Dissertations / Theses on the topic 'Emergency assessment'
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Jones, Brian J. "Assessment of emergency management performance and capability." Thesis, Cranfield University, 2003. http://dspace.lib.cranfield.ac.uk/handle/1826/3497.
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Hazardous industries in the UK and Europe are under pressure to increase the transparency and accountability of the ways in which they manage their hazards and the risks they pose to the population and environment. The literature has indicated that the field would benefit from a risk-based, continuous improvement approach to emergency management in hazardous industry. The aim of this research was to construct a framework to enable assessment of the emergency management performance and capability within UK hazardous industry operators. Continuous improvement models from other fields were examined, and an established model called the Capability Maturity Model was selected to form the basis of the framework. A three-stage data collection methodology was designed to gain an overview of an organisation's emergency management capability. This methodology involved reviewing a sample of emergency plans related to UK hazardous industrial sites and observing eight emergency exercises at major hazard industrial sites. The third stage was to record the learning capability of the organisation by observing their feedback processes and interviewing members of staff were necessary. Analysis of the resulting data enabled the construction of a set of eight key processes that define an emergency management system. Using the five- level structure of the Capability Maturity Model along with the principals of continuous improvement, an emergency management assessment framework was constructed. The assessment framework was successfully tested in a large Local Authority, using its emergency plan, a major exercise and a follow-up interview to collect the relevant information. The assessment provided clear details of current capability and maturity of the emergency management system, giving structured guidance on weaknesses in specific process areas and more generally in particular stages of the emergency management system. This ultimately enabled the Local Authority to focus its improvement efforts, increasing their efficiency in learning and effectiveness in preparedness and response.
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Bae, Crystal. "Emergency care assessment tool for health facilities." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20990.
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Includes bibliographical referencesTo date, health facilities in Africa have not had an objective measurement tool for evaluating essential emergency service provision. One major obstacle is the lack of consensus on a standardized evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine has developed an assessment tool, specifically for low- and middle-income countries, via consensus process that assesses provision of key medical interventions. These interventions are referred to as essential emergency signal functions. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. These are evaluated for the six specific clinical syndromes, regardless of aetiology, that occur prior to death: respiratory failure, shock, altered mental status, severe pain, trauma, and maternal health. These clinical syndromes are referred to as sentinel conditions. This study used the items deemed "essential", developed by consensus of 130 experts at the African Federation for Emergency Medicine Consensus Conference 2013, to develop a tool, the Emergency Care Assessment Tool (ECAT), incorporating these using signal functions for the specific emergency sentinel conditions. The tool was administered in a variety of settings to allow for the necessary refinement and context modifications before and after administering in each country. Four countries were chosen: Cameroon, Uganda, Egypt, and Botswana, to represent West/Central, East, North, and Southern Africa respectively. To enhance effectiveness, ECAT was used in varying facility levels with different health care providers in each country. This pilot precedes validation studies and future expansive roll out throughout the region.
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Mitra, Amlan. "Developing an integrated risk management system in emergency management process /." This resource online, 1992. http://scholar.lib.vt.edu/theses/available/etd-12232009-020038/.
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George, Taylor A., and Taylor A. George. "2016 Arizona Statewide Emergency Medical Services Needs Assessment (ASENA)." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626310.
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Emergency Medical Services (EMS) is an institution and product of public health, health care, and public safety that is chopped and scattered across multiple jurisdictional deployment methodologies throughout Arizona. To fully-asses the EMS needs of the state, those jurisdictions are considered as a whole; for it is the whole that makes a system, and a system is what truly impacts patient outcomes. Evaluating the ""whole"" is the genesis and driver of the 2016 Arizona Statewide EMS Needs Assessment (ASENA).
The primary objective of ASENA is to establish a current ""snap-shot"" of EMS in the state while simultaneously identifying needs and/or areas that can be targeted for further analysis and/or improvement as part of Population Health Management and Emergency Medical Services Integration under the AZ Flex Grant funded by the U.S. Health Resources and Services Administration (HRSA). In addition, the secondary objective of ASENA is to compare and contrast this current ""snap-shot"" with data obtained in a more narrow needs assessment conducted in 2001, allowing comparison of changes in Arizona's critical access EMS system over 15 years.
To accomplish this, a 105-question needs assessment survey tool was developed and distributed to EMS agencies throughout the state. The fully-vetted survey tool collected information pertaining to sixteen core functional sections. Eighty-six agencies fully-completed the needs assessment survey tool, with respondents evenly distributed across the state's four EMS coordinating regions and representative of the various service-delivery methodologies. The combined service areas of the respondents cover over 85% of the state's population.
Arizona's statewide EMS system is well organized and positioned to deliver advanced levels of prehospital care for the vast majority of its citizens and visitors, with some variation between urban and rural regions. Key needs identified relate to: patient care reporting between EMS providers, emergency departments and receiving hospitals; quality assurance activities; education and skills training programs; dispatch system capabilities; mass casualty and public health preparedness; equipment and supplies; and more robust use of data and analyses to inform continuous EMS system improvement.
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Crowe, Remle. "An Assessment of Burnout among Emergency Medical Services Professionals." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531751856368551.
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Trial, Shaina L. "Assessment of patient processing in emergency departments of hospitals /." View online version, 2009. http://ecommons.txstate.edu/arp/311.
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Richardson, Carline P. "An Assessment of Atlanta Area Emergency Operations Plans for Emergency Relief Services Utilized by Senior Citizens." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/iph_theses/38.
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The emergency response readiness of the public health and emergency management systems have become increasingly important topics for research, development and action in the United States. Senior citizens represent a large and growing population group in the United States. Older persons are likely to be disproportionately vulnerable during disasters because they are more likely to have chronic illnesses, functional limitations, and sensory, physical and cognitive disabilities than those of younger ages. Elderly health and safety have become the responsibility of the elderly themselves, of the community in which they live, and the various agencies and organizations charged with preparedness planning. The goal of this study was to assess the emergency operations plans (EOPs) of emergency relief agencies and organizations in the Atlanta area for the provision of emergency relief services utilized by senior citizens as a special needs population. The research and analysis performed was completed in two steps: a review of collected disaster and emergency operations plans (EOPs) and standard operating procedures (SOPs), and a qualitative analysis of a survey submitted to the agencies. Although many EOPs and SOPs referred to emergency relief services for special needs populations, the plans were not functional and did not fully outline the ‘who, what, when, where and how” to provide disaster relief services. Public health agencies must endeavor to better address the disaster related needs of elderly persons who have physical disabilities, special medical needs and communication disabilities. Disaster preparedness plans must ensure the availability of all items necessary to control and prevent complications related to chronic diseases, prevent acute events and promote functionality and independence.
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Garpenfeldt, Katarina. "Hazard Identification and Risk Assessment : Analysis of a Risk Assessment Process in Emergency Preparedness." Thesis, Högskolan i Gävle, Avdelningen för datavetenskap och samhällsbyggnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-31318.
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A challenging yet crucial component of emergency planning is to identify relevant hazards and assess their risk level. Within the Province of Ontario, Canada, governmental emergency management stakeholders are required to use the Hazard Identification and Risk Assessment (HIRA) process, developed by the Province, to meet legislative compliance. The HIRA process is based on the use of risk matrices and hence faces many of the inherent challenges of this method, potentially resulting in a poor risk assessment process with a low quality outcome. The aim of this thesis is to analyze Ontario’s Provincial HIRA process to identify weaknesses, strengths, and gaps, in order to increase understanding for potential issues related to this type of hazard identification and risk assessment process within emergency preparedness. The Provincial HIRA process will be analyzed, as it is implemented in the Regional Municipality of York, including the Public Health Unit, by comparing the process to six points identified in the literature as potential challenges with the ability to compromise the quality of a risk assessment process. The main focus is on the use of risk matrices although some aspects more generally related to risk assessments have been included. Overall the Provincial HIRA has several weaknesses and gaps. It is evident that the process demonstrates many of the issues that impair the quality of risk assessments supported by the use of risk matrices such as ambiguous input and out-puts, errors, poor resolution and sub-optimal resource allocation. Additionally, a significant amount of resources and access to hazard subject matter expertise would be required to execute the HIRA in accordance with the guideline. Such resources are not necessarily available to the target audience. All these aspects contribute to a risk assessment process that struggles to meet one of its main objectives, to provide the user with a quantitative risk ranking with the capacity to distinguish between risk levels of different hazards. Subsequently the outcome may not accurately support the emergency planning or the decision making process related to resource allocation.Identifiering av lokalt relevanta faror och bedömning av deras risknivåer är en kritisk och komplex del av arbetsområdet beredskap för nödsituationer (eng. emergency preparedness). Myndigheter som bedriver verksamhet inom detta område i provinsen Ontario, Kanada är enligt lag skyldiga att genomföra en ”Hazard Identification and Risk Assessment” (HIRA) process, utvecklad av provinsen. HIRA-metoden är baserad på användandet av risk matriser och står således inför många av denna metods inneboende utmaningar vilket kan resultera i svag riskbedömningsprocess med tvivelaktigt resultat. Syftet med denna uppsats är att analysera Ontarios HIRA-process för att identifiera potentialla svagheter, styrkor och luckor i processen och således generera insikt i potentiella utmaningar relaterat till denna typ av riskbedömningsprocess inom ”emergency preparedness”. HIRA-processen, så som den implementerats i York Region och inom dess folkhälsomyndighet, kommer att analyseras baserat på sex punkter identifierade inom litteraturen som aspekter med förmåga att påverka kvalitén på riskdömningsresultatet. Sammanfattningsvis ses att HIRA-processen innefattar många av de svagheter som diskuteras i litteraturen rörande riskmatriser som till exempel fel, tvetydig in- och utdata, dålig upplösning och suboptimal resursfördelning vilket potentiellt medför en riskbedömningsprocess av låg kvalité. För att genomföra HIRA-processen så som metoden är designad behöver användaren investera en betydande mängd resurser samt helst tillgå expertis inom riskbedömning relaterat till de olika farorna som skall bedömas, vilket inte alltid finns tillgängligt inom de organisationen som genomför en HIRA. Dessa aspekter sammantaget bidrar till en process som inte nödvändigtvis når fram till ett av sina primära mål; att skapa en kvantitativ rangordning av risker med förmåga att särskilja olika farors risknivå. Till följd finns en risk att resultatet av riskbedömning inte stödjer den operativa planeringen eller processen för beslutsfattande relaterad till resursfördelning.
