Thesis (Ph. D.)--University of Washington, 2006. / Includes bibliographical references (leaves 131-148).

The research problem addressed in this study was to develop a comprehensive marketing plan that would help an emergency medical service (EMS) in the Nelson Mandela Metropolitan Municipality (NMMM), capture a significant market share and gain a competitive advantage over competitors. To achieve this object, a literature study to determine the key components of a marketing plan was undertaken and used as a theoretical model in developing an actual marketing plan. In addition to the literature study, an empirical study was conducted to identify the key issues critical to the development of a marketing plan for the EMS. The survey method used, based on the key components gained from the literature study, consisted of an in-depth scan of the macro-environment and thorough market investigation of the target industry. The investigation involved the general management and senior personnel from the local emergency medical industry, medical aid schemes and private hospitals and clinics delimited in the study. The results of the above literature study were finally combined with the results of the empirical study and a marketing plan for an emergency medical service was developed. This study concludes with recommendations applicable for the implementation of the actual marketing plan.

Emergency Medical Services (EMS) is an institution and product of public health, health care, and public safety that is chopped and scattered across multiple jurisdictional deployment methodologies throughout Arizona. To fully-asses the EMS needs of the state, those jurisdictions are considered as a whole; for it is the whole that makes a system, and a system is what truly impacts patient outcomes. Evaluating the ""whole"" is the genesis and driver of the 2016 Arizona Statewide EMS Needs Assessment (ASENA). The primary objective of ASENA is to establish a current ""snap-shot"" of EMS in the state while simultaneously identifying needs and/or areas that can be targeted for further analysis and/or improvement as part of Population Health Management and Emergency Medical Services Integration under the AZ Flex Grant funded by the U.S. Health Resources and Services Administration (HRSA). In addition, the secondary objective of ASENA is to compare and contrast this current ""snap-shot"" with data obtained in a more narrow needs assessment conducted in 2001, allowing comparison of changes in Arizona's critical access EMS system over 15 years. To accomplish this, a 105-question needs assessment survey tool was developed and distributed to EMS agencies throughout the state. The fully-vetted survey tool collected information pertaining to sixteen core functional sections. Eighty-six agencies fully-completed the needs assessment survey tool, with respondents evenly distributed across the state's four EMS coordinating regions and representative of the various service-delivery methodologies. The combined service areas of the respondents cover over 85% of the state's population. Arizona's statewide EMS system is well organized and positioned to deliver advanced levels of prehospital care for the vast majority of its citizens and visitors, with some variation between urban and rural regions. Key needs identified relate to: patient care reporting between EMS providers, emergency departments and receiving hospitals; quality assurance activities; education and skills training programs; dispatch system capabilities; mass casualty and public health preparedness; equipment and supplies; and more robust use of data and analyses to inform continuous EMS system improvement.

Background: Comparing Full-Time (FT) and Part-Time (PT) staffing models for a mobile integrated health (MIH) program established by a local Fire Department. Objective: Determine if the program is sustainable and which staffing model is more effective at obtaining sustainability. Design: Quality Improvement project with retrospective data review. Setting: Green Valley Fire District in Green Valley, Arizona. A predominant retirement community. Target: The residents of the Green Valley Fire District. Interventions: Utilizing the RE-AIM framework, a retrospective review of the data collected by the previously implemented MIH Program in Green Valley was completed. The framework was utilized to review relevant data and determine if the program has achieved the expected outcomes, and maintained a sustainable and transferable MIH program. Measurement: Decrease in emergency medical (EM) calls for service with the implementation of the MIH program. Comparing staffing models for consistency in services. Results: The results showed a decline in EM calls for service with the MIH program, and more consistency in availability and patient services with the FT staffing model. Limitations: The demographics of the community limit the generalizability and transferability of the data obtained from the project. Additional data should be collected and analyzed both retrospectively and for successive years to substantiate the benefits and continue to improve the effectiveness of the MIH program. Conclusions: The program could be used as a model for other MIH programs, with adjustments made for the respective community. The value or sustainability of any MIH program cannot be limited to revenue solely. Other perspectives of value added service and cost savings must also be considered. Significance: This study highlights the effectiveness of an MIH program in a small retirement community and shows the benefit of a FT staffing model versus a PT staffing model for consistency of patient care and daily program operations. There are also multiple aspects of value to an MIH program, some of which are difficult to conceptualize and measure based on historical models of healthcare delivery and Fire Department Services. Further review of these types of programs is needed to establish the overall benefits of MIH.

M.A. (Clinical Psychology) / South African paramedics are thought to be exposed to a high number of critical incidents as compared to paramedics elsewhere (Ward, Lombard & Gwebushe, 2006). Therefore, South African paramedics are at particular risk of suffering from negative effects associated from the exposure to critical incidents. This study aimed to gain an in-depth understanding of the meaning which paramedics attach to the experience of “critical incidents” (Mitchell, 1983). This information may be beneficial for those working in Emergency Medical Services in South Africa to further understandings of paramedics’ experience of work related trauma. Five paramedics, sourced from both public and private ambulance service, between the ages of 27 and 36 years old, who have had between 8 to 12 years of working experience were interviewed regarding their lived experiences of critical incidents. The semi-structured interviews were transcribed and analysed based on the Interpretative Phenomenological Analysis (IPA) framework suggested by Smith and Osborn (2008). The analysis of each of the participant’s transcripts provided four master themes, some of which are supported by superordinate themes. The master themes are: 1) Experiencing the trauma of critical incidents, 2) Experiencing in the “World” of EMS, 3) Intrinsic factors and active attempts of coping with stress, and 4)Personal consequence of being a paramedic. For most of the participants, their narratives highlighted that the organisational variables were considered to be more important than the nature of the critical incidents they experienced. Critical incidents were deemed traumatic as there was a disparity between the participant’s expectations of what was expected and what they were confronted with in “reality”. In addition, the participants described forming an emotional bond with their patients or the patient’s family, which added to their distress. The participants’ narratives emphasised the importance of the role of the EMS organisation in influencing their experiences. Despite employing a number of coping strategies to mediate the effects of organisational as well as critical incident stress, the participants reported experiencing longterm negative psychological symptoms that have impacted on their personal and familial lives. These findings support the growing body of knowledge that demonstrates that organisational variables play an important role in either mediating or exacerbating posttrauma outcomes.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21700号 / 社医博第91号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.

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.

Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.