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Introduktion: I ambulansen sker ett dyadiskt teamarbete, där två personer, varav minst en sjuksköterska, arbetar tillsammans. Ett effektivt och välfungerande teamarbete har visat sig främja personalens hälsa och trygghet samt öka patientsäkerheten, medan hinder i teamarbetet kan skapa ineffektivitet och öka risken för misstag. Syfte: Specialistsjuksköterskors upplevelser av dyadiskt teamarbete i prehospital miljö. Metod: Studien har en kvalitativ design med induktiv ansats. Åtta specialistsjuksköterskor, arbetande på akutambulans i Sverige, intervjuades via semistrukturerade intervjuer. Kvalitativ manifest innehållsanalys valdes som analysmetod. Resultat: Analysen resulterade i fyra kategorier; vikten av öppenhet och trygghet, känslor av ensamhet och otrygghet, kommunikationens betydelse samt kompetens och erfarenhet påverkar samarbetet. Resultatet visade att specialistsjuksköterskorna upplevde att tillit inom teamet var avgörande för teamarbetet, där tryggheten i samspelet med kollegan bidrog till både lust och säkerhet i arbetet. Vid bristande tillit i teamarbetet kunde känslor av ensamhet och otrygghet uppstå vilket kunde ge osäkerhet i arbetet. Kommunikationen i teamet var viktigt för att kunna sköta sitt jobb och vid tydlig kommunikation minskade risken för missförstånd. Specialistsjuksköterskorna beskrev att erfarenhet och kompetens var en stark orsak till trygghet i teamarbetet. Slutsats: En slutsats utifrån studiens resultat är att det är viktigt att det dyadiska teamet i ambulansen är tillitsfullt och har en öppen karaktär. Att man vågar lita på varandra i teamet och att man har en gemensam bild av det arbete som skall genomföras. Att arbetet i ambulansen både blir roligare och säkrare om man har en bra kommunikation och försöker skapa en atmosfär som är tillåtande och utvecklande. Ett teamarbete med bristande tillit leder till osäkerhet, tvivel och ökar risken för missförstånd. Det behövs ytterligare studier för att utveckla metoder för att stärka den psykosociala arbetsmiljön men även för att undersöka teamarbetets påverkan på patientsäkerheten.

Bakgrund: Våld i nära relation är ett samhällsproblem som drabbar både kvinnor och män. Våldet sker i olika samhällsklasser och geografiska områden. Det pågår ofta under en lång tid och utövas främst i hemmet, vilket gör det svårt att upptäcka. Ett stort mörkertal förekommer på grund av skuld- och skamkänslor hos offren. Det finns olika typer av våld och det finns särskilt utsatta grupper som riskerar att utsättas för våld i nära relation. Normaliseringsprocessen är en överlevnadsstrategi för de utsatta. De våldsutsatta upplever svårigheter att avslöja sin utsatthet för vårdpersonalen. Akutmottagningen är ofta en första instans där våldsutsatta söker hjälp. Syfte: Syftet var att sammanställa kunskap om vårdpersonalens upplevda förutsättningar att ställa frågor om våld i nära relation till vuxna personer som söker vård på en akutmottagning. Metod: En kvalitativ strukturerad litteraturöversikt med en induktiv ansats genomfördes. Elva vetenskapliga artiklar inkluderades och en tematisk analys användes. Resultat: Sex deskriptiva teman framkom: behov av kunskap och utbildning, vårdpersonalens förhållningssätt påverkar patientmötet, behov av en anpassad arbetsmiljö, behov av tydliga strukturer och riktlinjer, stöd och hjälp av kollegor samt att patientens och närståendes agerande påverkar. Därefter framkom tre analytiska teman: förståelse för patienten, begränsad av yttre faktorer och det mellanmänskliga samarbetet. Slutsats: Vårdpersonalen upplevde att kunskap och utbildning var förutsättningar för att kunna ställa frågor om våld i nära relation. De efterfrågade också organisatoriska förutsättningar, såsom anpassad arbetsmiljö, riktlinjer och rutiner. Ett gott samarbete med kollegor och en förståelse för patienten bidrar till att frågor kan ställas om våld i nära relation. / Background: Intimate partner violence is a societal problem that affects both women and men. The violence takes place in different social classes and geographical areas. It often goes on for a long time and is mainly practiced in the home, making it difficult to detect. A great deal of unknown cases occur due to feelings of guilt and shame in the victims. There are different types of violence and there are particularly vulnerable groups that are at risk of being exposed to intimate partner violence. The normalization process is a survival strategy for the vulnerable. The victims of violence experience difficulties in revealing their exposure to healthcare staff. The emergency department is often the first instance where victims of violence seek help. Purpose: The aim was to compile knowledge about the healthcare staff's perceived prerequisites for asking questions about intimate partner violence to adults seeking care in an emergency department. Method: A qualitative structured literature review with an inductive approach was carried out. Eleven scientific articles were included, and a thematic analysis was used. Results: Six descriptive themes emerged: need for knowledge and training, the approach of the healthcare staff affects the patient encounter, need for an adapted work environment, need for clear structures and guidelines, support and help from colleagues and that the actions of the patient and their relatives have an influence. Subsequently, three analytical themes emerged: understanding of the patient, being limited by external factors, and the interpersonal collaboration. Conclusion: The healthcare staff felt that knowledge and education were prerequisites for being able to ask questions about intimate partner violence. They also requested organizational prerequisites, such as an adapted work environment, guidelines and routines. Good cooperation with colleagues and an understanding of the patient contribute to the ability to ask questions about intimate partner violence.

