M.A. (Psychology) / The aim of the research conducted was to analyze and evaluate the prevalence of Posttraumatic Stress Disorder (PTSD) in emergency workers. A literature study was formulated in which PTSD, and comorbid symptoms of Anxiety, Depression, Stress and Burnout were defined. These are seen as secondary symptoms to the overall effect of PTSD. Data was collected through the use of psychometric tests. These were administered to two main groups. The experimental group reflected the results of the emergency medical worker, while the control group reflected thescores attained by the emergency worker. Both groups were made up of a sample of 30 individuals (n= 30) making the full total of persons studied 60 (n=60). To evaluate for any level of significant difference t-tests for independent groups were administered. Scores found to be significant were trait anxiety scores and burnout scores. All other scores were found to be nonsignificant in a comparison of the two' groups.

Magister Artium (Social Work) - MA(SW) / Emergency services personnel are potentially exposed to events involving trauma, suffering and tragedy on a daily basis, which could consequently lead to secondary trauma and post- traumatic stress symptoms. The images and feelings that are associated with continuously being exposed to traumatic situations are not limited to the emergency services personnel, who are primarily exposed to the event, but these events can also have an effect on the significant others in their environment, such as their spouses. The aim of this study was to explore and describe the experiences of secondary trauma among the spouses of emergency services personnel. The research study followed a qualitative research approach, which provided in-depth descriptions and understandings of the participants’ secondary trauma experiences. The research design was explorative and descriptive in nature. Purposive sampling was used to select eight (8) participants, who were the spouses of emergency services personnel. The data was collected by means of semi-structured individual interviews and was analysed according to Creswell. Various research findings indicated that secondary trauma was prevalent in the emergency services industry and, in this current study, most participants indicated that it impacted their marital relationships. The experiences of secondary trauma among the spouses of emergency services personnel stemmed from their partners’ repeated exposure to trauma, managing everyday job stress, safety fears, behavioural changes, dealing with their partners’ emotional reactivity and emotional withdrawal from the family, following trauma exposure. Based on some of the suggestions provided by all the participants, the researcher concluded the study with recommendations for future practice and future research, the main recommendation being that organisational support systems be made available to spouses and families of emergency services personnel.

Recent published studies have provided new information about the significant influence of environmental factors, especially air pollution in the development of acute coronary syndrome. Besides the well-known controllable and uncontrollable risk factors it is necessary to focus on non-conventional risk factors. The thesis aims to determine whether there is a statistically significant relationship between the days in which patients with acute coronary syndrome type STEMI were rescued by the EMS Most and the average daily concentrations of pollutants in air (PM2,5 and PM10, ozone, carbon monoxide and nitrogen dioxide) in seven previous days. The research methodology is based on a retrospective observational analysis of 116 patients with acute myocardial infarction in prehospital emergency care and the impact of the above pollutants in air with the use of statistical methods. The results in sets of ozone and nitric oxide effect presents a significant impact of day (p=0.0283/0.0424), sex (p=0.0216/0.0232) and age (p=0.0008/0 .0187). Although we have found a statistically significant effect of a day, gender and age in our analysis, it is necessary to continue research in a larger statistical sample to minimize the statistical errors. Key words: acute coronay syndrome, air pollution, emergency medical service

