Att som ambulanssjuksköterska behandla patienter med hypoglykemi i hemmet är en vanlig åtgärd, i relation till den ökade belastningen på akutmottagningarna är det viktigt att kunna identifiera vilka patienter som behöver transporteras in till sjukhus. De flesta av patienterna vill stanna kvar i hemmet efter behandling, att vara medveten om vilka potentiella risker som finns om patienten stannar kvar hemma kan göra att det är lättare att bedöma vilken patient som bör åka med till sjukhus. Syftet med denna studie är att belysa riskerna med att patienter som behandlas för hypoglykemi kvarstannar i hemmet.  Studien genomfördes i form av en litteraturstudie. Sökningar gjordes i databaserna PubMed samt Cinahl. Dessa sökningar resulterade i fyra artiklar som inkluderades i resultatet. Under analysen av artiklarna framkom två problemområden, risk för återkommande hypoglykemi samt bristande uppföljning. För att kunna identifiera de patienterna som har ökad risk för återkommande hypoglykemi krävs en adekvat bedömning av sjuksköterskan samt att det finns beslutsstöd till hjälp. Bristande uppföljning av patienterna är det andra problemområdet, där krävs ett förbättrat samarbete mellan ambulans, sjukhus samt primärvård för att kunna förbättra uppföljningen, analysen visade på att även om risken för återkommande hypoglykemi inom 48 timmar är låg, så har många av patienterna upprepade hypoglykemi episoder sett ur ett längre perspektiv vilket understryker vikten av uppföljning. Där kan ambulanssjuksköterskan vara den som initierar uppföljningen, det är dock viktigt att beslutet tas i samråd med patienten. / That as an ambulance nurse treating patients with hypoglycemia in the home is a common practice, in relation to the increased burden on emergency departments, it is important to identify which patients need to be transported to the hospital. Most patients want to stay at home after treatment, to be aware of the potential risks that exist if the patient stays at home can make it easier to determine which patient should go to the hospital. The purpose of this study is to highlight the risks of patients being treated for hypoglycemia remains in the home.  The study was conducted in the form of a literature review. Searches were made in the PubMed and Cinahl. These searches resulted in four articles that were included in the results. During the analysis of the articles revealed two problem areas, the risk of recurrent hypoglycemia and inadequate follow-up. In order to identify those patients who are at increased risk for recurrent hypoglycemia requires an adequate assessment of the nurse and that there are decision supportto help. Lack of follow-up of patients is the second problem area, which require improved cooperation between ambulance, hospital and primary care to improve monitoring, analysis showed that although the risk of recurrent hypoglycemia within 48 hours is low, so many of the patients repeated hypoglycemic episodes from a longer perspective, which emphasizes the importance of follow-up. There, ambulance nurse to be the initiating follow-up, it is important that the decision taken in consultation with the patient.

The ambulance offload delay problem is a well-known result of overcrowding and congestion in emergency departments. Offload delay refers to the situation where area hospitals are unable to accept patients from regional ambulances in a timely manner due to lack of staff and bed capacity. The problem of offload delays is not a simple issue to resolve and has caused severe problems to the emergency medical services (EMS) providers, emergency department (ED) staff, and most importantly patients that are transferred to hospitals by ambulance. Except for several reports on the problem, not much research has been done on the subject. Almost all research to date has focused on either EMS or ED planning and operation and as far as we are aware there are no models which have considered the coordination of these units. We propose an analytical model which will allow us to analyze and explore the ambulance offload delay problem. We use queuing theory to construct a system representing the interaction of EMS and ED, and model the behavior of the system as a continuous time Markov chain. The matrix geometric method will be used to numerically compute various system performance measures under different conditions. We analyze the effect of adding more emergency beds in the ED, adding more ambulances, and reducing the ED patient length of stay, on various system performance measures such as the average number of ambulances in offload delay, average time in offload delay, and ambulance and bed utilization. We will show that adding more beds to the ED or reducing ED patient length of stay will have a positive impact on system performance and in particular will decrease the average number of ambulances experiencing offload delay and the average time in offload delay. Also, it will be shown that increasing the number of ambulances will have a negative impact on offload delays and increases the average number of ambulances in offload delay. However, other system performance measures are improved by adding more ambulances to the system. Finally, we will show the tradeoffs between adding more emergency beds, adding more ambulances, and reducing ED patient length of stay. We conclude that the hospital is the bottleneck in the system and in order to reduce ambulance offload delays, either hospital capacity has to be increased or ED patient length of stay is to be reduced.