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Kim, Paul. "Emergency care assessment tool for health facilities: a validity study in Cameroon." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29865.
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Background
To date, health facilities in Sub-Saharan Africa have not had an objective measurement tool for evaluating comprehensive emergency service provision. One major obstacle is the lack of consensus on a standardised evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine (AFEM) developed an assessment tool specifically for these settings - the Emergency Care Assessment Tool (ECAT) - that assesses provision of key medical interventions. These interventions are referred to as signal functions for the six sentinel conditions that occur prior to death: respiratory failure, shock, altered mental status, severe pain/trauma, and dangerous fever. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. Previous studies aimed at the refinement and context modification of the ECAT have already been performed in multiple African countries. We undertook a validation study to help determine the applicability of the tool in assessment of emergency services throughout the continent.
Aims and Objectives
The aim of this study was to determine the content, construct, and face validity of the AFEM Emergency Care Assessment Tool in Cameroon. To achieve this, the study had the following objectives: (1) Employ the ECAT in district, regional, and central hospitals in Cameroon. (2) Use direct observation to determine whether the signal functions can be performed in these facilities.
Methods
This was an observational study at a convenience sample of five hospitals in Cameroon: three district, one regional, and one central. The goal of this study was to validate the instrument, not the facility, and so the sample size was related to the number of signal functions witnessed rather than the number of facilities visited. The tool was administered with the Head of Emergency at each facility. This completed ECAT was then compared with direct observations of the signal functions, a process which was conducted by the partner local emergency care specialists accompanied by the ECAT researcher.
Results
In general, the higher the level of facility, the greater the emergency care capacity and the greater the number of signal functions that could be performed correctly and consistently. Discrepancies in funding, supplies, resource allocation, and care delivery ability were apparent through ECAT results, expounding on barriers to care delivery, and direct observation. McNemar tests on the ECAT results versus direct observation at each facility yielded statistically significant support for tool validation at the national level emergency unit as well as two of the district level emergency units. Concordance between reported and observed signal functions could not be achieved at the regional facility and one of the district facilities.
Conclusions
The ECAT has good potential for facility level assessment of emergency care provision, and collects meaningful information that can guide effective improvements in the delivery of emergency care.
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Teece, Stewart. "The assessment of ischaemic heart disease in the emergency department." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499952.
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McHale, Gene Michael. "An Assessment Methodology for Emergency Vehicle Traffic Signal Priority Systems." Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/26420.
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Emergency vehicle traffic signal priority systems allow emergency vehicles such as fire and emergency medical vehicles to request and receive a green traffic signal indication when approaching an intersection. Such systems have been around for a number of years, however, there is little understanding of the costs and benefits of such systems once they are deployed. This research develops an improved method to assess the travel time impacts of emergency vehicle traffic signal priority systems for transportation planning analyses.
The research investigates the current state of available methodologies used in assessing the costs and benefits of emergency vehicle traffic signal priority systems. The ITS Deployment Analysis System (IDAS) software is identified as a recently developed transportation planning tool with cost and benefit assessment capabilities for emergency vehicle traffic signal priority systems. The IDAS emergency vehicle traffic signal priority methodology is reviewed and recommendations are made to incorporate the estimation of non-emergency vehicle travel time impacts into the current methodology. To develop these improvements, a simulation analysis was performed to model an emergency vehicle traffic signal priority system under a variety of conditions. The simulation analysis was implemented using the CORSIM traffic simulation software as the tool. Results from the simulation analysis were used to make recommendations for enhancements to the IDAS emergency vehicle traffic signal priority methodology. These enhancements include the addition of non-emergency vehicle travel time impacts as a function of traffic volume on the transportation network. These impacts were relatively small and ranged from a 1.1% to 3.3% travel time increase for a one-hour analysis period to a 0.6% to 1.7% travel time increase for a two-hour analysis period. The enhanced methodology and a sample application of the methodology are presented as the results of this research. In addition, future research activities are identified to further improve assessment capabilities for emergency vehicle traffic signal priority systems.Ph. D.
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Spirito, Katheryn M. "Best practice suicide screening/assessment tools for the emergency department." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7433.
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Patients presenting to the emergency department (ED) often suffer from more than physical ailments when seeking care and treatment. Some of these patients have emotional ailments and suicidal ideation when they come to the local ED. The lack of recognition of at-risk patients by health care providers can lead to poor patient outcomes and death. The focus of this project was to understand which valid and reliable suicide assessment tools described in the literature were considered the best evidence-based instruments to identify ED patients who were at risk for suicide. Peplau's theory of interpersonal relations guided this project. A systematic review of the literature was conducted to assess tools that were used for the identification of at-risk patients. Analysis of the included literature was conducted using Melnyk's levels of evidence and a preferred reporting items for systematic reviews and meta-analyses tool to catalog the articles retrieved. Ten articles were included in the study. Final analysis of the articles identified the need for 100% of patients to be assessed for suicide risk upon arrival at the ED. The instrument identified to meet the need for the local organization was the Columbia-Suicide Severity Rating Screening tool. The findings of this project might promote social change by providing insights into best practice assessment tools to support improved assessment of suicide risk for ED patients.
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Chavula, Chancy. "Facility-based capacity assessment of emergency care services in public hospitals in Zambia." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24977.
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In sub-Saharan Africa, the shift in disease burden from infections to non-communicable disease and injury highlights the need for effective and efficient emergency care. Despite this, emergency care is a neglected sector of the health system in most low and middle-income countries. Funding and resource allocations are often small and have little impact on the development of emergency care systems, and provision of emergency care is therefore frequently left to under-trained and/or under-prepared nurses or clinical officers. In order to develop effective emergency care systems, one must first identify strengths and challenges in existing systems. The aim of this study was to determine facility-based emergency care capacity in public hospitals in Zambia. This descriptive cross-sectional study comprised of a total of 23 facilities: seven districts, 12 general and four central hospitals. Data were collected using a standardised Emergency Care Assessment Tool (ECAT); developed in 2013 by AFEM to ascertain facilities' strengths and weaknesses in the delivery of the emergency care services for five sentinel conditions and maternal health. The ECAT was administered through one-on-one interviews with designated personnel working in emergency receiving areas. The assessment tool consists of six main themes relating to the ability to provide care for patients suffering from respiratory failure, shock, altered mental status, severe pain, trauma and maternal health. The majority of facilities were able to perform almost all the procedures across all themes. However, some procedures, which were highly technical and required personnel with specialist training or specialised equipment, were not performed at all facilities. The level of the facility also dictated whether a procedure could be performed where higher-level health facilities like central hospitals were able to perform more procedures than lower-level facilities due to higher numbers of trained personnel, more equipment and supplies, and better infrastructure. Maternal health was covered in almost all (>90%) hospitals. Across all themes, the most frequent reasons for not performing procedures were lack of supplies (n=137) followed by no training (n=136), no infrastructure (n=35) and no human resources (n=34). At the central level, the most frequent reason for not performing procedures was no supplies (n=16), whereas at district and general levels the most frequent reason was no training. Overall, most facilities were able to offer basic emergency care services. However, there is limited capacity of training and supplies across all facilities, as well as a lack of infrastructure and policies for emergency care in lower-level facilities. Zambian hospitals can provide basic emergency care, but there is need to enhance training and improve on provision of supplies to enable facilities to provide emergency care. Focus must also be on development of policies relating to emergency care to guide and standardise procedures. Capacity building should be more focused at district and general hospitals to improve emergency care across all levels of health facilities, as it will reduce the burden at central level and improve patient outcomes since these are first-line access points for patients.
