Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature makes it clear that rate of road traffic death is related to country income and governance indicators, so first those variables needed to be equalized. My conceptual framework for this cross-sectional correlation study was the Haddon matrix, which organizes injuries by temporal (pre-event, event, and postevent) and epidemiological (host, agent, and environment) factors. Using World Health Organization data on road traffic injury and country income, World Bank data on governance indicators, and a literature search of 67 countries' prehospital response profiles, significant negative correlations (p > 0.001) were found for road traffic deaths and income, r (65) = -0.68, and governance indicators, r (65) = -0.646. No significant difference in the rate of road traffic death was found between physician and nonphysician prehospital staffing. Because increasing countries' income and improving governance are long-term, ambitious goals for developing countries, training nonphysician prehospital responders appears to be the most effective social change to decrease the burden of road traffic deaths.

Varje år genomför cirka 1100 personer i Sverige ett suicid. Varje suicid föregås av i genomsnitt 10 suicidförsök. Detta orsakar förutom kostnader i form av oerhörda summor pengar för samhället också otroligt mycket lidande för anhöriga. Ambulanssjuksköterskan är många gånger den första resursen i vårdkedjan som den suicidnära kommer i kontakt med. Detta ställer stora krav på bemötandet av patienten men också krav på kunskap om medicinska åtgärder för att rädda personen till livet. Detta arbete avser att studera ambulanssjuksköterskans bemötande och egna upplevelser av mötet med den suicidnära patienten genom att intervjua ambulanssjuksköterskor i Uppsala. Studien visar att få ambulanssjuksköterskor upplever sig ha tillräcklig kompetens för att bemöta den här typen av patienter. Vidare framgår att ambulanssjuksköterskan i mycket stor utsträckning känner en misstro till den vård som patienten erhåller från psykiatrin och att det förekommer stora skillnader i hur ambulanssjuksköterskan resonerar kring sin egen säkerhet i mötet med patienten. Studien visar också att de flesta av ambulanssjuksköterskorna bemöter patienterna enligt POSP-riktlinjerna (Prehospitalt Omhändertagande av Suicidnära Patienter). Patienten skriker ofta efter hjälp i samband med ett suicidförsök och vågar man identifiera syftet med handlingen så möts man ofta med tacksamhet. / Annually around 1100 individuals in Sweden end their lives by committing suicide. Prior to every completed suicide estimate shows that 10 attempts have been made. This results in both high costs for the society and unmeasurable suffering for their relatives. The nurses that are working in the Swedish ambulance system are often the first medical resources with whom the suicidal patient has contact. This means high demands are placed on the nurse both regarding the meeting itself with the patient but also with the medical knowledge that could prove to be lifesaving in an acute situation. This paper seeks to study the professional interaction and the strategies that the nurse uses to help the suicidal patients and their own experiences of the meeting by interviewing nurses working in the Uppsala ambulance service. This study shows that the nursing staff experiences a lack of knowledge in the meeting with the patients and a clear disbelief in the care that the patients receive at the psychiatric ward. Furthermore the study shows that most nurses in the study interact with the patients in accordance with the POSP-guidelines. The patient is often crying for help in connection to a suicide attempt and if the nurse has the courage to identify the purpose with the action one is most often met with gratitude.

Situated cognition argues that learning takes place in an embedded social and physical environment, and through a social process, reality takes on meaning. This dissertation investigated if a link exists between learners’ participation and advancement within a sociocultural community of practice as specifically evidenced by higher rates of tracheal intubations on live patients and scores on the national certifying examination by paramedics. During 2006, paramedic students taking the national certifying examination were asked to answer a post-examination questionnaire quantifying the number of intubations performed during training. For intubation experience, significant odds ratios (relative to none performed) were observed for 4 to 9 performed [OR = 1.66, 95% c.i. = (1.24, 2.23)] and 16 or more performed [OR = 1.76, 95% c.i. = (1.21, 2.56)]. The male to female odds ratio [OR = 1.25, 95% c.i. = (1.04, 1.52)] was significant. For age category, significant odds ratios (relative to 40 and over) were observed for 20 to 24 [OR = 1.70, 95% c.i. = (1.27, 2.28)] and 25 to 29 [OR = 1.32, 95% c.i. = (1.00, 1.73)]. For education, the bachelor’s degree to high school odds ratio [OR = 2.56. 95% c.i. = (1.95, 3.35)] was significant. For ethnicity, significant odds ratios (relative to African-Americans) were observed for whites [OR = 1.69, 95% c.i. = (1.04, 2.74)] and others [OR = 2.33, 95% c.i. = (1.15, 4.72)].The multivariable logistic regression model results suggest that the number of tracheal intubations, sex, ethnicity and education level are all associated with greater odds of passing the certifying examination. In addition to traditional classroom lectures and activities, paramedic students also learn in clinical situations with varying levels of supervision culminating in near independent practice. Theories of situated cognition provide insight into these clinical learning situations that break from traditional models. When context, content, and community merge, knowledge is generated in new and meaningful ways. By participating in communities of practice, knowledge is transferred, created, and altered along with the learner through active engagement with all the illstructured, dynamic, and unpredicted opportunities the ‘real world’ offers. The students’ exposure to live tracheal intubations during training serve as an example of situated learning environments and its influence can be observed through the national certifying examination. The findings provide guidance for paramedic educators in creating situative learning affordances and specifically, determining the number of tracheal intubations performed during paramedic training.

Syfte: Undersöka sjuksköterskor inom ambulanssjukvårdens erfarenheter och upplevelser av hot och våld i arbetslivet. Metod: Empirisk studie med kvalitativ ansats. Sex semi-strukturerade intervjuer genomfördes. Materialet analyserades med en innehållsanalys. Resultat:  Hot om våld och patienter med ett hotfullt beteende är en del av arbetet i ambulansen enligt informanterna. Med stöd av direktiv och riktlinjer från arbetsgivfaren prioriteras personalens säkerhet alltid först och vid varje patientkontakt görs en samlad analys av hotbilden. Ambulanssjuksköterskans bemötande är viktigt vid mötet av en hotfull patient. Studien ger en bild av att flera av informanterna beskriver att arbetet inom ambulanssjukvården kan upplevas otryggt eftersom man många gånger befinner sig i okända miljöer med begränsade resurser och vårdutrymmet i ambulansen upplevs som problematiskt då utrymmet är begränsat. På grund av en rädsla för att provocera patienten till ett våldsamt beteende görs endast de undersökningar som är mest nödvändiga. Undersökningar som gör ont eller som kan uppfattas provocerande av patienten eller andra närvarande utförs med försiktighet för att minska risken för att väcka agitation gentemot personalen. Kompletterande utbildning i hantering och bedömning av psykotiska och drogpåverkade ansågs relevant och efterfrågades. Några informanter påpekar även att larmcentralen bör bli bättre på att skicka med polis till misstänk hotfulla arbetsmiljöer. Slutsats: Prehospitalt arbete medför en stor risk att exponeras för hot och våld. Studien ger en bild av att ambulanssjuksköterskorna efterfrågar mer utbildning inom hantering och bemötande av hot och våld. / Objective: To study paramedics’ experiences and views of threats and violence in their daily work. Method: Empirical study with a qualitative approach. Six semi-structured interviews were performed. Results: Threats, violence and people with threatning behavior are a part of paramedics' daily work according to the participants in the study. With the support of directives and guidelines from the employer the safety of the staff is always to be prioritized first. At each patient contact, an overall threat assessment is performed. Ambulance staff attitude is important in the meeting of a threatening patient. The study provides a picture where several of the participants describe that working within the ambulance service may feel unsafe. This is due to the fact that they often find themselves in unfamiliar environments with limited resources. Fear of causing violent behaviour in the patient limits the staff to only adressing the most important vital parameters. Examinations that cause pain or might be percieved as provocative by the patient or others present on the scene are performed with caution to minimize the risk for aggression towards the staff. Also, the workspace in the ambulance is perceived as problematic as space is limited. Additional training in handling and assessment of psychotic and intoxicated patients is considered relevant and requested. Some patricipants also point out that the monitoring center should be better at sending the police to work environments that can be potentially threatening. Conclusion: Prehospital work involves a large risk of exposure to threats and violence. The study provides a picture of the ambulance personnel asking for more training in handling and addressing threats and violence.

This action research study explored the supports required to facilitate the successful transition for new graduate paramedics integrating into their role and to provide recommendations to AHS Emergency Medical Services managers to implement a positive change outcome. AHS paramedics who graduated in the last three years participated in a focus group and online survey. The study findings revealed that the transition experience was challenging and caused stress and anxiety for new graduates. Having a support system in place could increase job satisfaction, retention, organizational commitment, and enhance employee skill development. The study concluded that implementing a mentorship program with support of AHS leadership would prove invaluable. The recommendations reflect the importance of providing a healthy and supportive work environment and working collaboratively with key stakeholders to develop and implement support for new graduate paramedics in AHS. This study adhered to all ethical requirements.

Thesis (M.S.M.)--Regis University, Denver, Colo., 2006. / Title from PDF title page (viewed on Aug. 29, 2006). Includes bibliographical references.

Accidents with mass disability of people occur more and more. No matter if they are of a natural or human origin they are still a burden for both the rescuers and the civilian inhabitants. They have a huge impact on the social and economic aspects of the society. It si inevitable to be ready for such incidents in a sufficient way and thus keep the impact on the human health, lives and property as small as posssible. The purpose of this thesis is to analyse the education of paramedics in the Slovak Republic and the Czech Republic in three dimensions. First of all it is a complementary overview of the school education within the bachelor college study. The second level is addressing the providers of paramedical care and services and compiling an overview of the education at both the teoretical and practical level carried out for their employees. The third part consists of a summary of the current possibilities of individual education provided by conferences, competitions and trainings within associations or organizations. The thesis consists of 4 theoretical chapters and 3 chapters in the empirical part. In the theoretical part we define the medicine of disasters, massive accidents, incidents with a massive inflictions of persons, the sorting system START and others. We talk about the history and current practise of interventions within massive incidents. We also describe the occupation of a paramedic from the perspective of his/her competence, operation of a rescue service and methods of education. We focused mainly on trainings which are the most frequent form along with lectures. In the practical part we analyse the education of paramedics within schools by the means of the content and time. Based on the received questionaires we compare activities which are provided by paramedical care providers for the purpose of education, training and readiness of health care workers for the interventions with a large number of victims. The practical usage we illustrate in casuistics. We summarise a database of congresses, competitions and trainings carried out in given areas in the CR and SR. This thesis can be used as a base in the area of improving the education of paramedics in the area of emergency incidents for schools and paramedical services providers or the needs of the Ministry of Health, Ministry of Education. The differences found between the subjects or republics can be motivating for further progress of education. There is also space for removing all the found imperfections or development of new methods of educating.

The material in current emergency medical services (EMS) curricula is insufficient to prepare prehospital emergency medical care personnel recognize the signs and symptoms of post-traumatic stress disorder (PTSD) within their workforce. Prehospital emergency textbooks focus on treating patients affected with PTSD, but there is very little included about how EMS professionals may also be affected. Moreover, supervisors and managers of EMS agencies receive very little education on workforce PTSD in their personnel. The purpose of this study was to understand the educational preparation of EMS supervisors in order to develop a PTSD-awareness course. The research question investigated the educational preparation that EMS supervisors receive. The conceptual framework of the study was Conti-O’Hare’s wounded healer theory. EMS professionals are wounded healers from frequent critical incident exposure. A qualitative approach featuring a case study design was used. The study included 9 participants. A focus group was used that consisted of three paramedics and three emergency medical technicians (EMTs). Separate interviews were conducted with three EMS supervisors. Data gained from the focus group and individual interviews were analyzed through coding with the goal of investigating the education received by EMS supervisors on PTSD. The themes that emerged were EMS supervisors do not receive enough education on workforce PTSD and a course specifically targeted on this subject is needed. Positive social change may be achieved through this study by enabling EMS managers to help paramedics and EMTs cope with a critical incident (CI) improving prehospital healthcare.

This master thesis follows up the topic of posttraumatic growth of paramedics. The first part clarifies the concept of posttraumatic growth and factors which influence the process of growth that is following the trauma. The most substantial models of posttraumatic growth are also included. A paramedic as a profession is described, too. In this part, requirements for paramedics and possible intervences often used to handle with the stressful event. The empiric part deals with the relationship between posttraumatic growth and coping strategies among paramedics. A use of positive coping strategies is a possible way how to reach a higher level of post traumatic growth. The questionnaires PTGI and SVF 78 are used in the research to detect the level of posttraumatic growth achieved and the coping strategy that is used by the participants. The questionnaire PTGI detects the change in five areas: relationships with other people, stregths, new opportunities, change in spiritual areas and understanding of life. The research shows positive corelation between the level of posttraumatic growth and following coping strategies: control of situation, control of reactions and positive self- instruction. It was also found that women reach significantly better in the subscales relationships with other people and...

Bakgrund: En ambulans är en bil som är utrustad för att kunna utföra ambulanssjukvård och transportera akut sjuka patienter till sjukhus. Arbetsrelaterad stress innebär sambandet mellan anställda och arbetsmiljö på arbetsplatser. Det uppkommer när kraven på de anställda överstiger vad de egentligen klarar av. Sjuksköterskans kärnkompetenser bygger på ett ansvar att upprätthålla en god personcentrerad omvårdnad. Metod: Metoden var en kvalitativ empirisk intervjustudie. 2 ambulanssjuksköterskor och 2 sjuksköterskor som arbetar inom ambulanssjukvården intervjuades. Materialet analyserades genom Graneheim och Lundmans (2003) kvalitativa innehållsanalys. Syfte: Syftet med studien var att undersöka om och hur arbetsrelaterad stress påverkar den personcentrerade omvårdnaden till patienter inom ambulanssjukvården. Resultat: Genom den kvalitativa innehållsanalysen identifierades 2 kategorier: Upp till bevis och två sidor av samma mynt. Underkategorier till respektive tema identifierades. Resultatet visade att sjuksköterskorna som intervjuades menade att kollegor har en stor betydelse, erfarenhet och kompetens är viktigt för att känna trygghet, de upplevde en annan typ av stress när de var nya och att anhöriga kan bidra till den stressen som sjuksköterskan kan uppleva. Konklusion: Arbetsrelaterad stress är något som sjuksköterskor i ambulanssjukvården upplever. Syftet med denna studien var att undersöka hur detta kan påverka den personcentrerade omvårdnaden för patienten. Slutsatsen är att sjuksköterskorna inte upplever stress för patienten utan faktorer runt omkring. / Background: An ambulance is a car that is equipped to carry out prehospital care and transport acutely ill patients to hospitals. Work-related stress is defined as the relationship between employees and the work environment in workplaces. This occurs when the work load for employees exceed what they are actually capable of. The nurse in the ambulance is responsible for ensuring that good care is maintained as stated in the nurse's core competencies. Method: The method was a qualitative empirical interview study. 2 ambulance nurses and 2 nurses working in the ambulance service were interviewed. The material was analyzed through Graneheim and Lundman's(2003) qualitative content analysis. Aim: The aim of this study was to examine if work-related stress affects the person centered care to patients in prehospital care. Findings: Through the qualitative content analysis, 2 categories were identified: Earn your stripes and two sides of the same coin. Subcategories of each theme were identified. The results showed that the nurses interviewed meant that colleagues have a great importance, experience and competence are important to feel safe, they experienced a different type of stress when they were new and that relatives can contribute to the stress that the nurse can experience. Conclusion: Work-related stress is something that nurses experience. The aim was to investigate how this can affect the person-centered care for the patient. The conclusion is that the nurse´s do notexperience stress for the patients, but factors around.