In emergency medical transport, “time to definite care” is very important. Emergency medical services and transport medicine agencies have several possible vehicle options for interfacility transfers. Use of a land vehicle, helicopter, or fixed wing aircraft will be dependent on patient condition, distance between sending and receiving hospitals, crew configuration and capabilities, and other factors such as weather and road conditions. This thesis lays out the complex process of patient transfers and highlights the challenges in decision making under time pressure; it then describes the behaviour of human operators in estimating time to definite care. To support the operators in choosing a transportation mode, a decision support tool was built, which provides relevant time estimates for interfacility transfers based on historical dispatch and call data. The goal is to enable operators to make evidence-based decisions on vehicle allocation. A prototype interface was generated and was evaluated through a usability study.

Varje år traumatiseras 200 000 barn och trauma anses vara den vanligaste orsaken till att barn söker sjukvård i Sverige. Sjuksköterskor inom akutsjukvården träffar dessa barn i sitt arbete, men de procedurer och rutiner som finns för omhändertagande av vuxna anses inte direkt vara applicerbara på barn. Syftet med denna studie var att belysa hur specialistsjuksköterskor upplever omhändertagandet av traumatiserade barn. En kvalitativ studie med individuella intervjuer (n=9) genomfördes och analyserades med hjälp av innehållsanalys. Analysen resulterade i fyra kategorier: upplevelsen av kunskapsbrist, upplevelsen av svårigheter i samband med omhändertagandet, upplevelsen av behovet av god omvårdnadskunskap och upplevelsen av skillnader i gällande rutiner. I resultatet framkom att alla intervjuade specialistsjuksköterskor upplever kunskapsbrist och har ett stort behov av att öka sina kunskaper om barn och barntrauma. Det skulle öka deras upplevelse av trygghet i yrkesrollen som specialistsjuksköterskor avsevärt. / The most common reason for children to be seek in-hospital care in Sweden is trauma and every year more than 200000 children is traumatized. Nurses meet these children in their work but the procedures used to care for traumatized adults are not transferable to children. The aim of this study was to illuminate how special educated nurses experience the caring for traumatized children. A qualitative design with one-to-one interviews (n=9) was used to collect data. Content analysis was used to analyze the data. The analysis ended up in four categories; the experience of lacking knowledge, the experience of difficulties in the care, the experience of the need of good nursing skills and the experience of differences in the routines in use. The findings show that all the interviewed nurses experience a need to increase their knowledge concerning the care for traumatized children. Increased skills and knowledge in this matter would raise their feelings of being secure in their professional role.

This study examined the effect a telephone health care information system has on emergency department patients. The research questions address the patient's acuity and the length of time between the onset of symptoms and seeking treatment.A convenience sample of 80 ambulatory emergency department patients treated over a four month period, in one emergency department of a Midwest hospital with a published telephone health care information system. The sample was divided into two groups according to the treatment. The treatment group had accessed the telephone health information system prior to emergency department visit and the control group of patients had not. The procedure for the protection of human subjects were followed.Data was collected by two instruments, a demographic questionnaire completed by the subjects, and a patient acuity scale completed by the treating emergency nurse. Acuity is scored on a 1 through 5 point scale. Subjects selected the best time interval representing the onset of symptoms and treatment. The Whitney-Mann U test was used to test differences in mean ranks. When comparing individuals who used Ask-A-Nurse, there was no significant difference between the two groups and acuity scores. There were no differences between the frequency of time interval ranges in the two groups, however a pattern indicated the subjects sought treatment sooner if the telephone health care information systems was assessed. The ability of the telephone health care information system to refer nonemergency patients to physician's offices or medical clinic and avoid overcrowded emergnecy department appears limited. Implications call for an increased method of screening and providing information to emergency patients who need health care advice. / School of Nursing

This action research study explored the supports required to facilitate the successful transition for new graduate paramedics integrating into their role and to provide recommendations to AHS Emergency Medical Services managers to implement a positive change outcome. AHS paramedics who graduated in the last three years participated in a focus group and online survey. The study findings revealed that the transition experience was challenging and caused stress and anxiety for new graduates. Having a support system in place could increase job satisfaction, retention, organizational commitment, and enhance employee skill development. The study concluded that implementing a mentorship program with support of AHS leadership would prove invaluable. The recommendations reflect the importance of providing a healthy and supportive work environment and working collaboratively with key stakeholders to develop and implement support for new graduate paramedics in AHS. This study adhered to all ethical requirements.

In public safety, geography plays a significant role. One of the most important front-line elements of public safety is an efficient emergency transport and care system. The capacity to access and process information rapidly and organize resources where needed can be critically important in an emergency situation. Information about the locality of an event or a disaster is often vital in knowing how to respond. A significant operation in handling emergency situations is the routing of ambulances to incident sites and then to the closest appropriate hospitals. One of the important steps to survival in an emergency is quick response time. The aim of this thesis study is to build an immediate, rapid and efficient emergency medical transport system prototype, called Ambulance Routing Service Application Prototype (ARSAP), to be used in Middle East Technical University (METU) Emergency Service, Ankara, Turkey. In the study, geographical information systems (GIS) technology is used in assisting the development and implementation of an emergency medical service (EMS) response system. In this prototype, while choosing a proper facility, the available quantity of beds, respiratory equipments and doctors in a hospital&#039 / s intensive care room and the best traffic routes to the hospital in hand are also considered. The ARSAP is expected to shorten the commuting time and hence to reduce the damage to the patient to the lowest level and allow the ambulance staff to perform their task better. The results generated using the ARSAP are validated and analyzed by comparing with currently practiced emergency call paths data collected with the help of METU Emergency Service ambulance drivers.

