No description available.

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Trauma is a pandemic that has a significant negative impact on the lives of its victims and national economies. This descriptive study was conducted on 103 private medical general practitioners in Limpopo Province. Ethical approval for the study was obtained from the University of the Witwatersrand Committee for research on Human Subjects (Medical). Approval protocol number M050230. The aim of the study was to determine the state of pre-hospital trauma care: training and preparedness of and practice by private medical general practitioners (GPs) in Limpopo Province. Data was collected by means of an anonymous, confidential, self-administered questionnaire. The objectives were to determine demographic features of the respondents; determine the status of emergency pre-hospital trauma training, preparedness and practice amongst the respondents; and to determine their incentives and disincentives to trauma medicine training, preparedness and practice in Limpopo province. The response rate was 36%. Fifty five per cent (55%) of the respondents had received trauma training since they commenced work as GPs. The proportion of GPs who said that they received trauma training while working in hospitals casualty departments was 52%. The number of respondents who completed ATLS was 24 (23%). Five (21%) of those who had completed ATLS updated their qualifications during years 2001 to 2005. Of the GPs surveyed 46% were not aware of ATLS course offered by the College of Emergency Care at Polokwane City. The majority of the respondents graduated as medical practitioners from the university of Pretoria (38%) and MEDUNSA (31%). But undergoing trauma management training was not associated with the medical schools from which 4 respondents graduated as medical practitioners (p=0.767; Fisher’s exact=0.827; Pearson chi2 = 4.9075). The medical schools from which respondents graduated as medical practitioners was also not related to the amount of private medical practice that comprised emergency care (p= 0.372). Undergoing trauma training was not associated with the age of a GP (p value= 0.120; Fisher exact=0.127). Sex was not found to be associated with trauma training (p=0.895; Fisher exact=1.000). Sex also had no link to the proportion of medical practice comprising emergency care (p-value=0.153; Fisher ‘s exact=0.214; Pearson Chi2). Even though location of GP’s practice was reported to be both an incentive and disincentive to trauma management training it was found not to be associated with trauma management training (p=0.393; Fisher exact=0.426; Pearson chi2 =1.5687) There was no association between location of GP’s practice and preparedness for trauma management. The exception to the finding was in terms of availability of chest drains where the p-value was 0.001. It was found that 31% of respondents who indicated that they had chest drains were based in rural areas while about 6% were practicing in urban areas. Availability of morphine and other analgesics (p-value=0.025, Fisher’s exact=0.038, Pearson Chi2 (1)=5.0165) were associated with preparedness for trauma. There was no association between type of GP practice and trauma management training (Pearson Chi2 (2) =2.1242. p- value = 0.346. Fisher’s exact = 0.429). Almost 95% of those who stated that they spent at least 50% of their time in private general medical practice were full-time. Being in full-time private general medical practice did not necessarily translate into a higher proportion of the practice that comprised trauma care. It was found that 64% of the respondents who were in full-time private general medical practice had an emergency trauma care burden of less than 10% compared to 36% that had a proportion of 10% and more. Amongst part-time practitioners the percentage of those whose burden of trauma care was less than 10% was equal to that of those with 10% and more. The findings implied lack of an association between time spent in private general medical practice and proportion of the practice that constitutes trauma care (p=0.621). The commonest method of updating trauma management skills was through personal study (37% of respondents) followed by attendance of trauma meetings (24% of respondents). Trauma trained GPs tended to have a higher proportion of their practices that comprised emergency trauma care (p-value = 0.030; Fisher’s exact =0.050) than those who had not. The frequently used sources of trauma management information were personal experience (58%) of the respondents followed by continuing medical education (50% of respondents). Almost 50.8% of the respondents reported that they were fairly skilled to manage in a pre-hospital setting various types of injuries. Minor soft tissue injuries were the type of trauma that 68% of the respondents said that they could manage excellently. Incentives factors to both trauma training and practice were high trauma prevalence (33.3% of respondents-training: and 20.7% of respondents-practice); performance improvement (20% of respondents-training: 12.1% of respondents respectively-practice); adequate and managed trauma care facilities (17% of respondents-training: 10.4% of respondents-practice); trauma care support (6.7% of respondents-training: 6.9% of respondents-practice); the need to improve trauma knowledge and skills (17% of respondents-training: 17.2% of respondents-practice) and; strategic GP practice location (7% of respondents-training: 6.9% of respondents-practice). Major disincentives to both trauma training and practice were lack of time for trauma care (28.9% respondents-training: 14.9% respondents practice); unsupportive staff (10% respondents-training: 14.9% respondents-practice); perceived high cost of trauma care and poor rewards (15.6% respondents-training: 11.7% respondents-practice); substandard and inaccessible trauma care facilities (15.6% respondents-training: 24.5% respondents-practice); under-utilized trauma knowledge and skills (6.7% respondents-training: 4.3% respondents-practice); 6 restrictive healthcare regulations and policies (2.2% respondents-training: 2% respondents-practice); and low number of trauma patients seen (11.1% respondents-training: 3.2% respondents-practice). In terms of preparedness for trauma the respondents were ill-prepared for trauma as evidenced by insufficient trauma equipment and drugs. Whereas almost all the respondents (frequency 102 or 99%) had stethoscopes only 7% had cricothyrotomy set. Only 18% of them had needle with one-way valve and chest drains. The trauma drug that appeared to have been the most widely stocked was adrenaline with a frequency of 96 or 93%. It was followed by aspirin with a frequency of 95 or 92%. Ketamine and zidovudine were drugs that were least stocked by the respondents. Their frequencies were 27 or 26%) and 33 or 32% respectively. The other equipment that was infrequently available at GPs’ rooms was goggles (frequency 46%) suggesting poor adherence to safety measures. There were low levels of preparedness to manage trauma patients independently with 43% reporting that they could independently adhere to universal safety measures. Whereas 52% of the respondents stated that they had received training in CPR 54.5% stated that they were equipped and prepared to open and protect the airway; 43% could independently provide adequate breathing while 45% of them could restore and maintain sufficient circulation, indicating a need to improve levels of CPR training. It was recommended that more general practitioners in Limpopo province should be trained and involved in trauma care. It was further recommended that awareness should be raised about the ATLS offered at the College of Emergency Care in Polokwane City. Further research is needed to explore how trauma trained GPs could be better equipped, prepared and supported in the management of trauma. There was also a need to address the disincentive factors to trauma training, preparedness and practice while strengthening the incentives. Given the critical shortage of advanced emergency practitioners (such as paramedics) in Limpopo province, there was perhaps a need to consider how GPs, with their 7 advanced medical qualifications and strategic positioning within communities, could be better deployed in pre-hospital trauma care.

