Prehospital management of patients who are traumatically injured within the state of Florida starts with the use of the Florida Adult Trauma Scorecard Methodology. The scorecard methodology may indicate that a patient is a Trauma Alert based on applied physiological and other judgment criteria. However, patients may be transported via Helicopter Emergency Medical Services (HEMS) without justified physiological needs. Rawls’ theory of justice posits that a fair and equal distribution of social resources is essential to public wellbeing. To evaluate this premise regarding prehospital trauma transports, archival 2015 data from the Florida Department of Health Trauma Registry was obtained. Using logistic regression, each trauma scorecard assessment criteria was individually and collectively evaluated regarding its predictive likelihood of a scene responder requesting HEMS versus ground ambulance transport. Controlling for trauma center locations, all five of the triage classifications illustrated a significant likelihood (p = 0.000) of HEMS transportation requests. Category 4 (EMS Judgment) predicted the highest likelihood of HEMS transport requests (b = 2.39, Wald X2(1) = 2026.88, OR = 10.9, p = .000, CI [9.83, 12.09]). Categories 4 (14.7%) and 6 (Local Criteria; [25.8%]) illustrated unexpectedly high percentages of emergency department discharge when Trauma Alert patients were HEMS transported. Over triage of patients to HEMS without meeting physiologic criteria provides less than an equal and fair distribution of public and private resources. State-level social change can be realized through HEMS transport criteria modifications applying more stringent application of physiologic patient condition scoring when determining the mode of prehospital scene response transport.

A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the degree of Bachelor of Arts (Masters). / As the past decade has witnessed a growing interest in the nature, causes and management of stress reactions in emergency workers, the present study examined emergency workers' reactions to traumatic work related incidents. Furthermore, although Job Dissatisfaction and Increased levels of Turnover have been identified in literature and research on emergency workers as being behavioural manifestations of the traumatic stress associated with emergency work, the effect of occupational trauma on these variables has not been documented extensively in trauma literature or research. A second aim of the study was therefore to provide further insight into the effects of work related trauma on these constructs. Moreover, although literature on emergency workers has not documented the impact of occasional trauma on Job Involvement, the present study undertook to examine the effects of trauma on tnis construct. The study was considered to be exploratory in this regard. By examining how exposure to occupational trauma impacts on Job Satisfaction, Job involvement and Propensity to Leave, it was hoped that this will lead to a better understanding of the effects of occupational trauma and its implications for employees and organisations alike. One hundred full-time paramedics completed a self-report questionnaire. The questionnaire also included questions to obtain demographic variables as it has been documented that the relationship between exposure to traumatic events and the expression of distress is constructed by personal factors. In addition, qualitative data pertaining to the constructs under investigation was obtained from 30 paramedics. The reported symptoms revealed that 17% of the sample was suffering from rrso. Correlational analyses using a non-experimental, cross-sectional design, revealed a significant relationship between PTSD and Job Satisfaction. A non-significant relationship was found between PTSD and both Job Involvement and Propensity to Leave, Of the demographic variables measured, stepwise regression analysis. revealed that gender and previous exposure to trauma were the most efficient predictors of PTSD Content Analyses performed on the qualitative data indicated that paramedics were subjected to numerous job stressors which seemed to associated to Job Involvement and Propensity to Leave. The results of the study are discussed with respect of the literature reviewed and limitations and implications of these findings are discussed thereafter. Lastly implications of the present study for future research are presented. / Andrew Chakane 2018

