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The KwaZulu-Natal Department of Health highlighted in the 2005-2009/2010 Strategic Plan many challenges. One of the major challenges was an inadequate management information system at Emergency Medical Rescue Services (EMRS). It was further stated that decision-making becomes risky in the absence of reliable and accurate information. EMRS provides an ambulance service to the citizens of KwaZulu-Natal. This research will focus on EMRS in eThekwini District. In order to provide the best possible service to the citizens there has to be effective information management. The questionnaire survey used in this research project attempted to reach a broad cross-section of the various groups of people (management, operations and administrative staff) who take part in information work, and hence develop a broad sense of their perceptions and beliefs about how information is managed and used at eThekwini EMRS. The answering of questions varied between the groups. This showed that managers, operational staff and administrative staff have different perceptions on information management. Some of the recommendations included: EMRS has to adopt information as a strategic resource; information must be used in addressing problem areas; staff must have access to information that EMRS gathers; and further research has to be conducted at EMRS to address the challenges the organisation faces. / Thesis (MPA)-University of KwaZulu-Natal, Westville, 2010.

Saugos kultūra – pacientų saugos elementas nukreiptas sumažinti žalą pacientui, kuri gali būti padaryta teikiant jam sveikatos priežiūros paslaugas. Tikslas – Įvertinti Kauno regiono greitosios medicinos pagalbos tarnybų darbo vietos saugos kultūrą. Tyrimo metodas: 2012 metų kovo–gegužės mėnesiais atlikta vienmomentinė anoniminė apklausa. Tyrime dalyvavo aštuonių Kauno regiono greitosios medicinos pagalbos tarnybų darbuotojai (N=325, atsako dažnis 82,9 proc.). Tyrimui naudotas Požiūrio į saugą klausimynas (The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ). Nustatyta GMP Požiūrio į saugą klausimyno pakankamai aukštas vidinis nuoseklumas (α=0,822). Rezultatai: Kauno regiono greitosios medicinos pagalbos tarnybų specialistai, vertindami septynias saugos kultūros sritis, aukščiausiais teigiamais įverčiais vertino komandinio darbo (76,34 balai), pasitenkinimo darbu (76,49 balai) ir vadovų požiūrio į saugą sritis (75,98 balai). Žemiausiais balais darbuotojai vertino streso pripažinimo ir nepageidaujamų įvykių raiškos sritis, atitinkamai – 49,62 ir 37,24 balai. Komandinį darbą ir vadovų požiūrį į saugą dažniau teigiamai vertino slaugytojai, lyginant su GMP vairuotojais, o paramedikai labiau teigiamai vertino pasitenkinimą darbu, lyginant su gydytojais (p<0,05). Gydytojai ir paramedikai dažniau pripažino stresą, lyginant su slaugytojais ir vairuotojais (p<0,01). Daugiau kvietimų per metus atliekantys darbuotojai dažniau teigiamai vertino saugos klimato... [toliau žr. visą tekstą] / Safety culture is the element of patient safety that purposes to decrease the damage to the patient that may be done during provision of health care service. The purpose of this study was to investigate the safety culture at the workplace of emergency medical service at Kaunas region. Material and methods: Anonymous survey was conducted on March-May in 2012. The staff from eight emergency medical service institutions at Kaunas region took part in the survey (N=325 with response rate of 82.9 %). The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ was used after the permission by the authors was issued. The internal consistency of translated and adapted instrument was sufficiently high (Cronbach α=0,822). Results: The staff of emergency medical service of Kaunas region evaluated six dimensions of safety culture rating team work (76.34 scores), work satisfaction (76.49 scores) and perceptions of management at the highest level (75.98 scores). The lowest ratings were related to stress recognition and present of adverse events, respectively – 49.62 and 37.24 scores. Nurses scored the team work and perceptions of management more positive in comparison to drivers; paramedics have had more positive attitudes towards work satisfaction than physicians. Physicians and paramedics recognised stress more often in comparison to nurses and drivers. The attitudes towards a safety climate, perceptions of management and work satisfaction were more positive in... [to full text]

