Thesis (Masters Diploma(Technology)--Cape Technikon, Cape Town, 1988 / The project entails designing and installing an emergency fire telephone system (EFTS) for the 23 storey Cape Town Administrative Civic Centre. The original system, with its mostly analogue circuitry, has no documentation available, is difficult to maintain and has become unreliable. After considering alternative systems the most economical option was to expand the original system by adding more extension telephones and to redesign the control section. The new EFTS briefly operates as follows: The status of ninety six extension telephones, installed at the emergency exits on each floor, are displayed on a mimic status display which both operators can monitor. Any emergency call can be identified by a green flashing LED and a distinctive bleep. The LED indicates the exact position and number of the telephone in the building, Each operator has a keypad and a two digit numeric display fitted his telephone. The operator can immediately answer incoming calls by pressing the queue button. Calls queue on a first in first out basis. The number of the extension telephone will be displayed on a numeric display. The operator can also select the extension he wishes to contact, by dialling the extension number on the keypad. The EFTS consists of nine printed circuit boards. A rack mounted Microcomputer board, made up of a Motorola MC6809 microprocessor, six 6821 PlAs, 2 kilobyte RAM, up to 16 kilobyte ROM and a watchdog timer controls the EFTS.Two Telephone Controller boards process voice signals and generate logic control signals for the CMOS voice switching circuitry on the Multiplexer Monitor boards. Six Multiplexer Monitor boards switch the two operators to any of the ninety six extension telephones and continuously monitor the extension telephone lines for faults and handset statuses. Noise and over voltage line protection is provided. The multiplexing of the 192 LEDs on the Mimic Status Display is controlled by the Microcomputer board. An unusual principle used in this design is the combination of low frequency AM and audio to affect communication. Two uninterruptable power supplies provide user independence from mains. Software used for the EFTS is written in 6809 Assembly Language. A Real time interrupt controls the Mimic Status Display. Operator actions are interfaced with the program logic by means of hardware interrupts.

This critical realist thesis seeks to understand how student, graduate and professional identities emerge in Emergency Medical Science (EMS) students at a South African University of Technology (UoT) as well as in professional paramedics in the Emergency Medical Care Services (EMCS). It further considers the construct of graduate attributes (GAs) and its relationship to emergence of identity and influence on curriculum design. The research design is that of a case study. The theoretical framework is critical realism whose depth ontology posits three domains of reality. Causal powers and generative mechanisms exist in the Real domain which cause events or phenomena to emerge in the Actual domain that are experienced in the Empirical domain. Using retroduction one may come to explore some of the causes for the event. Using Bhaskar’s concepts of identity, the self, absence and emergence, ontology and four-planar social being, a Bhaskarian explanatory framework of identity to explore the emergence of identity has been created. In exploring graduate attributes, a critical realist question is posed: “What must the world be like for GAs to exist” to explore the possibilities of the existence of GAs. It was found that student identity emerges diachronically in three moments, while professional paramedic identity starts to emerge during the third year of study mainly through the structure, culture and agency of workplace-based learning. In answer to the critical realist question it was found that GAs emerge from the neoliberalist commodification of universities. In seeking an alternative to GAs, traits and attitudes were explored. It was found that these emerge from curriculum, interplay of departmental structure, culture and agency of and from students’ being which makes them ontologically radically different from GAs. This study concludes that student, graduate and professional identities emerge from a person’s core constellational identity diachronically within four-planar social being and the interplay of structure, culture and agency. GAs cannot be related to the emergence of identity and curriculum design because of their ontology; however, if traits and attitudes are substituted for GAs, a close relationship does exist between emergence of identity, traits and attitudes and curriculum design.

