The purpose of the study was to investigate the perceived occupational stress levels and coping mechanisms among Emergency Medical Technicians and paramedics in Delaware County. It was proposed that EMTs and paramedics perceive environmental and job stress for which they have developed specific coping mechanisms. It was further proposed that an association exists between levels of occupational stress and coping mechanisms used by Emergency Medical Technicians and paramedics.The population of prospective subjects for the study consisted of all part-time, full-time, and volunteer EMTs and paramedics of Delaware County, Indiana. The EMTs and paramedics were surveyed by an Occupational Stress Inventory-Revised, which they completed during mandatory training sessions. Delaware County and Yorktown EMS received the questionnaire packets by the researcher one half hour before the start of the subject's shift.The design of the study was nonexperimental, descriptive, and correlational. Pearson's product moment correlation, t-test, and multivariate analysis of variance were used to analyze the data.The results indicated that there were significant differences between the coping mechanisms used by EMTs and paramedics. There were also significant differences between occupational stress levels of paid and volunteer EMTs and paramedics and rural and urban area Emergency Medical Services. There were significant relationships between four of the six stress subscales, and average number of hours worked per week in the past year among EMTs and paramedics. No significant difference was found between EMTs and paramedics and levels of occupational stress. / Department of Physiology and Health Science

[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 74-75).

Thesis (M.Tech.: Emergency Medical Care)-Durban University of Technology, 2007 xiv, 116 leaves / The Professional Board for Emergency Care Practitioners (PBECP), a division of the Health Professions Council of South Africa, regulates the scope of practice and publishes guidelines and protocols that advanced life support (ALS) practitioners are required to follow. These define an acceptable, standardised approach to each commonly encountered emergency. Non compliance with the guidelines and protocols regularly occurs, which could impact on the quality of care delivered and may result in further injury or death of the patient. This study investigated the reasons for non-compliance by ALS practitioners and explored how compliance could be improved.

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

Abstract Emergency medical services (EMS) are designed to provide prompt response, on-scene treatment and transport for definitive care in patients with acute illness or injury. In recent years, the growing number of missions for non-urgent matters has challenged emergency care to design risk assessment protocols and tools to support decision-making and resource management at both dispatch and on-scene. The present study was designed to examine the efficacy of a criteria based dispatch protocol and National Early Warning Score (NEWS) in the Finnish EMS system. In addition, the aim of the research was to obtain data on patient allocation and mortality in the Northern Finnish population. The study data included 13,354 EMS missions from a six-month cohort (1.1.2014 - 30.6.2014) of prehospital emergency patients in two hospital districts – Kainuu and Länsi-Pohja – in Northern Finland, using a retrospective, observational design. Prehospital data including patient clinical physiological variables were combined with the national Finnish registries (Care Registry for Health Care, Intensive Care Consortium Database and Cause of Death Registry) in order to examine risk assessment in EMS and prehospital patient outcomes. Based on the result, the risk assessment at the dispatch was correct in 67.5% of the cases and four out of ten EMS missions did not lead to transportation by an ambulance. The use of the Finnish dispatch protocol resulted in an overall rate of 23% of over-triage and a 9% rate of under-triage. The highest NEWS category showed a good sensitivity for 1-day mortality but failed to adequately discriminate patients in need of intensive care or who died within 30-days in a large, unselected, typical EMS population. In conclusion, the criteria based dispatch protocol resulted in over-triage of a quarter of missions and in a significant rate of EMS missions without ambulance transportation. In addition, the predictive value of prehospital NEWS regarding the patient´s risk of death and need for intensive care was low. / Tiivistelmä Ensihoitopalvelu on suunniteltu tarjoamaan nopeaa vastetta, paikalla tapahtuvaa hoitoa ja kuljetusta lopulliseen hoitopaikkaan potilaille, joilla on akuutti sairaus tai vamma. Viime vuosien lisääntyneet yhteydenotot ei-kiireellisissä asioissa on johtanut riskinarviotyökalujen kehittämiseen tukemaan päätöksentekoa ja resurssienhallintaa hätäpuhelun aikana ja tapahtumapaikalla. Tässä tutkimuksessa tarkasteltiin kriteeripohjaista hätäpuhelun käsittelyä sekä varhaisen varoituspistejärjestelmän (NEWS) tehokkuutta suomalaisessa ensihoitojärjestelmässä. Lisäksi tutkimuksen tavoitteena oli saada tietoa ensihoitopotilaiden hoitotuloksista ja kuolleisuudesta Pohjois-Suomessa. Tutkimukseen sisältyi 13 354 ensihoitotehtävää kuuden kuukauden kohortista (1.1.2014 – 30.6.2014) kahden sairaanhoitopiirin alueelta – Kainuu ja Länsi-Pohja – Pohjois-Suomessa käyttämällä retrospektiivistä havainnoivaa tutkimusmenetelmää. Ensihoidon aikana kerätty tieto, mukaan lukien potilaan kliiniset fysiologiset arvot, yhdistettiin kansallisiin rekistereihin (hoitoilmoitusrekisteri, tehohoitokonsortion laatutietokanta sekä kuolinsyyrekisteri) jotta ensihoitopotilaiden riskinarviota ja hoitotuloksia voitiin tutkia. Tutkimustulosten mukaan 67.5 prosentissa tapauksista riskinarvio hätäkeskuksessa oli oikea ja neljä kymmenestä ensihoitotehtävästä ei johtanut kuljetukseen ambulanssilla. Suomalaisen hälytysprotokollan käyttö johti yliarviointiin 23 prosentissa tapauksista ja aliarviointiin 9 prosentissa tapauksista. Korkeariskin NEWS-luokan herkkyys 1-päivän kuolleisuudelle oli hyvä, mutta se ei kyennyt erottelemaan riittävän hyvin potilaita, jotka tarvitsivat tehohoitoa tai kuolivat 30 päivän sisällä suuressa ei-valikoidussa tyypillisessä ensihoitopotilasväestössä. Yhteenvetona todettiin, että kriteeripohjaisen riskinarvion käyttö johti yliarvioon neljänneksestä tapauksista sekä huomattavaan ensihoitotehtävämäärään ilman ambulanssikuljetusta. Lisäksi ensihoidon aikana käytetyn varhaisen varoituspistejärjestelmän ennusteellinen arvo potilaan kuolemanriskin ja tehohoidon tarpeeseen oli matala.