Objectives: 1. To describe variations in major trauma between rural and urban residents of Ontario in terms of external causes, severities, prehospital care and clinical outcomes. 2. To determine whether prehospital intubation improves survival to hospital discharge among victims of major trauma. Methods: The study involved secondary analyses of data from the Ontario Prehospital Advanced Life Support Study (OPALS). OPALS is the largest study of prehospital emergency medical services conducted worldwide. 1. Rural-urban status of trauma patients was determined using modified Beale Codes. Differences in trauma characteristics and patient care were compared among four geographic groups (Large Metro, Medium Metro, Small Metro, Rural). 2. Patients who were intubated in the field were individually matched with non-intubated patients by patient age, injury severity score category, abbreviated head injury score category, and exact Glasgow coma scores. Cox regression was used to estimate the effect of prehospital intubation on patients' survival to hospital discharge, stratifying on patient matching. Results: 1. Patients in the large metro and rural groups had higher injury severity scores (medial 25, 24, respectively) than the other two groups (median=22). Paramedics generally spent more time in rural and large metro areas (median=37.4, 36.6 minutes respectively) than in medium and small metro (median=32.0, 30.7 minutes respectively) areas. Response times and transport times in rural groups were significantly longer than the other three groups, while scene times in the large metro group were significantly longer compared with the other geographic groups. There were no significant differences in survival rates by geographic group. 2. There were no significantly differences between the intubated and the non-intubated groups by age, sex, Glasgow coma scores, injury severity score, and systolic blood pressure category. Prehospital intubated patients exprienced a 3-fold risk of mortality after adjustment for potential confounders (HR2.9; 95% CI 1.4 to 5.8). Conclusions: 1. While response and transport times for major trauma were longer in rural areas, there were no significant differences in mortality in patients with different rural urban status. 2. Prehosptial intubation showed a negative association with survival among major trauma patients. Further randomized trials are required to invesitigate this clinical issue. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2007-10-24 11:58:53.955