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Crowe, Remle P. "An Assessment of Burnout among Nationally-Certified Emergency Medical Services Professionals." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1452245440.
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Flowerdew, Lynsey Anne. "The assessment of registrars' non-technical skills in the Emergency Department." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9620.
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In recent years safety in medicine has been high on the agenda, both for government and for healthcare providers. This thesis starts by describing the evolution of patient safety and then goes on to explore error specifically in the Emergency Department (ED). Focus is drawn to the role of non-technical skills for improving safety. The initial broad aim of this research was to learn how the ED team could function better to improve patient care. An interview study is developed to investigate how ED staff change their behaviour during periods of high demand and to determine the direction of future research. This study highlights that staff would benefit from increased awareness of the nontechnical skills that contribute to effective teamwork and enhanced patient safety. The interviews also reveal the leadership role of the registrar is of particular importance. Therefore, a series of studies are developed to identify and describe the non-technical skills required by Emergency Medicine trainees, with a specific focus on leadership. The process of developing a provisional assessment tool for assessing non-technical skills in the ED is described. This draws on published literature and curricula as well as considering existing methods of assessment. The assessment tool is revised using re-analysis of staff interviews and a series of preliminary observations in the ED. Content validity of the tool is measured using a survey of expert opinion and this helps to further refine the tool components. An experimental study reveals that whilst adequate levels of inter-rater reliability are achievable, rater accuracy appears to be more problematic. Various sources or rater error are also explored and this leads onto a larger, multicentre observational study investigating use of the tool in the workplace. Further data for reliability is collected and field notes are analysed to provide a detailed description of the non-technical skills displayed by ED registrars. Findings of the studies are summarised and limitations, applications and further research are discussed.
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Opiro, Keneth. "Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/23746.
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Background: Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system, but health workers must understand it, and it must be used routinely. Whereas efforts have been made to introduce paediatric triage in Uganda, such as Emergency Triage Assessment and Treatment Plus (ETAT+), there is no unified adult triage system being used in Uganda, and it is not clear if hospitals have local protocols being used in each setting. There are limited data on adult triage systems in Uganda. This study aimed at determining how adult hospital-based triage is performed in hospitals in northern Uganda. Methodology: This was a descriptive study. Allocating numbers to the three sub-regions in the northern region, and using a random number generator, we randomly selected the Acholi sub-region for the study. The study was conducted in 6 of the 7 hospitals in the region - one hospital declined to grant permission for the research. It was a written questionnaire survey under supervision of the investigator. In each hospital, at least one representative of nurses in various duty shifts (night, morning and evening shifts), the nursing in-charge/leader, at least one doctor (head of department or any doctor on duty, if available) and a clinical officer (physician assistant, if available), making a minimum of 5-6 study participants who were health professional staff working in emergency receiving areas from each hospital consented and participated in the study. Results: Thirty-three participants from 6 hospitals including 5 doctors, 4 physician assistants, 11 registered nurses, 9 enrolled nurses and 4 nursing assistants consented and participated in the study. Experience of staff working in emergency receiving areas varied with 15(45.5%) greater than 2 years, 7(21.2%) 1-2 years, 5(15.2%) 6 - <12 months and 6(18.2%) for less than 6 months. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal adult hospital-based triage protocol in place. The triage guide/protocol/charts were kept in drawers, had 3 colours - red, yellow and green. Staff rated it as "good", and all staff acknowledged the need to improve it. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from Out Patient Department (OPD) and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improving/developing formal triage in all these hospitals. Conclusion: Formal adult, hospital-based triage is widely lacking in northern Uganda, and staff do perform subjective "eyeball" judgments to make triage decisions. Most hospitals do not have specifically allocated emergency department which risks disorganization in the flow of patients, crowding and consequently worse patient outcomes.
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Stang, Antonia. "Emergency department conditions associated with the number of patients who leave a pediatric emergency department prior to physician assessment." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86630.
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As emergency department (ED) waiting times and volumes increase, substantial numbers of patients LWBS (leave after registration but prior to physician assessment). The objective of this study was to identify ED conditions reflecting patient input, throughput and output associated with the number of patients who LWBS in a pediatric setting. Multivariate analysis was used to examine the impact of variables describing the timing of patient arrival and ED conditions including patient acuity, volume and waiting times on the number of patients who LWBS. During the study period there were 138,361 patient visits; 11,055 (7.99%) of patients LWBS. The throughput variables, time from triage to physician assessment (rate ratio 2.11 (95% CI 2.01-2.21)) and time from registration to triage (rate ratio 1.55 (95% CI 1.25 - 1.90)) had the largest impact on the number of patients who LWBS. Interventions designed to decrease the number of patients who LWBS should focus on improving ED throughput.Avec l'augmentation du débit et du temps d'attente dans les services des urgences, un nombre élevé de patients ayant rempli les formulaires d'accueil quittent avant d'avoir été vus par un médecin. Cette étude avait pour but de déterminer les conditions du service des urgences reflétant l'inscription, le temps de prise en charge ainsi que le débit de patients, et ayant un lien avec le nombre de personnes qui, dans un milieu pédiatrique, quittent avant d'avoir vu un médecin. Une analyse multivariée a été utilisée afin d'examiner l'effet de variables décrivant le moment de l'arrivée du patient et les conditions qui prévalent au service des urgences (y compris l'acuité des patients, le volume de patients et le délai d'attente), sur le nombre de personnes qui quittent sans avoir été examinés. Un total de 138,361 patients se sont présentés à l'urgence au cours de l'étude et 11,055 (7,99%) ont quitté avant d'avoir vu un médecin. Les résultats de l'étude révèlent que les variables liées au temps de prise en charge, soit le délai entre le moment du triage et l'examen du médecin (ratio des taux = 2,11; intervalle de confiance [IC] de 95% : 2,01 - 2,21) et le délai entre l'inscription et le triage (ratio des taux = 1,55; IC de 95% : 1,25 - 1,90) exercent la plus grande influence sur le nombre de patients quittant avant d'avoir été vus par un médecin. Les interventions visant à réduire le nombre de départs prématurés devraient être orientées en vue d'améliorer le temps de prise en charge dans les services d'urgence.
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Thompson, Jerry. "An assessment of local citizen corps councils /." View online, 2004. http://ecommons.txstate.edu/arp/28/.
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Wylie, Craig Alexander. "Waveform capnography in the South African prehospital setting: knowledge assessment of qualified advanced life support (ALS) paramedics." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22789.
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Although there is extensive literature regarding out-of-hospital use of capnography, the willingness and knowledge of South African paramedics where capnography is available for routine use is poorly understood. From informal reviews, it would appear that even when capnography is available the practitioners decided to not use the tool. Aim: To determine the knowledge of prehospital providers with respect to the use of capnography to guide decision making in the treatment of patients. Methods: A cross-sectional research-generated survey of 80 out-of-hospital advanced life support paramedic providers in South Africa working in the private industry where capnography is available. Participants will be recruited with the assistance of the company's research committee using an email platform, and consent process. The questionnaire will establish the knowledge, ability and willingness of advanced life support paramedics to identify and use capnography as part of their clinical decision making process. Descriptive statistics will be used to interpret and report the data. The study should be concluded within 6 months of receiving ethical approval from Human Research Ethics Committee of the University of Cape Town. Discussion: The findings of the study will describe a cohort of out-of-hospital practitioners' knowledge and willingness to use capnography in an environment where it is routinely available. Recommendations will be made regarding the need for further policy development and change management for the implementation of best practice.
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Vorwerk, Christiane. "Non-invasive cardio-haemodynamic assessment in adult emergency department patients with sepsis." Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/10975.
