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99 records – page 1 of 10.

Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.

https://arctichealth.org/en/permalink/ahliterature278758
Source
Int Emerg Nurs. 2015 Jul;23(3):244-9
Publication Type
Article
Date
Jul-2015
Author
D. Jakopovic
A-C Falk
V. Lindström
Source
Int Emerg Nurs. 2015 Jul;23(3):244-9
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Aged
Allied Health Personnel
Ambulances
Emergency Medical Services - organization & administration
Female
Hip Fractures
Humans
Interviews as Topic
Male
Pain Management - methods
Qualitative Research
Sweden
Abstract
Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions.
PubMed ID
25676257 View in PubMed
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Analysis of prehospital transport of head-injured patients after consolidation of neurosurgery resources.

https://arctichealth.org/en/permalink/ahliterature189076
Source
J Trauma. 2002 Aug;53(2):345-50; discussion 350
Publication Type
Article
Date
Aug-2002
Author
Carol D Holmen
Terry Sosnowski
Karen L Latoszek
Darryl Dow
Brian H Rowe
Author Affiliation
Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. cholmen@ualberta.ca
Source
J Trauma. 2002 Aug;53(2):345-50; discussion 350
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alberta - epidemiology
Brain Injuries - diagnosis - mortality - therapy
Emergency Medical Services - organization & administration
Female
Hospital Restructuring
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Transfer - statistics & numerical data
Retrospective Studies
Triage - methods
Abstract
Consolidation of neurosurgical (NS) services resulted in emergency medical services guidelines mandating transport of head-injured patients to the NS center if the Glasgow Coma Scale score is 3. This study determined what paramedic, system, or patient factors were associated with secondary head-injury transfer.
This study was a retrospective chart review from January 1996 to November 1998.
Ninety-one patient charts were reviewed. The median transport delay to the NS site was 4 hours 22 minutes. After transfer, 79 (96%) patients were admitted, 25 (30%) underwent craniotomy, and 18 (22%) died. The final diagnosis in 35 (43%) cases was subdural hematoma. Triage guidelines were violated in five patients (6%) and the NS center was on diversion in three (4%) cases. Most delays were related to patient presentations; 17 (21%) patients had no history of head trauma.
Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.
PubMed ID
12169945 View in PubMed
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[Analysis of the effectiveness of emergency treatment of cerebral ischemic stroke in first aid conditions].

https://arctichealth.org/en/permalink/ahliterature227677
Source
Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(9):34-6
Publication Type
Article
Date
1991
Author
S L Leont'ev
O V Krokhalev
A A Belkin
Source
Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(9):34-6
Date
1991
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Brain Ischemia - complications
Cerebral Infarction - physiopathology - therapy
Cerebrovascular Circulation - physiology
Combined Modality Therapy
Emergency Medical Services - organization & administration
Female
First Aid
Humans
Male
Middle Aged
Russia
Time Factors
Urban Population
Abstract
The impact of the delay in therapeutic intervention at the acute stage of the disease on restitution of neurological functions is shown in 493 patients with ischemic brain stroke, admitted to an emergency neurology unit. The regress of neurological symptoms was notable in 62.9% of patients who were treated by the 6th hour since the disease onset. With the therapy instituted after 6 h, the regress was evident in 49.8% of cases. The treatment impact on the restoration of neurological functions was analyzed in 273 cases.
PubMed ID
1664611 View in PubMed
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Are expert panel judgments of medical benefits reliable? An evaluation of emergency medical service programs.

https://arctichealth.org/en/permalink/ahliterature30995
Source
Int J Technol Assess Health Care. 2003;19(1):158-67
Publication Type
Article
Date
2003
Author
Ragnar Hotvedt
Hans Morten Lossius
Ival Sønbø Kristiansen
Petter Andreas Steen
Eldar Søreide
Olav Helge Førde
Author Affiliation
Institute of Community Medicine, University of Tromsø, Norway. ragnar.hotvedt@ism.uit.no
Source
Int J Technol Assess Health Care. 2003;19(1):158-67
Date
2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Air Ambulances
Ambulances
Child
Child, Preschool
Comparative Study
Consensus
Emergency Medical Services - organization & administration - standards - utilization
Female
Health Services Research - methods
Humans
Infant, Newborn
Male
Middle Aged
Norway
Observation
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: We have used multidisciplinary expert panels to assess the health benefits from two different emergency medical service programs in Norway. This gave the opportunity to study the reliability of the expert panel method. METHODS: Two panels assessed case reports for 18 children, and two other panels assessed case reports for 64 adult patients. The assessments of each case report were compared. These assessments were also compared with assessments of the same case reports, done by the same panels 1 and 9 years earlier. RESULTS: Two different panels agreed on the benefit/no benefit conclusion in at least 75% of the patients, both for children and adult patients (kappa 0.88-0.50). For groups of patients assessed to have some health benefit, the magnitude of the benefit estimates differed by 25% between the panels. When the same panels assessed the same patient groups twice, 1 and 9 years apart, their estimates of total benefit differed up to 30%. However, estimates for single patients, as well as estimates from single panel members, varied considerably more. CONCLUSIONS: Use of multidisciplinary expert panels is a useful method for estimating health benefits on program level or for groups of patients. But assessments from single panelists, and for single patients may be seriously biased.
PubMed ID
12701948 View in PubMed
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Being prepared for the unprepared: a phenomenology field study of Swedish prehospital care.