Ambulance response time is a key measure used to assess EMS system performance. However, the speed with which ambulances respond to emergencies can be highly variable. In some cases, this is due to geography. In dense urban areas for example, the distances traveled are short, but traffic and other hindrances such as traffic calming measures and high rise elevators cause delays, while rural areas involve greater distances and longer travel times. There are two major components of response time: first, pre-travel delay to prepare for ambulance dispatch, and second the actual travel time to the callers location. Response time standards are often established in order to provide fast and reliable service to the most severely ill patients. Standards typically specify the percentage of time an emergency response team can get to a call within a certain time threshold. This is referred to as “coverage”. This thesis deals with the development of a new response time model that predicts not only the mean response time, but estimates its variability. The models are developed based on historical data provided by the Region of Waterloo EMS and will permit the Region to predict EMS coverage. By analyzing the historical data, we found that response times from EMS stations to geographical locations within the Region of Waterloo are characterized by lognormal distributions. For a particular station – location pair we can thus use this information to predict coverage if we are able to specify the parameters of the distribution. We do this by characterizing the travel time and pre-travel delay times separately, and then adding the two to estimate coverage. We will use a previously proposed model that estimates the mean travel time from a station to a demand point as a function of road types traversed. We also compare the results of this model with another well known model and show that the first model is suitable to apply to the Region of Waterloo. In order to estimate the standard deviation of the response time, we propose a simple but effective model that estimates the standard deviation as a function of mean response time.

The ambulance offload delay problem is a well-known result of overcrowding and congestion in emergency departments. Offload delay refers to the situation where area hospitals are unable to accept patients from regional ambulances in a timely manner due to lack of staff and bed capacity. The problem of offload delays is not a simple issue to resolve and has caused severe problems to the emergency medical services (EMS) providers, emergency department (ED) staff, and most importantly patients that are transferred to hospitals by ambulance. Except for several reports on the problem, not much research has been done on the subject. Almost all research to date has focused on either EMS or ED planning and operation and as far as we are aware there are no models which have considered the coordination of these units. We propose an analytical model which will allow us to analyze and explore the ambulance offload delay problem. We use queuing theory to construct a system representing the interaction of EMS and ED, and model the behavior of the system as a continuous time Markov chain. The matrix geometric method will be used to numerically compute various system performance measures under different conditions. We analyze the effect of adding more emergency beds in the ED, adding more ambulances, and reducing the ED patient length of stay, on various system performance measures such as the average number of ambulances in offload delay, average time in offload delay, and ambulance and bed utilization. We will show that adding more beds to the ED or reducing ED patient length of stay will have a positive impact on system performance and in particular will decrease the average number of ambulances experiencing offload delay and the average time in offload delay. Also, it will be shown that increasing the number of ambulances will have a negative impact on offload delays and increases the average number of ambulances in offload delay. However, other system performance measures are improved by adding more ambulances to the system. Finally, we will show the tradeoffs between adding more emergency beds, adding more ambulances, and reducing ED patient length of stay. We conclude that the hospital is the bottleneck in the system and in order to reduce ambulance offload delays, either hospital capacity has to be increased or ED patient length of stay is to be reduced.

Ambulance response time is a key measure used to assess EMS system performance. However, the speed with which ambulances respond to emergencies can be highly variable. In some cases, this is due to geography. In dense urban areas for example, the distances traveled are short, but traffic and other hindrances such as traffic calming measures and high rise elevators cause delays, while rural areas involve greater distances and longer travel times. There are two major components of response time: first, pre-travel delay to prepare for ambulance dispatch, and second the actual travel time to the callers location. Response time standards are often established in order to provide fast and reliable service to the most severely ill patients. Standards typically specify the percentage of time an emergency response team can get to a call within a certain time threshold. This is referred to as “coverage”. This thesis deals with the development of a new response time model that predicts not only the mean response time, but estimates its variability. The models are developed based on historical data provided by the Region of Waterloo EMS and will permit the Region to predict EMS coverage. By analyzing the historical data, we found that response times from EMS stations to geographical locations within the Region of Waterloo are characterized by lognormal distributions. For a particular station – location pair we can thus use this information to predict coverage if we are able to specify the parameters of the distribution. We do this by characterizing the travel time and pre-travel delay times separately, and then adding the two to estimate coverage. We will use a previously proposed model that estimates the mean travel time from a station to a demand point as a function of road types traversed. We also compare the results of this model with another well known model and show that the first model is suitable to apply to the Region of Waterloo. In order to estimate the standard deviation of the response time, we propose a simple but effective model that estimates the standard deviation as a function of mean response time.