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Objective: To explore the potential benefit of non-invasive cardio-haemodynamic variables in the management of sepsis in the Emergency Department (ED) by measuring their changes with normal treatment and their relationship to outcome. Methods: Study 1: Prospective cohort study of a convenience sample of adult ED patients with uncomplicated sepsis. Cardio-haemodynamic parameters were obtained using a Thoracic Electrical Bioimpedance (TEB) device. Study 2: Prospective cohort study of a convenience sample of adult ED patients with severe sepsis / septic shock. Cardiohaemodynamic parameters were obtained using a TEB device, transcutaneous Doppler ultrasound and Near-Infrared Spectroscopy. Measurements for both studies were taken on ED arrival, ED departure and after 24 hours, whilst patients received normal treatment. All patients were followed up for 30 days. Results: 50 patients were enrolled in study 1 and 73 patients in study 2. Septic patients had a significantly higher cardiac output and significantly lower stroke volume and systemic vascular resistance than non-septic ED controls. After 24 hours of normal treatment cardio-haemodynamic parameters of patients with uncomplicated sepsis and survivors from severe sepsis / septic shock began to normalise. In addition, patients with severe sepsis/septic shock had abnormal tissue oxygen saturation on ED arrival, which, in survivors normalised with treatment. Conclusion: This is the first description of cardio-haemodynamic parameters in septic patients at their entry to hospital (ED). Septic patients have initially abnormal haemodynamics and the ability to normalise haemodynamics and tissue oxygen saturation is associated with good outcome. This thesis has identified a number of parameters, which warrant validation to define their role as diagnostic or co-diagnostic biomarkers for sepsis and sepsis outcome.
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Bentley, Melissa. "A National Assessment of Ideal Cardiovascular Health among Emergency Medical Service Professionals." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480456097279235.
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Kling, Michael Patrick. "Needs Assessment for Mental Health Support Towards Emergency Medical Service (EMS) Personnel." Thesis, Regent University, 2021. http://pqdtopen.proquest.com/#viewpdf?dispub=27961789.
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Understanding and assessing the needs of Emergency Medical Service (EMS) personnel and other first responders is crucial for providing these individuals with the resources needed within their community. The literature discusses how EMS personnel are at risk for psychological impairment due to routine exposure to traumatic events and occupational stressors within EMS organizations. Additionally, the research has supported the importance of positive coping abilities, organizational belongingness, and social support within the lives of EMS personnel to enable them to resiliently handle the occupational stress of their job. This study investigated the occupational needs of EMS providers to determine if they are receiving resources within their organization to cope with occupational stressors. Participants for this study comprised (n=153) paramedics and fire-fighters from the Tidewater EMS Council organization. A needs assessment was conducted to explore correlations between quality of life, resiliency, years of service, level of education, burnout, secondary traumatic stress, interpersonal support, positive and negative religious coping, and the occupational needs of EMS personnel. The results revealed that burnout (r=4.27**) and secondary traumatic stress (r.215*) were important factors for determining occupational turnover among EMS personnel. Furthermore, EMS providers reported occupational needs such as easier access to mental health, improved staff relations, adequate staffing, and improved shift hours are needed within their organization. Future research should explore differences in occupational needs with EMS providers among EMS organizations in metropolitan and rural communities. Keywords: Emergency Medical Services (EMS), Burnout, Occupational Stress, Traumatic Critical Incidents
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Gihwala, Raina Tara. "Out-of-hospital assessment and management of rape survivors by pre-hospital emergency care providers in the Western Cape." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21186.
Full textAbstract:
South African incidence of rape ranks amongst the highest worldwide. No direct policy exists for the emergency care provider management of rape victims in the pre-hospital setting. The pre-hospital exposure to rape cases is unknown as its health information system is not gender-based violence sensitive. In the absence of a clearly defined protocol, indiscretion in the emergency care treatment of rape victims remains undocumented. As a particularly vulnerable group globally, victims of rape are deserving of focused intervention. A qualitative, descriptive approach guided the research in which nine semi-structured voluntary interviews were held with emergency care providers, forensic medical practitioners and emergency consultants. Through a critical theory lens thematic content analysis was employed. University of Cape Town ethics approval was attained. The study found that pre-hospital providers lack knowledge and skills of rape victim identification and management but are desirous of evidence-informed guidelines for treatment and referral in a multidisciplinary approach. Educational and policy deficiencies are documented. The recommendations support a community of practice that is mutually inclusive of specialist rape-care centres, emergency department and pre-hospital providers in the interest of forensic emergency medicine. Due regard must be had for needs of practitioners at risk of vicarious traumatization from sexual assault management. Transformative curricula and responsive clinical guidelines are likely to redress any complicity of the health sector non-response to rape/sexual assault. This study is likely to benefit emergency care regulators, educators and researchers whose professional interest is to promote responsivity of the health system to rape.
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Cullen, Louise A. "Accelerated strategies in the assessment of emergency patients with possible acute coronary syndromes." Thesis, Queensland University of Technology, 2015. https://eprints.qut.edu.au/86998/1/Louise_Cullen_Thesis.pdf.
Full textAbstract:
This thesis synthesises advancements made in the method of assessment of emergency patients with possible acute cardiac disease and has defined new assessment strategies that supports the safe early discharge of patients at low risk for acute coronary syndromes. These important findings have informed clinicians and health services about improvements that can be made at this current time in the process of care of ED patients, and the studies have had local, national and international influence.
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Underwood, Stacy, and Stacy Underwood. "Nurses' Perception of the Use of the Dynamic Appraisal of Situational Aggression (DASA) in an Emergency Psychiatric Setting." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624529.
Full textAbstract:
Background: The use of the Dynamic Appraisal of Situational Aggression (DASA) in acute psychiatric settings to identify aggressive and/or violent patients upon admission.
Objective: Determining nurses' perception of the usefulness of the Dynamic Assessment of Situational Aggression (DASA) in a psychiatric emergency room setting.
Theoretical Background: Langley, Nolan, Nolan and Provost’s (2009) Model for Improvement, which incorporates Deming’s Plan-Do-Study-Act (PDSA) cycle, was utilized as the theoretical framework to guide this DNP project.
Setting: An adult psychiatric emergency room in urban Phoenix, Arizona.
Measurement: A six-item survey questionnaire measured on a five-point Likert scale ranging from "Strongly Disagree" (1) to "Strongly Agree" (5) describes and measures nurses' perception on the usefulness of the DASA. An additional question explored the influence of static nursing factors (gender, years of experience, level of education, years at the facility), on nurses' perception of the usefulness of the DASA.
Results: Overall, nurses (90%) of the study participants perceived the DASA to be effective in identifying aggressive violent patients and 70% of the participants would like to continue to use the DASA. Static nursing factors showed no difference in nurses' perception of usefulness.
Limitations: Further exploration in similar settings such as regular emergency departments and psychiatric emergency and crisis settings are recommended. In this study only nursing perception was explored. Analysis of the validity of the DASA tool in the psychiatric emergency room setting in addition to nursing perceptions would be more beneficial in determining the DASA’s true usefulness.
Conclusion: The results of this DNP project demonstrate that nurses at the SAUPC perceive the DASA to be a useful addition to their admission assessment. Overall nursing response was positive and the SAUPC seclusion and restraint committee recommended incorporating the DASA into the triage nursing admission assessment.
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Richards, Traci, Marianne Tysoe, and Grant H. Skrepnek. "The Assessment of Clinical and Economic Outcomes Associated with Stroke in Rural Emergency Departments." The University of Arizona, 2013. http://hdl.handle.net/10150/614294.
Full textAbstract:
Class of 2013 AbstractSpecific Aims: The purpose of this study was to assess the clinical and economic predictors associated with rural emergency department visits in stroke patients. Methods: The current research was a retrospective, observational, cohort study. Multivariate regression was used to assess data from the Agency for Healthcare Research and Quality (AHRQ) 2009 Nationwide Emergency Department Sample (NEDS). Inclusion criteria were at least 18 years of age and rural ED admission with principle diagnoses of stroke. Main Results: Significant results for risks included: Intubation for increased mortality (OR = 17.432, p = 0.001), increased length of stay (IRR = 1.643, p = 0.018) and increased charges (exp β = 2.289, p = < 0.001); myocardial infarction for increased mortality (OR = 1.969, p = 0.006), decreased charges (exp β = 0.862, p = 0.013) and decreased length of stay (IRR = 0.853, p = 0.001); moderate to severe liver disease for increased mortality (OR = 62.691, p = 0.001) and reduced length of stay (IRR = 0.517, p = 0.025); congestive heart failure for increased mortality (OR 1.978, p = 0.003) and increased charges (exp β = 1.118, p = 0.039); non-specific cancer (OR = 2.447, p = 0.017) and metastatic cancer (OR = 4.799, p = 0.016) for mortality; hemiplegia/paraplegia for increased charges (exp β = 1.173, p = < 0.001). Conclusion: The current study found a better understanding of national estimates of burden of illness to further define clinical decision rules for stroke in rural emergency departments.
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Bowers, Garrett Phyllis Marie. "Using SBAR to Decrease Transfers from the Long-term Care to the Emergency Room." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2395.
