abstract: Emergency Medical Services (EMS) first response personnel treat urgent and immediate illnesses and injuries in prehospital settings, and transport patients to definitive care if needed. EMS originated during warfare. The practice of rescuing wounded soldiers started during the Byzantine Empire, and developed along with other medical advances to the present day. Civilian EMS in the United States grew rapidly starting in the 1960s. Following the landmark National Research Council white paper of “Accidental Death and Disability: The Neglected Disease of Modern Society”, the nation addressed the key issues and problems faced in delivering emergency medical services. Today, colleges and universities often sponsor EMS organizations to serve populations concentrated in complex campuses. These are collectively known as Collegiate-Based Emergency Medical Services (CBEMS). By September 2018, there were 252 registered CBEMS organizations in the United States. Most are affiliated with the National Collegiate Emergency Medical Services Foundation (NCEMSF), which advocates, encourages, and provides support for CBEMS organizations. A survey repeating prior work (1996 and 2005) was sent to all NCEMSF registered CBEMS organizations, and 24 responded. The survey included questions on demographics, response capacities, coverage, organization, and logistics information. Locally, Arizona State University Student Emergency Medical Services (SEMS at ASU) began as an all-student-run volunteer organization in 2008. In 2018, SEMS at ASU became ASU EMS, as an official subdivision of the ASU Environmental Health Safety (EH&S) Department. This study summarizes the history of EMS, investigates the current status of CBEMS organizations and traces the history of ASU EMS from a volunteer group to an official department. / Dissertation/Thesis / Masters Thesis Biology 2019

Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature makes it clear that rate of road traffic death is related to country income and governance indicators, so first those variables needed to be equalized. My conceptual framework for this cross-sectional correlation study was the Haddon matrix, which organizes injuries by temporal (pre-event, event, and postevent) and epidemiological (host, agent, and environment) factors. Using World Health Organization data on road traffic injury and country income, World Bank data on governance indicators, and a literature search of 67 countries' prehospital response profiles, significant negative correlations (p > 0.001) were found for road traffic deaths and income, r (65) = -0.68, and governance indicators, r (65) = -0.646. No significant difference in the rate of road traffic death was found between physician and nonphysician prehospital staffing. Because increasing countries' income and improving governance are long-term, ambitious goals for developing countries, training nonphysician prehospital responders appears to be the most effective social change to decrease the burden of road traffic deaths.

Agriculture is a hazardous industry with high rates of occupational industry. Due to a variety of occupation-related factors, farmers may also be at risk for delays in reaching trauma services. Though the state of Iowa has a comprehensive trauma system implemented to provide an efficient response to traumatic injuries, it is unknown how farmers fare in this system. The aims of this study were to determine if the use of emergency medical services (EMS), the occurrence of interfacility transfers, the time to definitive care in severely injured patients, and the length of prehospital intervals for those using EMS differs between farmers and other workers. A population-based, retrospective observational study was performed using data from the Iowa State Trauma Registry for the years 2005-2011. Eligible entries included adults (≥15 year old) sustaining an occupational injury within the state of Iowa and treated in an Iowa trauma center. Multiple imputation was performed to replace values for missing covariates. Logistic regression modeling was performed to examine the use of EMS and the occurrence of interfacility transfers among farmers compared to non-farmers. Survival analysis was performed to determine the time to definitive care for severely injured farmers compared to severely injured non-farmers; similarly, a survival-based multi-state model was performed to compare the prehospital time intervals for farmers to non-farmers among EMS users. The study demonstrated that the likelihood of EMS use was dependent on injury severity. For lower severity injuries, farmers were less likely to use EMS, but there was no difference in EMS use for high severity injuries. The occurrence of interfacility transfers was also dependent on injury severity as well as rurality. Farmers tended to be less likely to receive an interfacility transfer in more rural areas; in large town and urban areas, farmers tended to be more likely to receive an interfacility transfer, particularly for moderate and severe injuries. These trends were slightly stronger for EMS non-users than EMS users; however, the results did not reach statistical significance for most levels. The median time to definitive care for farmers was nearly an hour longer for farmers compared to non-farmers (1h48m vs. 2h46m, respectively). In the survival analysis, time to definitive care for severely injured farmers compared to severely injured non-farmers was found to be time-dependent, and was only significant in the first hour after injury. When the prehospital time intervals for farmers using EMS (included all severities) were compared to non-farmers, farmers took longer to complete the discovery, response, and transport intervals; the scene interval was the only interval that did not reach statistical significance. The results obtained from this study provide useful information about the operation of the Iowa State Trauma System. While EMS use was lower for minor injuries, farmers with severe injuries had no significant difference in EMS use compared to non-farmers, suggesting comparable access. Likewise, the probability of transfer was only higher in specific instances when the patient did not use EMS. However, the fact that both time to definitive care and several prehospital intervals were longer suggest that occupation-specific factors may contribute to delay. Further research is needed to identify these barriers and develop new strategies to improve the response to traumatic agricultural injury.

