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<p><em>Introduction: </em>In Sweden the definition of <em>ambulance nursing </em>is the examination and treatment of sick or injured people done by ambulance nurses during transport.  This means not only focus on the illness or injury but also the human being treated. The paramedic service must be based on the presumption that the medical needs of the patients are guaranteed, and that the expectations and demands of the public are satisfied. Competence and availability are basic terms for a well-functional paramedic service. There is a lot of pressure put on the people working with pre-hospital nursing. One mistake can lead to serious consequences for the patient. <em>Purpose: </em>The purpose of this study is describing patient’s experience of pre-hospital nursing. <em>Method:</em> The study is based on ten scientific articles. The articles were found on the internet by searching in the databases Academic Search Elite, Cinahl and MedLine. <em>Results:</em> The following themes have been identified: a feeling of uncertainty of the patient – how ill am I?, ambulance or own car?,  the patients worry about if the ambulance will arrive in time, voluntary self-surrender, patients experience of the competence of the staff, lack of understanding that an ambulance is more than a transport service. <em>Discussion:</em> Since the study is based on such a limited material it's not reasonable to draw any extensive conclusions. Still the results are so unanimous so we think that they are well worth to take into consideration.</p> / <p><em>Introduktion:</em> I Sverige definieras ambulanssjukvård med undersökningen och behandlingen av sjuka eller skadade människor, vilket utförs av ambulanspersonal i samband med transport. Ambulanssjukvården måste bygga på förutsättningen att patientens medicinska behov säkerställs och att allmänhetens förväntningar och krav blir tillgodosedda. Kompetens och tillgänglighet är grundläggande begrepp för en väl fungerande ambulanssjukvård. Det ställs stora krav på personalen inom den akuta prehospitala sjukvården. Ett enda felaktiga beslut kan få svåra konsekvenser för patienten. <em>Syfte:</em> Syftet med studien är att belysa patienters upplevelser av prehospital sjukvård. <em>Metod:</em> Litterturstudie vars resultat baseras på tio vetenskapliga artiklar publicerade 2003-2008. Litteratursökningen utfördes med de elektroniska databaserna Academic Serch Elite, CINAHL och MedLine<em>. Resultat:</em> De rubriker som identifierades var: en känsla av osäkerhet hos patienten, hur sjuk är jag?, ambulans eller egen bil?, oro hos patienten, när kommer ambulansen?, frivilligt "självöverlämnande", patienters upplevelse av personalens kompetens, och brist på insikt om att ambulans är mer än en transportservice. <em>Diskussion:</em> Att, utifrån ett begränsat material som det vi har arbetat med, dra några långtgående slutsatser är inte rimligt. Vi anser dock att samstämmigheten i resultatet är så god att vi vill klassa resultatet som väl värt att ta i beaktande.</p><p>                   </p> / Presentation är gjord via webben.

Introduction: In Sweden the definition of ambulance nursing is the examination and treatment of sick or injured people done by ambulance nurses during transport.  This means not only focus on the illness or injury but also the human being treated. The paramedic service must be based on the presumption that the medical needs of the patients are guaranteed, and that the expectations and demands of the public are satisfied. Competence and availability are basic terms for a well-functional paramedic service. There is a lot of pressure put on the people working with pre-hospital nursing. One mistake can lead to serious consequences for the patient. Purpose: The purpose of this study is describing patient’s experience of pre-hospital nursing. Method: The study is based on ten scientific articles. The articles were found on the internet by searching in the databases Academic Search Elite, Cinahl and MedLine. Results: The following themes have been identified: a feeling of uncertainty of the patient – how ill am I?, ambulance or own car?,  the patients worry about if the ambulance will arrive in time, voluntary self-surrender, patients experience of the competence of the staff, lack of understanding that an ambulance is more than a transport service. Discussion: Since the study is based on such a limited material it's not reasonable to draw any extensive conclusions. Still the results are so unanimous so we think that they are well worth to take into consideration. / Introduktion: I Sverige definieras ambulanssjukvård med undersökningen och behandlingen av sjuka eller skadade människor, vilket utförs av ambulanspersonal i samband med transport. Ambulanssjukvården måste bygga på förutsättningen att patientens medicinska behov säkerställs och att allmänhetens förväntningar och krav blir tillgodosedda. Kompetens och tillgänglighet är grundläggande begrepp för en väl fungerande ambulanssjukvård. Det ställs stora krav på personalen inom den akuta prehospitala sjukvården. Ett enda felaktiga beslut kan få svåra konsekvenser för patienten. Syfte: Syftet med studien är att belysa patienters upplevelser av prehospital sjukvård. Metod: Litterturstudie vars resultat baseras på tio vetenskapliga artiklar publicerade 2003-2008. Litteratursökningen utfördes med de elektroniska databaserna Academic Serch Elite, CINAHL och MedLine. Resultat: De rubriker som identifierades var: en känsla av osäkerhet hos patienten, hur sjuk är jag?, ambulans eller egen bil?, oro hos patienten, när kommer ambulansen?, frivilligt "självöverlämnande", patienters upplevelse av personalens kompetens, och brist på insikt om att ambulans är mer än en transportservice. Diskussion: Att, utifrån ett begränsat material som det vi har arbetat med, dra några långtgående slutsatser är inte rimligt. Vi anser dock att samstämmigheten i resultatet är så god att vi vill klassa resultatet som väl värt att ta i beaktande. / Presentation är gjord via webben.