https://arctichealth.org/en/permalink/ahliterature129598
Source
J Emerg Nurs. 2012 Nov;38(6):571-7
Publication Type
Article
Date
Nov-2012
Author
Birgitta Wireklint Sundström
Karin Dahlberg
Author Affiliation
School of Health Sciences and Research Centre PreHospen, University of Borås, The Prehospital Research Centre in Western Sweden, Borås, Sweden. birgitta.wireklint.sundstrom@hb.se
Source
J Emerg Nurs. 2012 Nov;38(6):571-7
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Ambulances - organization & administration
Emergency Medical Service Communication Systems - organization & administration
Emergency Medical Services - organization & administration
Female
Humans
Male
Medical Errors - prevention & control
Patient Care Planning - organization & administration
Professional-Patient Relations
Risk Management - organization & administration
Sweden
Abstract
This paper presents a study of prehospital care with particular focus on how ambulance personnel prepare themselves for their everyday assignments.
The caring science field study took a phenomenological approach, where data were analyzed for meaning. Two specialist ambulance nurses, three registered nurses, and six paramedics participated.
The previously known discrepancy between in-hospital care and prehospital care was further interpreted in this study. The pre-information from an emergency medical dispatch (EMD) center provides ambulance personnel with basic expectations as to what they will have to take care of. At the same time that they maintain their certainty and control, our major findings indicate that prehospital care in emergency medical service requires the personnel to be prepared for an open and flexible encounter with the patient; to be prepared for the unprepared, i.e., to be open and to avoid being governed by predetermined statements.
Our findings suggest that the outcomes of good prehospital care affect patient security. The seemingly time-consuming dialogue with the patient facilitates understanding and decision-making regarding the patient's medical needs, and it is comforting to the patient. The ambulance personnel need to be well prepared for this task and fully understand that the situation might differ considerably from the information provided by the EMD centers. All objective information is of great value in this care context, but ultimately it is the patient who provides reliable information about her/his own situation.
PubMed ID
22088772 View in PubMed
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Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions.

https://arctichealth.org/en/permalink/ahliterature133786
Source
Int Emerg Nurs. 2011 Jul;19(3):113-9
Publication Type
Article
Date
Jul-2011
Author
Birgitta Wireklint Sundström
Karin Dahlberg
Author Affiliation
School of Health Sciences, PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, SE-501 90 Borås, Sweden. birgitta.wireklint.sundstrom@hb.se
Source
Int Emerg Nurs. 2011 Jul;19(3):113-9
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Ambulances
Decision Making
Emergency Medical Services - organization & administration
Female
Health Services Research
Humans
Interviews as Topic
Male
Nursing Assessment
Stress, Psychological
Sweden
Triage
Abstract
This study has a health care science approach and explores pre-hospital emergency care with emphasis on assessment. Health care science is focused on the patient with the general aim to describe care that strengthens and supports health. Assessment in the ambulance services has not been explored earlier from this perspective, despite the emphasis on 'coming close' to the acute suffering patient. The aim of the study is to describe and analyse assessment in caring situations. Data was collected by participant observations. The major findings point out the importance of professional carers' recognition of the patient's lifeworld as an essential part of assessment. The carers' openness to the situation and to the patient's suffering and needs vary from being of minor interest to complete focus of the assessment. It seems that assessments that focus solely on a patient's medical condition can be an obstacle to a full understanding of the individual, and thereby the illness per se. A caring assessment based on an encounter and a dialogue between patient and carer, characterised by inviting the patient to participate, adds further dimensions to the objective data. Therefore, the inclusion of the patient perspective relieves suffering and enables more safe decisions.
PubMed ID
21665154 View in PubMed
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Challenges in out-of-hospital cardiac arrest - A study combining closed-circuit television (CCTV) and medical emergency calls.