En litteraturbaserad studie som belyser patienters erfarenheter av omhändertagandet i samband med trauma, där patienternas utsatthet framkommer på ett tydligt sätt. En litteraturöversikt med studier utförda i Sverige, England och USA.       Patienterna betonar vikten av sjuksköterskans empatiska förhållningssätt i mötet och vid den fysiska omvårdnaden. Trygghet uppstår när sjuksköterskan är vänlig, visar engagemang och bemöter patienten med respekt. Patienterna beskriver att de känner sig väl omhändertagna när sjuksköterskan vårdar dem ömt, samtidigt som de beskriver känslor av utsatthet och obehag vid fysiska undersökningar. Organisationen på sjukhuset påverkar patienternas erfarenheter av omhändertagandet. Patienterna upplever en tillfredställande vård när traumateamet har en god sammanhållning, skicklighet och kompetens. Vid en god kommunikation mellan sjuksköterskan och patienten upplevs känslor av förtroende och tillit. Patienterna vill få information om vad som händer och det är betydelsefullt att sjuksköterskan aktivt lyssnar på patientens enskilda behov och önskemål. Sjuksköterskan beskrivs som viktig då patienten behöver stöttning i att hantera sin nya situation och att kunna se en hoppfull framtid efter den traumatiska händelsen. Studiens resultat belyser att patienterna är i behov av stöd efter den traumatiska händelsen.       Dagens sjukvård har ekonomiska utmaningar och svårigheter som personalbrist vilket kan emellertid hindra ett optimalt omhändertagande av den sjuka och skadade patienten. En ökad kunskap hos sjuksköterskan och vårdorganisationen om att patienterna är i behov av stöd efter den traumatiska händelsen, kan bidra till en mer individanpassad och tillfredställande vård för patienten. / Background: Trauma is a common cause of death and disability and an event that can lead to a major suffering for the patient. To be exposed to trauma entails both physical and mental stress. Some patients expressed feelings such as guilt and hopelessness and had difficulty seeing the meaning of life after the accident, when the patient´s lifeworld was changed. Aim: The aim of this study was to illuminate patients' experiences of trauma care. Method: A literature review based on a content analysis of nine qualitative and three quantitative studies.  Results: The result revealed that patients needed support after the traumatic event. The findings were three main themes; Professional support from the nurse, Support of a functioning organization, Support of a good communication. Conclusion: The traumatic event turned out to be very emotional for the patients and they needed professional support after the accident. The nurse had a significant role and supportive function in the trauma care of the patient and could help the patient to feel safe in the situation and look hopefully on life again by means of an empathetic approach.

This century will bring an explosion in the geriatric population aged 65 and older, with those over 80 the fastest growing group. Falls, vehicle collisions, burns, and abuse are traumatic events that our geriatric patients may be susceptible to and from which they may not recover. Primary care providers should enhance their understanding of the complex issues of geriatric trauma to facilitate prevention and to assist the patient's recovery to normal function, addressing barriers such as immobility, pain, malnutrition, and acute confusion. Improved outcomes require combined efforts of disciplines and specialties intervening for optimal management for older trauma patients from pre-hospital care through rehabilitation or end-of-life issues.

Introduction: Trauma is one of the leading causes of premature death and disability in South Africa. There is a paucity of data describing the prehospital trauma burden in sub-Saharan Africa. The aim of this study was to describe the epidemiology and common trauma emergencies managed by the Western Cape Government emergency medical service (WCG EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this was the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these cases, 168 980 (34.3%) or 25.9 per 1000 population were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were males and between the socio-economically active ages of 21-40 years old (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS case load managed. The patient acuity was categorised as being urgent for 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report of the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the WHO or any other LMIC. It also provides the foundation for further research towards understanding the emergency care needs in South Africa and to support Afrocentric health care solutions to decrease this public health crisis.

No description available.

Prehospital emergency care systems are complex and do not necessarily respond predictably to changes in management. A combined discrete-continuous simulation model focusing on trauma care was designed and implemented in SIMSCRIPT II.5 to allow prediction of the systems response to policy changes in terms of its effect on the system and on patient survival. The utility of the completed model was demonstrated by the results of experiments on triage and helicopter dispatching policies. Experiments on current and two alternate triage policies showed that helicopter utilization is significantly increased by more liberal triage to Level 1 trauma centers, which was expected, but that the waiting time for pending accidents tended to decrease, an unexpected consequence. Experiments on helicopter dispatch policy showed that liberalization of the dispatch policy would have much greater consequences than would changing the triage criteria. Again, this result was unexpected and has received little attention from system planners and administrators, especially with respect to the degree of discussion and controversy surrounding triage criteria.