Full textAbstract:
Care of the elderly, long-term care resident in the emergency department is an issue of importance because of the overall impact on healthcare costs, potential for negative outcomes for the resident, and the loss of revenue. The purpose of this project was to decrease avoidable transfer of residents to the Emergency Department. Using the Antecedent, Target, Measurement logic model, poor quality assessment data was deemed the antecedent of the avoidable transfer. The goal of the project was the implementation of a standardized process of assessment that would have decreased avoidable transfer of the resident. The project would have involved training of the nursing staff in the use of the Situation Background Assessment and Recommendation tool for collecting and communicating pertinent data. The tool would have been completed at each acute complaint and would have indicated disposition. Data would have been collected by the Education Coordinator and organized for review and comparison with preintervention data. Social change implications would have included enhanced communication, potential for increased nurse and physician satisfaction which could have potentially increased job satisfaction, and improved recruitment and retention. Autonomy and self-pertinence empowers the nurse to be a stronger advocate. Positive outcomes increase when care is provided by those familiar with the patient norms and the setting. Financial savings can have an impact on the cost of healthcare. This project would also have allowed for and encouraged internal review of process and practices. This project was not implemented and so remains inconclusive.
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Andersen, Sharri Suesette. "Assessment of Detroit Hospital Preparedness for Response to an Improvised Nuclear Attack." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2634.
Full textAbstract:
An improvised nuclear device (IND) is considered by the DHS to be the most catastrophic terrorist incident that could befall the United States, causing severe economic damage, extensive property damage, and enormous loss of life. Effective response to an IND is best accomplished with preparation including emergency operations plans (EOP) specific to an IND and training for staff on how to respond. The literature documents several areas of weakness in U.S. health services' preparation that affects entire communities and puts lives at risk. The purpose of this study was to assess the strengths, weaknesses, and gaps in Detroit, Michigan hospitals' EOP for responding to an IND terrorist attack. The conceptual framework used systems theory to look at how an event's complex individual components work as parts of a larger whole. Specifically, the interconnections that the individual parts of an event have on the outcome were assessed as means of evaluating the IND EOP that Detroit area hospitals have in place. This qualitative study consisted of an interview approach with the emergency management representatives of Detroit hospitals responsible for EOP development. Data analysis was completed using categorization based on research questions to look for commonalities and trends. This study revealed gaps that the 5 participating Detroit hospitals have in their preparation, training, and staff knowledge in response to an IND. Implications for positive social change, at local and national levels, include creation and dissemination of an improved model for disaster planning and training in the hospital setting, which correlates to improved community response and community care for health service organizations and throughout health services as a whole.
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McMullan, Jason T. M. D. "Prospective Prehospital Evaluation of the Cincinnati Stroke Triage Assessment Tool." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522417658333396.
Full text
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Veronese, Jean-Paul Tyrone. "An assessment of theoretical knowledge and psychomotor skills of Basic Life Support Cardio-Pulmonary Resuscitation provision by Emergency Medical Services in a province in South Africa." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16524.
Full textAbstract:
Includes bibliographical referencesIntroduction: When high quality cardiopulmonary resuscitation (CPR) is performed, survival rates can approach 50% following witnessed out-of-hospital cardiac arrest. However, survival rates are more commonly much worse in both the in-hospital and out-of-hospital context and range from 0% to 18%. There is a paucity of evidence surrounding the competency at which basic life support (BLS) CPR is provided among Emergency Medical Services (EMS) personnel in South Africa, and quality assurance mechanisms are generally scarce or do not exist. Methods: A descriptive analytical study design was used to assess theoretical knowledge and psychomotor skills of BLS CPR provision by EMS personnel in a province in South Africa. An assessment questionnaire from a 'BLS for healthcare providers' course was used to determine theoretical knowledge. Cardiac arrest simulations were video recorded to assess psychomotor skills. BLS instructors independently scored the latter. Results: Overall competency of BLS CPR among the participants (n=115) was poor. The median knowledge assessment was 50% and the median skills 22%. Only 25% of the items tested showed that the participants applied the relevant knowledge to the equivalent skill and the nature and strength of theory influencing skills was small. However, certain demographic and circumstantial variables such as sector of employment, guidelines they were trained according to, age, and location where trained had a significant effect (p<0.05) on knowledge and skills. Discussion: This study suggests that theoretical knowledge has a small but notable role to play in psychomotor skills performance of BLS CPR. Demographic and circumstantial variables that were shown to affect knowledge and skill may be used to improve training and therefore competency. The results of this study highlight the need for continuous, and perhaps tailored BLS CPR instruction to bring the diverse set of EMS personnel currently practicing in South Africa up to international competency standards.
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/710.
Full textAbstract:
Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/710.
Full textAbstract:
Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Zurcher, Kenneth. "Assessment of the Analgesic Efficacy of Intravenous Ibuprofen in Biliary Colic." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623565.
Full textAbstract:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.It is estimated over 20 million people aged 20‐74 have gallbladder disease, with biliary colic being a common and painful symptom in these patients. Likely due to the relatively recent approval of intravenous ibuprofen use for fever and pain in adults, no assessment of its analgesic efficacy for biliary colic currently exists in the literature. In this double‐blind, randomized, controlled trial we aim to assess the analgesic efficacy of intravenous (IV) ibuprofen given in the emergency department (ED) for the treatment of biliary colic. Analgesic efficacy was evaluated using a visual analog scale (VAS) to assess for a decrease in pain scores. A VAS score decrease of 33% in relation to the VAS taken at the time of therapy drug administration was considered a minimum clinically important difference (MCID) in patient‐perceived pain. A VAS was administered in triage upon enrollment, at the time of therapy administration, at 15‐minute intervals during the first hour post‐administration, and 30‐minute intervals in the second hour. As the standard of care for suspected biliary colic at the study institution is administration of a one‐time dose of IV morphine, patients were not denied initial morphine analgesia and were permitted to receive “rescue” morphine analgesia at any point during their ED course. A total of 22 patients completed the study. 9 were randomized to the IV ibuprofen arm, 9 to placebo, and 4 were excluded for a diagnosis other than biliary colic. Mean VAS values at time 0 to time 120 decreased from 5.78 to 2.31 in the ibuprofen group, and from 5.89 to 2.67 in the control group. There was no statistically significant difference in treatment status of ibuprofen vs. placebo (p‐value (p.) 0.93), though there was a significant decrease in the measured VAS scores over time (0 minutes to 120 minutes, p.0.031) in both ibuprofen and placebo groups. A statistically significant and clinically important decrease in average VAS scores were seen in both placebo and ibuprofen groups (55% and 60%, respectively). There was no difference in time needed to achieve a clinically significant reduction in pain between groups. The sample size of this study may be inadequate to fully assess the analgesic efficacy of IV ibuprofen for biliary colic. In the analysis group (n=18) no significant difference in treatment status of ibuprofen vs. placebo was seen, however there was a statistically and clinically significant decrease in pain in both groups. Two potential confounding factors may have affected the trial’s results: administration of standard‐of‐care IV morphine following initial triage assessment, and the inherent episodic and self‐limited nature of biliary colic.
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Cooks, Tiffany. "Factors Affecting Emergency Manager, First Responder, and Citizen Disaster Preparedness." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1530.
Full textAbstract:
Despite the increased frequency of natural and man-made disasters, there is a problem in the level of preparedness of emergency managers, responders, and citizens to address them. The purpose of this grounded theory study was to explore the factors that affect these groups' preparedness to inform the development of better emergency plans to handle emergency incidences. The conceptual framework for the study was knowledge management, which was used with a grounded theory approach. The study was guided by primary research questions that focused on understanding psychological, material, temporal, organizational, and other factors that affect the preparedness of emergency managers, first responders, and citizens, and on identifying measures for improving those levels of preparedness. Interview data were collected from a purposeful sample of emergency managers (n = 11), first responders (n = 26), and citizens (n = 26) from South Carolina who had experienced disasters. Secondary data from 6 disasters, 3 emergency operations plans, and 2 standard operating procedure guides were also collected. The constant comparative method was used to analyze data, informing the development of a theory that suggests emergency managers, first responders, and citizens must act collaboratively to prepare for and respond more effectively to disasters, in addition to their independent work. This study promotes positive social change by providing emergency management agencies with information necessary for developing better emergency preparedness plans, thus reducing the personal and economic impact of future disasters.
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Robinson, Thomas Russell. "Assessment of coseismic landsliding from an Alpine fault earthquake scenario, New Zealand." Thesis, University of Canterbury. Department of Geological Sciences, 2014. http://hdl.handle.net/10092/10029.
Full textAbstract:
Disasters can occur without warning and severely test society’s capacity to cope, significantly altering the relationship between society and the built and natural environments. The scale of a disaster is a direct function of the pre-event actions and decisions taken by society. Poor pre-event planning is a major contributor to disaster, while effective pre-event planning can
substantially reduce, and perhaps even avoid, the disaster. Developing and undertaking effective planning is therefore a vital component of disaster risk management in order to achieve
meaningful societal resilience. Disaster scenarios present arguably the best and most effective basis to plan an effective emergency response to future disasters.
