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.

Thesis (M.S.)--University of Tennessee, Knoxville, 2003. / Title from title page screen (viewed Oct. 14, 2003). Thesis advisor: Ralph Kimberlin. Document formatted into pages (x, 64 p. : ill. (some col.), col. maps). Vita. Includes bibliographical references (p. 58-63).

Thesis (Ph. D.)--University of Oklahoma. / Includes bibliographical references.

Un déploiement adéquat et une bonne gestion des ambulances amènent des temps de réponse plus courts lors d'un appel d'urgence et ainsi permettent de réduire la souffrance, la mortalité et les conséquences néfastes sur la santé des patients. Ce mémoire est divisé en deux parties et adresse sous forme de deux articles les problèmes de la localisation des ambulances et de leur gestion. L'objectif du premier article est de résoudre le problème de localisation d'ambulances multi-périodes en faisant l'hypothèse d'une demande déterministe, dynamique et cyclique. Un modèle mathématique ainsi que deux méthodes heuristiques sont proposés pour aider à résoudre ce problème. La première heuristique utilise de façon répétitive la version mono-période du modèle mathématique proposé alors que la deuxième est une heuristique itérative composée d'une phase de construction et une phase d'amélioration. L'efficacité de ces méthodes est démontrée par leur application pour résoudre des problèmes fictifs ainsi qu'un problème réel fourni par la corporation Urgences-santé. Les résultats obtenus avec les deux méthodes heuristiques nous indiquent que ces méthodes, en plus d'être très rapides, donnent des plans de déploiement près du plan optimal. De plus, la méthode heuristique basée sur le modèle mono-période semble dominer la méthode heuristique itérative sur tous les points en plus d'être plus simple. L'objectif du deuxième article est d'évaluer l'efficacité de plusieurs règles de répartition dans le cadre de la gestion des demandes d'intervention d'un réseau de service ambulancier. Deux types de décisions font l'objet de cette étude : le choix d'une ambulance pour répondre à une demande d'intervention et le choix du poste d'attente où ce véhicule sera redéployé après son intervention. Les règles généralement utilisées en pratique sont comparées à des règles visant non seulement la réduction des temps d'attente mais aussi le maintient d'une bonne couverture territoriale. Différentes règles sont testées sur des problèmes fictifs ainsi que sur un problème réel fourni par la corporation Urgences-santé. Les résultats obtenus démontrent que l'application d'une règle d'assignation simple comme affecter l'ambulance qui peut se rendre le plus rapidement possible sur les lieux de la demande d'intervention peut être efficace seulement si un bon plan de déploiement et de redéploiement est maintenu. On démontre que l'utilisation d'une règle de redéploiement visant la maximisation de la couverture du territoire permet d'atteindre un bon niveau d'efficacité.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2015. / Introduction: A Helicopter Emergency Medical Service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. There is an absence of literature describing the types of patients treated and the clinical outcome of these patients flown by Helicopter Emergency Medical Services within South Africa. The paucity of literature on this topic poses a challenge for current aeromedical services as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS within South Africa. Purpose of the study: The purpose of this study was to undertake a descriptive analysis of the patients flown by the Netcare 911 HEMS over a 12 month period in both Gauteng and KwaZulu-Natal and to assess the patients’ outcomes. The objectives of the study were to analyse the clinical demographics of patients transported by the Netcare 911 HEMS operation, determine the time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital and undertake a correlational analysis of crew qualifications, clinical procedures performed and their outcomes at 24 hours and 72 hours. A further objective was to make recommendations regarding the refinement of current aeromedical policies as well as the education and training requirements. Methodology: The research study was conducted utilizing a retrospective quantitative, descriptive design to undertake an analysis of patients transported by a private helicopter emergency medical service within South Africa. The records of all patients transported by the Netcare 911 HEMS operations between 01 January 2011 and 31 December 2011 were included. Results: In the 12 month study period there were a total of 547 cases. However, the final study population was made up of 537 cases as 10 cases had to be excluded due to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KwaZulu-Natal HEMS and 455 (84.7%) were managed by the Gauteng HEMS. Findings revealed that the majority of patients flown in both Gauteng and KwaZulu-Natal were adult males: males (n=398; 74.1%) and adults (n=437; 81.4%). Motor vehicle accidents were the most common incident type for both operations (n=193; 36%). At the 24-hour follow up, 339 (63.1%) patients were alive and stable and at the 72-hour follow up, 404 (75.3%) were alive and stable. Conclusion and recommendations The findings of this study provide valuable information that may have an impact on the current staffing and authorization criteria of South African HEMS operations.