Yes / Dog bite injuries are a common cause of patient presentation to NHS emergency departments (EDs) and minor injuries units, and are generally associated with a low level of acuity, despite an inherent capacity for significant soft tissue damage to be inflicted by canine jaws capable of exerting terrific bite forces. Anatomical sites for injury correlate to victim age, with hand and wrist injuries predominating in the adult population. The most common complication is infection secondary to inoculation of oral flora, with the hands being particularly vulnerable due to their anatomy. Injuries to structures such as tendons can be discreet, and retained foreign bodies can easily be overlooked. Wound care has a propensity to attract a disproportionately high level of malpractice actions, and approaches to the management of dog bite injuries have largely been empirical, which may render the practitioner particularly exposed. In response to increasing pressures on healthcare systems, paramedics with extended scopes of practice, including wound care and suturing, are being utilised to assess, manage, treat, and either refer or discharge patients with apparently minor injuries, in strategies aimed at reducing hospital admissions. This article adopts a case study format to examine and evaluate treatment modalities and the current evidence base informing best practice in terms of dog bite injuries from the perspective of a paramedic practitioner, with critical reflection on the decision making process and complexities of such episodes of care in the pre-hospital setting.

Yes / The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase ‘see and treat’ opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients’ blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated. / The full-text of this article will be released for public view at the end of the publisher embargo on 1 Jun 2024.

Yes / Purpose The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout. Design/methodology/approach A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019. Findings In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout. Originality/value This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers. / This research was funded by the University of Bradford Research Development Fund. This research was supported by Yorkshire Ambulance Service NHS Trust, and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).

The purpose of this research was to examine physical layout and organization of equipment as it pertained to patient care in rotor-wing air ambulances. The qualitative approach included observations, interviews, surveys and incident report reviews; and involved paramedics, educators, engineers and physicians affiliated with Ornge Transport Medicine. Findings showed that there is inconsistent placement of equipment within and between bases. A standardized approach to storing equipment, including labelling, could improve readiness for a call by assisting paramedics in ensuring equipment is properly stocked. It was also found that the layout of the patient care compartment was not optimal for some tasks, such as intubation and documentation, due to lack of space. Future helicopters should have seating, both behind the head and at the side of the patient that accommodates safe postures and allows paramedic’s access to the supplies necessary for the full spectrum of patient care expected in this environment.

The purpose of this research was to examine physical layout and organization of equipment as it pertained to patient care in rotor-wing air ambulances. The qualitative approach included observations, interviews, surveys and incident report reviews; and involved paramedics, educators, engineers and physicians affiliated with Ornge Transport Medicine. Findings showed that there is inconsistent placement of equipment within and between bases. A standardized approach to storing equipment, including labelling, could improve readiness for a call by assisting paramedics in ensuring equipment is properly stocked. It was also found that the layout of the patient care compartment was not optimal for some tasks, such as intubation and documentation, due to lack of space. Future helicopters should have seating, both behind the head and at the side of the patient that accommodates safe postures and allows paramedic’s access to the supplies necessary for the full spectrum of patient care expected in this environment.