For effective emergency response planning, disaster scenarios must be as realistic as possible. Yet for disasters resulting from natural hazards, intricately linked secondary hazards and effects make development of realistic scenarios difficult. This is specially true for large earthquakes in mountainous terrain. The primary aim of this thesis is therefore to establish a detailed and realistic disaster scenario for a Mw8.0 earthquake on the plate boundary Alpine fault in the South Island of New Zealand with specific emphasis on secondary effects. Geologic evidence of re-historic earthquakes on this fault suggest widespread and large-scale landsliding has resulted throughout the Southern Alps, yet, currently, no attempts to quantitatively model this landsliding have been undertaken. This thesis therefore provides a first attempt at quantitative assessments of the likely scale and impacts of landsliding from a future Mw8.0 Alpine fault earthquake.
Modelling coseismic landsliding in regions lacking historic inventories and geotechnical data (e.g. New Zealand) is challenging. The regional factors that control the spatial distribution of landsliding however, are shown herein to be similar across different environments. Observations from the 1994 Northridge, 1999 Chi-Chi, and 2008 Wenchuan earthquakes
identified MM intensity, slope angle and position, and distance from active faults and streams as factors controlling the spatial distribution of landsliding. Using fuzzy logic in GIS, these factors are able to successfully model the spatial distribution of coseismic landsliding from both the 2003 and 2009 Fiordland earthquakes in New Zealand. This method can therefore be applied to estimate the scale of landsliding from scenario earthquakes such as an Alpine fault event.
Applied to an Mw8.0 Alpine fault earthquake, this suggests that coseismic landsliding could affect an area >50,000 km2 with likely between 40,000 and 110,000 landslides occurring.
Between 1,400 and 4,000 of these are expected to present a major hazard. The environmental impacts from this landsliding would be severe, particularly in west-draining river catchments, and sediment supply to rivers in some catchments may exceed 50 years of background rates. Up to 2 km3 of total landslide debris is expected, and this will have serious and long-term consequences. Fluvial remobilisation of this material could result in average aggradation depths on active alluvial fans and floodplains of 1 m, with maximum depths substantially larger. This is of particular concern to the agriculture industry, which relies on the fertile soils on many of the active alluvial fans affected.
This thesis also investigated the potential impacts from such landsliding on critical infrastructure. The State Highway and electrical transmission networks are shown to be particularly
exposed. Up to 2,000 wooden pole and 30 steel pylon supports for the transmission network are highly exposed, resulting in >23,000 people in the West Coast region being exposed
to power loss. At least 240 km of road also has high exposure, primarily on SH6 between Hokitika and Haast, and on Arthur’s and Lewis Passes. More than 2,750 local residents in Westland District are exposed to isolation by road as a result. The Grey River valley region is identified as the most critical section of the State Highway network and pre-event mitigation is strongly recommended to ensure the road and bridges here can withstand strong shaking and liquefaction hazards. If this section of the network can remain functional post-earthquake,
the emergency response could be based out of Wellington using Nelson as a forward operating base with direct road access to some of the worst-affected locations. However, loss of functionality of this section of road will result in >24,000 people becoming isolated across almost the entire West Coast region.
This thesis demonstrates the importance and potential value of pre-event emergency response planning, both for the South Island community for an Alpine fault earthquake, and globally for all such hazards. The case study presented demonstrates that realistic estimates of potential coseismic landsliding and its impacts are possible, and the methods developed herein can be applied to other large mountainous earthquakes. A model for developing disaster scenarios in collaboration with a wide range of societal groups is presented and shown to be an effective method for emergency response planning, and is applicable to any hazard and location globally. This thesis is therefore a significant contribution towards understanding mountainous earthquake hazards and emergency response planning.
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Lyons, Melinda. "Evaluation of a task performance resource constraint model to assess the impact of offshore emergency management on risk reduction." Thesis, Cranfield University, 2000. http://dspace.lib.cranfield.ac.uk/handle/1826/4056.
Full textAbstract:
In this age of safety awareness, technological emergencies still happen, occasionally with catastrophic results. Often human intervention is the only way of averting disaster. Ensuring that the chosen emergency managers are competent requires a combination of training and assessment. However, assessment currently relies on expert judgement of behaviour as opposed to its impact on outcome, therefore it would be difficult to incorporate such data into formal Quantitative Risk Assessments (QRA). Although there is, as yet, no suitable alternative to expert judgement, there is a need for methods of quantifying the impact of emergency management on risk reduction in accident and incidents. The Task Performance Resource Constraint (TPRC) model is capable of representing the critical factors. It calculates probability of task success with respect to time based on uncertainties associated with the task and resource variables. The results can then be used to assess the management performance based on the physical outcome in the emergency, thereby providing a measure of the impact of emergency management on risk with a high degree of objectivity. Data obtained from training exercises for offshore and onshore emergency management were measured and successfully used with the TPRC model. The resulting probability of success functions also demonstrated a high level of external validity when used with improvements in emergency management or design changes or real data from the Piper Alpha disaster. It also appeared to have more external validity than other HRQ/QRA techniques as it uses physical data that are a greater influence on outcome than psychological changes - though this could be because the current HRA/QRA techniques view human unreliability as probability of error rather than probability of failure. The simulation data were also used to build up distributions of timings for simple emergency management tasks. Using additional theoretical data, this demonstrated the model's potential for assessing the probability of successf or novel situations and future designs.
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Gokdemir, Nuray. "Identification And Representation Of Information Items Required For Vulnerability Assessment And Multi-hazard Emergency Response Operations." Master's thesis, METU, 2011. http://etd.lib.metu.edu.tr/upload/12613239/index.pdf.
Full textAbstract:
Emergency response teams, need various internal information about facilities such as building usage type, number of floors, occupancy information, building contents and vulnerable locations in facility during and immediately after multi hazard emergencies. Accessing such information accurately and timely is very important in order to speed up the guidance of occupants in a facility that is under the effect of multi-hazards to safe exits and speed up the decision process of emergency response teams to identify vulnerable locations (e.g. locations where secondary disasters can arise following an earthquakefires, explosions). In the current practice, emergency response teams access such vital information to respond the emergency by visual investigating the environment and by asking the people in the neighborhood which causes gaining wrong and misleading information and results in loosing time and increasing the hazardous effect of emergency. Hence, there is a need for an approach to enable emergency response teams to access timely and accurate needed information items. To start the first step of this approach, the information items needed by emergency response teams to guide occupants the safe exits, to direct emergency response teams to vulnerable locations of the facility are identified and classified. Identified information items will be represented to emergency response teams by a model based system (BIM). The opportunities of model based system (BIM) will enable fast and safe evacuation of the facility, identification of vulnerable locations within the facility in a multi hazard emergency.
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McGeoch, Ross James. "The assessment of microvascular injury in patients undergoing emergency PCI for ST - elevation myocardial infarction." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3560/.