Introdução Após mais de uma década de implantação do Serviço de Atendimento Móvel de Urgência (SAMU), torna-se importante lançar um olhar crítico a este serviço a fim de identificar as propostas da Política Nacional de Atenção às Urgências. Objetivo - Descrever e analisar criticamente o processo de trabalho da Central de Regulação do SAMU São Paulo (SAMU SP). Métodos Foi realizado um estudo de caso descritivo exploratório, com estratégia de métodos mistos, integrando as abordagens quantitativa (dados secundários referentes ao mês de outubro de 2012) e qualitativa (observação direta e entrevistas com três médicos reguladores). O banco de dados secundários permitiu descrever a demanda do SAMU SP e verificar a existência de padrões de associação entre as variáveis. Foi realizado o cálculo das frequências absolutas e relativas de todas as variáveis categóricas e cálculo dos tempos envolvidos no atendimento préhospitalar. As entrevistas foram transcritas e analisadas por meio da análise de conteúdo de Bardin com o objetivo identificar fatores subjetivos que não foram possíveis de serem mensurados na análise quantitativa. Foi realizada uma segunda análise estatística do banco de dados, com foco no processo de priorização das ocorrências, sendo investigadas as variáveis despacho e tempo de regulação, segundo determinante de prioridade e queixas principais. Foi utilizado o teste chi-quadrado para significância estatística. Resultados - A demanda é majoritariamente clínica (59,2 por cento ), masculina (52,2 por cento ), entre 20 e 59 anos (54,5 por cento ) e classificadas com Determinantes de alta prioridade (Echo e Delta) (52,5 por cento ). As transferências inter-hospitalares correspondem a 0,6 por cento da demanda. A frequência de despacho de ambulância é de 63,4 por cento e decresce conforme a prioridade diminui, chegando a 21,2 por cento no Determinante de menor prioridade (Ômega). O tempo resposta é inversamente proporcional ao Determinante de prioridade, e uma parte significativa de ocorrências de baixa prioridade (35,9 por cento ) são incluídas no sistema de saúde. Foram identificadas três dimensões que influenciam o processo de priorização das ocorrências: condições clínicas reportadas (parada cardiorrespiratória, problemas respiratórios, inconsciência) condições de vulnerabilidade e risco específicos (idosos e crianças abaixo de 3 anos, quedas, medo por parte do médico regulador de subestimar, presença de violência, interação com outros serviços) e condições intrínsecas ao processo de trabalho da central de operações SAMU SP (alta demanda e poucos recursos, trabalho colaborativo com outros profissionais). Conclusões A descrição e análise crítica da demanda e do processo de trabalho do SAMU SP traz elementos para a discussão sobre seu papel dentro do sistema de saúde do município. É possível afirmar que o SAMU SP tem cumprido a missão de salvar vidas, provendo assistência qualificada para pacientes classificados de altíssima prioridade que necessitam de atendimento fora do ambiente hospitalar. Ordenar a demanda de urgência e se configurar como um observatório de saúde passam pela necessidade do reconhecimento técnico e político de que se trata de um serviço integrado a rede de atenção à saúde e não apenas a rede temática da urgência / Introduction After more than a decade of Brazilian Mobile Emergency Services (SAMU) implementation, it becomes importante to launch a critical look at this service in order to identify the proposals of the National Policy for Emergency Care. Objective To critically describe and analyze the work process of SAMU Regulation Center of the city of São Paulo (SAMU SP). Methods A descriptive exploratory case study with mixed methods strategy, integrating the quantitative (secondary data for October 2012) and qualitative (direct observation and interviews with three regulatory physicians) approaches. The secondary database was used to describe SAMU SP demand and to verify the existence of patterns of association between the variables. Absolute and relative frequencies of all categorical variables and the times involved in prehospital care were calculated. The interviews were transcribed and analyzed through Bardin content analysis with the objective of identifying subjective factors that were not possible to be measured in the quantitative analysis. A second statistical analysis of the database was carried out, focusing on the prioritization of emergency incidentes. The frequency of dispatch and regulation time were investigated, according to the Priority Determinant and main complaint. The chi-square test was used for statistical significance. Results - The demand is composed mainly by clinical chief complaints (59.2 per cent ), male patients (52.2 per cent ), between 20 and 59 years old (54.5 per cent ) and classified with high priority determinants (Echo and Delta) (52.5 per cent ). Interhospital transfers correspond to 0.6 per cent of the demand. Ambulance dispatch frequency is 63.4 per cent and decreases as the priority decreases, reaching 21.2 per cent in the lowest Priority Determinant (Omega). The response time is inversely proportional to the Priority Determinant, and a significant portion of low priority occurrences (35.9 per cent ) are included in the health system. Three dimensions have been identified that influence the