Submitted in fulfillment of the requirements for the degree of Master of Health Sciences in Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2017. / Introduction: Response times are considered to be one of the oldest and most popular indicators which are used to measure the efficiency of Emergency Medical Services (EMS), particularly to cases in which the patient’s condition is deemed to be life threatening. Purpose: To analyse emergency response times within the public sector Emergency Medical Services in KwaZulu-Natal and to compare these to the national norms. Methods: Using a mixed method approach, the study was conducted in two phases. The first phase involved collecting quantitative data for all the cases logged in the Umgungundlovu Health District Communications Centre over a period of one week (seven days). Phase Two involved the collection of qualitative data from focus group discussions which were conducted with three groups which had been identified. These groups included the communications centre staff, operational staff and supervisory staff. The aim of these focus group discussions was to identify factors that influenced response times as well as to propose strategies which would improve these response times. Content analysis was utilised to interpret the qualitative data which had been collected. Results: Quantitative data was collected from a total of 1 503 cases of which 680 were categorised as priority 1 (P1), 270 as priority 2 (P2) and 553 as inter facility transfer (IFT). The majority of the cases (895) had occurred in urban areas. A total of 406 cases were exempted as no patient was transported. The number of these cases was greater on days when the total case load was higher as compared to days with a lower total case load. The mean response time to cases in rural areas was 129 minutes and 110 minutes to cases in urban areas. All the time intervals were found to be longer for cases in rural areas as compared to those for cases in urban areas but with the exception of the EMD response interval. P1 cases had the shortest mean response times for both urban area cases (33 minutes) and rural area cases (95 minutes) as compared to the other case categories. Nevertheless, the national norm of 15 minutes in urban areas and 40 minutes in rural areas was not achieved in the majority of the cases. The mean Emergency Medical Dispatch (EMD) response interval was 41 minutes for P1 cases, 56 minutes for P2 cases and 96 minutes for IFT cases. The qualitative data revealed factors that impacted on the response times and helped to explain and account for the quantitative data results. Challenges regarding the availability of resources, including vehicles, staff and equipment, as well as the way in which such resources are managed, were highlighted. The high demand for services compared to the available resources was raised by the focus group participants with this high demand resulting in extended EMD response intervals. This was exacerbated by the overwhelming demand for IFT cases which are serviced by the same resources as emergency cases and which have a much longer mission time, thus delaying response times continuously. Exempt cases were also found to impact negatively on response times as, although operational vehicles are committed to these cases, services are not required. Inconsistencies with regards to case prioritisation and dispatch triage also emerged. External factors, including poor road infrastructure, lack of road names and house numbers, weather conditions and long distances between EMS bases, the patient or incident location and health care facilities were also identified as factors that resulted in extended response times. Strategies to improve the situation were explored. These strategies included the effective management of resources in order to ensure optimal availability, the introduction of a formal, computer aided, dispatch system, the adoption of demand pattern analysis and dynamic location/relocation models, standardised processes and procedures to guide all areas of EMS operations and the education of both the public and staff. Conclusion: South African EMS response time national norms for both rural and urban areas are unachievable under the majority of circumstances and, thus, they may be said to be unrealistic. Until these national norms, against which the efficiency of EMS in South Africa is measured, are revised, the service will be deemed to be incompetent. / M

This study investigated the health and injury risks faced by emergency medical workers in the Nelson Mandela Metropolitan Municipality. The aim of the study was to establish the emergency worker`s awareness, level of knowledge and attitude to practices of health and safety issues. The study sample consisted of eighty (80) emergency medical workers stationed in Port Elizabeth and Uitenhage. A self- administered questionnaire was developed and used in an empirical survey to collect data from the respondents on information such as health and safety knowledge, behavior, experiences, attitudes, beliefs and opinions in their workplace. The results of the study indicated that 90% of the workers experienced all occupational hazards identified in the questionnaire. Percutaneous injuries were found to be at 48%, PTSD was rated at 40% due to horrific accidents and incidents complicated by violent threats and armed robberies with emergency workers being victims. Musculoskeletal injuries were found to be very common. Ordinary stress was caused by dissatisfaction over human resources issues and structural changes by the management internally. The findings revealed that some workers took incapacity leave for long periods, sometimes more than three years at a time. The emergency workers are at high risk of being infected by ordinary TB or the more complex type, the DR-TB in their line of duty. The study revealed that there were no health and safety structures in the institution; as a result there was no formal documenting and identification of hazards in order to implement measures to protect the workers from future incidences. Health related absenteeism was high when employees were exposed to such hazards and replacement of skill was not implemented. The main recommendations included wearing of personal protective equipment, safe disposal of sharps objects, guidelines for lifting objects, introduction of organizational safety culture and safe transportation of PTB patients.

This study concerned itself with planned teaching in the hospital emergency department, that area of the hospital health care system that is becoming increasingly popular for short-term ambulatory care. However, the nursing care provided by this department has been largely unexplored by research. The purpose of this experimental study was to determine whether planned teaching involving verbal and written instructions given to a mother prior to the discharge of her child from the emergency department following treatment for a traumatic limb fracture requiring cast application, would enable her to cope more adequately with the home care of her child than the mother not receiving this planned teaching. The Null hypothesis was tested: there is no significant difference in the coping abilities of the mothers of the experimental group as compared with the mothers of the control group. Using five general hospital emergency departments, twenty mothers were assigned to alternate experimental and control groups, with the experimental subjects receiving the planned teaching before discharge. Through home visit interviews with all subjects, the mothers' coping abilities were assessed by the number of specified care objectives they had achieved. The individual totals were ranked and analyzed using the Mann-Whitney U test, the results of which led to the rejection of the Null hypothesis with p = .001, thus indicating a greater ability to cope by the mothers receiving the planned teaching. The total achievement scores of each objective were analyzed using the Fisher Exact Probability Test, resulting in five of the twenty objectives achieving significance at the .05 level. As four of the control subjects received routine written instructions before discharge from one hospital, the evaluation scores of these were compared with the remaining control subjects using the Mann-Whitney U test. No significant difference was found suggesting the ineffectiveness of written instructions without explanatory verbal instructions as well. Selected personal characteristics of the subjects and their children provided a description of the study population. The study's findings suggested that there is a lack of planned patient teaching in emergency departments although literature sources indicate that such teaching is necessary if patients and their families are to assume full responsibility for their own care. The study recommends that nurse practitioners be made aware of their teaching function and be encouraged to achieve competence and confidence in this function through inservice programs. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

