Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The use of emergency lights and sirens as warning devices by ambulances is a hotly debated topic within the Emergency Medical Services. For the last few decades, research has shown that lights and sirens have only a minimal effect on time required to transport patients to the hospital, and essentially no positive effect on patient outcome. Meanwhile, thousands of ambulance crashes occur every year (usually during the operation of lights and sirens), and its possible that's tens of thousands of crashes are occurring as a result of a passing ambulance, though not directly involving the ambulance itself. This paper is meant to provide a thorough review of the science behind the use of lights and sirens, the risks they pose to EMS providers, patients, and the public, and strategies to help curb the cost they pose both in dollars and lives. The available literature on this subject all points to the use of lights and sirens being out dated, ineffective, and dangerous, and yet almost nothing has been done to solve the problems they cause. Continued research and development is needed to help make ambulances safer for their occupants, more effective driver training programs need to be offered to EMS providers, and protocols need to be adopted to limit the unnecessary use of L&S. / 2031-01-01

Thèse (de maîtrise)--Université Laval, 2007. / Bibliogr.: f. 69-70. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

Information was collected in an eight and a half month prospective study about 358 recent cardiac disease-related cardiac arrest cases which were attended by personnel from the Provincial Ambulance Service in the Lower Mainland of British Columbia. When possible, advanced life support personnel (EMA Ills), regular ambulance attendants (EMA Ms) and Fire Department staff are dispatched to cardiac arrest calls. At the time of this study some areas in the region did not have advanced life support coverage, and some cardiac arrest calls occurred while the EMA Ills were already engaged with another case. Such calls, attended by EMA lis, but not by EMA Ills, served as the comparison group for paramedic performance in this study. Patient outcomes were compared at admission to hospital and at discharge from hospital for the group of patients treated by EMA Ms and the group of patients treated by EMA Ills, or by a combination of EMA Ills and EMA Ms. Strongly significant differences in initial outcome (hospital admission) were found between the two patient groups, with EMA IM patients faring better (p.=0.002). Marginally significant differences in final outcome (discharge alive) between the two patient groups were found, with the EMA III group again doing better (p.=0.10). Whether or not the receiving hospital had a coronary care unit was not associated with a difference in initial (p.=0.45) or final outcome (p.=1.0) for the entire group of patients in the study. Short time in arrest without CPR was associated with better initial outcome (p.=0.00), and with better final outcome (p.=0.01) for all patients. in the study, as was short time to definitive care (initial outcome p.=0.001; final outcome p.=0.03). EMA II patients had a better chance of survival when they arrested during attendance by EMA lis than they did when they were found in arrest. This study suggests that significantly more cardiac arrest victims reach hospital alive, and more survive to be discharged alive from hospital, when their prehospital treatment is provided by advanced life support personnel than when it is provided by regular ambulance personnel. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

We study two different operational scenarios for a regional air ambulance service-company which has bases in Northern California. Two of these bases serve the land areas encompassed roughly in a circular area of radius 100 miles centered in Gilroy and Salinas, respectively; with a large part of their coverage areas reachable from either base. The base in Salinas currently operates one helicopter only from Thursday to Monday, whereas the base in Gilroy operates one helicopter 24/7. The company is considering extending the operation of one helicopter to 24/7 for its Salinas base. In this study we analyze the operational impacts of that extension, and develop a framework that can be applied towards the study of the ambulance assignment problem faced by small operators. / pa/cb Original. 10/06/05. updated 09/09/2011.

Thesis (M.S. in Operations Research)--Naval Postgraduate School, June 2005. / Thesis Advisor(s): Roberto Szechtman. Includes bibliographical references (p. 67-70). Also available online.

Sistemas de atendimento emergencial estão presentes nos grandes centros urbanos de todo o mundo. Sua finalidade é fornecer socorro a indivíduos acidentados, catástrofes e pessoas com problemas de saúde de maneira ágil e eficaz. Assim, uma característica importante desses sistemas é a prontidão dos recursos e o planejamento da malha de atendimento, definida pelas localizações das bases de veículos e pelas viaturas de atendimento. A operação desses sistemas é ainda mais crítica em grandes centros urbanos, nos quais as condições de trânsito e os padrões de variação da demanda por atendimento emergencial inserem um grau de complexidade extra ao problema. Desta forma, um mapa de localização de bases e viaturas eficientemente elaborado é crítico para o desempenho do sistema como um todo. Como no Brasil existe uma lacuna entre os mecanismos de planejamento dessas malhas de atendimento e as teorias de localização de instalações, observa-se que os métodos atualmente utilizados para a localização das bases e veículos, bem como para o dimensionamento desses serviços, dependem da percepção e da experiência dos gestores responsáveis. Este trabalho visa tratar esse problema de estruturação das malhas de atendimento quanto à localização e alocação dos recursos chave (bases e viaturas) utilizando ferramentas e modelos matemáticos, de modo a propor uma formalização de todo o processo de planejamento. São revisados diversos modelos de localização de instalações e veículos de emergência e com base nas características dos grandes centros urbanos, propõe-se uma formulação matemática para o problema. Uma vez que esse modelo recai num problema de complexidade não polinomial, também é proposto um método de solução baseado no comportamento de colônias de abelhas na busca de alimentos. O método de soluções proposto é aplicado ao Serviço de Atendimento Móvel Pré-hospitalar de Urgência do Município de São Paulo em um estudo de caso. / Emergency systems are present in most of the large urban centers around the world. Its main goal is to provide assistance to victims of accidents, catastrophic events and general health issues in a quick and effective way. Therefore, a major characteristic of such systems is their resources readiness and a well-structured service network consisted basically by their emergency sites and ambulances. Operation of these systems is even more critical in large cities, in which the traffic conditions and the shifting pattern of demand along the day impose an extra complexity to the problem. Thus, an efficiently defined location/allocation map is crucial for the systems performance. In Brazil however, there is a gap between the processes, by which these maps are obtained and the facility location theories. Besides that, the methods currently applied to achieve a location/allocation map strongly depend on the perception and experience of decision makers. This work aims to deal with this planning problem by tackling the question with mathematical tools and models, resulting in a formal procedure for future emergency service network planning. A review of theories and mathematical models regarding emergency siting models is presented, and based on the large cities main characteristics, a model is proposed. Also, once this problem leads to a problem with non-polynomial complexity, a meta-heuristic was developed based on the behavior of foraging bees. This proposed solution method is also applied in a case study in São Paulo\'s Ambulance Service System (Serviço de Atendimento Móvel Pré-hospitalar de Urgência do Município de São Paulo).