prioritization of emergency incidents: reported clinical conditions (cardiorespiratory arrest, respiratory problems, unconsciousness), vulnerable conditions and specific risk of the emergency incident (elderly and children under 3 years, falls, medical doctor fear of underestimation, presence of violence, interaction with other services) and work process intrinsic conditions of SAMU SP operations center (high demand and few resources, collaborative work with other professionals). Conclusions The description and critical analysis of the demand and work process of the SAMU SP brings elements to the discussion about its role within the health system of the city of São Paulo. It is possible to affirm that SAMU SP has fulfilled the mission of saving lives, providing qualified assistance to patients classified as high priority who need care outside the hospital environment. In order to SAMU SP organize the demand for urgent care and to be a health observatory, there is the need of technical and political re-recognition that it is a service integrated to the health care network and not just a thematic network of urgency

Introdução Após mais de uma década de implantação do Serviço de Atendimento Móvel de Urgência (SAMU), torna-se importante lançar um olhar crítico a este serviço a fim de identificar as propostas da Política Nacional de Atenção às Urgências. Objetivo - Descrever e analisar criticamente o processo de trabalho da Central de Regulação do SAMU São Paulo (SAMU SP). Métodos Foi realizado um estudo de caso descritivo exploratório, com estratégia de métodos mistos, integrando as abordagens quantitativa (dados secundários referentes ao mês de outubro de 2012) e qualitativa (observação direta e entrevistas com três médicos reguladores). O banco de dados secundários permitiu descrever a demanda do SAMU SP e verificar a existência de padrões de associação entre as variáveis. Foi realizado o cálculo das frequências absolutas e relativas de todas as variáveis categóricas e cálculo dos tempos envolvidos no atendimento préhospitalar. As entrevistas foram transcritas e analisadas por meio da análise de conteúdo de Bardin com o objetivo identificar fatores subjetivos que não foram possíveis de serem mensurados na análise quantitativa. Foi realizada uma segunda análise estatística do banco de dados, com foco no processo de priorização das ocorrências, sendo investigadas as variáveis despacho e tempo de regulação, segundo determinante de prioridade e queixas principais. Foi utilizado o teste chi-quadrado para significância estatística. Resultados - A demanda é majoritariamente clínica (59,2 por cento ), masculina (52,2 por cento ), entre 20 e 59 anos (54,5 por cento ) e classificadas com Determinantes de alta prioridade (Echo e Delta) (52,5 por cento ). As transferências inter-hospitalares correspondem a 0,6 por cento da demanda. A frequência de despacho de ambulância é de 63,4 por cento e decresce conforme a prioridade diminui, chegando a 21,2 por cento no Determinante de menor prioridade (Ômega). O tempo resposta é inversamente proporcional ao Determinante de prioridade, e uma parte significativa de ocorrências de baixa prioridade (35,9 por cento ) são incluídas no sistema de saúde. Foram identificadas três dimensões que influenciam o processo de priorização das ocorrências: condições clínicas reportadas (parada cardiorrespiratória, problemas respiratórios, inconsciência) condições de vulnerabilidade e risco específicos (idosos e crianças abaixo de 3 anos, quedas, medo por parte do médico regulador de subestimar, presença de violência, interação com outros serviços) e condições intrínsecas ao processo de trabalho da central de operações SAMU SP (alta demanda e poucos recursos, trabalho colaborativo com outros profissionais). Conclusões A descrição e análise crítica da demanda e do processo de trabalho do SAMU SP traz elementos para a discussão sobre seu papel dentro do sistema de saúde do município. É possível afirmar que o SAMU SP tem cumprido a missão de salvar vidas, provendo assistência qualificada para pacientes classificados de altíssima prioridade que necessitam de atendimento fora do ambiente hospitalar. Ordenar a demanda de urgência e se configurar como um observatório de saúde passam pela necessidade do reconhecimento técnico e político de que se trata de um serviço integrado a rede de atenção à saúde e não apenas a rede temática da urgência / Introduction After more than a decade of Brazilian Mobile Emergency Services (SAMU) implementation, it becomes importante to launch a critical look at this service in order to identify the proposals of the National Policy for Emergency Care. Objective To critically describe and analyze the work process of SAMU Regulation Center of the city of São Paulo (SAMU SP). Methods A descriptive exploratory case study with mixed methods strategy, integrating the quantitative (secondary data for October 2012) and qualitative (direct observation and interviews with three regulatory physicians) approaches. The secondary database was used to describe SAMU SP demand and to verify the existence of patterns of association between the variables. Absolute and relative frequencies of all categorical variables and the times involved in prehospital care were calculated. The interviews were transcribed and analyzed through Bardin content