Emergency medical teams operate under unusual circumstances. They assemble for a singular, temporary purpose, potentially change in size and composition, and their performance can influence whether a patient lives or dies. Although leadership is a critical component to team success, it is rarely investigated in the context of emergency medical teams. This study sought to examine the relationship between directive leadership behaviors and team performance outcomes. It was hypothesized that directive leadership would be particularly effective for emergency medical teams. In addition, a contingency model was proposed. Specifically, it was hypothesized that the effectiveness of directive leadership is contingent upon the complexity of the situation and the experience level of the team such that directive leadership is more effective when teams are inexperienced and the situation is complex. Neonatal resuscitation teams served as the emergency medical teams in this study. The proposed relationships were tested using observations from high-fidelity, neonatal resuscitation team training simulations. Hypotheses were not supported. Limitations and suggestions for future research for the development of leadership training curriculum are discussed.

No universal approach for application procedures has been established for paramedic curriculum programs. The field of pre-hospital, Emergency Medical Services (EMS) has evolved quickly from its inception to present date. The educational components of EMS are still in their infancy and lack evidence-based protocols (Drees, 2006). Predicting success in an allied health program typically concentrates on some type of academic instrument. The use of personality inventories has been underexplored; however, literature reveals they may be more reliable in determining academic and employment success compared with other non-cognitive tools (Groves, Gordon, & Ryan, 2007; Marrin et al., 2004; McManus & Richards, 1986; Sadler, 2003). The purpose of this study was to explore the relationship of affective domains to cognitive scores in entrance and exit examinations of paramedic students (Fisdap, 2013). Comparing the results of affective domains to areas of cognition should enable administrators in pre-hospital health care systems to make admission recommendations based on evidence-based research rather than intuition. Identifying the candidates who have a higher potential of success for completing an academic program and the possibility of contributing to the profession is necessary for the advancement of emergency medical service programs. A quantitative, retrospective study using data collected by Fisdap® was used to test four separate research questions. The general premise of the four research questions can be combined by asking: Is there a relationship between selected affective domains and the sub-categories and totals of an entrance and comprehensive exam? Pearson product-moment correlation coefficients were used for data analysis in all four research questions. As was analyzed through Pearson correlations, the selected affective domains did not show any statistically significant relationship to any of the cognitive portions of the EE or the PRE3. However, an additional multiple regression concluded that the EE positively predict the PRE3. This research project was the first to explore the relationship of affective domains and cognitive ability in paramedic students. Although no statistically significant data for the four proposed research questions was reportable, future publications from this project will assist administrators and educators associated with emergency medical education.