Full textAbstract:
Despite the interventional and pharmacological advances in treatment in ST elevation myocardial infarction in recent decades, it continues to be a significant cause of morbidity and mortality in Scotland and around the world. The diagnosis and treatment of ST-elevation myocardial infarction has been the subject of intense investigation and the focus of numerous randomised clinical trials over past decades. In an attempt to minimise adverse sequelae it is imperative that in patients with ST elevation myocardial infarction (STEMI) the immediate goal of therapy is to rapidly achieve patency of the epicardial infarct related artery (IRA) and consequently reperfusion of the affected myocardium. Thrombolysis achieves normal flow (TIMI grade 3) in the IRA in around 50% of patients compared to around 90% with primary PCI (pPCI). The successful restoration of epicardial coronary artery patency with TIMI grade 3 flow, however, does not necessarily translate into adequate tissue level perfusion. Inadequate tissue level perfusion in ST – elevation myocardial infarction in the presence of a patent epicardial artery is characterised by myocardial microvascular dysfunction. Evidence of microvascular obstruction (MVO) regardless of how it is assessed is associated with adverse clinical outcomes in this patient group. A series of consistent data has clearly shown that MVO has a strong negative impact on outcome. The index of microvascular resistance is a marker of myocardial microvascular resistance which be validated in vitro and in vivo and has been shown to be independent of variations in haemodynamic state. By incorporating collateral flow IMR has been validated in the presence of an epicardial stenosis and therefore can be calculated prior to and following stenting. Calculation of IMR at the time of emergency PCI for STEMI could potentially provide a marker of microvascular and myocardial injury in the very early post infarct period when further potential interventions would be most beneficial to the patient. Cardiac MRI imaging is the current gold standard for assessment of left ventricular ejection fraction and infarct volumes. Using Gadolinium contrast agent CMR can characterise microvascular obstruction and calculate infarct volumes. This useful information is not normally available at the time of emergency PCI. The principle aim of this thesis is to compare pressure wire derived markers of microvascular obstruction, principally IMR, calculated at the time of emergency PCI for STEMI with evidence of microvascular and myocardial damage as assessed by ceCMR scanning at 2 days and 3 months post PCI. In particular I will look at whether IMR at the time of PCI for STEMI can be used as a predictor of myocardial damage on ceCMR.I will also compare IMR the “traditional” indices currently used to assess microvascular perfusion and assess the impact that stenting itself has on the coronary microvasculature by comparing IMR prior and following PCI. CMR imaging is not commonly available in the early post infarct period. I will therefore also look at the safely, feasibility and clinical utility of ceCMR imaging in the 24 to 48 hour period following PCI for STEMI. Patients who were undergoing emergency PCI for STEMI were recruited. They underwent pressure wire assessment at the time of emergency PCI and had ceCMR scans at 2 days and 3 months following their myocardial infarction. A total of 77 patients were consented for the study between 04/01/2007 and 28/02/2008 and 69 patients had successful coronary physiological studies at the time of PCI. Two hundred patients in total underwent early ceCMR post STEMI over a longer time period. In summary the findings of this thesis are: IMR is significantly higher in patients in whom there is evidence of MVO in ceCMR scanning at 48h but does not predict the amount of MVO present. IMR is a strong independent predictor of LVEF, infarct volumes and LVESV on ceCMR imaging at 48h and 3 months. IMR was an independent predictor of transmurality score on ceCMR IMR does not alter significantly following stenting in emergency PCI indicating that stenting itself does not significantly alter the coronary microvasculature. IMR correlates closely with the “traditional” markers of myocardial damage and myocardial infarction in ST – elevation myocardial infarction. Anatomical site if myocardial infarction and therapeutic interventions at the time of emergency PCI do not significantly influence coronary pressure wire derived markers of microvascular obstruction taken immediately post – procedure. There was a nearly exact relationship between the presence of “early” and “late” MVO assessed by ceCMR imaging 48h post STEMI CMR in the early post infarct period is safe, feasible and provides useful diagnostic information This was the first study to directly compare IMR with ceCMR assessment of MVO and myocardial damage. I feel that my results complement the other work done in this field both in stable patients and in the STEMI population. I have shown that an elevated IMR is linked to microvascular and myocardial damage as revealed by ceCMR in the early post infarction period and at longer term follow up. Accordingly, I suggest measurement of IMR represents a new approach to risk assessment at the very earliest stage of acute MI management, and potentially, therefore enables triage of higher risk patients to more intensive therapy.
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Peters, Ekong Johnson. "Exploring Spontaneous Planning During the North Texas April 3, 2012, Tornadoes: an Assessment of Decision-making Processes." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc700105/.
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The primary purpose of this research program is to confirm the spontaneous planning behavior in post-disaster operations while at the same time contribute to the development of the concept in a tornado type disaster. An additional goal also includes examining how the process takes place in resolving unanticipated problems as a disaster unfolds. This study uses qualitative methodology which is case study to probe the concept of spontaneous planning behavior to solve unexpected challenges as a disaster develops. Specifically, semi-structured, open-ended questions were utilized to collect data from stakeholders in eleven functional organizations in three impacted cities during the North Texas April 3, 2012, tornadoes. Findings indicate that debris removal and ensuring public safety, search and rescue, securing damaged neighborhoods, activation of emergency operations centers, damage assessment, restoration of communication system, public relations and media, and volunteer and donation management activities appear to have benefited from spontaneous planning behavior. Further findings suggest that the driving forces behind the phenomenon were gathering valuable new information, learning opportunity within the disaster, relative freedom and significant high degree of discretion, response was innovative with flexibility, and solutions waiting for problems features proposed in the integrated decision-making model (IDMM). However, it was uncovered that interview respondents’ answers tend to indicate that mixed organizational structures helped in problem resolutions rather than just flat organizational structure as some decision making literature may suggest. Analysis of this decision-making model expanded the understanding of how spontaneous planning behavior took place in resolving unforeseen problems in post-disaster operations. This research project confirmed the concept of spontaneous planning in the North Texas tornadoes as well as suggesting how it occurred. The research program validates spontaneous planning behavior in tornadoes; advances and develops the concept of spontaneous planning; increases understanding, description, and management of post-disaster operations; improves emergency management operations; promotes spontaneous planning as a key principle among responders and others involved in emergency management; and proposes IDMM as a useful model that explains decision-making behavior during a disaster.
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Lourens, Andrit. "Developing an in-depth understanding of acute pain assessment and management in the prehospital setting in the Western Cape, South Africa, the factors influencing practice and what improvement measures could advance prehospital acute pain management." Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32775.
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Introduction: Acute pain is a common reason for seeking emergency care in the prehospital and emergency centre settings where pain prevalence ranges widely. Pain is a significant global health problem which often goes unnoticed and is undermanaged. To this end, a project consisting of a series of research studies aimed to develop an understanding of acute prehospital pain assessment and management in South Africa was conducted to identify how best to improve this field. Methods: The project consisted of four distinct objectives to be investigated as separate but interconnected studies. The first objective was answered through a secondary research methodology (scoping review) to identify and map the body of evidence on acute prehospital pain assessment and management in Africa. The remaining three objectives were answered using primary research methods in studies conducted in the Western Cape, South Africa. Two observational studies, (i) a cross-sectional online survey and (ii) a retrospective review, respectively, aimed to describe (i) the knowledge, attitudes and practices regarding prehospital acute pain assessment and management among emergency care providers and (ii) current prehospital acute pain assessment and management practices in high acuity trauma patients. The final study employed qualitative research methods using focus groups and content analysis to explore and describe emergency care providers' perspectives of acute pain assessment and management as well as perceived barriers and facilitators to pain management. Main results: In the scoping review, six publications on acute pain research in the African prehospital setting were identified, indicative of the paucity and immaturity of this research area. In the cross-sectional online survey, suboptimal levels of knowledge and attitudes regarding pain (58.01%) were found among emergency care providers, with gaps in all aspects of pain knowledge and attitudes of distrust in self-reported pain identified. The retrospective review recorded pain scores were documented in only 18.1% of the high acuity trauma patients reviewed, while moderate-to-severe pain (78.6%) was prevalent among those who had a pain score documented. Less than 3% of all trauma patients, and less than 8% of those with moderate-to-severe pain received analgesic medication, thus, suggesting less than ideal prehospital pain assessment and management practices. In the final qualitative study, six focus groups and one interview were conducted among 25 emergency care providers. Through content analysis five themes, namely: assessing pain is difficult in this setting; many factors affect clinical reasoning some unique to this (hostile) setting; basic and intermediate life support practitioners' reality of prehospital pain care; the emergency centre does not understand what we do, how we work, what it is like; and how can we do better; emerged from the data. Conclusion: Africa has a scarcity of prehospital pain research with current evidence mainly from South Africa while knowledge of prehospital pain assessment and management in the Western Cape, South Africa proved to be a significant gap. This gap appears to be underpinned by limited educational focus, lack of pain prioritisation in emergency medical services (EMS) organisations, lack of clear evidence-based prehospital pain clinical practice guidelines, and emergency care providers' indifference towards prehospital pain care. A joint approach from EMS organisations and educational institutions, coupled with clinical practice guideline development, as well as interdisciplinary collaboration between prehospital emergency care and emergency medicine, are required. Further research must focus on developing the body of African prehospital pain knowledge to inform clinical practice and advance quality prehospital pain care.
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Percy, Daphne Helen. "A Study of Five Cincinnati Health Department Dental Clinics: An Assessment of Emergency Dental Patients Needs." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1029530616.
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Hategekimana, Celestin. "Evaluating the implementation of the emergency, triage, assessment and treatment plus admission care intervention in Rwanda." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/55056.
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Background: Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) intervention – a locally adapted pediatric advanced life support program – introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The current thesis was undertaken as part of a larger program of research that aims to evaluate the ETAT+ implementation in Rwanda.
Methods: Data were gathered during a cross-sectional study in 8 district hospitals across Rwanda; an audit in these hospitals was undertaken to establish a baseline description of the availability of essential resources and process of care related to the leading causes of under-five mortality in Rwanda. To determine changes in participating healthcare providers’ knowledge and practical skills (n=374) between pre- and post ETAT+ implementation, a one group pre-posttest design was used. Paired t-test was used to assess the effect of ETAT+ training on knowledge improvement; and, linear and logistic regression models were fitted to examine factors associated with healthcare providers’ performance on ETAT+ knowledge and skills assessments in Rwanda.
Results: Baseline assessment reveals some deficiencies in processes of care (i.e. assessment, treatment and follow-up care), poor organization of some hospital services (e.g., triage), and poor uptake of current pediatric clinical practice guidelines (e.g., dehydration). Post ETAT+, participants’ knowledge scores improved on average by 22.8% (95% CI 20.5, 25.1). Compared to participants who identified as proficient in French, those who identified as proficient in both English and French had on average a higher improvement in knowledge (least square mean=6.64; 95% CI 3.79, 9.49) and were more likely to pass the practical skills assessment (adjusted odds ratio=2.58; 95% CI 1.28, 5.48).