[pt] Serviços Médicos de Emergência (SME) proveem ajuda essencial a pessoas em situações de emergência, através de atendimento com primeiros socorros e transporte para unidades de saúde. Sistemas SME devem utilizar da melhor maneira possível seus recursos limitados de atendimento. Esse desafio já foi amplamente estudado por pesquisadores, na forma de problemas de roteamento de veículos, tanto estáticos quanto dinâmicos. No presente trabalho, estudamos um problema estático de roteamento de ambulâncias, cujo objetivo é minimizar o tempo ponderado de espera dos pacientes. O problema considera também o tempo acumulado de espera, restrições de compatibilidade de ambulâncias a serviços, seleção de pacientes, redirecionamento de ambulâncias e redistribuição de ambulâncias. Implementamos um algoritmo exato usando Branch and Price e uma formulação do problema como uma Partição de Conjuntos, usando código aberto. Estudamos os resultados obtidos com esse algoritmo e os comparamos com métodos heurísticos online estudados anteriormente. Para tal, utilizamos dados obtidos do SAMU da cidade do Rio de Janeiro. Os resultados possibilitam a avaliação do valor de informação perfeita nesse contexto e proveem resultados comparativos para embasar o futuro desenvolvimento de algoritmos online. / [en] Emergency Medical Service (EMS) systems provide life-saving support to people in emergency situations via first aid treatment and emergency transport to medical facilities. Such systems must strive to make the best use of their limited resources; they have thus been studied in the context of static and dynamic vehicle routing problems. In this work, we study a static ambulance routing problem aiming to minimize the weighted sum of patients waiting time while considering ambulance compatibility, patients priorities, ambulance redirection, and ambulance reassignment. We implement an exact Branch-andPrice algorithm over a Set Partitioning Formulation, study the results of this algorithm, and compare them to previously studied online heuristics using data from Rio de Janeiro s public SAMU system. The results obtained allow us to assess the value of perfect information in such systems, providing a comparative baseline for subsequent developments of online algorithms.

