Effective teamwork has been shown to optimize patient safety. However, teamwork research in Emergency Medical Services (EMS) is sparse. Before successful interventions can be implemented, the appropriate content of such interventions should be determined. We tested the applicability of a teamwork processes framework in emergency care (Fernandez et al., 2008) to the EMS context. We recruited participants from an EMS agency in Houston, TX, using purposive sampling. Full-time employees with a valid EMT/paramedic license were eligible. Using semi-structured format, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS. Phone interviews were recorded and transcribed. Structural coding was based on our theoretical model. Through a deliberative process, we combined codes into candidate themes. Analytic memos during coding and analysis identified potential themes, which were reviewed/refined, and compared against our framework. We reached saturation once 32 respondents completed interviews. Among participants, 30 (94%) were male; the median experience was 15 years. Our analysis identified the team processes in the Marks’ Teamwork Process Model in four domains: Action, Planning, Reflection and Interpersonal Processes. Additionally, the concepts cited as being central to team effectiveness in EMS were: leadership, crew familiarity, team cohesion, interpersonal trust, shared mental models, and procedural knowledge. The revised model was useful for describing teamwork processes that providers employ to drive performance in EMS. Additionally, we identified emergent concepts that influence teamwork processes in EMS. Our findings inform our understanding of teamwork processes in EMS, and may be useful in guiding future team-based interventions tailored to EMS. / 2019-11-08T00:00:00Z

This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.

This study examines the visibility of moral agency in the daily work and production of healthcare in emergency medicine at an urban emergency medical center in the United States. Through detailed ethnographic research, this study investigates how the work of paramedics, nurses and physicians within their professional practice spheres of emergency medicine constantly resolve challenges that make their moral agency visible. Several themes emerge from this study by examining and closely noting how these individuals interact and express less a principled bioethical script, but instead a personal one that is or is not explained by their professional role in treating patients. This study follows the daily conversations and interactions that embody the local moral worlds of emergency medicine in paramedics, nurses and physicians and how each of these professional groups work through and around medical and patient care issues to create care. As these individuals within their professional role address challenges in emergency care, it is their interactions and conversations that make visible the moral agency of the individual healthcare worker. By examining the domain of these work lives this study investigates the ongoing and new conflicts and resolutions for the healthcare workers and how they assert moral agency; the intersubjective local moral worlds of care; use of technology to mediate care; and the structure of medicine in emergency medical care.

Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018. / Physical injury is a major cause of premature death and disability worldwide (WHO, 2015). Mortality statistics for South Africa indicate that approximately half of all injury-related deaths were intentionally inflicted, often as a result of sharp-force injuries (Donson 2009). Cape Town is reputed to be a violent city (Nicol et al., 2014). Pre-hospital emergency care providers are often the first medical contact for injured patients. Previously, it was understood that high volume crystalloid administration would improve survival and was standardised in the management of shock (Santry & Alam 2010). However, over-administration of crystalloid fluid can cause patient harm by potentially worsening injuries and can be detrimental to a patients survival. Current evidence supports the practice of lower volume crystalloid intravenous fluid administration- permissive hypotension. Little is known about pre-hospital emergency care providers intravenous fluid management practices for penetrating injury. Injury surveillance data for victims of penetrating injury is also scarce with the majority of current data taken from mortality sources. Surveilling pre-hospital cases may yield opportunities for prevention from premature mortality and morbidity. The aim of this study is to undertake surveillance of penetrating injury and related intravenous fluid resuscitation in the pre-hospital emergency care environment. A prospective observational descriptive survey was conducted in the Cape Metropole1. Over three consecutive months, emergency care providers documented parameters related to mechanism of injury, scene vital signs, hospital vital signs, intravenous fluid resuscitation and basic patient demographic information for patients with penetrating injury. A predetermined inclusion and exclusion criteria was used to sample patients.

Emergency Medical Service (EMS) professionals are consistently exposed to a variety of traumatic events on the job, such as cases that involve the death or injury of a patient, being physically threatened, or encountering a mass casualty incident. Not surprisingly, research has found that such traumatic exposure has major implications, as it has been related to a plethora of negative strain outcomes such as posttraumatic stress (PTS) symptoms and burnout. However, at this point, research has not empirically examined the mechanisms by which these traumatic events lead to strain. Therefore, this study aims to further investigate these mechanisms by incorporating the role that emotion regulation (i.e., expressive suppression) plays in this process. Further, this study investigates various moderators in this process, including one individual difference factor (i.e., implicit theories about emotion expression) and two contextual factors (i.e., social support and organizational constraints). To test the links in the aforementioned process, a weekly diary study was conducted online with 200 current EMS professionals. Specifically, participants completed a baseline survey (Time 0) that measured trait-level variables and demographics. Then, participants completed 10 weekly diary studies that included measures of exposure to traumatic events, negative affective reactions, expressive suppression, and strain outcomes. Multilevel structural equation modeling was used to test the study hypotheses. Results of this study show that within person, traumatic event exposure was related to strain. Further, although traumatic event exposure was not consistently related to expressive suppression, the positive link between expressive suppression and strain was consistent. Additionally, organizational constraints were found to serve as a moderator in the relationship between expressive suppression and strain, such that higher organizational constraints exacerbate this relationship. Overall, these results provide a better understanding of the process that links traumatic event exposure to strain in the EMS profession. This research has implications for organizations, as it examines various factors that may be addressed in order to ensure that EMS professionals are better equipped to deal with these unfortunate exposures. Ultimately, the results of this study will hopefully prove helpful in devising interventions to enhance the wellbeing of EMS professionals in the wake of exposure to traumatic events.