https://arctichealth.org/en/permalink/ahliterature275268
Source
Resuscitation. 2015 Nov;96:317-22
Publication Type
Article
Date
Nov-2015
Author
Gitte Linderoth
Peter Hallas
Freddy K Lippert
Ida Wibrandt
Søren Loumann
Thea Palsgaard Møller
Doris Østergaard
Source
Resuscitation. 2015 Nov;96:317-22
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Ambulances - standards
Cardiopulmonary Resuscitation - methods
Denmark - epidemiology
Emergency Medical Service Communication Systems - standards
Emergency Medical Services - organization & administration
Female
Follow-Up Studies
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - mortality - therapy
Survival Rate - trends
Television
Time Factors
Video Recording - methods
Abstract
The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls.
All OHCA captured by CCTV in the Capital Region of Denmark, 15 June 2013-14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance.
Based on the 21 CCTV recordings collected, the main challenges in OHCA seemed to be situation awareness, communication and attitude/approach. Situation awareness among bystanders and the emergency medical dispatchers (dispatcher) differed. CCTV showed that bystanders other than the caller, were often physically closer to the victim and initiated cardiopulmonary resuscitation (CPR). Hence, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example, receiving the ambulance or retrieving an Automated External Defibrillator (AED).
CCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene. A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA.
Notes
Comment In: Resuscitation. 2015 Nov;96:A3-426212867
PubMed ID
26073272 View in PubMed
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Comparing Methodologies for Evaluating Emergency Medical Services Ground Transport Access to Time-critical Emergency Services: A Case Study Using Trauma Center Care.

https://arctichealth.org/en/permalink/ahliterature120702
Source
Acad Emerg Med. 2012 Sep;19(9):E1099-108
Publication Type
Article
Date
Sep-2012
Author
Aristithes G Doumouras
David Gomez
Barbara Haas
Donald M Boyes
Avery B Nathens
Author Affiliation
Keenan Research Center in the Li Ka Shing Knowledge Institute of St Michael's Hospital and the Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Source
Acad Emerg Med. 2012 Sep;19(9):E1099-108
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Ambulances - organization & administration
Critical Care - organization & administration
Emergency Medical Services - organization & administration
Emergency Service, Hospital - organization & administration
Female
Geography
Hospitals, Urban
Humans
Male
Ontario
Risk assessment
Time Factors
Transportation of Patients - organization & administration
Trauma Centers - organization & administration
Abstract
The regionalization of medical services has resulted in improved outcomes and greater compliance with existing guidelines. For certain "time-critical" conditions intimately associated with emergency medicine, early intervention has demonstrated mortality benefits. For these conditions, then, appropriate triage within a regionalized system at first diagnosis is paramount, ideally occurring in the field by emergency medical services (EMS) personnel. Therefore, EMS ground transport access is an important metric in the ongoing evaluation of a regionalized care system for time-critical emergency services. To our knowledge, no studies have demonstrated how methodologies for calculating EMS ground transport access differ in their estimates of access over the same study area for the same resource. This study uses two methodologies to calculate EMS ground transport access to trauma center care in a single study area to explore their manifestations and critically evaluate the differences between the methodologies.
Two methodologies were compared in their estimations of EMS ground transport access to trauma center care: a routing methodology (RM) and an as-the-crow-flies methodology (ACFM). These methodologies were adaptations of the only two methodologies that had been previously used in the literature to calculate EMS ground transport access to time-critical emergency services across the United States. The RM and ACFM were applied to the nine Level I and Level II trauma centers within the province of Ontario by creating trauma center catchment areas at 30, 45, 60, and 120 minutes and calculating the population and area encompassed by the catchments. Because the methodologies were identical for measuring air access, this study looks specifically at EMS ground transport access.
Catchments for the province were created for each methodology at each time interval, and their populations and areas were significantly different at all time periods. Specifically, the RM calculated significantly larger populations at every time interval while the ACFM calculated larger catchment area sizes. This trend is counterintuitive (i.e., larger catchment should mean higher populations), and it was found to be most disparate at the shortest time intervals (under 60 minutes). Through critical evaluation of the differences, the authors elucidated that the ACFM could calculate road access in areas with no roads and overestimates access in low-density areas compared to the RM, potentially affecting delivery of care decisions.
Based on these results, the authors believe that future methodologies for calculating EMS ground transport access must incorporate a continuous and valid route through the road network as well as use travel speeds appropriate to the road segments traveled; alternatively, we feel that variation in methods for calculating road distances would have little effect on realized access. Overall, as more complex models for calculating EMS ground transport access become used, there needs to be a standard methodology to improve and to compare it to. Based on these findings, the authors believe that this should be the RM.
PubMed ID
22978740 View in PubMed
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99 records – page 1 of 10.