Conclusions: The audit of medical records reveals gaps in the process of pediatric care; and these gaps were found to be consistent with knowledge gaps among healthcare providers, as assessed through the ETAT+ pre-assessment. Improvements in post-ETAT+ performance were significant and a number of factors (e.g., language barriers) were identified as important influences on ETAT+ training outcomes. These factors need to be taken in account when implementing ETAT+ and other continuing medical education interventions within the Rwandan context.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Davison, John. "Multifactorial assessment and intervention in cognitively intact older recurrent fallers attending an accident & emergency department." Thesis, University of Newcastle Upon Tyne, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424016.
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Jordan, Alexandra M. "An overview of the volcano-tectonic hazards of Portland, Oregon, and an assessment of emergency preparedness." Thesis, Massachusetts Institute of Technology, 2011. http://hdl.handle.net/1721.1/114368.
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Thesis: S.B., Massachusetts Institute of Technology, Department of Earth, Atmospheric, and Planetary Sciences, 2011.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 106-119).
Portland, Oregon, lies within an active tectonic margin, which puts the city at risk to hazards from earthquakes and volcanic eruptions. The young Juan de Fuca microplate is subducting under North America, introducing not only arc magmatism into the overlying plate, but also interplate and intraplate seismicity related to the subduction zone. Large crustal earthquakes are also probable in Portland because of the oblique strike-slip Portland Hills Fault zone. These hazards create risk to Portland residents and infrastructure because of pre-existing vulnerabilities. Much of Portland's downtown area, including the government and business districts, is at risk of ground shaking infrastructure damage, liquefaction and landslides due to earthquakes. Additionally, the city is within 110 km of three active Cascadia stratovolcanoes, two of which pose hazards from tephra and lahars. Though the city is under the umbrella of four emergency response plans-city, county, state and federal-there are critical gaps in mitigation strategies, emergency exercises and community education and outreach. Portland cannot prevent earthquakes or volcanic eruptions, but the city can reduce its vulnerability to these hazards.
by Alexandra M. Jordan.
S.B.
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Percy, Daphne H. "A study of five Cincinnati Health Department dental clinics an assessment of emergency dental patients needs /." Cincinnati, Ohio : University of Cincinnati, 2002. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=ucin1029530616.
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Jacklitsch, Brenda L. "Assessing Heat-Related Knowledge, Perceptions, and Needs among Emergency Oil Spill Cleanup Responders." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1509983799665014.
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Cisneros, Martha, Jennie Danielson, and Velvet Deleal. "Evaluation of Numerical Pain Scale Use in the Emergency Department at a Rural Community Hospital." The University of Arizona, 2006. http://hdl.handle.net/10150/624518.
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Class of 2006 AbstractObjectives: To evaluate the use of the numerical pain scale at the Sierra Vista Regional Health Center Emergency Department in adult patients presenting with a chief complaint of pain. Methods: A retrospective chart review was performed on 299 charts of patients presenting to the emergency department with a chief complaint of pain. Results: Pain was assessed in 86.2% of 299 patients at triage, 26.4% post-intervention, and 58.2% at discharge. The average pain value reported by patients at triage was 6.3. Subsequent average pain value post-intervention was 4.1 and 2.9 at discharge. The average pain value at triage compared to the average pain value at discharge was statistically different (p<0.05). Conclusions: Pain assessment using the NRS is not being performed adequately in all patients presenting to the emergency department at SVRHC with a chief complaint of pain.
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Hoffman, Evelina, and Anna-Josephine Johansson. "Faktorer som kan ha betydelse för sjuksköterskans triagebedömning : En litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-19303.
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Bakgrund: Flera svenska sjukhus utvecklade under 1990-talet triageskalor för att prioritera och sortera patienter på akutmottagningar. En av anledningarna var att patientantalet ökade och resurser på tillgängliga doktorer var begränsade. Syfte: Att beskriva vilka faktorer som kan ha betydelse för sjuksköterskans triagebedömning på akutmottagningar och att beskriva vilka datainsamlingsmetoder de valda artiklarna har använt sig av.Metod: En litteraturstudie med deskriptiv design som baseras på 12 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Sökningarna efter artiklar har skett i databaserna Cinahl, PubMed och Google Scholar.Resultat: Hög arbetsbelastning och brist på personal var faktorer som hade betydelse för sjuksköterskans arbete. En del sjuksköterskor ansåg att hög arbetsbelastning kunde leda till färre korrekta prioriteringar, att det är svårare att prioritera en patient när sjuksköterskan är stressad. Mindre erfarna sjuksköterskor ändrade sina beslut i triageringen och tog längre tid på sig vid triagebedömningen. Utbildning och simuleringsträning var viktigt i triageprocessen för att sjuksköterskorna skulle kunna utveckla färdigheter, fatta beslut och samla in mer korrekt information vid bedömningen. Triagesjuksköterskor kunde bli avbrutna av patienter som frågar hur lång tid det tar innan de blir bedömda. Detta var en källa till stress och otillfredsställelse samt påverkade koncentrationen. Sju artiklar har använt sig av intervjuer, fyra har använt sig av observationer och fem har använt sig av andra datainsamlingsmetoder.Slutsats: En stor anledning till färre korrekta triageprioriteringar är hög arbetsbelastning och stress. Sjuksköterskans koncentration påverkas av patienter som avbryter under triageprocessen och bristen på personal gör att patientflödet genom akutmottagningen påverkas negativt.Background: Several Swedish hospitals developed triage scales in the 1990s to prioritize and sort patients in emergency rooms. One of the reasons was that the number of patients increased and resources of available doctors were limited. Aim: To describe the factors that may be important for the nurse’ triage assessment in emergency departments and to describe the data collection methods the chosen articles have used.Method: A literature study with descriptive design based on 12 scientific articles with both qualitative and quantitative approach. The search for articles have occurred in the databases Cinahl, PubMed and Google Scholar.Results: The high workload and lack of staff were factors that were relevant to the nursing profession. Some nurses felt that the high workload could lead to fewer correct priorities, it is difficult to prioritize a patient when the nurse is stressed. Less experienced nurses changed their decisions in the triage and took more time at the triage assessment. Training and simulation training was important in the triage process so the nurses could develop skills, make decisions and gather more accurate information in the assessment. Triage Nurses could be interrupted by patients asking how long it takes before they are assessed. This was a source of stress and dissatisfaction and affect concentration. Seven articles have used interviews, four have used observations and five have used other methods of data collection.Conclusion: A major reason for fewer correct triage priorities are high workload and stress. Nurse's concentration is affected by patients who discontinue during the triage process and the lack of staff means that the patient flow through the emergency department adversely affected.
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Bentley, Melissa Ann. "An Assessment of Depression, Anxiety, and Stress among Nationally Certified EMS Professionals." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306521665.
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Hamouda, Ghada. "Risk-Based Decision Support Model for Planning Emergency Response for Hazardous Materials Road Accidents." Thesis, University of Waterloo, 2004. http://hdl.handle.net/10012/829.
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Hazardous Materials (HazMat) are transported throughout Canada in a great number of road shipments. The transportation of HazMat poses special risks for neighboring population and environment. While HazMat accidents are rare events, they could be catastrophic in nature and could result in substantial damage to nearby communities. Effective emergency response plays an important role in the safe transportation of HazMat. Transportation of HazMat involves different parties, including shippers, regulators, and surrounding communities. While the shipping party is responsible for safe delivery of HazMat shipments, it is the responsibility of local emergency service agencies to respond to accidents occurring within their jurisdictions. In this research, the emergency response to HazMat transport accidents is assumed to be delegated exclusively to specially trained and equipped HazMat teams. This research proposes a new comprehensive systematic approach to determine the best location of HazMat teams on regional bases utilizing HazMat transport risk as a location criterion. The proposed model is the first to consider emergency response roles in HazMat transport risk analysis, and was intended as an optimization tool to be used by practitioners for HazMat emergency response planning. Additionally, the proposed model can be used to assess risk implications in regards to current locations of HazMat teams in a region, and to develop effective strategies for locating HazMat teams, such as closing and/or relocating teams in the region. The model investigates how HazMat team locations can be tailored to recognize the risk of transporting HazMat and would provide a more objective set of input alternatives into the multi-criteria decision making process of regionally locating HazMat teams. The proposed model was applied to the region of southwestern Ontario in effort to illustrate its features and capabilities in the HazMat emergency response planning and decision making process. Accordingly, the model provided very useful insights while reviewing several HazMat team location strategies for the southwestern Ontario region and investigating tradeoff among different factors. This research contributes to a better understanding of emergency response roles by reducing HazMat transport risks, and will greatly benefit both researchers and practitioners in the field of HazMat transport and emergency response.