissue plasminogen activator (rt-PA). Therefore, the American Heart Association and the European Stroke Organization recommend the use of assessment scales by prehospital care teams. Objective: To translate the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen to Portuguese, make a cross-cultural adaptation to Brazilian culture, and validate and verify its reliability in a Brazilian population. Material and Methods: This was a cross-sectional and prospective methodological study carried out in two stages: the first one consisted of the translation and crosscultural adaptation of the original scale and the second involved the application of the final instrument, which occurred between July 2016 and December 2017. Results and discussion: The final version of the Cincinnati Prehospital Stroke Scale was called the “Escala de Avaliação pré-hospitalar do AVC – Cincinnati”. The results showed Cronbach's alpha was 0,39 and a high interobserver reliability of the final instrument, evidenced by the high value of the Kappa index, especially in the items "arm drop" and "speech," which exhibited the maximum values. The scale showed accuracy of 93% (95% CI 87.76 - 98.24%), sensitivity of 92.42% (CI 95% 86.03 - 98.80% / PPV = 71.76) and specificity of 4%... (Complete abstract click electronic access below) / Doutor

Para dar resposta às necessidades de saúde de uma população o sistema de saúde requer um nível de organização suficiente para acolher o usuário em suas unidades e dar conta de suas necessidades conforme rezam os princípios do Sistema Único de Saúde (SUS). Neste sentido destaca-se a importância da implantação do Serviço de Atendimento Móvel de Urgência (SAMU) preenchendo este vazio assistencial dentro da área de Urgência e Emergência. O presente estudo teve como Objetivo Geral: Analisar o processo de tomada de decisão dos profissionais de saúde no SAMU e sua relação com a produção de cuidado. Como Objetivos Específicos 1 - Analisar os elementos que concorrem para a tomada de decisão dos profissionais do SAMU no ato da cena; 2 - Analisar o processo de tomada de decisão na regulação do atendimento às urgências pelos médicos reguladores. O estudo é do tipo descritivo e exploratório de abordagem qualitativa. Foram sujeitos desta pesquisa os profissionais do SAMU que atuam no campo prestando assistência presencial ou por regulação ao usuário. Os instrumentos de coleta de dados utilizados foram a entrevista semi-estruturada e a observação participante. A pesquisa foi desenvolvida em consonância com a Resolução 466/2012 do Conselho Nacional de Saúde que trata da pesquisa com seres humanos. A tese que sustenta esse estudo é que as decisões tomadas que geram o trabalho vivo em ato dos profissionais do SAMU tem relação com o desenho do Sistema de Saúde local. Os dados dos depoimentos foram organizados em categorias e subcategorias com o software Atlas Ti 7.0. Com base na Análise de Conteúdo de Bardin (2009) foram determinadas três categorias principais que respondem ao problema do estudo: Urgência e Emergência, Educação Permanente e Tomada de Decisões e relação com a Produção do Cuidado. O estudo revelou que os profissionais do SAMU utilizam-se do seu núcleo de saberes e práticas profissionais e do Atendimento Pré-Hospitalar, seus valores e conhecimentos empíricos para tomar decisões no ato da prestação da assistência ao usuário gravemente enfermo e que, essas decisões, são compartilhadas entre os membros das equipes. Foi possível apreender ainda que os princípios da Educação Permanente e Educação Popular em Saúde podem melhor qualificar o processo de tomada de decisões dos profissionais do SAMU. O Acolhimento e Classificação de Risco pode conferir uma linguagem padronizada para o adequado encaminhamento do usuário e suas demandas dentro do sistema de saúde. As tomadas de decisões dos profissionais do SAMU no ato da cena produzem resultados que podem ajudar na reorientação do modelo assistencial ou favorecer a manutenção de um modelo centrado no enfrentamento das situações agudas, quando implantado num Sistema de Saúde com problemas organizacionais e estruturais, além de colaborar na construção da Rede de Atenção as Urgências e da Rede de Atenção a Saúde como um todo / To fullfill the needs of a population, the Healthcare system requires a level of organization that is good enough to take care of the users in its facilities and cope with their needs, according to the principles of SUS, which stands for \"Sistema Único de Saúde\" (Brazil Healthcare system). In this way, we highlight the importance of SAMU, which fills the assistance gap in the area of Medical Emergencies. This paper had the general goal of