Sistemas de atendimento emergencial estão presentes nos grandes centros urbanos de todo o mundo. Sua finalidade é fornecer socorro a indivíduos acidentados, catástrofes e pessoas com problemas de saúde de maneira ágil e eficaz. Assim, uma característica importante desses sistemas é a prontidão dos recursos e o planejamento da malha de atendimento, definida pelas localizações das bases de veículos e pelas viaturas de atendimento. A operação desses sistemas é ainda mais crítica em grandes centros urbanos, nos quais as condições de trânsito e os padrões de variação da demanda por atendimento emergencial inserem um grau de complexidade extra ao problema. Desta forma, um mapa de localização de bases e viaturas eficientemente elaborado é crítico para o desempenho do sistema como um todo. Como no Brasil existe uma lacuna entre os mecanismos de planejamento dessas malhas de atendimento e as teorias de localização de instalações, observa-se que os métodos atualmente utilizados para a localização das bases e veículos, bem como para o dimensionamento desses serviços, dependem da percepção e da experiência dos gestores responsáveis. Este trabalho visa tratar esse problema de estruturação das malhas de atendimento quanto à localização e alocação dos recursos chave (bases e viaturas) utilizando ferramentas e modelos matemáticos, de modo a propor uma formalização de todo o processo de planejamento. São revisados diversos modelos de localização de instalações e veículos de emergência e com base nas características dos grandes centros urbanos, propõe-se uma formulação matemática para o problema. Uma vez que esse modelo recai num problema de complexidade não polinomial, também é proposto um método de solução baseado no comportamento de colônias de abelhas na busca de alimentos. O método de soluções proposto é aplicado ao Serviço de Atendimento Móvel Pré-hospitalar de Urgência do Município de São Paulo em um estudo de caso. / Emergency systems are present in most of the large urban centers around the world. Its main goal is to provide assistance to victims of accidents, catastrophic events and general health issues in a quick and effective way. Therefore, a major characteristic of such systems is their resources readiness and a well-structured service network consisted basically by their emergency sites and ambulances. Operation of these systems is even more critical in large cities, in which the traffic conditions and the shifting pattern of demand along the day impose an extra complexity to the problem. Thus, an efficiently defined location/allocation map is crucial for the systems performance. In Brazil however, there is a gap between the processes, by which these maps are obtained and the facility location theories. Besides that, the methods currently applied to achieve a location/allocation map strongly depend on the perception and experience of decision makers. This work aims to deal with this planning problem by tackling the question with mathematical tools and models, resulting in a formal procedure for future emergency service network planning. A review of theories and mathematical models regarding emergency siting models is presented, and based on the large cities main characteristics, a model is proposed. Also, once this problem leads to a problem with non-polynomial complexity, a meta-heuristic was developed based on the behavior of foraging bees. This proposed solution method is also applied in a case study in São Paulo\'s Ambulance Service System (Serviço de Atendimento Móvel Pré-hospitalar de Urgência do Município de São Paulo).

<p><strong>Introduktion: </strong>Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. <strong>Syfte:</strong><em> </em>Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. <strong>Metod: </strong>En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet.<strong> </strong>I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  <strong>Resultat: </strong>En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling.<strong> </strong>En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. <strong>Konklusion:</strong> Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel.</p> / <p><strong>Introduction:</strong> Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.<strong>Purpose:</strong><em> </em>The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. <strong>Method: </strong>A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.<strong>Results: </strong>A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully. </p><p><strong>Conclusion:</strong> Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.</p>

Introduktion: Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. Syfte: Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. Metod: En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet. I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  Resultat: En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling. En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. Konklusion: Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel. / Introduction: Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.Purpose: The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. Method: A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.Results: A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully.  Conclusion: Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xvii, 198 leaves. / The purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.