[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Sammanfattning Bakgrund: Inom akutsjukvård behandlas och vårdas kritiskt sjuka eller skadade patienter till följd av trauma eller sjukdom. Sannolikt kommer de i sällskap av närstående som kan vara oroliga och rädda. Om patienten dessutom plötsligt avlider kan situation bli traumatisk för närstående och resultera i bestående men. Omhändertagande av närstående i dessa situationer är därför av stor vikt och ligger inom sjuksköterskans kompetensområde. Genom att belysa sjuksköterskans erfarenheter av dessa möten syftar vi till att få en djupare förståelse och öka kunskapen inom omhändertagandet av närstående i samband med plötsliga dödsfall. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att möta närstående i samband med dödsfall inom akutsjukvård, med särskilt fokus på plötslig död.  Metod: Elva vetenskapliga artiklar har analyserats i enlighet med Fribergs (2017) metod och sammanställts i en litteraturöversikt. De använda databaserna var CINAHL Complete, Medline with Full Text samt PubMed. Både kvalitativa och kvantitativa artiklar inkluderades i resultatet.  Resultat: Denna litteraturöversikt resulterade i fyra huvudteman: sjuksköterskans upplevelser och uppfattning av dödsfall. Arbetsrelaterade faktorer med underteman utbildning, erfarenhet och miljöns påverkan. Närvaro av närstående med underteman vid återupplivningsförsök och hos döende patienter Sjuksköterskans roll i mötet med närstående med underteman sjuksköterskans kommunikativa roll och sjuksköterskans praktiska roll. Diskussion: I metoddiskussionen diskuterades styrkor och svagheter med litteraturöversikten. Styrkorna låg i författarnas gemensamma arbete att hitta relevanta vetenskapliga artiklar samt att vidare minska risken för språkliga feltolkningar då artiklarna var skrivna på engelska. I resultatdiskussionen diskuterade författarna den emotionella påverkan sjuksköterskor kan uppleva samt sjuksköterskans roll i samband med plötsliga   dödsfall. Vidare diskuterades hur närstående kunde påverkas av bristen på avskildhet inom akutsjukvården och hur det kunde relateras till Roys adaptionsmodell. Resultatet diskuterades även mot bakgrunden samt annan forskning.   Nyckelord: Sjuksköterskans erfarenheter, närstående, akutsjukvård, plötslig död. / Abstract  Background: In emergency medical care critically sick or injured patients are being cared and treated for following trauma or disease. They are likely accompanied by their family members who can be frightened and scared. If the patient also suddenly dies the situation can be traumatic for the family members and result in lasting marks. The care of family members in these situations is there for important and this lies within the nurses’ area of   competence. By illustrating nurses’ experiences of these encounters we aim to receive a deeper understanding and knowledge in caring for family members in conjunction with sudden death.      Aim: The aim was to illustrate nurses’ experiences of encountering with family members in conjunction with death in emergency medical care, with a particular focus on sudden death. Method: Eleven scientific articles were analyzed in accordance with Fribergs (2017) method and complied in a literature review. The databases CINAHL Complete, Medline with Full Text and PubMed were used. Both quantitative and qualitative articles were included in the   result.   Results: This literature review resulted in four main themes: Nurses experiences and perception of death. Work related factors with subthemes education, experience and environmental impact. Presence of family members with subthemes during resuscitation attempts and with dying patients. Nurses role while encountering with family members with subthemes nurses communicative role and nurses practical role. Discussion: In the method discussion the authors discussed strengths and weaknesses with the literature review. The strengths were a joint effort to find relevant scientific articles and to further reduce the likelihood of linguistic misinterpretations when the articles were written in English. In the outcome discussion, the authors discussed the emotional impact nurses may experience as well as the nurse's role in the event of sudden deaths. Furthermore, it was discussed how family members could be affected by the lack of privacy in emergency medical care and how it could be related to Roys adaptation model. The result was also discussed against the background and other research. Keywords: Nurses experiences, family members, emergency medical care, sudden death.