Emergency departments (ED) provide access to care for large numbers of patients who have nonemergent medical needs. More than half of the patients presenting to the ED at Salem Hospital in Salem, Oregon, were found to be seeking care for nonemergent medical needs. In an effort to provide an alternative location for receiving this medical care, the hospital opened an Urgent Care Center (UCC) a few blocks from the ED. The purpose of this study was to determine who uses the ED, why, and what effect the UCC had on providing an alternative to the ED. My anthropological methodology uses both quantitative and qualitative techniques. Included in the study is a random retrospective chart review of 462 patients who utilized the ED and 183 patients who utilized the UCC. The collected data were analyzed and compared with information found in the literature review. Interviews with hospital staff and patients using the two facilities are integrated into the analysis. My own experience as a nurse allows me a certain insider's perspective which was useful in interpreting data, while doing observation, and during the interview process. Findings from my research show that the Urgent Care Clinic does provide an alternative source of health care to the ED for many people. This is particularly true for those whose usual source of care is unavailable and for those who are unable to find a primary care provider to accept them. The emergency department provides nonemergent care for large numbers of patients, some of whom have psycho-social problems which differ as compared to the general population. Some of these patients have moderate psychiatric dysfunction and/or addiction problems or homelessness as well as underlying medical problems, all of which are barriers to obtaining care in a regular office setting. In some cases, the emergency department provides the best option of available care. / Graduation date: 1999

<p>Syfte: </p><p>Syftet med studien var att studera erfarenheter, inställning och önskemål inför arbete med förskrivning av fysik aktivitet på recept, FaR, på vårdcentraler i Stockholms innerstad. Ytterligare ett syfte var att ge förslag på modeller för hur vårdcentralerna kan arbeta med FaR, bland annat gällande samordningsfunktionen mellan olika aktörer.</p><p>Metod: </p><p>En enkätstudie genomfördes på totalt 13 vårdcentraler på Kungsholmen, Norrmalm, Vasastaden, City, Östermalm, Hjorthagen och Gärdet. Totalt 119 enkäter besvarades av läkare, sjuksköterskor och undersköterskor. En intervju genomfördes med en person anställd på Beställarkontor Vård, Stockholms läns landsting för att ta reda på hur de ser på hinder, möjligheter och genomförbarhet av FaR och FYSS inom SLL.</p><p>Resultat: </p><p>Från enkätundersökningen framkom bland annat att en klar majoritet svarande ställde sig positiva till att arbeta med fysisk aktivitet på recept både i preventivt och behandlande syfte. Mer information och utbildning efterfrågades av många. Ungefär hälften av personalen på vårdcentralerna angav att de kände till FYSS respektive FaR. 104 av de svarande uppgav att de idag rekommenderar fysisk aktivitet muntligt. Endast 14 gav en skriftlig rekommendation. En övervägande andel av de tillfrågade var positiva till arbetsformer såsom skriftlig rekommendation, motiverande samtal, arbeta med en koordinatorfunktion samt tillämpning av hälsotest. Från enkätundersökningen framkom vidare att det finns en oklarhet kring metoderna för att hjälpa patienten till lämplig aktivitet samt för motivation och uppföljning av patienten. Hela 82 tillfrågade upplevde inte att det fanns några hinder för att arbeta med FaR. De vanligaste hindren i arbetet med FaR uppgavs vara osäkerhet om vart man kan skicka patienten med receptet, osäkerhet kring förskrivningen av FaR samt tidsbrist.</p><p>Slutsats: </p><p>I enkätundersökningen framkom således att det fanns ett stort intresse för att arbeta med FaR i Stockholms innerstad. I dag saknas dock utarbetade metoder för arbetsprocessen med FaR samt friskvårdsaktörer att skicka patienterna till. Från tidigare studier har framkommit att för ett lyckat arbete med FaR krävs utbildning i FaR och FYSS hos vårdpersonalen, motiverande samtal med patienten, en koordinator med kontakt till friskvårdsaktörer samt uppföljning av patienten med receptet.</p> / <p>Aim: </p><p>The aim of this study was to look at the experience, attitude and needs in the primary care in the city of Stockholm in order to work with FaR (physical activity by prescription) and the book FYSS (Physical activity in health prevention and medical treatment). Another purpose was to make a suggestion for a model of how the primary care may work with FaR, for example with a co-ordinator function.</p><p>Method: </p><p>A questionnaire was handed out to 13 healthcare centres at Kungsholmen, Norrmalm, Vasastaden, City, Östermalm, Hjorthagen and Gärdet. 119 questionnaires were answered and handed in. The people participating in the study were doctors and nurses. One person at BKV, SLL, (BKV decides what the healthcare in Stockholm should focus on and not) was interviewed, to find out how they look upon obstacles, possibilities and if and how FaR and FYSS is an alternative in SLL.</p><p>Results: </p><p>The study showed that the big majority were in favour of working with FaR an FYSS both in health prevention and health care. Many of those who participated in the study wanted more information and education. About half of the respondents knew what FYSS respectively FaR were. 104 answered that they gave an oral recommendation to their patients. Only 14 prescribed written recommendations. A majority were in favour of working with written recommendations, motivating conversations, working with a co-ordinator and applying some kind of health test. Another result from the study was that there are a lot of questionmarks when it comes to helping the patient to start with a suitable activity, motivation and evaluation. Interestingly 82 of the respondents did not see any obstacles working with FaR. The most frequent obstacles suggested were insecurity of where to send the patient, insecurity of how to work with the process of prescription and the lack of time.</p><p>Conclusion: </p><p>In this study it was concluded that there is a big interest in working with FaR. Today there is a lack of effective working methods and activities to send the patients to. Earlier studies have shown that for FaR to work successfully it requires education in FaR and FYSS for the health care staff, motivating conversations with the patients, a co-ordinator with contacts with the prophylaxis and a follow up</p>

