Tesi: "Ambulance service"

1

Manuel, Richard A. "Street supervision in the BC Ambulance Service". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ59459.pdf.

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2

Newton, Andrew. "Ambulance Service 2030 : the future of paramedics". Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/15437.

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Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

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3

Yeung, Man-pun. "A review of the mode of service delivery of emergency ambulance service (EAS) in Hong Kong". Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36443062.

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4

O'Meara, Peter Francis Public Health &amp Community Medicine Faculty of Medicine UNSW. "Models of ambulance service delivery for rural Victoria". Awarded by:University of New South Wales. Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/18771.

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The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.

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5

Yu, Kim-ching. "A study of the feasibility of privatising ambulance services in Hong Kong". Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21036706.

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6

Wong, Lut-man. "Contemporary pre-hospital ambulance services in Hong Kong a study of development and reform /". Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41006057.

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7

Aharonson-Daniel, Limor. "Application of operations research in studies of ambulatory care services". Thesis, Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B17054928.

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8

Johnston, Janice Mary. "Ambulatory care: a comparison of event and episode utilisation patterns". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31237125.

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9

Lo, Shun-tong. "A feasibility study on privatization of emergency ambulance services in Hong Kong". Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22054431.

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10

Tareghian, H. R. "Application of hybrid simulation models to ambulance services problems". Thesis, Cranfield University, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.374009.

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11

Yeung, Man-pun, e 楊文彬. "A review of the mode of service delivery of emergency ambulance service (EAS) in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B36443062.

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12

To, Wing-chow Raphael. "Emergency ambulance service in Hong Kong : a study of continuity and change /". Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21037899.

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13

Schinbein, John Richard. "Occupational stress and the British Columbia Ambulance Service management staff". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0005/MQ41838.pdf.

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14

Wong, Chun-kit. "St. John Ambulance Brigade Kln & N.T. Command Headquarters". Hong Kong : University of Hong Kong, 1998. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25953382.

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15

James, A. E. C. "Stress in the ambulance service : An investigation into the sources of occupational stress perceived by managerial, control and operational staff of the Devon ambulance service". Thesis, University of Bradford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.381016.

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16

Jones, Anna L. "An ergonomic evalution of equipment to support patient movement and transfer in the ambulance service". Thesis, Loughborough University, 2007. https://dspace.lboro.ac.uk/2134/8036.

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It is commonly accepted that ambulance staff undertake a large amount of lifting and handling in their daily work. Their primary role is to provide pre-hospital care and to transport sick and injured people to hospital. The emergency nature of the job means that ambulance workers have to assist people who are incapable of moving themselves in awkward and potentially hazardous environments. While safer lifting policies have been introduced ambulance workers still lift weights which other healthcare workers can avoid. However since the introduction of manual handling regulations and more recently CEN standards, ambulance services and manufacturers have been trying to find new ways of moving and transferring patients. Ambulance services have purchased new equipment to reduce musculoskeletal risks but there is little scientific evidence to support their purchasing choices. This thesis presents two case studies describing ergonomic equipment evaluations of stretcher loading systems and mobility equipment to provide a scientific basis to support purchasing decisions. Case study one is a comparative analysis of stretcher loading equipment used in UK ambulance services. The study was carried out in two phases. Phase 1 was a field study which used observation and interview methods to identify issues affecting equipment use in a range of environments. Phase 2 was a simulation study which used task simulation to assess the postures adopted during loading and unloading activities with each system. Both phases identified the tail lift as the preferred system to reduce manual handling and improve patient and operator safety. Case study two is a comparative evaluation of mobility equipment. User trials were carried out to evaluate 12 transport chairs and 4 stretchers for Accident and Emergency and Patient Transport Service staff to identify preferred equipment for each team. 16 staff assessed the equipment by conducting task simulations and completing questionnaires for each product. Postures adopted during the tasks were assessed using Rapid Entire Body Assessment. The mechanised stair climber chair was the preferred chair for both teams. The stretcher analysis was inconclusive. This thesis has used two case studies to establish a protocol for field and lab based evaluations of movement and transfer equipment in the future for the ambulance vehicle. A more comprehensive procurement process is recommended to include detailed ergonomic evaluation, ensuring that the end user is fully represented. The thesis concludes that automation is way forward to reduce manual handling risks posed to ambulance workers. The output from case study 1 (tail lift) has been included in the national specification for future Emergency Ambulances in the UK.

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17

Gamble, Robert Paul. "The health, physical fitness and occupational demands of Belfast's Ambulance Service". Thesis, Queen's University Belfast, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333812.