The goal of this thesis was to analyze processes of the Emergency Medical Dispatch Center of the Emergency Medical Service of the Pilsen Region (ZOS ZZS Pk) when dealing with a mass casualty incident. The theoretical part of the thesis provides basic information relevant to the Pilsen Region, the Emergency Medical Service of the Pilsen Region, basic information on operations and general work processes of an emergency medical dispatch center during a normal work regime, and specific activities performed when dealing with a mass casualty incident. The research part of this thesis analyses activities and processes of an emergency medical dispatch center as described in the Mutual Mission Types Manual for Integrated Rescue System forces while at a mutual incident - Activities of Integrated Rescue System Forces at a Mass Casualty Incident (STČ 09/IZS). Further on the thesis evaluates activities of the ZOS ZZS Pk taken while dealing with two mass casualty incidents. These were a bus accident nearby Rokycany town in 2013 and a two trains collision nearby Horažďovice town in 2015. In order to make the analysis of readiness of the ZOS ZZS Pk to deal with mass casualty incidents more complex, SWOT analysis was added to the results. Based on the results of the STČ 09/IZS-manual analysis and of the SWOT analysis, suggestions for new manuals were made, that should make all the actions taken by employees of the ZOS ZZS Pk while dealing with a mass casualty incident more efficient and more effective. The goal of this thesis: to analyze activities of the ZOS ZZS Pk while dealing with a mass casualty incident, and to create suggestions of which inadequacies to remove and how to make operations of the ZOS ZZS Pk more efficient and more effective when dealing with mass casualty incidents; has therefore been fulfilled. The main outcome of the thesis are the final recommendations for making operations of the ZOS ZZS Pk more efficient and more effective when dealing with a mass casualty incident.

