Introdução: Manaus dispõe de um Serviço de Atendimento Móvel de Urgência (SAMU) fluvial que atende a população que reside em comunidades ribeirinhas dos rios Negro e Amazonas. Tem-se observado várias iniciativas de atendimento pré-hospitalar (APH) com uso desse tipo de transporte; no entanto, não foram encontradas na literatura informações sobre esses serviços, perfil dos usuários e fatores associados a desfechos indesejáveis do atendimento. Objetivo: Caracterizar o perfil dos usuários, aspectos do atendimento do SAMU fluvial de Manaus e identificar fatores relacionados ao agravamento no APH fluvial. Método: Estudo descritivo correlacional realizado em duas etapas. Na primeira etapa, a coleta de informações foi retrospectiva e teve como fonte os registros dos atendimentos realizados pelo SAMU fluvial de Manaus de 2009 a 2015. Na segunda etapa, a coleta de dados foi prospectiva; indivíduos com 15 anos ou mais, atendidos pelo SAMU fluvial no período de seis meses (janeiro a junho de 2016), tiveram informações coletadas desde a chamada na Central de Regulação até a chegada à base fluvial. Pacientes encaminhados para hospitais tiveram a coleta de informações estendida até a saída hospitalar. Testes de associação foram aplicados considerando as características do atendimento e usuário perante o agravamento do paciente, identificado por meio das mudanças do Rapid Emergency Medicine Score (REMS) entre o atendimento inicial e final do SAMU fluvial. Resultados: Entre 2009 e 2015, o SAMU fluvial de Manaus realizou 2.002 atendimentos, a maior parte em comunidades do Rio Negro e próximas da base fluvial. A grande maioria dos atendidos pelo SAMU fluvial foi removida para Manaus (92%), variando o tipo de embarcação mais frequentemente utilizada no transporte ao longo dos anos e com ajustes na tripulação da modalidade Unidade de Suporte Avançado (USA) após 2015. Foi baixa a frequência de procedimentos nos atendimentos (média 1,5 procedimento), porém o acesso venoso foi realizado em quase todos os usuários (97,8%). Houve grande variabilidade dos tempos de APH. As médias do tempo de resposta (84 minutos) e total de APH fluvial (172 minutos) foram bastante elevadas. A maioria dos pacientes removidos foi encaminhada para hospital (44,9%) ou serviço de pronto atendimento (37,1%). A frequência de homens e mulheres atendidos foi semelhante e os usuários com menos de 35 anos predominaram. As causas mais frequentes dos atendimentos foram as relacionadas a sintomas, sinais e achados anormais e causas externas de morbidade e mortalidade. Os parâmetros fisiológicos e o valor médio do REMS inicial, 2,7 (dp = 3,6), indicaram baixo risco de morte dos pacientes. No entanto, a mortalidade hospitalar dos internados foi de 8,7%. Dos pacientes transportados pelo SAMU fluvial, 68,5% mantiveram o quadro clínico, 18,0% pioraram e 13,5% melhoraram durante o atendimento. Houve associação entre piora e local de destino dos usuários (p=0,037), também com as ocorrências relacionadas a contato com serpentes venenosas (p= 0,039) e dor aguda (p= 0,005). Conclusão: No geral, os resultados mostraram peculiaridades do SAMU fluvial de Manaus em relação a serviços terrestres que necessitam ser consideradas no planejamento, implementação e avaliação do APH fluvial. / Introduction: Manaus has a fluvial Mobile Emergency Care Service (SAMU) that serves the population who lives in riverside communities of Negro and Amazon rivers. Several prehospital care initiatives (APH) have been observed regarding this type of transportation. However, information on these services, users\' profiles and factors associated with undesirable outcomes were not found in the literature. Objective: To characterize the profile of the users and aspects of Manaus fluvial SAMU and to identify factors related to the worsening in fluvial APH. Method: Descriptive, correlational study carried out in two stages. In the first stage, the information collection was retrospective and was based on the records of the services performed by Manaus fluvial SAMU from 2009 to 2015. In the second stage, data collection was prospective. Individuals aged 15 years and older attended by fluvial SAMU in the six-month period (January to June 2016) had information collected from the call to the Regulation Center until arrival at the fluvial base. Patients referred to hospitals had information collection extended until hospital discharge. Association tests were applied considering the characteristics of care and user before the patient\'s worsening, identified through the changes of the Rapid Emergency Medicine Score (REMS) from the initial care until the final care by fluvial SAMU. Results: From 2009 to 2015, Manaus fluvial SAMU carried out 2,002 visits, mostly in communities of Rio Negro and near the fluvial base. The vast majority of people served by the fluvial SAMU were removed to Manaus (92%). The type of boat most frequently used has changed over the years. Additionally, there were adjustments to the Advanced Support Unit (USA) crew after 2015. The frequency of procedures occurred during management was low (mean 1.5 procedure), but venous access was performed in almost all patients (97.8%). There was great variability of APH times. The mean response time (84 minutes) and total fluvial APH (172 minutes) were quite high. The majority of patients removed were referred to hospital (44.9%) or emergency care (37.1%). The frequency of men and women attended was similar and users less than 35 years old predominated. The most frequent causes of the visits were related to \"symptoms, signs and abnormal findings\" and \"external causes of morbidity and mortality\". The physiological parameters and the mean value of the initial REMS, 2.7 (SD = 3.6), indicated a low risk of death related to the patients. However, in- hospital mortality was 8.7%. Considering the patients transported by fluvial SAMU, 68.5% maintained the clinical presentation, 18.0% worsened and 13.5% improved during the care. There was an association between worsening and destination of the users (p = 0.037), as well as occurrences related to contact with venomous snakes (p = 0.039) and acute pain (p = 0.005). Conclusion: In general, the results showed peculiarities of Manaus fluvial SAMU related to terrestrial services that need to be considered in the planning, implementation and evaluation of fluvial APH.

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The purpose of the study was to examine Mexican-Americans values and attitudes toward education and further explore some of the reasons Mexican-Americans drop out of school at such high rates.

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The focus of this study was to design, implement, and evaluate a community college based program that utilizes contextual teaching and learning methods that will prepare completers for careers in public safety.