O tempo resposta é um indicador usado para avaliação da qualidade de serviços de atendimento pré-hospitalar (APH). Consiste no intervalo de tempo entre a expressão do pedido de socorro até a chegada da equipe à cena do evento. Assim, o objetivo do estudo foi analisar o tempo resposta de um SAMU, referente aos chamados para atendimentos clínicos e traumáticos demandados à Central de Regulação de Urgências. Os agravos clínicos foram compostos pelas síndromes neurológicas, cardiovasculares e respiratórias, por serem considerados agravos tempo dependentes; os agravos traumáticos foram constituídos pelos acidentes de trânsito e quedas, por serem os mais prevalentes no serviço. Trata-se de um estudo transversal retrospectivo. A amostra foi constituída por 1.580 atendimentos realizados em 2013, sendo 793 atendimentos clínicos e 787 atendimentos traumáticos. Os dados foram extraídos do sistema informatizado da central de regulação do SAMU de Porto Alegre (SAPH True), transpostos para o programa Microsoft Excel e analisados através do Programa Statistical Package for the Social Sciences (SPSS), versão 21.0. Os resultados evidenciam que o tempo resposta total foi de mediana de 19 minutos e os fatores que permaneceram associados estatisticamente com maior tempo de resposta total, após o ajuste pelo modelo multivariado, foram: tipo de socorro clínico (p<0,001), turno da noite (p<0,001), equipe básica (p=0,016), dias úteis da semana (p<0,001) e ocorrência de incidente no local do chamado (p=0,001). Em relação à faixa etária e gravidade presumida, não há diferenças significativas de tempo resposta. O tempo resposta total, formado pelas parcelas de tempo de cada etapa do atendimento, é influenciado pelo desempenho dos profissionais na comunicação e na avaliação das demandas do usuário e pelo tempo de mobilização da equipe para a partida para os atendimentos. O tempo resposta poderá ser reduzido através de processos de educação permanente com os profissionais do serviço para discussão e reorganização de práticas e com medidas de planejamento na organização estrutural do SAMU. / Response time (RT) is an indicator used to assess the quality of prehospital emergency care (PHEC). It is defined as the interval of time between a call for help and the arrival of the response team at the scene of the incident. In light of this, the objective of this study was to analyze the response time of the Brazilian Mobile Emergency Service (SAMU) to calls regarding clinical conditions and traumas made by the emergency control center. Clinical conditions comprised cardiovascular affections, neurological syndromes, and respiratory failure, due to their time-sensitive nature; traumatic injuries consisted of those caused by automobile accidents and falls, as they were the most prevalent in the service. This was a cross-sectional retrospective study with a sample of 1,580 cases from 2013, of which 739 were clinical conditions and 787 were traumatic injuries. Data were extracted from the SAMU call center’s computer system of the city of Porto Alegre (SAPH True), and then transposed to Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0. The results showed that median total response time was 19 minutes and the factors that were statistically associated with greater total response time, after adjustment by the multivariate model, were: type of clinical assistance (p<0.001), night shift (p<0.001), basic team (p=0.016), week business days (p<0.001), and the occurrence of an incident at the call location (p=0.001). There were no significant differences in RT in terms of age range and emergency severity. Total response time, defined as the sum of the time elapsed in each phase of emergency care, was influenced by the performance of health professionals in communicating and assessing user demands and team mobilization for departure. Response time can be reduced by means of continuing education processes with the service professionals to discuss and reorganize the practices, implementing measures to plan the service’s structural organization. / El tiempo de respuesta es un indicador usado para evaluación de calidad de atención de emergencias prehospitalarias (AEP). Es el intervalo temporal entre la solicitud del pedido de socorro hasta la llegada del equipo al lugar del evento. Se objetivó entonces analizar el indicador de tiempo-respuesta de un Servicio de Atención Móvil de Urgencias (SAMU) respecto de llamadas para urgencias clínicas y traumáticas realizadas a la Central de Regulación de Urgencias. Las urgencias clínicas consistieron en afecciones cardiovasculares, síndromes neurológicos y disfunciones respiratorias, consideradas urgencias tiempo-dependientes; las urgencias traumáticas constituyeron accidentes de tránsito y caídas, las más prevalentes en el servicio. Estudio retrospectivo transversal, con muestra constituida por 1580 atenciones realizadas en 2013, 793 clínicas y 787 traumáticas. Los datos se tomaron del sistema informático de la central de regulación del SAMU de Porto Alegre (SAPH True), fueron volcados a planilla de Microsoft Excel y analizados con Statistical Package for the Social Sciences (SPSS), versión 21.0. Los resultados evidencian que el tiempo de respuesta total tiene una mediana de 19 minutos, y los factores que permanecieron estadísticamente asociados al mayor tiempo de respuesta total luego del ajuste por modelo multivariado fueron: tipo de socorro clínico (p<0,001), turno nocturno (p<0,001), equipo básico (p=0,016), días hábiles (p<0,001) y acontecimiento de incidente en el lugar del llamado (p=0,001). Respecto a la faja etaria y gravedad presumida, no hay diferencias significativas de TR. El TR total, integrado por la sumatoria de lapsos de tiempo de cada etapa de atención, resulta influido por el desempeño de los profesionales en comunicación y evaluación de solicitudes del usuario, y preparación del equipo para salida de atención. El tiempo de respuesta podrá ser reducido a través de procesos de educación permanente con los profesionales actuantes en el servicio para discusión y reorganización de prácticas y con medidas de planificación en la organización estructural del SAMU.