analysis with the objective of identifying subjective factors that were not possible to be measured in the quantitative analysis. A second statistical analysis of the database was carried out, focusing on the prioritization of emergency incidentes. The frequency of dispatch and regulation time were investigated, according to the Priority Determinant and main complaint. The chi-square test was used for statistical significance. Results - The demand is composed mainly by clinical chief complaints (59.2 per cent ), male patients (52.2 per cent ), between 20 and 59 years old (54.5 per cent ) and classified with high priority determinants (Echo and Delta) (52.5 per cent ). Interhospital transfers correspond to 0.6 per cent of the demand. Ambulance dispatch frequency is 63.4 per cent and decreases as the priority decreases, reaching 21.2 per cent in the lowest Priority Determinant (Omega). The response time is inversely proportional to the Priority Determinant, and a significant portion of low priority occurrences (35.9 per cent ) are included in the health system. Three dimensions have been identified that influence the prioritization of emergency incidents: reported clinical conditions (cardiorespiratory arrest, respiratory problems, unconsciousness), vulnerable conditions and specific risk of the emergency incident (elderly and children under 3 years, falls, medical doctor fear of underestimation, presence of violence, interaction with other services) and work process intrinsic conditions of SAMU SP operations center (high demand and few resources, collaborative work with other professionals). Conclusions The description and critical analysis of the demand and work process of the SAMU SP brings elements to the discussion about its role within the health system of the city of São Paulo. It is possible to affirm that SAMU SP has fulfilled the mission of saving lives, providing qualified assistance to patients classified as high priority who need care outside the hospital environment. In order to SAMU SP organize the demand for urgent care and to be a health observatory, there is the need of technical and political re-recognition that it is a service integrated to the health care network and not just a thematic network of urgency

Bakgrund: Basala hygienrutiner ska enligt Socialstyrelsen tillämpas för att förebygga vårdrelaterade infektioner (VRI). VRI är ett hot mot patientsäkerheten och kan medföra ökat lidande för patienten och ökade kostnader för samhället. Syfte: Att undersöka följsamhet till basala hygienrutiner inom ambulanssjukvård i ett antal utvalda omvårdnadssituationer. Metod: En deskriptiv kvantitativ studie där data inhämtades genom strukturerad observation. Bekvämlighetsurval tillämpades och totalt 68 observationer gjordes på två ambulansstationer inom samma landsting. Huvudresultat: Följsamhet till basala hygienrutiner varierade, med högst följsamhet till rutinen om kort eller uppsatt hår (87%) samt till användning av handskar (87%). Lägst följsamhet observerades till rutinen om handdesinfektion före patientnära arbete eller användning av handskar (1%). Inte vid någon observation (0%) visades följsamhet till samtliga sju basala hygienrutiner som undersöktes. Slutsats: Att brister av varierande grad fanns i följsamhet till basala hygienrutiner. Särskilt stor förbättringspotential visade de basala hygienrutinerna gällande handdesinfektion före och efter patientnära arbete eller användning av handskar. Bristerna i följsamhet till basala hygienrutiner kan leda till brister i patientsäkerhet i form av en risk att patienter drabbas av VRI och ökat lidande. Orsakerna till resultatet kan troligtvis ligga både på individnivå och organisationsnivå vilket gör det särskilt angeläget att resultatet diskuteras i berörda verksamheter samt fortsatta studier. / Background: According to the Swedish National Board of Health and Welfare, compliance to hygiene routines is important to prevent healthcare-associated infections (HCAI). HCAI are a threat to patient safety and may increase patient suffering and costs for the society. Aim: To describe compliance to hygiene routines within ambulance care in a number of given situations. Method: A descriptive quantitative study with data collection through structured observation. Convenience sampling was used and 68 observations in total were made on two ambulance stations. Main result: Varying compliance to hygiene routines was found, with highest compliance to the routine stating that hair should be short or up (87%) and the routine about use of gloves (87%). The lowest compliance was found to the routine about hand disinfection before patient contact or glove use (1%). No observation showed compliance to all seven hygiene routines covered by the study. Conclusion: That compliance with hygiene routines has shortcomings, especially regarding hand disinfection, which may lead to weak patient safety through a risk of HCAI and patient suffering. The shortcomings are probably grounded both on an individual and an organisational level which makes discussion of the subject in affected organisations and further studies important.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M.A.)--University of North Carolina Wilmington, 2009. / Title from PDF title page (February 22, 2010) Includes bibliographical references (p. 109-116)