<p>Syfte och frågeställningar</p><p>Syftet med denna uppsats var att utifrån intervjuer med representanter för olika företag belysa och problematisera hur den särskilda sjukförsäkringsavgiften kommer att påverka företagens personalpolitik.</p><p>Frågeställningar var:</p><p>- Hur påverkar den särskilda sjukförsäkringsavgiften företag?</p><p>- Vad är företags åtgärder för att möta den särskilda sjukförsäkringsavgiften?</p><p>- Hur långt ska företagens ansvar för individens hälsa sträcka sig?</p><p>Metod</p><p>Utifrån ovan nämnda syfte valdes en kvalitativ undersökning. Sex representanter från olika företag intervjuades varpå innehållet i det material som erhölls tolkades och problematiserades; eventuella motsägelser i respondenternas tankebanor lyftes fram likväl som orsak- och verkansamband mellan olika aspekter belystes. Dessa aspekter knöts sedan an till relevant teori eller litteratur för att avslutningsvis diskuteras i ett större perspektiv.</p><p>Resultat</p><p>Den särskilda sjukförsäkringsavgiften kommer för de intervjuade företagen att innebära en ökad kostnad som många gånger upplevs som orättvis och en följd av införandet kan bli att företagen i framtiden blir försiktigare vid nyrekryteringar. Företagens strategi för att bemöta sjukpenningsreformen är i första hand en ökad fokusering på rehabilitering. Ansvaret för individens hälsa anser företagen vara gemensamt, deras huvudsakliga uppgift är dock att skapa goda förutsättningar för medarbetarna under arbetstimmarna.</p><p>Slutsatser</p><p>Det faktum att rehabilitering är den åtgärd som företagen huvudsakligen fokuserar på i dagsläget kan tolkas som att det på de intervjuade företagen råder ett sjukdomssynsätt. Detta innebär att hälsa är detsamma som frånvaro av sjukdom och ett hälsoarbete innebär då att man behandlar och förebygger sjukdom. Man tar således inte bort orsaken till problemet vilket kan liknas vid att när ett badkar svämmar över, endast torka upp vattnet på golvet istället för att stänga av kranen.</p> / <p>Aim</p><p>The aim of this essay was, based on interviews with representatives from different corporations, to enlighten and problemize how the co-financing reform will affect the corporate policies regarding human resources.</p><p>The questions were:</p><p>- How will the co-financing reform affect corporations?</p><p>- What is the corporate measures to co-financing reform?</p><p>- How far does the corporations´ responsibility for the employees´ health reach?</p><p>Method</p><p>Based on the aim a qualitative research was chosen. Six representatives from various corporations were interviewed whereas the content of the material given was interpreted and problemized; contradictions in the respondents thoughts were high lightened as well as cause- and effect between different aspects were enlightened. These aspects were then connected to relevant theory and literature and finally discussed in a larger perspective.</p><p>Results</p><p>The co-financing reform will, for the interviewed corporations, lead to an increase in cost that may seem unjust and a result of the introduction can lead to the corporations being more cautious when employing. The corporate strategy to answer to the co-financing reform is primarily an increase in focus on rehabilitation. The responsibility for the individuals´ health is in the mind of the corporation shared; their prime task is though to create possibilities for the employees during work hours.</p><p>Conclusions</p><p>The fact that rehabilitation is the measure the corporations are primarily focusing on today can be interpreted as that there is a view of illness. This means that health equals lack of illness and health work in this sense means treating illness, rather than eliminate the cause of the problem.</p>