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18

To, Wing-chow Raphael, e 杜榮洲. "Emergency ambulance service in Hong Kong: a study of continuity and change". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31966020.

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19

Peters, Jeremy. "An evaluation of ambulance service performance using a Geographic Information System". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq30253.pdf.

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20

O'Neill, M. "Carriage with compassion : an ethnographic study of a Welsh ambulance service". Thesis, Swansea University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.638352.

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The ambulance service through one of the most visible areas of health care provision is also one of the least researched. This study presents an analysis to how members of this particular group manage their occupational identity in the wider social milieu. By an examination of the cultural rules of the organisation and the implications of both history and occupational relations, this study provides a holistic examination of how such identity is managed and maintained on the various stages that ambulance workers perform their daily working activities. As will be explained in the study, during the past ten years there have been many developments in ambulance provision in the UK, a central one of which has been the organisation now not only provides transport for the sick and injured but also active medical care. One consequences of this changing role is a nascent "professional" occupational identity, which has to negotiate its position in relation to other "professional" groups. The main findings of the research were that the organisation was characterised by its large spatially spread out nature, which had implications for the development of multi organisational sub-cultures, which, in turn, had ramifications for occupational identity. In order for ambulance workers to manage such identity in the wider milieu they need to draw on occupational classifications that exist in society. The study also presents an analysis of the classificatory systems that staff utilise to address the contingencies of their working environment, which it is argued other studies in this field have failed to analyse sufficiently.

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21

Elks, Eric Desmond. "A Cultural Historical Activity Theory Perspective of the Queensland Ambulance Service". Thesis, Griffith University, 2005. http://hdl.handle.net/10072/367378.

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The study relates to the diverse Queensland community which contributes to the service provided by the Queensland Ambulance Service (QAS). The QAS motive of improving the health and well being of all Queenslanders has remained stable since 1892, despite changes in organisational structure and the actions employed by paramedics in achieving motive. The QAS is primarily focused on the pre-hospital facets of health care and in this study the changing nature of paramedic actions are juxtaposed with the longevity of QAS motive. The research deals with QAS vocational training coupled with technological innovation and evolving community expectation in meeting the demands of contemporary clinical paramedic practice. The thesis focus is on the contemporary work practices of QAS paramedics, why dominant practices prevail above the plethora of alternatives thus pointing the way to future development of the service. The theoretical framework of the study takes account of Queensland's geographical and sociological diversity, coupled with the heterogenous nature of paramedic practice. Cultural Historical Activity Theory (CHAT) informs a study into a broad range of mediating influences, unified into an account of current QAS motive, culture and clinical interventions. The CHAT approach provides ongoing potential to inform QAS policy and optimise the clinical performance of rural paramedics. The empirical framework, congruent with paramedic practice, contains elements of both scientific practice and deductive reasoning. These elements lend themselves to the descriptive nature of qualitative research methods to facilitate the application of scientific principles while visualising the multi-faceted human health experience as experienced by paramedics. Research tools including literature review, interview and questionnaire facilitate a study of specific areas of paramedic practice. The research reveals paramedics as diverse and complex individuals with professional practices unique to the individual, yet remaining within the acceptable parameters of QAS convention on most occasions. The study identifies and interprets a number of workplace contradictions in terms of the meanings that paramedics attribute to them and the consequences of these tensions for paramedic practice. The study concludes that paramedic practices are a consequence of complexities within an activity system which belie the simplicity of direct relationships between QAS education, directives and practice. Findings relate to paramedic dissatisfaction with several restrictions imposed on their clinical practice - explicit restrictions as prescribed in the QAS Clinical Practices Manual 2001 to which QAS paramedic are required to adhere. Paramedic perceptions of identified contradictions are inductively and numerically analysed leading to data synthesis and a narrative summary of findings. Identified contradictions embedded in work practices of QAS paramedics have been argued to provide the impetus for either positive or negative development within the system. The summary of findings visualises the collective paramedic experience and thus speak to recommendations aimed at the amelioration of identified systemic contradictions. Recommendations include reviewing the clinical practice profile of paramedics in remote rural areas, review of clinical accreditation levels, the retaining of clinical placements in preliminary training and the provision of more comprehensive information technology support for paramedics. In this study, recommendations are portrayed in a positive light as signals of opportunities for both expansive paramedic learning and for organisational expansion through policy initiatives embracing the contemporary demands on the QAS and its operational paramedics.
Thesis (Professional Doctorate)
Doctor of Education (EdD)
School of Vocational, Technology and Arts Education
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22

Gibson, Nicholas P. "The epidemiology of acute asthma managed by ambulance paramedics in the prehospital setting in Western Australia /". Connect to this title, 2006. http://theses.library.uwa.edu.au/adt-WU2007.0142.