Syftet med studien var att utifrån ambulanssjuksköterskors berättelser redogöra för upplevelsen av arbetet med HLR vid ett pre-hospitalt omhändertagande och hur fysiska och psykosociala omständigheter kan påverka deras arbetsmiljö samt att undersöka om det automatiska HLR-systemet LUCAS har påverkat arbetssituationen. En kvalitativ intervjustudie med deskriptiv design har genomförts. Undersökningsgruppen bestod av sex ambulanssjuksköterskor på en ambulansstation i Mellansverige. Intervjuerna genomfördes med semistrukturerade frågor och insamlat material analyserades utifrån en kvalitativ innehållsanalys. Utifrån analysen framkom tre kategorier samt temat ”Att känna stöd på arbetsplatsen trots brister i arbetsmiljön”. Resultatet visade att ambulanssjuksköterskorna upplevde arbetsutrymmet i somliga ambulanser så begränsande att det försvårade deras möjlighet att utföra adekvata vårdåtgärder, de upplevde sig vara beroende av LUCAS för att kunna utföra HLR. De upplevde ett svagt stöd från cheferna i frågan om inköp av ambulanser. Vidare framkom att samarbetet med räddningstjänsten var ett viktigt stöd vid HLR samt att en god stämning på arbetsplatsen främjade välbefinnandet. De riktlinjer som ambulanssjuksköterskorna hade att rätta sig efter upplevdes också som ett stöd, samt att det nya HLR-systemet LUCAS till stor del upplevdes avlastande i arbetet med HLR. Författarnas slutsats är att det finns både positiva och negativa upplevelser kring arbetsmiljön bland ambulanssjuksköterskorna och att det behövs mer forskning för att kunna förbättra ambulanssjuksköterskornas arbetsmiljö. / The aim of the study was to describe the ambulance nurses’ own experiences of working with pre-hospital CPR and how the physical and psychosocial factors effected their working environment. To investigate if the automatic CPR-system LUCAS have had any impact on their work situation. This study is based on qualitative interviews with a descriptive design. The study group consisted of six nurses who worked at an ambulance station in the central part of Sweden. The interviews were conducted with semi structured questions and the collected data was analyzed through a qualitative content analysis. The analysis resulted in three categories and a theme. The result showed that the ambulance nurses experienced that the space in some of the ambulances was too limited to be able to provide necessary care for their patients, they experienced being dependent to the LUCAS-device to be able to perform CPR. The ambulance nurses also felt a weak support from the head management when deciding on which ambulance to purchase. Furthermore, it appeared that the cooperation with the emergency services was of a great support when performing CPR as well as creating a good atmosphere between co-workers was of importance for the employee’s wellbeing. The guidelines for the ambulance nurses were also seen as a support as were the new automatic CPR-system LUCAS, which perceived as minimizing the workload on the ambulance personnel during CPR. The authors’ conclusion is that both positive and negative experiences were found in the ambulance personnel´s work environment and that more studies are required in order to improve the ambulance personnel’s work milieu.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2003. / Titre provenant de l'écran-titre.

The demand for emergency ambulance services in Hong Kong is on the rise. Issues such as climate change, ageing population, constrained space, and limited resource capacity mean that the present way of meeting service demand by injecting more resources will reach its limit in the near future and unlikely to be sustainable. There is an urgent need to develop a more realistic forecast model to account for the anticipated demand for emergency ambulance services to enable better strategic planning of resources and more effective logistic arrangement. In this connection, the research objectives of this thesis include the following: 1. To examine relationships between weather and ambulance demand, with specific reference to temperature effects on demographic and admission characteristics of patients. 2. To establish a quantitative model for short-term (1-7 days ahead) forecast of ambulance demand in Hong Kong. 3. To estimate the longer-term demand for ambulance services by sub areas in Hong Kong, taking into account projected weather and population changes in 2019 and 2036. The research concurs with the findings of other researchers that temperature was the most important weather factor affecting the daily ambulance demand in 2006-2009, accounting for 49% of the demand variance. An even higher demand variance of 74% could be explained among people aged 65 and above. The incorporation of 1-7 day forecast data of the average temperature improved the forecast accuracy of daily ambulance demand on average by 33% in terms of R2 and 11% in terms of root mean square error (RMSE). Moreover, the forecast accuracy could be further improved by as much as 4% for both R2 and RMSE through spatial sub models. For demand projection of a longer-term, significant underestimation was observed if changes in the population demographics were not considered. The underestimation of annual ambulance demand for 2019 and 2036 was 16% and 38% respectively. The research has practical and methodological implications. First, the quantitative model for short-term forecast can inform demand in the next few days to enable logistic deployment of ambulance services beforehand, which, in turn, ensures that potential victims can be served in a swift and efficient manner. Second, the longer-term projection on the demand for ambulance services enables better preparation and planning for the expected rise in demand in time and space. Unbudgeted or unnecessary purchases of ambulances can be prevented without compromising preparedness and service quality. Third, the methodology is adaptable and the model can be reconstituted when more accurate projections on weather and population changes become available. / published_or_final_version / Geography / Doctoral / Doctor of Philosophy

No description available.

The purpose of this research was to examine physical layout and organization of equipment as it pertained to patient care in rotor-wing air ambulances. The qualitative approach included observations, interviews, surveys and incident report reviews; and involved paramedics, educators, engineers and physicians affiliated with Ornge Transport Medicine. Findings showed that there is inconsistent placement of equipment within and between bases. A standardized approach to storing equipment, including labelling, could improve readiness for a call by assisting paramedics in ensuring equipment is properly stocked. It was also found that the layout of the patient care compartment was not optimal for some tasks, such as intubation and documentation, due to lack of space. Future helicopters should have seating, both behind the head and at the side of the patient that accommodates safe postures and allows paramedic’s access to the supplies necessary for the full spectrum of patient care expected in this environment.