Esta investigación crítica denominada “Aspectos a reforzar en relación al manejo de medicamentos inotrópicos por el Profesional de Enfermería en el Servicio de Emergencia”, presenta el objetivo de determinar qué aspectos se deben fortalecer en el manejo de inotrópicos por el personal de enfermería en las áreas de emergencia, la justificación se basa en que un error durante la administración de estos fármacos genera efectos adversos en la salud del paciente. La metodología aplicada fue Enfermería Basada en Evidencia (EBE), donde según el esquema de MARCO PS se formuló la pregunta clínica: ¿Cuáles son los aspectos a reforzar en relación al manejo de medicamentos inotrópicos por el profesional de enfermería en los Servicios de Emergencia? Para la búsqueda de bibliografía, se utilizaron distintas bases de datos, entre los años 2018-2023, en idiomas: español, inglés y portugués; encontrando doce investigaciones, las cuales fueron sometidas a la validación de Gálvez Toro y sólo 4 aprobaron. La investigación seleccionada fue: “Calidad en la administración de medicamentos inotrópicos en profesionales de enfermería de un hospital de Tabasco, México” la cual se analizó con la lista de chequeo ASTETE. Ante la pregunta planteada: el nivel de conocimientos y la forma en que estos fármacos son administrados, son aspectos a reforzar, ya que las principales fallas se encontraron en estos ámbitos, por lo que se sugiere desarrollar estrategias de supervisión y capacitación en aquellos aspectos críticos identificados con la finalidad de prevenir eventos adversos y salvaguardar la seguridad del paciente. / This critical review called "Aspects to be reinforced in relation to the management of inotropic medications by the Nursing Professional in the Emergency Service", presents the objective of determining which aspects should be strengthened in the management of inotropic medications by nursing staff in the emergency areas, the justification is based on the fact that an error during the administration of these drugs can generate adverse effects on the patient's health. The methodology applied was Evidence-Based Nursing (EBE), where according to the MARCO PS scheme, the clinical question was formulated: What are the aspects to be reinforced in relation to the management of inotropic drugs by the nursing professional in Nursing Emergency Services? For the bibliography search, different databases were used, between the years 2018-2023 in languages: Spanish, English and Portuguese; finding twelve investigations, which were submitted to validation by Gálvez Toro and only 4 approved. The selected research was: “Quality in the administration of inotropic drugs in nursing professionals in a hospital in Tabasco, Mexico” which was analyzed with the ASTETE checklist. Given the question posed: the level of knowledge and the way in which these drugs are administered are aspects to be reinforced, since the main failures were found in these areas, therefore it is suggested to develop supervision and training strategies in those critical aspects identified in order to prevent adverse events and safeguard patient safety.

No / This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED.

The use of wireless sensor networks for a myriad of applications is increasing. They can be used in healthcare for emergency management. In Florida, hurricanes are the main source of natural disasters. There has been a high incidence of hurricanes over the past decade. When a hurricane warning is issued it is important that people who live in potentially dangerous areas, such as along the coast, evacuate for their safety. Nursing homes and other care facilities for elderly or disabled people experience difficulty with the evacuation as their residents require additional assistance. The characteristics and challenges of a hurricane evacuation are investigated. A patient-centric hurricane evacuation management system is proposed to allow healthcare providers the ability to continuously monitor and track patients. During a hurricane there are usually scarce energy resources and a loss of basic communication services such as cellular service and Internet access. We propose the architecture of the system that allows it to operate in the absence of these services. The hardware and software architectures are also presented along with the main phases of operation. The system was then validated and the performance evaluated via simulation using the OPNET Modeler. / by Arny Isonja Ambrose. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