analyzing the SAMU professionals\' process of decision- making and their relation to Healthcare production. As specific goals: 1- analyzing the elements that contribute to the decision-making of SAMU professionals at the place of occurrence; 2- analyzing the process of decision-making according to the regulation of the Medical Prority Dispatch System. This is a descriptive explanatory study of qualitative approach. The subjects of this study were the professionals of SAMU who act outdoors, dealing with emergencies or users regulation. The tools of data collection were semi-structured interview and observation in loco. The research was developed in consonance with Resolution 466/2012 from \"Conselho Nacional de Sáude\" (Healthcare regulator), which is responsible for research with human beings. The supporting thesis of this study is the course of action taken by SAMU professionals at dealing with emergencies has a relation to the local Healthcare System model. The interview data was organized in categories and sub-categories with software Atlas Ti 7.0. Having the \"Bardin Content Analysis\" (2009) as basis, we determined 3 main categories which solve the problem of this study. Medical Emergency, Permanent Education and Decision Making and its relation to Healthcare Production. The study has shown that SAMU professionals make use of their knowlegde and professional practice and Prehospital Treatment, their values and empirical knowlegde to make decisions at the site of the emergency and that, those decisions are shared among team members. We were also able to learn that the principles of Permanent Education and Popular Education in Health can improve the decision making process of SAMU professionals. The Risk Assesment can determine a standarazied language to an accurate plan of action to be performed. SAMU professionals\' decision making in loco produces results that can help in reorientating the Aid model or favor the maintence of a model centered in facing severe situations, when deployed in a Healthcare System with structural and organization problems, besides it can cooperate in contructing the Emergency Care Network and Healthcare Network as a whole

Readiness of the urgent reception to mass disasters This thesis is dedicated to the readiness of the urgent reception to mass disasters. It deals with the history, evolution and the current state of the urgent reception, both in the Czech Republic in the first place and in the world. Within the scope of this thesis I focus mainly on the work scope of the urgent receptions in dependence to their structure, equipment and their actual preparedness to deal with mass accidents. I focus besides other things on technical equipment of the urgent receptions, which is in frames of the Czech Republic very heterogeneous, but totally crucial to handle possible mass accident. A very import aspect is the matter of education and further training of the medical employees on all levels. It concerns not only medical positions, but also nurses and auxiliary staff. The question of the conditions severity of the admitted patients, their classification according to these conditions and transparent processing of the information about them cannot be passed over. Furthermore the thesis discusses emergency medicine as a discipline and the direction it should, in my opinion, further be heading in order to improve the functioning of the present system of pre-hospital and hospital emergency care. Urgent receptions in the Czech Republic represent a relatively new thing, which results into certain ambivalence of their concept and structure. Each urgent reception is somehow original and adapted to the requirements of the founder and the local situation. There is one thing the urgent receptions have in common, overload with patients who fall into the competence of practitioners. This is associated with the financial loss-making of these departments within the medical facilities. This, especially in the case of the private hospitals, leads to a reluctance of the founder to invest to the urgent reception. In this thesis I mention legal framework, contingency planning in the Czech Republic, contingency plans, their content purpose and type plan with its importance for solving crisis events. Another plan that is resolved in my thesis and that has crucial importance especially, for urgent receptions is the trauma plan of medical facility whose application into practice in the Czech Republic in many health care facilities is very problematic. And the practice of the trauma plan activation itself is, according to my research, the prerogative of only a very small amount of medical facilities.