EMS personnel tend to face higher burnout rates than those in similar professions, which makes them more likely to make mistakes, engage in safety-compromising behaviors, and get injured. This project examines humor used in the form of Internet memes as a coping mechanism. Internet memes are modifiable, replicable units of cultural transmission that are passed and gain influence through the Internet. I applied the Maslach Burnout Inventory to EMS related memes on the website Reddit. I found that memes that dealt with burnout typically referenced non-traumatic factors as being the source of burnout, and that these memes would often lead to conversations that allowed EMS personnel to share their experiences with one another. I concluded that internet memes can provide a way for EMS personnel to express their feelings anonymously and through a façade of humor, and can also let other people who may be going through similar experiences know that they are not alone.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22380号 / 社医博第102号 / 新制||社||医11(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 中山 健夫, 教授 小池 薫, 教授 今中 雄一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Simulation is a powerful technique to study complex problems and systems. This thesis explores two different problems. Part 1 (Chapters 2 and 3) focuses on the theory and practice of the problem of simulating graphs with a prescribed degree sequence. Part 2 (Chapter 4) focuses on how simulation can be useful to assess policy changes in emergency medical services (EMS) systems. In particular, and partially motivated by the COVID-19 pandemic, we build a simulation model based on New York City’s EMS system and use it to assess a change in its hospital transport policy. In Chapter 2, we study the problem of sampling uniformly from discrete or continuous product sets subject to linear constraints. This family of problems includes sampling weighted bipartite, directed, and undirected graphs with given degree sequences. We analyze two candidate distributions for sampling from the target set. The first one maximizes entropy subject to satisfying the constraints in expectation. The second one is the distribution from an exponential family that maximizes the minimum probability over the target set. Our main result gives a condition under which the maximum entropy and the max-min distributions coincide. For the discrete case, we also develop a sequential procedure that updates the maximum entropy distribution after some components have been sampled. This procedure sacrifices the uniformity of the samples in exchange for always sampling a valid point in the target set. We show that all points in the target set are sampled with positive probability, and we find a lower bound for that probability. To address the loss of uniformity, we use importance sampling weights. The quality of these weights is affected by the order in which the components are simulated. We propose an adaptive rule for this order to reduce the skewness of the weights of the sequential algorithm. We also present a monotonicity property of the max-min probability. In Chapter 3, we leverage the general results obtained in the previous chapter and apply them to the particular case of simulating bipartite or directed graphs with given degree sequences. This problem is also equivalent to the one of sampling 0–1 matrices with fixed row and column sums. In particular, the structure of the graph problem allows for a simple iterative algorithm to find the maximum entropy distribution. The sequential algorithm described previously also simplifies in this setting, and we use it in an example of an inter-bank network. In additional numerical examples, we confirm that the adaptive rule, proposed in the previous chapter, does improve the importance sampling weights of the sequential algorithm. Finally, in Chapter 4, we build and test an emergency medical services (EMS) simulation model, tailored for New York City’s EMS system. In most EMS systems, patients are transported by ambulance to the closest most appropriate hospital. However, in extreme cases, such as the COVID-19 pandemic, this policy may lead to hospital overloading, which can have detrimental effects on patients. To address this concern, we propose an optimization-based, data-driven hospital load balancing approach. The approach finds a trade-off between short transport times for patients that are not high acuity while avoiding hospital overloading. To test the new rule, we run the simulation model and use historical EMS incident data from the worst weeks of the pandemic as a model input. Our simulation indicates that 911 patient load balancing is beneficial to hospital occupancy rates and is a reasonable rule for non-critical 911 patient transports. The load balancing rule has been recently implemented in New York City’s EMS system. This work is part of a broader collaboration between Columbia University and New York City’s Fire Department.