OBJETIVOS: O estudo explorou diferentes métodos de séries temporais visando desenvolver um modelo para a previsão do volume diário de pacientes no Pronto Socorro do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da USP. MÉTODOS: Foram explorados seis diferentes modelos para previsão do número diário de pacientes no pronto socorro de acordo com algumas variáveis relacionadas ao calendário e à temperatura média diária. Para a construção dos modelos, utilizou-se a contagem diária de pacientes atendidos no pronto socorro entre 1° de janeiro de 2008 a 31 de dezembro de 2010. Os primeiros 33 meses do banco de dados foram utilizados para o desenvolvimento e ajuste dos modelos, e os últimos três meses foram utilizados para comparação dos resultados obtidos em termos da acurácia de previsão. A acurácia foi medida a partir do erro médio percentual absoluto. Os modelos foram desenvolvidos utilizando-se três diferentes métodos: modelos lineares generalizados, equações de estimação generalizadas e modelos sazonais autorregressivos integrados de média móvel (SARIMA). Para cada método, foram testados modelos que incluíram termos para controlar o efeito da temperatura média diária e modelos que não incluíram esse controle. RESULTADOS: Foram atendidos, em média, 389 pacientes diariamente no pronto socorro, número que variou entre 166 e 613. Observou-se uma sazonalidade semanal marcante na distribuição do volume de pacientes ao longo do tempo, com maior número de pacientes às segundas feiras e tendência linear decrescente ao longo da semana. Não foi observada variação significante no volume de pacientes de acordo com os meses do ano. Os modelos lineares generalizados e equações de estimação generalizada resultaram em melhor acurácia de previsão que os modelos SARIMA. No primeiro horizonte de previsão (outubro), por exemplo, os erros médios percentuais absolutos dos modelos lineares generalizados e de equação de estimação generalizada foram ambos 11,5% e 10,8% (modelos que incluíram e que não incluíram termo para controlar o efeito da temperatura, respectivamente), enquanto os erros médios percentuais absolutos para os modelos SARIMA foram 12,8% e 11,7% (modelos que incluíram e que não incluíram termo para controlar o efeito da temperatura, respectivamente). Para todos os modelos, incluir termos para controlar o efeito da temperatura média diária não resultou em melhor acurácia de previsão. A previsão a curto prazo (7 dias) em geral resultou em maior acurácia do que a previsão a longo prazo (30 dias). CONCLUSÕES: Este estudo indica que métodos de séries temporais podem ser aplicados na rotina do serviço de pronto socorro para a previsão do provável volume diário de pacientes no serviço. A previsão realizada para o curto prazo tem boa acurácia e pode ser incorporada à rotina do serviço, de modo a subsidiar seu planejamento e colaborar com a adequação de recursos materiais e humanos. Os modelos de previsão baseados unicamente em variáveis relacionadas ao calendário foram capazes de prever a variação no volume diário de pacientes, e os métodos aqui aplicados podem ser automatizados para gerar informações com antecedência suficiente para decisões de planejamento do serviço de pronto socorro / OBJECTIVES: This study aims to develop different models to forecast the daily number of patients seeking emergency department (ED) care in a general hospital according to calendar variables and ambient temperature readings and to compare the models in terms of forecasting accuracy. METHODS: We developed and tested six different models of ED patient visits using total daily counts of patient visits to the Instituto Central do Hospital das Clínicas Emergency Department from January 1, 2008 to December 31, 2010. We used the first 33 months of the dataset to develop the ED patient visits forecasting models (the training set), leaving the last 3 months to measure each model\'s forecasting accuracy by the mean absolute percentage error. Forecasting models were developed using 3 different time series analysis methods: generalized linear models, generalized estimating equations and seasonal autoregressive integrated moving average (SARIMA). For each method, we explored models with and without the effect of mean daily temperature as a predictive variable. RESULTS: Daily mean number of ED visits was 389, ranging from 166 to 613. Data showed a weekly seasonal distribution, with highest patient volumes on Mondays and lowest patient volumes on weekends. There was little variation in daily visits by month. Generalized linear models and generalized estimating equation models showed better forecasting accuracy than SARIMA models. For instance, the mean absolute percentage errors from generalized linear models and generalized estimating equations models at the first month of forecasting (October, 2012), were 11.5% and 10.8% (models with and