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.

The provision of equitable access to health care, particularly acute care remains a challenge. This challenge is often met through the provision of outreach critical care services. These services may take the form of Medical Emergency Teams responding to hospital in-patients who become acutely ill outside a hospital critical care environment (eg a general medical ward) or medically staffed retrieval services that respond to patients who become acutely ill in an out of hospital environment for which critical care resources are not immediately available and are delivered to the patient by a responding retrieval team. In both circumstances the intention is early recognition of the acutely ill patient, a timely response by a team with the desired critical care skills, where appropriate deliver the patient to a Critical Care environment (eg an Intensive Care Unit) for ongoing management and by doing so prevent potential adverse patient events. Retrieval services are becoming increasingly important as centralisation of specialty and acute medical services is increasing. These processes involve many complex interactions, with the potential for adverse patient events. Thus it is important to better understand the nature, frequency of occurrence and patient outcomes associated with out of hospital patient transportation, particularly with critically ill patients requiring admission to an Intensive Care Unit. This body of work, across a number of studies, showed that patients whose ICU source of admission was another hospital had a severity of illness that was higher than for other ICU admissions, had a greater than expected mortality and a mortality and hospital length of stay that exceeded that of similar patients, matched for demographics and casemix who had not undergone a interhospital transfer. These findings varied according to the diagnostic category (being stronger for trauma, respiratory illness, sepsis and intra cranial haemorrhage) and varied across geographical regions. These studies also showed that there was regional variation in the proportion of patients admitted to an ICU from another hospital, the proportion of such patients was increasing (particularly for sepsis) as well as patterns of variation based upon day of the week (highest occurrence Friday and Saturday) and moth of the year (mostly July to October). They also revealed that there is a negative correlation between the proportion of patients admitted to an ICU from another hospital with the proportion of elective and post operative admissions to the ICU. This information is important in regards to planning for the provision of acute care and emergency services resources. The interhospital transfer of critically ill patients has been previously documented to be associated with significant adverse patient events. However our understanding of these events in terms of contributing factors, preventability, potential for harm and minimizing factors has not been well documented. This body of work also showed that medical treatment may be altered based solely on the fact that a patient is undergoing retrieval. An example of this is the finding that such patients have a significantly greater likelihood of endotracheal intubation and mechanical ventilation that similar patients matched for demographics, severity of illness and diagnosis who have not undergone retrieval. Retrieval however can provide significant patient benefit, and this body of work illustrates that through the description of a number of unique and challenging cases and the retrieval specific factors that were associated with a good outcome for each of those cases. This information points to the importance of identifying quality in retrieval practice. This body of work outlines the original development of an incident monitoring tool for retrieval, based upon existing examples of use of the incident monitoring methodology within other medical and non medical domains. Following a retrospective review and analysis of comments from retrieval patient records and consultation a tool for Retrieval Incident Monitoring was developed. An investigation of the use of Retrieval Incident Monitoring across a number of retrieval organisations and pre hospital activities, including during deployment at a major public event (2000 Sydney Olympics) was undertaken. The findings of this study showed that the majority of incidents during retrieval are preventable (91%) and that most incidents were related to problems with equipment, then patient care, and transport operations, interpersonal communication, planning or preparation, retrieval staffing and tasking. Incidents were most likely to occur during patient transport to the receiving facility, at patient origin, during patient loading and at the retrieval service base. Contributing factors were almost equally spread between those that were system and human based. Patient harm was documented in 59% as well as a death. The importance of good crew skills/teamwork was highlighted as a minimising factor to incident occurrence. Subsequently this knowledge, experience and data was used to develop and validity a Retrieval and Ambulance Healthcare Incident Type within the generic and widely used Advanced Incident Management System (AIMS). Finally the occurrence of retrieval can be used as a quality measure for the wider health system. Ideally, because of the findings from this body of work of an associated greater than expected mortality and hospital stay of patients undergoing retrieval, particularly for certain diagnostic categories, then a measure of the occurrence of retrieval could be used as a quality indicator of health service provision across a region. As the need for retrieval will never be negated, outcomes associated with retrieval can be measured and benchmarked across a number of regions In summary, in its entirety, this work has added and tested new knowledge and methods as well as value added to existing knowledge for critical care delivery in the out of hospital environment, in particularly to medical retrieval of critically ill patients admitted to an Intensive Care Unit within Australia and New Zealand. It has developed and validated the efficacy of a new quality tool for retrieval and retrieval based quality measures. It has also pointed towards new areas of future investigation particularly in relation to factors that may favourably or adversely impact upon retrieval outcomes and outcomes of patients undergoing retrieval. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346925 / Thesis (M.D.) - University of Adelaide, School of Medicine, 2008.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Thesis (M.Sc.)--Edith Cowan University, 2007. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.