In the diploma work, we familiarised the reader with the basic theoretical starting points concerning emergency medical services and preparedness for emergencies. First of all, in this part, we elaborated a basic overview of the organisational structure of the emergency medical services of the Ústecký kraj region, and of its subdivisions. Next, we outlined the educational system of the paramedical staff of the emergency medical services of the Ústecký kraj region, focused on the area of crisis management. The crisis management competence of paramedical staff involved in emergency medical services was the subject of a separate sub-chapter. We linked these chapters with the issue of the formation of the department of disaster medicine. Here, we defined the tasks and aims of disaster medicine. To create a better understanding of the issue, a part of the chapter consists of the basic terminology used in disaster medicine. The main aim of the diploma work is the analysis of the knowledge of the paramedical staff of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies. The sub-objectives of the thesis are the analysis of the knowledge of the medical rescue workers of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies, and the analysis of general nurses' knowledge of, and qualifications in, the specialist anaesthesiological-resuscitative care of the emergency medical services of the Ústecký kraj region in terms of preparedness for emergencies. The methodology of the work lay in the quantitative analysis of statistical data that we gathered from questionnaires that were filled in by randomly selected respondents among the paramedical staff of the emergency medical services of the Ústecký kraj region. We prepared the content of the questionnaire in the context of the issues studied. The respondents chose from a number of pre-defined answers to a total of 20 questions. The data obtained underwent statistical analysis with the use of statistical research methods, scaling, measurement in descriptive statistics, elementary statistical processing, non-parametric testing, estimation theory, and parametric testing. From the results of the practical part of the diploma work, it is evident that the knowledge of the medical rescue workers of the emergency medical services in terms of the preparedness for emergencies of the Ústecký kraj region is close to the normal frequency distribution N (mi and sigma). Also the general nurses' knowledge of, and qualification in, the specialist anaesthesiological-resuscitative care of the emergency medical services of the Ústecký kraj region, in terms of preparedness for emergencies, is close to the normal frequency distribution N (mi and sigma).

The theme of my thesis is the System of logistical support for emergencies in the Emergency Medical Service in selected regions of the Czech Republic. I chose this theme mainly because of the fact that I work as a rescuer in the Emergency Medical Service of the Central Bohemian Region. In the first part of the thesis, there is specified the essential terminology which is included in the whole project. There is described the historical summary of the beginning of the Emergency Medical Service and the logistics. Other chapters concern the description of the Integrated Rescue System and the essential cooperation of its elements during the intervention. I also analyse the issue of the logistics and public health disabilities on the place of the intervention. In addition, I describe individual Emergency Medical Services in three selected regions of the Czech Republic. It included the Emergency Medical Service of the Central Bohemian Region, the Prague Emergency Medical Service and the Emergency Medical Service of the South Bohemian Region. In chapters which deal with these Emergency Medical Services, there are expounded their forces, (medical) facilities and material support for coping with emergencies. In last chapters, I submit the summary of activities of the Ministry of Health. Furthermore, I mention activities of the allowance organization of Medical Support for the State of Emergency and also activities and roles of the Administration of State Material Reserves ? Czech Republic. Lastly, I summarize findings of the whole thesis in the chapter called ?Discussion?. I also evaluate the accomplishment of set goals and answer to scientific questions which I have already put before the formation of this thesis in the Groundwork for the thesis. In the part ?Results?, I illustrate the amount of exit positions of EMS in individual regions through the use of tables and graphs and I add an overview of the average number of exit positions and rescue teams related to the area of the territory and the number of inhabitants in the region. The aim of my thesis (was): ? to describe the state of the logistical support of the Emergency Medical Service in three selected regions of the Czech Republic (the Central Bohemian Region, Prague, the South Bohemian Region) ? to choose the most appropriate model of the logistical support for emergencies Questions of research: ? What are differences in logistical support for emergencies in the Emergency Medical Services in selected regions of the Czech Republic? ? Which aspects influence the selection of the most appropriate model? The main aim of my thesis ? to describe the state of the logistical support of the Emergency Medical Service in three selected regions of the Czech Republic ? was accomplished. I go into details in chapters 6, 7 and 8. In the chapter ?Discussion?, I described differences in logistical support and in this chapter I write that the mathematical quantification of the material support is not as important as the fact that there is a logistical planning of support for emergencies based on an analysis of risks which are the part of an emergency medical plan of concrete Emergency Medical Services in all selected regions of the Czech Republic. Each of mentioned EMS has special modules for the solution to eventual emergencies and in their usage employees are regularly schooled. In my opinion, this is the most important fact.