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23

Fitzpatrick, David. "Hypoglycaemic emergencies attended by the Scottish Ambulance Service : a multiple methods investigation". Thesis, University of Stirling, 2015. http://hdl.handle.net/1893/21854.

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Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

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24

王律文 e Lut-man Wong. "Contemporary pre-hospital ambulance services in Hong Kong: a study of development and reform". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41006057.

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25

Ng, Bong-loy, e 吳邦來. "A study on the performance of the first responder programme adopted bythe Hong Kong Fire Services Department: frompolicy analysis and human resources perspectives". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B46775250.

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26

Wong, Chun-kit, e 黃駿傑. "St. John Ambulance Brigade Kln & N.T. Command Headquarters". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1998. http://hub.hku.hk/bib/B31984204.

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27

Moore, Simon Peter. "Delays in the emergency department and their effects on the ambulance provider". CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2067.

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28

Yu, Kim-ching, e 余劍靑. "A study of the feasibility of privatising ambulance services in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B3196607X.

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29

Brereton, John. "An evaluation of introducing advanced airway skills in the Western Australian Ambulance Service". University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2005.0065.

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[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.

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Chen, Jen-Ming 1960. "Developing and validating a simulation model for emergency vehicle locations". Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276894.

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This thesis deals with the problem of locating emergency ambulances in an urban area. We developed a simulation model to analyze possible improvements in ambulance service. A new point-to-point travel time model is introduced in our simulation. Validating the model proved to be a difficult task and is discussed in detail. Our model has been applied to the Tucson Emergency Medical Service system.

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Gleby, Fia. "Ambulance in Red Zones in Cape Town, South Africa : Waiting time for patients when ambulance requires armed escort". Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-14723.

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Background. In South Africa violence related crimes are frequent, and interpersonal violence is one of the most common causes of injury and death. Violence can be related to social structures, poverty and income inequality. In South Africa 25% of the population live in extreme poverty, and 16% of households in Western Cape live in Informal dwellings. Drug and alcohol miss-use is a big problem. EMS personnel all over the world are exposed to violence. The last couple of years the rate of incidents of violence against the ambulances and EMS personnel in Western Cape and Cape Town has escalated, and a protocol to protect the personnel has been established. The protocol of Red Zones requires an armed escort for the ambulance and EMS personnel when working in certain areas. The red zones are often in low income areas, which makes United Nations’ Sustainable Development Goal of Reduced inequality relevant. The Purpose of this study is to describe how red zones affect patient waiting times and mission times for the ambulance in the Western Cape province of South Africa. Method. Quantitative analysis of priority 1 assignments in one month periods in 2016, 2017 and 2018 to Hanover Park, a suburb of Cape Town. Hanover Park has been considered a red zone since September 2016. Result. Seven different time periods in the missions were analyzed, comparing the City of Cape Town and Hanover park in 2016, 2017 and 2018. Conclusion. The result shows an increase in waiting times for EMS in Hanover Park, even though the precise response time could not be described. Call times and mission times for the entire City of Cape Town seem to have increased, indicating a problem beyond the red zones, potentially affecting everyone in need of an ambulance in the city. Further studies are encouraged.
Bakgrund. I Sydafrika är våldsrelaterade brott vanligt förekommande, och interpersonellt våld är en av de vanligaste orsakerna till skada och död. Våldet kan relateras till sociala strukturer, fattigdom och inkomstskillnad. I Sydafrika lever 25% av befolkningen i extrem fattigdom och 16% av hushållen i Western Cape lever i informella bostäder. Missbruk av droger och alkohol är ett stort problem. Ambulanspersonal över hela världen utsätts för våld. De senaste åren har graden av våldshändelser mot ambulanser och dess personal i Western Cape och Kapstaden eskalerats och ett protokoll för att skydda personalen etablerats. Protokollet för Röda Zoner kräver en beväpnad eskort för ambulans och personal vid arbete i vissa områden. De röda zonerna är ofta i låginkomstområden, vilket gör FN: s hållbara utvecklingsmål för minskad ojämlikhet relevant. Syftet med denna studie är att beskriva hur röda zoner påverkar patienters väntetid och uppdragstider för ambulansen i Western Cape i Sydafrika. Metod. Kvantitativ analys av prio 1-uppdrag under en månadsperiod i 2016, 2017 och 2018 till Hanover Park, en förort till Kapstaden. Hanover Park har ansetts vara en röd zon sedan september 2016. Resultat. Sju olika tidsperioder i uppdragen analyserades, och jämfördes mellan hela Kapstaden och Hanover Park 2016, 2017 och 2018. Slutsats. Resultatet visar ökad väntetid för ambulansvård i Hanover Park, även om den exakta framkörningstiden inte kunde beskrivas. Uppdragstider för hela staden Cape Town verkar ha ökat, vilket indikerar ett problem bortom de röda zonerna, vilket potentiellt kan påverka alla som behöver en ambulans i staden. Ytterligare studier rekommenderas.