Thesis (M. Nursing) -- University of Limpopo, 2022 / Background: Emergency departments (EDs) as the hospitals' front door have a critical role in ensuring access to and efficient care of acute illness and injuries in the healthcare system. The environment in EDs is physically and emotionally demanding and burdened by complex patient loads, long shifts, and administrative challenges resulting in high pressure and high volume workloads amongst the staff members. Purpose: The study aimed to develop support strategies for the resuscitation team in EDs of Mankweng and Pietersburg public hospitals in Limpopo Province, South Africa. Study method: A descriptive, phenomenological, and explorative research design was used to explore the resuscitation team's experiences and the available strategies to support them. Purposive and convenience sampling methods were used to select five Medical doctors and twelve Professional nurses to participate in the study. The sample size was determined by the depth of the information obtained from the participants.Data was collected through semi-structured individual interviews. Interview guide was developed to guide with organised line of questioning and thinking. Qualitative data analysis using Tesch's approach was then followed. The quality of data was ensured by applying four elements; credibility, transferability, dependability, and confirmability. Turfloop Research Ethics Committee, the Limpopo Department of Health, and the Mankweng/Pietersburg Ethics Committee permitted the study. The study's details were explained to potential participants, who then agreed to be part of the study and signed consent forms. Results: The following themes emerged: Challenges related to the shortage of resources in the ED, challenges related to lack of standardized procedures and policies for handling the resuscitation process, psychological challenges of resuscitation failure, leadership, and managerial support challenges, and challenges related to education and training of the resuscitation team. Conclusion: This study's results indicated that the resuscitation teams of EDs from Mankweng and Pietersburg Public Hospitals face challenges that cause them stress and burnout. The challenges result from an increased overload of work with no personnel and material resources. They become demoralized by being engaged in failed resuscitation with no psychological support from the management. They don't receive any debriefing or counseling post failed resuscitation and no educational backing of the management. The study's findings guided the researcher in developing strategies to support the resuscitation teams in the EDs of Mankweng and Pietersburg Public Hospitals.

The pre-hospital industry is faced with many challenges, one of which is the skills shortage of advanced life support paramedics in the country. The industry has naturally dictated competition both nationally and internationally for the recruitment of these advanced life support paramedics. Staff turnover has increased as a result of this issue which also has financial implications on the individual business of constant recruitment and turnover. The purpose of this study is to investigate problems that currently exist in the industry with regards to the advanced life support paramedic employment which will provide valuable information on retention strategies and reduce staff turnover.

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2014. / Introduction: The Emergency Medical Service (EMS) is required to respond to cases of life threatening illness or injury which may later be found to be non-emergent thus creating a mismatch between the dispatch of limited EMS resources and actual patient need. This study proposed that such a mismatch presently exists among South African urban EMS systems resulting in unacceptably high levels of inappropriate emergency responses. The purpose of this study therefore, was to evaluate the appropriateness of EMS responses in comparison to patient needs in a South African urban EMS system. Methods: All emergency cases dispatched over a 72 hour period at the Emergency Medical Communication Centre (EMCC) of the eThekwini Emergency Medical and Rescue Service (EMRS), a public sector urban EMS system, were prospectively enrolled in a quantitative study employing a descriptive, comparative design. Computer generated Vehicle Control Forms (VCF) containing dispatch data were matched and compared with Patient Report Forms (PRF) containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis and comparisons were analysed with correlations and chi-square. The Pearson's г and Spearman's rho were used to establish significance between more than two variables. Results : A total of 1689 cases were enrolled in the study of which 1385 met the inclusion criteria; 304 cases were excluded due to incomplete or duplicated data. The demand for EMS resources fluctuated widely throughout the day with levels peaking at midday and declining sharply after midnight. The median response time across all priorities was 56 minutes (IQR 59min) with just under half (46.4%) of all cases having a response time of more than an hour and almost one in ten (9.5%) exceeding 2½ hours. Significant variations existed between dispatch and on-scene priority settings and category descriptors most notable of which was seen in the highest priority ‘red code’ category which constituted more than 56% of all cases dispatched yet accounted for less than 2% on-scene (p <0.001). Conversely, over 80% of ‘red code’ responses actually required a lower priority response. Similarly, significant discrepancies were seen in the allocation of resources compared to the interventional needs of patients where it was shown that more than 58% of all cases required no interventions and just under 36% required only basic life support (BLS) level interventions (p <0.001). Of those patients triaged as ‘red code’ on-scene, less than 12% were initially allocated an appropriate Advanced Life Support (ALS) level of response and, of particular concern, only 7% of patients found to be dead or ‘blue code’ on-scene were initially dedicated a ‘red code’ response. Conclusion: South African urban EMS systems are presently unable to meet the needs of patients in terms of demand and matching resources to patient needs with evidently high levels of inconsistent and inappropriate responses resulting in sub-optimal use of limited resources.