This thesis covers research around the Medical Emergency Team (MET) system, describing its development, evaluation and other related research that evolved as a result of the MET concept. The basic problem that prompted development of the MET system was related to the inadequate care given to the seriously ill in acute hospitals. This thesis contains background research on some of the reasons why a MET system may be useful, including the limited skills and knowledge of medical training and the sort of acute problems encountered in a hospital at night. Research then describes how the MET system works, including published data on when and how often the team is called, the type of patient the team is called to, the interventions performed by the team, and the outcome of patients on whom a MET was called. At the same time research was being performed around outcome indicators used to measure the effectiveness of the MET system, resulting in the use of cardiac arrests, deaths and unanticipated admission to the Intensive Care Unit (ICU) as common end-points for research in this area. Further research demonstrated that potentially preventable antecedents were common before serious illness The thesis then concentrates on how effective the MET system was in reducing death and serious adverse events. The first study compared a hospital where a MET system had been implemented to two control hospitals and found there was a reduction in admissions to the ICU but after adjustment, not for deaths and cardiac arrests. The second study used a cluster randomised methodology, enrolling 23 hospitals across Australia, comparing the three end-points described above. The study found no difference between both groups. It did highlight some interesting areas around the importance of effective implementation in determining the effectiveness of systems in health. Other publications have described the importance of developing effective ways of caring for the seriously ill outside traditional areas such as ICUs. The MET system, or variations on it, is now implemented in many hospitals in Australia and around the world and there have been two international MET conferences held in North America and international guidelines on the MET concept established.

The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.

<p>The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim.</p><p>The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain.</p><p>The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day.</p> / <p>Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad.</p><p>Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan.</p><p>Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.</p>

Background: Protection against cold is vitally important in prehospital trauma care to reduce heat loss and prevent body core cooling. Objectives: Evaluate the effect on cold stress and thermoregulation in volunteer subjects byutilising additional insulation on a spineboard (I). Determine thermal insulation properties of blankets and rescue bags in different wind conditions (II). Establish the utility of wet clothing removal or the addition of a vapour barrier by determining the effect on heat loss within different levels of insulation in cold and warm ambient temperatures (III) and evaluating the effect on cold stress and thermoregulation in volunteer subjects (IV). Methods: Aural canal temperature, sensation of shivering and cold discomfort was evaluated in volunteer subjects, immobilised on non-insulated (n=10) or insulated (n=9) spineboards in cold outdoor conditions (I). A thermal manikin was setup inside a climatic chamber and total resultant thermal insulation for the selected ensembles was determined in low, moderate and high wind conditions (II). Dry and wet heat loss and the effect of wet clothing removal or the addition of a vapour barrier was determined with the thermal manikin dressed in either dry, wet or no clothing; with or without a vapour barrier; and with three different levels of insulation in warm and cold ambient conditions (III). The effect on metabolic rate, oesophageal temperature, skin temperature, body heat storage, heart rate, and cold discomfort by wet clothing removal or the addition of a vapour barrier was evaluated in volunteer subjects (n=8), wearing wet clothing in a cold climatic chamber during four different insulation protocols in a cross-over design (IV). Results: Additional insulation on a spine board rendered a significant reduction of estimated shivering but there was no significant difference in aural canal temperature or cold discomfort (I). In low wind conditions, thermal insulation correlated to thickness of the insulation ensemble. In greater air velocities, thermal insulation was better preserved for ensembles that were windproof and resistant to the compressive effect of the wind (II). Wet clothing removal or the use of a vapour barrier reduced total heat loss by about one fourth in the cold environment and about one third in the warm environment (III). In cold stressed wet subjects, with limited insulation applied, wet clothing removal or the addition of a vapour barrier significantly reduced metabolic rate, increased skin rewarming rate, and improved total body heat storage but there was no significant difference in heart rate or oesophageal temperature cooling rate (IV). Similar effects on heat loss and cold stress was also achieved by increasing the insulation. Cold discomfort was significantly reduced with the addition of a vapour barrier and with an increased insulation but not with wet clothing removal. Conclusions: Additional insulation on a spine board might aid in reducing cold stress inprolonged transportations in a cold environment. In extended on scene durations, the use of a windproof and compression resistant outer cover is crucial to maintain adequate thermal insulation. In a sustained cold environment in which sufficient insulation is not available, wet clothing removal or the use of a vapour barrier might be considerably important reducing heat loss and relieving cold stress.

This thesis investigated whether or not the parents of children seen in emergency treatment department could learn the child's medical regime better if reinstructed on the regime in a quiet place after the child has been discharged from the department. An experimental group reinstructed under the above conditions was compared with a control group.The investigation revealed that there was better learning of medical instructions by those parents reinstructed on the medical regime under the ideal conditions in the emergency treatment department.Ball State UniversityMuncie, IN 47306