An Intensive Care Unit (ICU) is an extreme technological environment where different t)?es of equipment and devices, intended for the care of critically ill patients, are found. The use of technological equipment has assisted in reduction of morbidity, mortality, and length of hospital stay because the problems are diagnosed earlier. The purpose of the study was to explore the perceptions of nu$es who work in the Intensive Care Units about the effects of the use of technological equipment, with the intention of making recommendations for clinical practice, education of nurses and further research. A quantitative, descriptive, prospective, and non-experimental study design was utilised in this study, as well as a non-probability sampling method. Participants (n:60) were drawn from neurosurgical, cardiothoracic and main ICUs. Data collection was done by use of questionnaire. Descriptive and inferential statistics were used to analyse data.

The Helicopter Emergency Medical Service (HEMS) accident rate has driven operators from around the world to address the management of risks inherent to their operations. In-flight decision-making, pre-flight planning, failure to follow standard operating procedures, delayed remedial actions, and misinterpretation of environmental cues are all areas that need to be addressed for safe HEMS operations. HEMS operations are complex, being a joint exercise between the flight crew, paramedics and supporting agencies. Operations occur around-the-clock, in all-weather conditions, and often with no fore-warning. In a time critical operation, where precious minutes may cost lives, operators must decide which cases warrant a HEMS response and if so, whether the conditions are safe to conduct the mission. Intelligent systems are an emerging field offering benefits to a multitude of applications. This research forms a comprehensive investigation of the application of 'intelligent systems' to the pre-mission analysis of HEMS operations. The research has resulted in the development of a prototype decision support system capable of assisting in the pre-mission analysis of HEMS operations. The prototype system is capable of supporting flight coordinators and crew in the decision-making processes prior to HEMS operations and can potentially improve emergency medical services to the community.

BARNA, Alexander: Trauma readiness of emergency medical services in the Czech Republic and Slovak Republic [Diploma thesis]. University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences. Lecturer: Mgr. Zuzana Freitinger-Skalická, Ph.D. The main topic of this work was the introduction of the issue of trauma readiness of the emergency medical service in the Czech Republic and the Slovak Republic, the issue of emergency events with mass casualty incidents and the mapping of the knowledge and orientation of paramedical personnel in the emergency medical services. The diploma thesis is divided into two major parts - theory and research. The theoretical part introduces legislative norms, regulations and expert recommended procedures, based on which providers of emergency health services ensure their activity and crisis readiness, especially through crisis readiness workplaces. The chosen issue in the research part was the knowledge of the members of the emergency medical services groups solved by the quantitative method - a survey carried out by means of an anonymous non-standardized questionnaire, was prepared individually for the Czech Republic and for the Slovak Republic. From the results of the questionnaire survey it can be deduced that the knowledge of the members of the emergency medical service groups is sufficient, but there is still a need to incorporate the expertise and knowledge of the trauma readiness issues. Above all, finding deficiencies in knowledge, which are used to carry out rescue and liquidation work in dealing with emergency events, is particularly problematic.

Hot och våld inom ambulanssjukvård är ett arbetsmiljöproblem såväl nationellt som internationellt. Ambulanssjukvården är den första länken i vårdkedjan och ställs inför många olika utmaningar varav hot och våld kanske är den största av dem alla då personalen som är där för att hjälpa istället är den som behöver hjälp. Forskningen inom området är begränsad och uteslutande kvantitativ vilket är ett problem då fenomenet är en högst subjektiv upplevelse. Syftet med studien var att beskriva ambulanspersonalens erfarenheter av hot och våld inom ambulanssjukvården. Metoden var empirisk med kvalitativ ansats och datainsamlingen bestod av intervjuer. Resultatet visar att hot och våld inom ambulanssjukvården har stor påverkan på personalen såväl psykiskt som fysiskt. Fenomenet är ofta oförutsägbart och därför svårt att skydda sig mot men med hjälp av kroppsspråk och planering är det möjligt att förebygga hot och våld. Sociala problem samt den egna utrustningen och attityden upplevs som möjliga orsaker till att personalen utsätts för övergrepp. Den publicerade forskningen inom ambulanssjukvård har aldrig tidigare undersökt hur individerna bakom siffrorna i statistiken upplever hur det är att utsättas för hot och våld i yrket. Att ta del av ambulanspersonalens erfarenheter av fenomenet är således ny kunskap som belyser problematiken ur ett annat perspektiv vilket kan bidra till att medvetenheten om hot och våld ökar hos både personal, arbetsgivare samt högskolor och universitet. / Program: Specialistsjuksköterskeutbildning med inriktning mot ambulanssjukvård

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 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.

This thesis deals with issue of preparedness of EMS Central Bohemia on multiple victims' emergencies. In addition to preparedness of EMS Central Bohemia the thesis also analyses the system of training and education of employees in the management of mass casualty. The theoretical part discusses the legislation on EMS, files from Catalogue of model activities related to this issue, coordination of parts of Integrated Rescue System (IRS) on site of event and role of EMS on-site emergencies. Further, the specifics of EMS Central Bohemia are described, the development of EMS Central Bohemia since its establishment (inception) to the present, organizational structure, mass casualty's emergencies preparedness, EMS dispatch (medical operations center), system of emergency calls management and finally Traumatology plan of EMS Central Bohemia. Aim of the thesis was based on analysis of the current status to propose optimal system of deployment and activation of forces and resources, and to propose system of employees' education and system of testing exercises. Based on research, SWOT analysis was developed (composed) and the results were compared with pre-established hypotheses. From obtained findings the comprehensive overview of forces and resources of EMS Central Bohemia region for mass casualty management was prepared. In particular, the number of available resources on duty, system of backups, modules and containers for mass casualties and their deployment. When evaluating resources for mass casualty management also an economic aspect was taken into consideration, as well as ambulance crews' knowledge on possible use of these resources. Based on this review, it was found that in terms of securing forces and resources, the readiness of EMS Central Bohemia is appropriate. Hereby the hypothesis nr.1, which presumed that EMS Central Bohemia has sufficient number of forces and resources to deal with emergencies with multiple victims has been confirmed. The hypothesis nr.2, which presumed that forces and resources deployment is not ideal, on the contrary has not been confirmed. In this thesis the current status of employees' preparation for mass casualty was also discussed. It was found that the base of this preparation is Course for leading employee of rescue service, organized by Department of crisis preparedness. At the same time the conception is set that after first four pilot courses this education system will be applied to particular areas, thereby should be secured sufficient education of crews of EMS Central Bohemia region in this issue. Other education options were also defined, which are now already available in the organization. The hypothesis nr.3, which presumed that system of preparation and training focused on mass casualty is not appropriate, have thus managed to disprove. However it was found that although a clear conception and education options in this field exist, it's not well known to ordinary employees. One of the conclusions is therefore also a recommendation to managers of EMS Central Bohemia to more inform their employees about these options. One of the goals of this thesis was to suggest a system of learning and testing exercises. This proposal is described in the conclusion the proposed number of testing exercises is at least 4 times a year. The total number of employees of the organization and the number of those who may have the capacity and operational reasons to participate on similar exercises has been taken into consideration here. The education system was found appropriate, only with above mentioned objection regarding to awareness of ordinary employees about it.

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

No description available.

Dissertation (M Cur (Trauma and Emergency Nursing))--University of Pretoria, 2006. / Nursing Science / unrestricted