The emergency department of Lions Gate Hospital was studied both in regard to the patients' current visit to this facility and in regard to the patients' other sources of ambulatory medical care. The objectives of the study were: (1) to understand why patients seek care at Lions Gate's emergency department; (2) to discover how this facility fits into the patients' overall patterns of medical care; and (3) on the basis of the above data, to propose any appropriate changes in the organization of the emergency department. The study was conducted during 14 days in September, 1974; the sampling frame covered all hours of the day and all days of the week. Data were gathered by questionnaires administered in the emergency department, with 85.60 percent of the sample responding. The increase in demand for emergency department services has been attributed to a variety of factors. The present study determined that private physicians and their non-availability are the predominant factors contributing to emergency department usage at Lions Gate Hospital, indicating that this facility is substituting for the wider primary care system. Data pertaining to the patients' overall patterns of medical care provided further evidence that the emergency department has gained wide acceptance by the patients as a source of primary medical care. Moreover, the emergency department was identified as an important and continuing source of care in the medical care patterns of many of its patients. As a result of the above findings, it was recommended that future plans for either the modification or expansion of Lions Gate's emergency department should include the establishment within the department of a walk-in ambulatory clinic. The proposed ambulatory care department, consisting of an emergency centre and primary care clinic, would assist Lions Gate Hospital to fit its services to the medical care needs which its patients exhibit. / Business, Sauder School of / Graduate

The rapid and accelerating growth of hospital Emergency Department utilization over the past twenty years has transformed a once well-defined and well bounded care setting into a highly complex and integral component of a total health care system. This increasing role complexity has created a demand by hospital decision-makers for an information system to describe, measure and evaluate Emergency Department activity within the context of broader health care issues and activities. This study is an attempt to identify and integrate the information needs of the hospital decision-makers into a meaningful whole. The evolution of emergency care in British Columbia is described in order that needs for information will not be developed in isolation from the activities of major planning, funding and professional groups in the health services. Two major issues are identified in the literature - the utilization of Emergency Departments and thrusts towards classification or categorization of Emergency Department capabilities. From this, three major policy/planning foci are selected - day to day emergency care, disaster planning, and the "mopping-up" role of Emergency Departments. Ideas about these are developed in light of six classifications of information users' needs - patient care, management, quality of care, strategic planning, research and development and policy-formulation. "Needs" were validated by two panels of major decision-makers from a representative sample of Greater Vancouver Regional Hospital District Hospitals. The results of the investigation are analyzed in light of the issues of professional power and control and political influences and recommendations made as to the appropriate components of a hospital emergency department information system. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Emergency Management Information Systems (EMIS) are defined as a set of tools that aid decision-makers in risk assessment and response for significant multi-hazard threats and disasters. Over the past three decades, EMIS have grown in importance as a major component for understanding, managing, and governing transportation-related systems. To increase resilience against potential threats, the main goal of EMIS is to timely utilize spatial and network datasets about (1) locations of hazard areas (2) shelters and resources, (3) and how to respond to emergencies. The main concern about these datasets has always been the very large size, variety, and update rate required to ensure the timely delivery of useful emergency information and response for disastrous events. Another key issue is that the information should be concise and easy to understand, but at the same time very descriptive and useful in the case of emergency or disaster. Advancement in EMIS is urgently needed to develop fundamental data processing components for advanced spatial network queries that clearly and succinctly deliver critical information in emergencies. To address these challenges, we investigate Spatial Network Database Systems and study three challenging Transportation Resilience problems: producing large scale evacuation plans, identifying major traffic patterns during emergency evacuations, and identifying the highest areas in need of resources. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients, that the nurse knows or is related to, cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.

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Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Responses were individually reviewed and coded by the research team.Results: Major obstacles relating to ED design identified by emergency nurses included (1) many issues related to limited space, (2) poor department layout and design features, and (3) the lack of privacy. Despite EDs being a challenging place to provide EOL care, positive ED design characteristics impacted EOL care for dying patients and families.Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed due to the immediate need for a second trauma patient and family. Nurses can evaluate existing facilities and identify areas where potential change and remodeling would improve patient care, increase patient privacy, or further utilize space. Conclusion: Understanding ED designs impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new EDs or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.