Exercising their profession, nursing staff in health facilities may commit a fatal mistake in tense moments in terms of time. An illustrious example may be the admission of a higher number of casualties after an emergency event. So that to prevent these negative consequences, emphasis is put on the readiness of the entire health system from the headquarters to individual care providers. Special attention is also paid to trauma planning, because especially in complex cases greater demands are developed on the functioning and rapid succession of individual operations of medical care, along with observing all approved medical principles, of course. To verify the readiness and to reveal any shortcomings and reserves tactical exercises are held. The Krnov hospital also participated in that kind of training with activating the trauma plan. Another workplace involved was also the radio-diagnostic department. A simulated bus accident was to reveal whether the individual workplaces could provide adequate examinations and treatment. The thesis is divided into several parts. In the introductory section it is explained in brief how the health system is organized. To understand the text, it was necessary to define the necessary terminology and to mention the binding, legal legislation for emergency management authorities at all levels that affect the operations and carry out supervision on medical institutions. Gradually, the theoretical part presents trauma plans, sorting out casualties in the place of an emergency event, and specific exercises in the Krnov hospital that were announced and carried out in the early afternoon, when the hospital was fully filled with staff members. In the research part the analysis of a real accident that occurred in a late evening about a year later is made. Time demandingness of individual examinations is evaluated. Factual results are compared with the data obtained from simulated exercises. In the final part I tried to assess the quality and topicality of the trauma plan elaborated by our facility as well as the internal trauma plan of the RDG department and to propose possible changes and improvements.

Bakgrund: Centralisering av sjukvård har bidragit till färre antal akutmottagningar. Antalet ambulanstransporter har blivit fler och avstånden till sjukhus längre, vilket ställer höga krav på ambulanspersonalens kompetens. I glesbygd ställs ambulanspersonalen ofta inför utmaningar då för få resurser finns att tillgå. Syfte: att beskriva sjuksköterskors upplevelser av att prehospitalt vårda patienter med kritiska tillstånd i glesbygd. Metod: Nio legitimerade sjuksköterskor som arbetade på två olika ambulansstationer belägna i glesbygd i Norra Sverige intervjuades med semistrukturerade intervjuer. Den transkriberade texten analyserades med kvalitativ innehållsanalys. Resultat: Analysen av intervjuerna resulterade i fem kategorier: Att långa avstånd förlänger vårdtiden, Att bristande resurser försvårar omhändertagandet, Att känna sig ensam och otillräcklig, Att trygghet i teamet stärker omvårdnaden av patienten, Att utbildning och utveckling bidrar till ökad trygghet. Sjuksköterskorna i ambulans i glesbygdstudien upplevde att det var påfrestande att stå ensam med stora och för patienten livsavgörande beslut. De upplevde att arbetet krävde mycket av dem som sjuksköterskor då de fick vårda patienter med kritiska tillstånd under en lång tid på grund av långa avstånd och samtidigt hade för få resurser att tillgå. Vidare upplevdes arbetet som utmanande och deltagarna beskrev att de alltid försökte lösa situationerna efter de förutsättningar som fanns. Ett väl fungerande samarbete med kollegor beskrevs vara viktigt. Sjuksköterskorna beskrev även att det var viktigt att ha en bred kompetens inom akutsjukvård. Slutsats: Prehospital vård i glesbygd och omhändertagande av patienter med kritiska tillstånd är utmanande. Sjuksköterskor bör besitta bred kompetens och utbildning inom akutsjukvård kan främja omvårdnaden i komplexa situationer. Utvecklingsområden har identifierats under studiens process och ytterligare forskning inom området är önskvärt för vidare kliniska implikationer.