Bakgrund: Den svårt skadade traumapatienten kräver ett multidisciplinärt och tvärprofessionellt omhändertagande vid ankomst till akutmottagningen. En av anestesisjuksköterskans arbetsuppgifter är att delta i omhändertagandet av traumapatienter. Detta kräver att anestesisjuksköterskan kan arbeta i ett anpassat arbetstempo samt kunna arbeta tvärprofessionellt i en stressad miljö. Rött traumalarm ökar kraven på anestesisjuksköterskan som skall inneha fördjupade medicinska- och omvårdnadskunskaper vid omhändertagandet av traumapatienter. Syfte: Studiens syfte var att belysa hur anestesisjuksköterskor upplevde deltagandet vid rött traumalarm. Metod: En kvalitativ design användes och besvarades med semistrukturerade intervjuer. Studien innefattade tio anestesisjuksköterskor från två mellanstora sjukhus i södra Sverige. Intervjuernas datamaterial analyserades med hjälp av en kvalitativ latent innehållsanalys. Resultat: Anestesisjuksköterskor i studien beskrev ett engagemang till det akuta omhändertagandet samt en vilja till att leverera en kvalitativ vård. Traumaomhändertagandet upplevdes ibland som utmanande, framförallt om det var flertalet skadade eller om patienten var svårt skadad. Samtidigt beskrevs ett ansvar över att vara en resurs för teamet och en länk för patienten under omhändertagandet. Struktur och trygghet var viktiga faktorer till ett lyckat teamsamarbete. För att arbetet kring patienten skulle ske på ett systematiskt och patientsäkert sätt, betonade anestesisjuksköterskorna vikten av utbildning inom traumasjukvård. Slutsats: Anestesisjuksköterskans deltagande i rött traumalarm kräver god kunskap inom såväl traumasjukvård som förmågan till samarbete och kommunikation. Kommunikation och samarbete visade sig oftast fungera väl, men då brister uppstod påverkades traumaomhändertagandet negativt, vilket även innefattade patientsäkerheten. Studien visar att traumaledaren har en avgörande betydelse gällande teamets förmåga till ett lyckat traumaomhändertagande. / Background: The severely injured trauma patient requires a multidisciplinary and interdisciplinary medical care on arrival to the emergency department. One of the nurse anaesthetists tasks is to participate in the care of trauma patients. This requires that the nurse anaesthetists can work in an adapted pace of work and be able to work interdisciplinary in a stressed environment. Red-trauma emergency increases the demand for nurse anaesthetist who shall hold in-depth medical and nursing skills in the care of trauma patients. Objective: The aim of this study was to illustrate the nurse anaesthetist experiences of taking part in red-trauma alarm. Method: The study had a qualitative approach and was answered by semi-structured interviews. The study included ten nurse anaesthetists from two middle large hospitals in southern Sweden. The data from the interviews were analyzed by using a qualitative latent content analysis. Results: Nurse anaesthetists in the study described an attraction to the acute care and a desire to deliver quality care. Trauma care perceived sometimes as challenging, especially if it was the most damaged, or if the patient was seriously injured. At the same time the nurse anaesthetists described a responsibility as being a resource for the team and a link to the patient during care. Structure and security were important factors in a successful team collaboration. So, that the work around the patient would be done in a systematic and patient safely, the nurse anaesthetists emphasize the importance of education in trauma care. Conclusion: The nurse anaesthetist attending in red-trauma emergency requires good knowledge in both trauma care as the ability to co-operation and communication. Communication and co-operation shown to usually work well, but when the deficiencies arose impacted negatively trauma care, which also included patient safety. The study have shown that the trauma leaders expertise have an essential role for a successful trauma-care.

Alla människor kan drabbas av en akut sjukdom eller skada. Hur de drabbade hanterar händelsen är mycket varierande. Känslor som rädsla, oro och smärta kan öka risken för mer eller mindre långdragna psykiska reaktioner. Om det akuta vårdteamet har kunskap om den intima kopplingen mellan människans kropp och psyke kan de ge ett korrekt stöd och bemötande redan i ett tidigt skede och därmed kanske minska patientens psykiska lidande. Trots att traumavården gör stora tekniska framsteg finns endast liten kunskap om hur det är att vara traumapatient. Syftet med studien är därför att belysa patienters upplevelse av det akuta omhändertagandet. Empirisk kvalitativ innehållsanalys användes som metod då författarna avsåg att undersöka patienters upplevelser i en specifik situation.Resultatet är en bearbetning av 10 vetenskapliga artiklar som belyser patienters upplevelser av akut omhändertagande på akutmottagningar och intensivvårdsavdelningar. Vid bearbetningen av artiklarna framkom flera områden som visar på patienternas upplevelser. Dessa har kategoriserats enligt följande: trygghet, professionalism, närhet, att ta kontroll samt kommunikation. Trygghet upplevdes som kärnan då övriga kategorier tycktes bidra till dess övergripande betydelse. Ett viktigt resultat som framkom var att vårdpersonalens tekniska kompetens upplevdes som viktigare än deras bemötande initialt i det akuta omhändertagandet. Förutom att patienterna hade ett behov av att få tydlig information så behövde de också känna att personal, familj och vänner fanns i deras närhet även om de inte kommunicerade med varandra. För att patienternas behov av trygghet skall tillgodoses vid det akuta omhändertagandet är det viktigt att vårdpersonalen ser till helheten och tar hänsyn till den enskilda individens psykiska status just i den aktuella situationen. / <p>Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård</p><p>Uppsatsnivå: D</p>