ABSTRACT Key words: major trauma, mortality, emergency pre-hospital, performance indicators. Australian and New Zealand Standard Research Classifications: Division 11 (Medical and Health Sciences); Group 1117 (Public Health and Health Services) Background Response times are a common performance measure for many ambulance services and emergency medical response systems and are considered to be a standard measure of emergency medical services quality. The development of formalised Emergency Medical Systems in Australia and internationally have almost universally assumed a link between shorter response times and improved patient outcome measured by survival. While the evidence to support time-criticality for patients who experience a cardiac arrest is considered unequivocal, the assumption that response and scene times are universally important across all patient groups is not consistently supported by the research evidence. Little is known about whether or not the importance of time-dependent performance measures vary as a function of the Emergency Medical System arrangements to which they apply, the skill set of attending paramedics or the epidemiology of the target population. Despite this, response times continue to be one of the key performance measures for ambulance services regardless of the wider health services system in which they operate. Given the significant investment in paramedic training and increasing levels of clinical responsibility witnessed in the last decade, the development of a robust body of evidence about whether this investment and expertise alters outcomes for patients is yet to develop and there has been little shift in measures of performance. Major traumatic injury is associated with significant disease burden in Australia as elsewhere in the world. An estimated 1,500 Queenslanders die each year as a result of major traumatic injury and injury remains the single most common cause of death in Queenslanders between the ages of 1 and 35 years. As such, injury has a massive impact on the health of Queenslanders. Each year, around 10% of Queenslanders will suffer from an injury of some kind and it is known that injury results in 10% of all hospital admissions and 40-60% of attendances at hospital Emergency Departments. In Australia, injury is recognised as one of the seven National Health Priority Areas by the Australian Government. While this document provides for the setting of broad targets for reduction in injury and its social, economic and health corollaries, little advice is provided regarding health service performance with this target group. The emergency pre-hospital environment is absent in this and most strategic policy documents of this ilk in Australia. This thesis has two core aims: • to provide for the first time a descriptive analysis of major trauma in Queensland for the period 1998-2001 including description of the systemic factors influencing patient mortality; and in the light of these findings to • examine the utility of emergency pre-hospital time-dependent performance indicators as predictors of mortality in this patient group. The period of interest 1998-2001 was selected to provide a baseline for the development of the Queensland Trauma Plan implemented by government in 2007. Methods This thesis involved three key activities: (1) a review of the literature on the basis for time-dependent measures of pre-hospital performance in trauma, impacts of system design and emergency pre-hospital skill set on mortality from major trauma; (2) a descriptive quantitative analysis of linked patient data over a four year period (1998-2001) of the relationship between pre-hospital time and mortality; and (3) the theoretical development of alternative emergency pre-hospital performance measures for trauma. Results Of the 23,462 patients in the study population, 29.0% (n= 6,793) died as a consequence of their injuries. Fifteen percent (15.0%) of the patients died in the pre-hospital environment. After adjustment for age, sex and severity (GCS<9) and the presence or absence of co-morbidities, a response interval in excess of 10 minutes (the State benchmark for high acuity cases) did not affect all-cause, all-age mortality from major trauma (OR 1.03; 95%CI 0.93-1.13) compared to response times < 10 minutes. Similarly, no significant effect of response interval >10 minutes (OR 1.11; 95%CI 0.98-1.26) was noted in the pre-hospital period. Scene time >20 minutes (OR 0.75; CI 0.65-0.86) improved the chance of survival to hospital by comparison to scene times <20 minutes. At all times in the pre-hospital care continuum, the presence of an Intensive Care Paramedic improved survival (OR 1.29; 95%CI 1.13-1.48) when compared to solely Advanced Care Paramedic crews, however this effect was not sustained for overall mortality. Conclusions Traditional time-dependent emergency pre-hospital performance measures are not associated with pre-hospital survival from major traumatic injury in Queensland. This finding differs from the experience of similar systems in Canada and elsewhere and may be due to differences in trauma profile, system arrangements, skill sets and funding models. Alternatively, the system operating in Queensland may in fact be optimised in terms of response, scene and transfer times given the size and geography of the State. This study has confirmed the positive survival benefit associated with highly skilled paramedics in the field and demonstrates that time-dependent performance measures should not be considered proxy measures of survival. New performance indicators specifically targeted to patient outcomes need to be developed to monitor the performance of trauma systems in the pre-hospital sector.

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