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo, descritivo, teve como objetivo elaborar uma proposta para organizaÃÃo do Sistema Estadual de UrgÃncia e EmergÃncia no estado do CearÃ-Brasil, baseado na implantaÃÃo de serviÃos de atendimento prÃ-hospitalar de urgÃncia e emergÃncia. PropÃe o desenho de regionalizaÃÃo dos serviÃos na Ãtica do atendimento prÃ-hospitalar com Ãnfase na integralidade da atenÃÃo e integraÃÃo dos serviÃos, da qualificaÃÃo e da humanizaÃÃo da atenÃÃo. Com base nos dados do Datasus, e IBGE, ano 2003 e de acordo com o estabelecido pela Portaria GM-MS 2048/2003, foram definidos 12 pÃlos regionais de urgÃncia e emergÃncia com o mesmo nÃmero de centrais de regulaÃÃo (11 a serem implantadas). SÃo necessÃrias 133 ambulÃncias de suporte bÃsico (USB) e 28 ambulÃncias de suporte avanÃado (USA). O pessoal necessÃrio serÃ: 396 mÃdicos, 396 enfermeiros, 737 auxiliares/tÃcnico de enfermagem, 660 condutores socorristas, 11 farmacÃuticos, 110 telefonistas, entre outros. Foi analisado o quantitativo de internaÃÃes realizadas nos 20 hospitais pÃlos em relaÃÃo a intervalos de distÃncia do local da residÃncia. A ocupaÃÃo dos leitos à em sua maioria feita pelos residentes dos municÃpios onde o hospital està localizado. Com base nos parÃmetros do Ato Portaria n 1101/GM-MS e de acordo com o agrupamento pÃlo-regional sugerido foi analisado o quantitativo de leitos disponÃveis, verificou-se que o nÃmero de leitos à insuficiente, sendo mais preocupante a situaÃÃo dos leitos de UTI. Quanto aos tipos de procedimentos de urgÃncia e emergÃncia, na comparaÃÃo entre os pÃlos, por freqÃÃncia, existe maior concentraÃÃo nas internaÃÃes para realizaÃÃo de partos, cesarianas e curetagem pÃs-aborto. Sugere-se que a implantaÃÃo seja feita de forma gradual com prioridade para as regiÃes mais desassistidas. Na repactuaÃÃo da ocupaÃÃo dos leitos dos hospitais pÃlo-regionais deverà haver definiÃÃo clara de um percentual eqÃitativo para os tipos de procedimentos por internaÃÃo a serem utilizados pelos moradores dos municÃpios da Ãrea de cobertura regional, com definiÃÃo de um âportfÃlioâ padronizado de serviÃos hospitalares, almejando auto-suficiÃncia do atendimento de urgÃncia e emergÃncia a nÃvel micro e macrorregional de saÃde no estado do CearÃ. / This study, descriptive, aimed to develop a proposal for organizing the State System of Urgency and Emergency in the state of CearÃ-Brazil, based on the deployment of the prehospital emergency care. Proposes the design of regional services in the optics of prehospital care with emphasis on the completeness of care and integration of services, qualification and the humanization of attention. Based on data from DATASUS and IBGE, year 2003, in conformity with a Minister of Health Order n 2048/2003-GM-MS, were defined 12 regional clusters of urgency/emergency, with the same number of centrals regulation (11 to be implanted), 133 ambulances are needed for basic support (USB in portuguese) and 28 ambulances for advanced support (USA in portuguese). The necessary staff will be: 396 physicians, 396 nurses, 737 assistant/technical nursing, 660 ambulance drivers, 11 pharmacists, 110 telephone operators, among others. It was analyzed the admissions quantitative made in 20 poles hospitals in relation to the intervals of distance from the place of domicile. The occupation of beds is, in its majority, made by people of the municipality where the hospital is located. Based on the features of the Act Order of a Minister of Health n 1101/GM-MS and according to the pole-regional grouping suggested, an analysis was made to verify the amount of beds available. It was obeyed that the number of beds is insufficient, more worrying is the situation of the ICU beds. As for the types of procedures of emergency, in the comparison between the poles, by frequency, there is greater focus on admissions for carrying out deliveries, cesarean sections and curettage post-abortion. It is suggested that the implementation of services should be done gradually with priority to the most underprivileged regions. In the re agreement of occupation of the beds in poleregional hospitals there should be clear a fair percentage for the types of procedures to be used by residents of the municipalities in regional coverage area, with definition of a standardized portfolio of hospital services, targeting self-sufficiency of emergency care at micro and macrorregional health in the state of Ceara.