without control for the temperature effect, respectively), while the mean absolute percentage errors from SARIMA models were 12.8% and 11.7% (models with and without control for the temperature effect, respectively). For all models, controlling for the effect of temperature resulted in worse or similar forecasting ability than models with calendar variables alone, and forecasting accuracy was better for the short term horizon (7 days in advance) than for the longer term (30 days in advance). CONCLUSIONS: Our study indicates that time series models can be developed to provide forecasts of daily ED patient visits, and forecasting ability was dependent on the type of model employed and the length of the time-horizon being predicted. In our setting, generalized linear models and generalized estimating equation models showed better accuracy, and including information about ambient temperature in the models did not improve forecasting accuracy. Forecasting models based on calendar variables alone did in general detect patterns of daily variability in ED volume, and thus could be used for developing an automated system for better planning of personnel resources

緊急醫療救護法自從民國84年8月9日公布迄今，已歷經四次修正，最後ㄧ次修正為民國96年7月。公布後迄今的十多年間，緊急醫療救護之環境丕變，從原本消防局救護人員擔任從家裡送到醫院，單純的「運送」角色，然後轉交於醫院醫護人員為急診醫療處置的情況，驟然變成了由指導醫師教育、訓練、督導、考核之下，得由救護技術員於現場實行不等的醫療救護行為，有問題時得詢問線上醫療指導醫師。除此之外，在需救護車送到醫院情況下，民眾現在得自由選擇民間救護車機構或是消防局救護車。換句話說，緊急救護場景即從原本的三角當事人關係，演變成了複雜五角甚至六角當事人關係。當事人間的權利義務關係為何？查詢最近的論文，多為醫師與病患間醫療行為的刑事與民事關係，卻鮮少論及到院前救護時，地方政府、救護技術員、醫療指導醫師與緊急傷病患間之權利義務關係。 本論文之研究目的，就在於了解並釐清緊急救護系統內各當事人間之權利義務，待損害發生時可得適當之救濟途徑；並嘗試藉由美國與我國已有之到院前救護相關爭訟判決，來了解未來我國到院前救護可能發生之紛爭，進而提出改善建議，來達到預防爭訟之效果。本研究之範圍將限於緊急醫療系統中之到院前救護階段，著重於緊急傷病患之現場緊急救護及醫療處理，與送醫途中之緊急救護。而大量傷病患、重大傷病患或離島、偏遠地區難以診治之傷病患之轉診與醫療機構內之緊急醫療，以及災難醫療救護部分則不在本論文之討論範圍內。 本文共分五章，分別為第一章緒論、第二章我國緊急醫療系統的介紹與現狀、第三章派遣與反應階段損害賠償責任之成立、第四章現場救護與送往醫院階段損害賠償責任之成立、第五章結論。 第一章為緒論，在於闡述本研究之動機與目的，與進行本研究之範圍及研究方法，最後作架構性的介紹與各章節的簡介，祈能使讀者對本論文架構有一初步的認識。 第二章首先對於緊急醫療救護的定義與目的作一概要之介紹，再來介紹我國現行到院前緊急救護系統中各個當事人於現行法規規定下所扮演的身分、角色與工作內容。之後對於我國到院前緊急醫療系統資源現況、缺失與運作流程作一清楚之描述。 第三章首先介紹到院前救護損害賠償責任之態樣，分「國家賠償責任」與「民法損害賠償責任」兩種為說明。本文認為「救災救護指揮中心啟動之到院前救護」為具公法性質之行政事實行為，因而如該當國家賠償之要件時，自有國家賠償請求權。而「非救災救護指揮中心啟動之到院前救護」則為民法之範疇，並將之類型化可分為「民眾直接聯絡民間救護車營業機構」、「負保護義務之人聯絡簽約之救護車設置機構」及「救護車設置機構自行啟動」三種類型，並對其中當事人間之法律關係作一描述與釐清相對之權利義務。 再來論及緊急救護中借名醫療院所的連帶責任，並搜集學說與實務判決以了解目前通說與實務之見解。隨後介紹派遣與反應階段可能發生的問題，及美國與我國之實務判決。 第四章介紹現場救護階段與送往醫院階段所可能發生的法律問題。首先釐清救護技術員執行緊急醫療救護是否違反醫師法之密醫罪。接著探討現場救護人員之注意義務標準與共同侵權責任判定之實務見解。再來討論線上醫療指導制度所可能引發之問題與解決方案。另外亦分析如非緊急醫療系統的醫師於救護現場時可能發生的情況與相關問題。之後對於現場救護時所可能遭遇的說明義務履行困境及相關建議。本章的最後，則再探討送往醫院的路程中可能發生的問題，包括送往醫院的決定者為誰，與救護車發生車禍時，對於緊急情況判定的法院見解與本文建議。 第五章為結論。

The study aimed to investigate the implementation of customer care at the Casualty Department of Edenvale Regional Hospital in Gauteng Province. The research was conducted using a qualitative case study approach, which sought to gain deeper understanding of the impact of customer care in the hospital’s Casualty Department from the employees’ point of view. Data was collected from 16 purposively selected respondents using semi-structured interviews and document analyses were interpreted by the researcher to give voice and meaning to the assessment topic. Data was analysed using the Content Analysis framework and six themes emerged from the data analysis: (1) High expectation levels from the community; (2) Quality of patient care; (3) Lack of resources; (4) Malfunctioning equipment; (5) Compromised safety and security; (5) Strategies to improve customer care; and (6) The effect of policies and guidelines on the quality of services rendered. The study revealed that the surrounding community that is served by the Edenvale Hospital’s Casualty Department had high expectations which the hospital was unable to meet because of the many limitations, especially resource constraints. The issues and difficulties associated with overcrowding in the emergency section were raised by respondents, who reported several challenges experienced in the hospital. These included patients sleeping on floor mattresses and even on stretchers, inadequate beds, shortage of staff, malfunctioning equipment and lack of sufficient infrastructure. These challenges resulted in long waiting periods for patients to be given open beds in the wards, bad attitudes from both patients and employees alike, poor communication among staff and patients and their families, and an unsafe environment for the staff and customers (patients). There is hence a need for the Gauteng Health Department together with the hospital management to review resources allocated to the Edenvale Regional Hospital and to increase awareness among the community about the operations of the level 2 hospitals such as this. / Public Administration / M. P. A.