<p>Aim</p><p>The aim with this essay was to find out what the personal in the primary care of Värmdö have for attitude to work with physical activity in prevention and treatment of diseases, how they work with the method today and how they think about working with the method in the future. Following questions were in focus of the study: How are they working in the primary care of Värmdö today with physical activity in prevention and treatment of diseases? What is the attitude to work with physical activity in prevention and treatment of diseases? And how do they want to work with physical activity in prevention and treatment of diseases in the future?</p><p>Method</p><p>The study includes all doctors, nurses and physiotherapists in Gustavsberg and Djurö primary care in Värmdö. To get answers on the question of issue was a questionnaire handed out. 82 % answered, which means that 45 of totally 55 employed in both primary care units answered the questinnaire.</p><p>Results</p><p>44 of 45 asked reported that they give verbal advice about physical activity to their patients today. 10 doctors and nurses answered that they sometimes complete the verbal advice with a written prescription on physical activity. 42 of 45 were very positive adjusted to work with physical activity in prevention of diseases. 40 of 45 were very positive adjusted to work with physical activity as a treatment of diseases.</p><p>Discussion</p><p>The study showed that almost all asked were positive adjusted to work with physical activity in prevention and treatment of diseases and that almost all are given verbal advice about physical activity today. It is however few that gives prescription on physical activity. The results indicate a lack of structure in both primary care units about how you should work with the moments that is included in a prescription on physical activity. It was few that saw any obstacle to work with physical activity on prescription and almost all was positive to work with physical activity on prescription including those methods that could lead to a more structure work with physical activity in this primary care units.</p> / <p>Syfte och frågeställningar</p><p>Syftet med denna studie var att ta reda på vad personalen på vårdcentralerna i Värmdö har för inställning till att arbeta med fysisk aktivitet som sjukdomsprevention och sjukdomsbehandling, hur de arbetar med metoden idag samt hur de kan tänka sig arbeta med den i framtiden. Frågeställningarna var: Hur arbetar man på vårdcentralerna i Värmdö med fysisk aktivitet som sjukdomsprevention och sjukdomsbehandling idag? Vad har man för inställning till att arbeta med fysisk aktivitet i sjukdomspreventivt syfte och som sjukdomsbehandling? Hur vill man arbeta med fysisk aktivitet som prevention och behandling i framtiden?</p><p>Metod</p><p>Studien innefattade samtliga läkare, sjuksköterskor, sjukgymnaster och arbetsterapeuter på Gustavsberg och Djurö vårdcentral i Värmdö. För att få svar på studiens frågeställningar utformades ett enkätformulär. Svarsfrekvensen uppgick till 82 % vilket innebär att 45 av totalt 55 anställda personer på de båda vårdcentralerna har svarat på enkäten.</p><p>Resultat</p><p>44 av 45 tillfrågade uppgav att de idag ger muntliga rekommendationer om fysisk aktivitet som sjukdomsprevention eller sjukdomsbehandling till sina patienter. 10 läkare och sjuksköterskor uppgav att de ibland kompletterar den muntliga rekommendationen med ett recept på fysisk aktivitet. 42 av 45 tillfrågade var mycket positivt inställda till att arbeta med fysisk aktivitet i sjukdomspreventivt syfte. 40 av 45 tillfrågade var mycket positivt inställda till att arbeta med fysisk aktivitet som sjukdomsbehandling.</p><p>Diskussion</p><p>Studien visade att i stort sett alla tillfrågade var positivt inställda till att arbeta med fysisk aktivitet som sjukdomsprevention och sjukdomsbehandling och att de flesta idag ger muntliga rekommendationer om fysisk aktivitet. Det är dock få som kompletterar den muntliga rekommendationen med en skriftlig ordination. Resultaten indikerar att det saknas en tydlig struktur på vårdcentralen för hur man ska arbeta med de moment som en ordination av fysisk aktivitet på recept innefattar. Det var få som såg hinder för att arbeta med ordination av fysisk aktivitet i primärvården och de allra flesta var positivt inställda till att arbeta med de metoder som skulle kunna leda till ett mer strukturerat arbete kring skriftliga ordinationer av fysisk aktivitet.</p>