The expression ``motivation`` describes the fact that the human psyche is affected by internal driving forces, both conscious and subconscious. Holland´s vocational personality typology presents six basic types, namely Realistic, Investigative, Artistic, Social, Enterprising and Conventional. This thesis is aimed at finding and evaluating motivation factors which influence prospective emergency medical technicians in their professional choice. To get the research data, the combination of quantitative and qualitative techniques was used. The research was conducted among emergency medical technician students at the college and university and, as a supportive research material, among Czech and Scottish Emergency Medical Service professionals. The students´ primary motivating factor influencing their vocational choice to become an emergency medical technician is their interest in this field, sometimes supported by a healthcare worker in the family. Over 80% respondents prefer working in the field which they study. An emergency medical technician belongs to the most popular positions while an emergency dispatcher to the less popular ones. The fact that women respondents like working positions connected with driving a car was a surprising discovery of the research. Corresponding to the recent professional literature, the most frequent career types among professionals and students are Realistic and Social types. This thesis can contribute to further research into this topic (working position preferences, career types). Component findings can be introduced into personnel and human resources management of the Emergency Medical Service, especially searching for Investigative and Conventional career types of workers and their subsequent engagement in pedagogical and administrative work. The research can also be helpful in other issues, e.g. how to make a position of an emergency dispatcher more popular.

Sjuksköterskor vid Sjukvårdens Larmcentral (SvLC) i Uppsala och Västmanlands län hänvisar regelbundet lågakuta patienter som bedöms inte vara i behov av ambulanssjukvård till alternativa vårdformer. I denna studie kopplades patientdata från SvLC till sjukhusregister för att identifiera patienter som besökte en akutmottagning inom 72 timmar efter en hänvisning vid SvLC. Prevalensen av ett antal utfallsmått undersöktes och logistisk regression användes för att fastställa effekten av ett antal variabler. 20% av hänvisade inringare besökte en akutmottaging inom 72 timmar. Av dessa fick 57% vård på specialistnivå och 37% lades in vid en slutenvårdsenhet. 86% av akutmottagningsbesöken gällde det besvär som patienten kontaktade SvLC för. Äldre patienter hänvisades mindre ofta till alternativa vårdformer, men löpte större risk att kräva vård på specialistnivå och läggas in vid sjukhuset till följd av ett akutmottagningsbesök. Samtal med personer som ringde in flera gånger per månad hänvisades oftare av SvLC än patienter med en kontakt under studiens lopp, medan patienter som ringt in endast ett fåtal gånger besökte akutmottagningen oftare och blev där oftare inlagda. Icke-användning av SvLCs beslutsstöd var vanligare bland hänvisade patienter. Uppdrag som avlsutades utan vidare hänvisning till en annan sjukvårdsinstans resulterade mindre ofta i ett akutmottagningsbesök. Prevalensen av akutmottagningsbesök och inläggningar vid sjukhus efter hänvisning liknar nivån som funnits i andra studier av nordisk prehospital triage. Baserat på resultaten från denna studie föreslås ett antal kvalitetsutvecklingsprojekt samt framtida studier. / Nurses working at the Emergency Medical Dispatch (EMD) centers in the Swedish counties of Uppsala and Västmanland routinely refer patients determined to not require an ambulance to non-emergency care. In this study, hospital records were reviewed to match calls to patients visiting an Emergency Department (ED) within 72 hours of being referred to non- emergency care by an EMD nurse. The prevalence of a number of outcomes was examined, and logistic regression models were used to analyze the effects of several variables of interest. 20% of callers referred to non-emergency medical care visited an ED within 72 hours. Of these, 57% received specialist level care, and 37% were admitted to the hospital. 86% of ED visits were found to be in regards to the condition the patient contacted the EMD for. Elderly patients were less likely to be referred to non-emergency care, but more likely to receive specialist care and be admitted. Very frequent callers were more likely to be referred to non-emergency care, while a moderate rate of contact was associated with increased odds of ED visitation and hospital admission from the ED. Non-utilization of the EMDs’ decision support tool was more common among callers referred to non-emergency care. Calls closed by dispatchers without further referral to other healthcare providers were less likely to result in an ED visit. The prevalence of ED visitations and admissions found in this study are similar to those found in other studies of Scandinavian pre-hospital triage, and a number of possibilities for quality improvement and future studies were identified.

This thesis is a case analysis of the nature of delays in emergency room admissions and the effects on ambulance dispatching and availability as it occurred in Southern California.