Dissertation submitted in fulfillment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2012. / Background In the emergency setting, the onus is on the individual practitioner’s ability to make critical decisions at critical moments in order to provide the best level of care to their patient. In order to ensure that these decisions fall in line with the best interests of the patient, the South African paramedic requires a better understanding of how to arrive at such a decision; they need to understand the clinical decision making process. This study focused on South African paramedic clinical decision making with specific reference to acute traumatic pain management, with the aim of determining the factors which influence South African paramedic clinical decision making by revealing the current method of pain management employed by South African paramedics, how they view the priority of pain management in the continuum of care and if there were any context specific factors influencing their clinical decision making. Methods A mixed method design was used to determine the factors contributing to the clinical decision making process of South African paramedics in the acute pain management of patients with acute traumatic pain. A mixture of qualitative and quantitative approaches was utilized by means of a research questionnaire as well as in-depth interviews. The questionnaires were targeted at all South African paramedics while the in-depth interviews were conducted with five participants who had been purposefully selected from the questionnaire respondents. The data analysis was conducted in a descriptive manner in order to inform the explanatory nature of the answers to the research questions and objective. Results The results provided insight into the current methods and clinical decision making processes employed by South African paramedics in the management of patients’ experiencing acute traumatic pain. The study determined that the South African paramedic’s clinical decision making process involves three key phases in the acute traumatic pain management setting, the assessment phase, the initiation/pain management phase and the conclusion/re-evaluation phase, with each phase utilizing different decision making models, the intuitive/humanist model, the hypothetico- deductive model and a model which combined both of the aforementioned models. In addition to this, numerous factors such as the provision of care in order to facilitate further management and transportation to an appropriate facility, which influenced clinical decision making, were identified. Amongst South African paramedics, pain management was identified as coming second only to the interventions required to manage immediately life threatening conditions in terms of the prioritization of treatment. Recommendations A variety of recommendations which included the need to further the development of clinical decision making and pain management through research and education as well as considerations for investigation into the potential expansion of South African paramedic scope of practice in the pain management environment were made.

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.

The purpose of this study is to investigate the preparedness at the prehospital emergency care unit in north-western Skåne. Measuring preparedness is important to ensure that the ability to respond on emergency calls is satisfactory. To do this for north-western Skåne historical data from 2015 was extracted from SOS Alarm’s database. It was used to calculate preparedness using workload and coverage as measurements. The workload was calculated by taking the busy periods and comparing them to the ambulances working times. The coverage was calculated by defining neighbouring stations to cover for each station and then finding the amount of hours when there was no ambulance at either station. These calculations show that two of the six stations in north-western Skåne are in need of improvement. To increase the preparedness to a good level resources will have to be added at the liable stations. These resources would be new ambulances. There is a possibility to relocate ambulances from stations within the district but that would lead to a worsened preparedness for the stations which these ambulances belonged to in the first place.

Bakgrund: Ambulanspersonal är en yrkesgrupp som i sitt yrkesutövanden riskerar att utsättas för traumatiska händelser som kan vara mycket påfrestande och stressfulla. Trots erfarenhet och träning blir vissa trauman stundtals övermäktiga och kan ge reaktioner som posttraumatiskt stressyndrom. Risken att utveckla PTSD ökar med antalet upplevda trauman och prevalensen i yrkesgruppen är hög. Syfte: Syftet var att beskriva vilka traumatiska händelser ambulanspersonalen upplevde som mest stressfulla. Syftet var även att beskriva ambulanspersonalens upplevelser och hantering av posttraumatiskt stressyndrom i relation till traumatiska händelser i sitt yrkesutövande. Syftet var dessutom att granska artiklarnas kvalitet utifrån den metodologiska aspekten undersökningsgrupp. Metod: Beskrivande litteraturstudie innefattande elva vetenskapliga artiklar av både kvalitativ och kvantitativ ansats sökta i medicinsk och omvårdnadsorienterade databas. Huvudresultat: Traumatiska händelser som upplevdes mest stressfulla innefattade händelser som involverade akut sjuka och allvarligt skadade barn, vilka väckte en emotionell respons och där ambulanspersonalen identifierade sig med nödställda. Upplevelser av PTSD kännetecknades av överspändhet, sämre prestation, mental avstängning och återupplevande av minnesbilder. Hantering av PTSD utmärktes av copingstrategier som känslomässig distans, fokusering, stöd, återhämtning, kontroll och förberedelse. Slutsats: Ambulanspersonal upplever i sitt yrkesutövande traumatiska händelser som kan vara mycket stressfulla och som kan leda till posttraumatiskt stressyndrom. Upplevelserna kan ge psykiska och fysiska symtom som påverkar hälsa och funktionsförmåga. Ambulanspersonalen behöver utbildning i copingstrategier för att hantera kritiska incidenter på ett gynnsamt sätt, speciellt händelser som involverar barn. Strategier behövs för att stärka känslan av kontroll och förmågan till fokusering, där förberedelse, socialt stöd och återhämtningstid är betydelsefullt.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences