Bakgrund: Att vara illamående påverkar människan negativt och den som upplever illamående känner ofta samtidigt ett lidande. Ett av sjuksköterskans grundläggande arbeten är att lindra lidande och främja hälsa. För att på bästa sätt kunna lindra lidande behöver ambulanssjuksköterskan behärska både sina vårdvetenskapliga och medicinska kunskaper. Illamående inom ambulanssjukvården är ett relativt outforskat område som förtjänar ett större fokus. Syfte: Studiens syfte var att kartlägga förekomsten av illamående hos patienter inom ambulanssjukvården samt om faktorer som kön, ålder, vårdtid i ambulans och mottagande klinik relaterat till sjukdomstillstånd utgör skillnader i förekomsten av illamående. Metod: Undersökningen genomfördes som en retrospektiv journalgranskning med en kvantitativ ansats där 362 journaler granskades. Även demografisk data och farmakologisk behandling med antiemetika registrerades. Resultatet analyserades och hypotesprövningar genomfördes med chitvåtest. Resultat: Studien visade att 17,1% av patienterna var illamående, 17,4% var inte illamående och dokumentation om illamående saknades i 65,5% av journalerna. Patienter som led av kirurgiska tillstånd upplevde mer illamående jämfört med patienter med ortopediska eller medicinska tillstånd, p = 0,0303. En tendens till mer illamående hos kvinnor än män kunde tydas, liksom hos yngre jämfört med äldre. Det fanns även en trend till att illamåendet ökade vid längre vårdtider i ambulansen. Totalt 40,3% av patienterna som upplevde illamående behandlades med antiemetika. Slutsats: Studien visade att både dokumentation om illamående i ambulansjournaler och behandling av illamående var otillräcklig. Det fanns ett samband mellan mottagande klinik och frekvensen av illamående, där patienter med kirurgiska tillstånd upplevde mest illamående. Vidare forskning om avsaknad av dokumentation av illamående och vilka faktorer som påverkar förekomsten av illamående skulle kunna leda till en utveckling av behandlingsriktlinjer och beslutstöd inom ambulanssjukvården. / Background: Nausea is an unpleasant sensation that can cause considerable suffering. One important task for nurses is to relieve suffering and promote wellbeing. In order to relieve suffering paramedics need to be proficient in both medical and caring skills.  Nausea amongst patients within the ambulance service is a relatively sparsely researched field that deserves a greater focus. Aim: To examine the prevalence of nausea amongst patients within the ambulance service and whether the prevalence is affected by factors such as gender, age, time in the ambulance or clinic. Method: In this study 362 ambulance journals from a Southern region in Sweden were examined retrospectively for documentation of nausea. Demographic data and treatment with antiemetics were also recorded. Statistical analysis of significance levels was performed using the Chi-squared test. Results: In 17.1% of cases the patient suffered from nausea and in 17.4% there was documentation that the patient was not nauseous, while there was a lack of documentation in 65.5% of the journals. A significantly larger proportion of patients with surgical conditions suffered from nausea than those with medical or orthopaedic conditions (p = 0.0303). The prevalence of nausea was slightly greater for women than men and for patients under age 60 than over age 60 and there was a trend towards more nausea the longer the time in the ambulance was. Only 40.3% of those who reported nausea were given antiemetics Conclusions: The study showed that both documentation and treatment of nausea were inadequate. There was a connection between which hospital clinic the patients were handed over to and the frequency of nausea, with surgical patients showing the most nausea. Further studies are needed to investigate the lack of documentation of nausea within the ambulance service and factors influencing the prevalence of nausea. This could lead to a predictive instrument to help paramedics detect nausea and better protocols for treating and helping to alleviate nausea.

The United States is experiencing a severe shortage of Emergency Medical Service (EMS) paramedics. The job outlook for paramedics (EMT-P) for the years 2012-2022 is predicted to increase by 23%-33%, which is much faster than the 4% average increase of other first-response professions. The average tenure of paramedics is less than 4 years. There is a significant gap in the literature concerning paramedic personality traits and tenure. The primary objective of the current study is to provide empirical data on the personality traits possessed by long-term paramedics (5+ years), and compare them to those with shorter tenure (< 5 years). Using Allport's Trait Theory, I predicted that personality would affect paramedic longevity. The 6 personality traits tested were warmth, reasoning, emotional stability, liveliness, social boldness and openness to change. A socio-demographic questionnaire, determined the length of their EMS career, while the 16PF® Assessment, tested their personality traits. Using t tests, Mann-Whitney U tests, and a set of regression analyses, data were examined to determine if length of career and personality traits predicted paramedic tenure. The research sample consisted of long term paramedics and former paramedics. The results showed that of the 6 personality traits, only warmth was a significant predictor of paramedic tenure. A logistic regression showed for every additional point in warmth, the odds of leaving EMS prior to 5 years increased by a factor of 2.77. This study provides support for positive social change by helping EMS to learn how to increase recruitment and tenure. It also helps by advising EMS agencies to attend to the mental and emotional health of their paramedics by being aware of the level of their warmth personality trait.

The foundation of modern-day emergency medical service (EMS) systems began in 1966, based on hospital medical care. Demand for evidence to support prehospital practices that have been in existence for the past half-century has continued to grow; yet, researchers have not adequately explored the relationship between the medical certification level of emergency first responders and the amount of time an ambulance spends on the scene. The purpose of this quantitative study was to examine and compare ambulance scene times for emergency responses when basic life support (BLS) certified first responders or advanced life support (ALS) first responders are first on the scene, and whether the level of first responder training reduces the time spent on the scene by a paramedic ambulance. A final research question dealt with whether there is a relationship between how long the first responder is on the scene and the amount of time an ambulance spends at the scene of an emergency. The publicly available archival data used for the study were from a community that had BLS and ALS first responders. Data analysis involved t-tests of the hypotheses for the first 2 research questions and a linear regression analysis of the hypotheses for the third research question. The findings showed that there is a clear difference in ambulance scene times based on the certification level of the first responders. Advanced life support first responders significantly reduced the scene time of ambulances when they arrived at the scene prior to the ambulance. Positive social change could result from this study if understanding the impact that ALS first responders have on ambulance scene times leads EMS planning managers to deploy resources more strategically, thus improving the efficiency of the public safety system and saving lives.

[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.

Bakgrund:Under de senaste decennierna har medvetenheten om barnmisshandel samt utvecklingen av förebyggande politik kring detta ökat. Ambulanssjuksköterskor har en unik möjlighet att upptäcka dessa barn som misstänks fara illa då de är först på plats vid ett akut sjukdomstillstånd och kan se tecken i hemmiljön som kan leda till en orosanmälan. Det kan leda till ett minskat lidande för barnen men för att det ska kunna ske bör en medvetenhet om vad en orosanmälan innebär finnas. Syfte:Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser av att göra en orosanmälan av barn som far illa.   Metod:En studie med tio stycken kvalitativa intervjuer gjordes. En öppen fråga med möjlighet till följdfrågor ställdes utifrån en intervjuguide. Materialet analyserades på en latent nivå utifrån Lundman och Hällgren Graneheims kvalitativa innehållsanalys.   Resultat:Resultatet redovisas utifrån tre huvudkategorier; Misstankar väcks, Påverkan på orosanmälansamt Samarbete och Öppenhet. Av dessa kategorier framkom sju underkategorier som beskrev informanternas upplevelser. Det framkom att brist på kunskap angående identifieringen av barn samt en okunskap kring vad ens egenansvar innebär, finns. Rädslan för repressalier kan ses som en anledning till att orosanmälan inte görs.   Slutsats:Utbildning i ämnet barn som far illa är av stor vikt för att kunna identifiera de utsatta barnen. En rädsla för repressalier kan vara anledningen till att orosanmälningar inte görs men skulle kunna öka om möjlighet till anonymitet i utförandet finns. Mer utbildning och stöttning i ämnet behövs. / Background: In recent decades, awareness of child abuse and the development of preventive policies has increased. Ambulance nurse have a unique opportunity to identify children who may be in a vulnerable situation as they are the first at the scene in the event of acute illness and can pick up signs in the home environment which could lead to suspicions of neglect being reported.This may result in less suffering for the children concerned, but in order for this to happen, it is important to be aware of the implications of making a report. Purpose:The purpose of the study was to describe the ambulance nurses’ experiences of reporting suspicions of child neglect. Method:The study is based on ten qualitative interviews. One open question with the possibility of follow-up questions were posed, based on an interview guide. The material was analyzed on a latent level based on Lundman and Hällgren Graneheim's qualitative content analysis Result: The results are reported based on three main categories: Suspicions arise, Impingement of reporting child neglect andCooperation and Transparency.Seven subcategories, that best described the informants experiences, were then selected. It was found that lack of knowledge regarding the identification of children as well as an ignorance of what one's own responsibility implies exists. The fear of reprisals can be seen as a reason for not reporting on suspicion of child neglect. Conclusion: Education in the subject child neglect are important for identifying the exposed children. A fear of reprisals may be the reason why no report on child neglect is made but could increase, if there is an opportunity for anonymity in the implementation. More education and support on the subject is needed.

Members of the ambulance teams of Emergency Medical Services are increasingly becoming victims of assaults by patients, their close relatives or passers-by. Many of them does not end with only verbal threat or insult, but also with direct physical confrontations that affect not only the quality of pre-hospital care provided, but also the physical and psychological state of the crew members. On the contemporary risk of reprisal attacks aren't members of the Emergency Medical Service adequately prepared, equipped and mainly protected by law. Emergency Medical Service occupies a specific position with respect to powers and duties, which means to the level of legal protection in the same position as the basic components of the integrated rescue system. The theoretical part deals with the current level of legal protection of paramedic in practice. The beginning of work briefly defines and characterizes pre-hospital emergency care, which is the subject of daily activities of Emergency Medical Services. The analysis of laws listed the competencies of paramedic, then analysis of rights and obligations during the provision of pre-hospital care, but also offered a view of the recent changes in the legal protection or outlined the legal inequalities in Integrated Rescue System. The work also defined the risks of field emergency work and causes of aggression, which is causing attacks. The theoretical part is closed by chapter dealing with the consequences of the attacks themselves, which are taking their toll on the quality of pre-hospital care and the physical and mental state of paramedics. Introduction of practical part is dedicated to the processed statistical surveys. For the verification of research questions and for meeting the objective of this thesis was done supporting statistical surveys in order to determine the frequency of attack of paramedics in the individual regional emergency medical services in the period from 2010 to 2014, i.e. since amendment of the Criminal Code, which changed legal protection of paramedics. The aim is to evaluate the legal protection of paramedics in providing pre-hospital care and propose measures to improve its protection. The chosen research question determines what resources can be used to enhance the protection of paramedics For the practical part of the work was used the Region of South Bohemian, which was used for the qualitative method of data collection using structured interviews and subsequent analysis of data. Data collection was done through structured interviews and the sample consisted of 10-attackedparamedics in all regional centres of Emergency Medical Services in Region of South Bohemia in České Budějovice, Český Krumlov, Jindřichův Hradec, Písek, Prachatice, Strakonice and Tábor. As the respondents' answers fixation method was used audio recording, followed by transcription of the audio into written form. By summarizing data obtained from structured interviews was carried The SWOT analysis based on the comparison of the internal and external environment in order to evaluate the legal protection in practice. From the percentages of the individual areas of the SWOT analysis has been chosen, for the needs of the work, WO strategy, which is aimed at eliminating weaknesses using the opportunities. From the apparent results of the level of legal protection, which is also demonstrated by the worsening prognosis of processed survey in the practical part from which is monitored an increase of attacks were in response suggested means to increase the legal protection of paramedics, which aim to minimize attacks on outreach EMS crew.

This diploma thesis deals with problematic of emergency medical service preparedness in the Czech Republic, in the place of disaster and during this situation especially in bus accident with large number of injuries and casualties. Bus accident can create high risk of forming mass disaster due to many people transported in small area with low safety components. High risk of many injuries and casualties with chaotic first call make hard decision to activate plans to solve this situation for emergency services. Theoretical part of diploma thesis maps transformation of Czech paramedic system organization from districts to regions and new legislations for emergency medical service that solve preparedness, organization and duties during large incidents. Due to this new legislations were formed offices for emergency preparedness which ensure this preparedness. Practical part of diploma thesis is analysis of Czech paramedic preparedness that solve bus accidents as disaster. For this analysis were used data from regional emergency medical service headquarters (EMS HQ) - bus accident reports, drills for staff and special material equipments. But only 3 EMS HQ provided acceptable data and 1 EMS HQ partly acceptable data. Aim of this study is assessment in preparedness change for disaster during examined time (2000 - 2011) and comparison of real event to training drills. This part of thesis is supplied by statistic data (transformed into graphs) of bus accidents with injuries and casualties from department of Transportation Police of the Czech republic and Fire Rescue Service Directorate. Whole practical part is made by analysis of primary (documents, EMS HQ personal visits) and secondary information (information servers, journals). Within this analysis was made evaluation of Czech emergency medical preparedness for bus accidents with large number of injuries and casualties. This analysis shows that in area of the Czech Republic is missing central directorate for Czech paramedic system. Which is shown in varying material, drill and whole preparedness for disaster situation. This problem is also made by new legislation that were not here before (law for emergency medical system and law notices). High variation of equipments and procedures in solving disasters can cause difficulties during accident intervention on the borders of paramedic regions. For comparison to other countries preparedness is in this thesis mentioned Poland - special training course for specialist in disaster management, USA - Medical Alert Center (MAC) and Israel - control system for disaster drills.

Till the present-day the problems of the professional pressure have been explored above all in the field of the EMS nevertheless the inquiry in the field of urgent reception was and still is the field much less explored. In the thesis three aims were specified: To evaluate the most stressing situations of the urgent reception. To compare the stressful aspects of the paramedics at the places of urgent reception with EMS. To suggest the ways of managing stress at the urgent reception. Two inquiry questions were asked to fulfill the aims of the work: Are the paramedics working at the urgent reception able to describe stressing factors? Are the stressing situations same when working at the urgent reception and at the EMS? The inquiry was realized by the collection and analyses of the data while the collection of the data was realized by the qualitative form, by the method of semi-structured dialogues. The dialogues were led with 14 middle medical workers who worked at the position of paramedics. The choice of the workers was random, some of them worked at the urgent reception in Prague, in the Motol Teaching Hospital, in the Střešovice Central Military Hospital and in Královské Vinohrady Teaching Hospital. The questions were ranked into four areas. The first area dealt with the stressing factors and their comparison with the EMS. The respondents were asked why they find their work more difficult and in which it is easier then working at the EMS. Futher which situations they perceive as the most difficult for their psychical balance, if they face some fear in their service or if they are afraid of anything. In the second area we tried to go back with the respondents to the subsequences of the situations they experienced during their service. We traced the situations with which they feel to be influenced at the urgent reception and what kind of situations they were. The third area regarded the professional intervention. Here we found out if the respondents needed the help of the professional psychologist. Consequently if they have a psychologist at their disposal within the framework of their workplace. Lastly the respondents should express their opinion about the professional psychologist in the context of their profession. In the last forth area we dealt with the managing of stress. In this area we found out if the respondents try to cope with the stress load during their service or if they go back to such situations. Then the respondents were to answer if they have some kind of active relaxation and how often they practise this kind of relaxation. Then there was time to answer questions regarding the problems of smoking, alcohol and drugs. Thanks to the determination supported by the inquiry that the most demanding situations at the urgent reception regard death or serious health condition of a young man or a child, it was possible to state the proposion that the paramedics working at the urgent reception were able to describe the stressing factors they deal with. From the results it was also possible to state that the stressing situations at the urgent reception and EMS vary. Also it is necessary to remark that although the stressing situations and their perception vary in specific details, the perception of the demandingness of the work at the urgent reception can be subjective.The results also showed that some respondents found their work easier than working at the EMS. But the paramedics of these two subjects agreed in perceiving the most stressing situation the serious heath condition and death of young people and children. This thesis could be used in praxis to create a conception of a preventive and intervention program as an instrument of managing stress coming out of these results and the mentioned points. It would be only necessary to modify them in the area of urgent reception and in the situations which the respondents find demanding.

Maldistribution of healthcare professionals persists in remote and rural communities throughout the world. Adoption of a Community Paramedic (CP) program could improve access to quality healthcare for rural communities. The conceptual framework defined rural communities by their distinct characteristics — community efficacy, weaknesses, attitudes, assets, deficits, local culture, and the driving and restraining forces — and not defined by their small populations or distances to cities. The theoretical foundation was a synthesis of theories of Bandura, Rogers, and Lewin. This study assessed community characteristics that may influence the likelihood of success, sustainability, or program failure of the Australian CP model in a single remote Texas border community. In this qualitative formative bounded case study, 3 bounded groups were examined; data collection was by in-person interviews. Group members were purposively selected: 5 residents and 3 EMS members. The 3rd group consisted of 4 randomly self-selected resident interviews, field observations, news articles, and local social media. Data transcripts were coded using theoretical coding based on the conceptual framework and theoretical foundation. Strong individual and group efficacy, efficacy resilience, adaptability, strong communications, overlapping groups, and a strong sense of community program ownership were evident in this study. The probability of establishing an effective CP program based on the Australian model is high based on study findings. Improved access to quality healthcare in remote and rural communities could result in improved health of community members and significant social change.

Bakgrund: År 2060 beräknas antalet personer över 65 år att ha ökat till 56 % av befolkningen i Sverige. Fastän äldre patienter nyttjar ambulansen i allt högre omfattning så har inte utbildningen för ambulanssjuksköterskor förändrats särskilt mycket för att möta de specifika behov som en äldre befolkning har. Den förväntade livslängden ökar bland jordens befolkning och under det senaste århundradet har kroniska hälsoproblem ersatt infektiösa sjukdomar som den dominerande belastningen på hälso- och sjukvården. Nästan alla kroniska tillstånd är starkt relaterade till åldrande. Syfte: Att belysa ambulanssjuksköterskors upplevelse av att vårda äldre patienter som är multisjuka. Metod: Ett ändamålsenligt urval av nio ambulanssjuksköterskor intervjuades om sina upplevelser av att vårda äldre patienter som är multisjuka. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Utifrån analysen presenterades fem huvudkategorier; Att utesluta livshot, Att det är komplext att ge vård till äldre, Att bygga upp en bank av kunskaper, Att kunna göra något för den äldre patienten och Att lyssna till den äldre patientens livshistoria. De flesta deltagare beskrev det på ett eller annat sätt som positivt att vårda äldre patienter. Alla beskrev hur det var viktigt att se till hela patienten och dennes omgivning och att anpassa kommunikationen för att kunna ge bästa vård. Mer utbildning efterfrågades för att kunna möta de behov som finns hos den äldre patientgruppen. Akutsjukvård ansågs inte alltid vara den bästa vården för denna patientgrupp. Slutsats: Ambulanssjuksköterskorna upplevde arbete med de äldre patienterna både roligt och utmanande. Även om deltagarna tyckte att grundutbildningen gav en bra grund att stå på i sitt yrke så ville många utöka sina kunskaper inom området äldre patienter och deras sjukdomar. Deltagarna beskrev tydligt vikten av att se till hela patienten vid vårdtillfället och hur den holistiska synen på människan och dess omgivning både kunde ge lindring men även mer information om patienten och dennes sjukdomshistoria. Synen på vad vård och omsorg innebär verkar vara genomgående lika hos alla deltagare i studien. Ett intresse för att göra gott för individen genomsyrar de svar som kommer fram i studien. / Background: In 2060, the number of people over 65 years old is estimated to have increased to 56% of the population in Sweden. Although older patients use the ambulance to an increasing extent, the training for ambulance nurses has not changed much to meet the specific needs of an elderly population. Life expectancy is increasing among the world's population and over the last century, chronic health problems have replaced infectious diseases as the dominant burden on health care. Almost all chronic conditions are strongly related to aging. Objective: To illustrate the paramedics experience of caring for elderly patient with multimorbidity. Method: An appropriate selection of nine paramedics were interviewed of their experiences in caring for elderly patients with multimorbidity. The interviews were analyzed with the help of a qualitative content analysis. Results: The analyze presented five categories; To exclude lifethreat, To care for the elderly is complex, To build up a bank of knowledge, To do something for the elderly patient and To listen to the elderly patients life story. Most participants described it to be positive in one way or another to care for older patients. All the participants describe how important is was to see the whole patient and their surrounding and to adapt the communication to give the best care. More education was requested to be able to meet the needs of the elderly patients. Emergency care was not always considered to be the best care for this group of patients. Conclusion: The paramedics experienced the work with elderly patient to be both fun and challenging. Even if the participants thought that the basic training of the nursing programme provided a good foundation for their profession a lot of them wanted to increase their knowledge in the area of older patients and their diseases. The participants clearly described the importance of seeing the whole patient when caring for them and how the holistic view of the human being and their surroundings could both palliate but also give more information about the patient and their anamnesis. The approach to what nursing and care really means seems to be consistent in all the participants in the study. An interest to do good for the individual pervades the answers in this study.