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Lingsarve, Johan. "Beslutsstöd i svåra prehospitala vårdsituationer : Vilka beslutsstöd behöver ambulanssjuksköterskor?" Thesis, Uppsala University, Caring Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108600.

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33

Hayes, Jared, e n/a. "Reducing the impact of decision complexity in ambulance command and control". University of Otago. Department of Information Science, 2008. http://adt.otago.ac.nz./public/adt-NZDU20080404.160620.

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The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.

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34

Ahern, Anthony J. "The management of information technology investments in the Australian ambulance services". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1994. https://ro.ecu.edu.au/theses/1105.

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Information Technology plays a significant role in the administration and operation of most organisations today. This is certainly the case with each of the Australian Ambulance Services. With the rapid increase in the use of Information Technology and the expectation about its use by both staff and the general public, the Ambulance Service managements' are faced with the dilemma of trying to ensure that their organisations are able to get the full advantage of advances in Information Technology and at the same time ensure that investments in IT are maintained at appropriate levels that will ensure the maximum return on the investment in terms of the Ambulance Service achieving its mission and objectives. The research considers three questions: How are IT investment decisions determined? How are levels of IT investments determined? Do IT investments contribute to the organisation's overall effectiveness? The general feeling by the ambulance service CEOs is that the investment in IT has been worthwhile in terms of contributing to the organisation being more effective. These findings are contrary to a study by United Research/Business Week and described by LaPlante (1988) where less than half of CEOs surveyed felt that their organisation did an excellent job of linking computer strategy to corporate goals.

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35

Gulden, Birsen. "A Geographical Information System Application For Ambulance Routing Services:a Prototype". Master's thesis, METU, 2004. http://etd.lib.metu.edu.tr/upload/2/12605085/index.pdf.

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In public safety, geography plays a significant role. One of the most important front-line elements of public safety is an efficient emergency transport and care system. The capacity to access and process information rapidly and organize resources where needed can be critically important in an emergency situation. Information about the locality of an event or a disaster is often vital in knowing how to respond. A significant operation in handling emergency situations is the routing of ambulances to incident sites and then to the closest appropriate hospitals. One of the important steps to survival in an emergency is quick response time. The aim of this thesis study is to build an immediate, rapid and efficient emergency medical transport system prototype, called Ambulance Routing Service Application Prototype (ARSAP), to be used in Middle East Technical University (METU) Emergency Service, Ankara, Turkey. In the study, geographical information systems (GIS) technology is used in assisting the development and implementation of an emergency medical service (EMS) response system. In this prototype, while choosing a proper facility, the available quantity of beds, respiratory equipments and doctors in a hospital'
s intensive care room and the best traffic routes to the hospital in hand are also considered. The ARSAP is expected to shorten the commuting time and hence to reduce the damage to the patient to the lowest level and allow the ambulance staff to perform their task better. The results generated using the ARSAP are validated and analyzed by comparing with currently practiced emergency call paths data collected with the help of METU Emergency Service ambulance drivers.

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36

Booker, Matthew James. "Exploring 'primary care sensitive' contacts with the ambulance service : a mixed-methods, ethnographic study". Thesis, University of Bristol, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.738253.

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37

Galeano, Richard. "Understanding the health of operational personnel in an ambulance service: A mixed methods study". Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134241/2/Richard_Galeano_Thesis%5B1%5D.pdf.

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This mixed methods study was designed to review the health of ambulance operational personnel and to better understand the complex relationship between the organisation of the work and the working and organisational environment in which the work is done. The study found that the physical and mental health of ambulance operational personnel is worse than the Australian population due to the interplay of long working hours, shift work and a perceived lack of support. Ambulance services need to take a lead role in designing health support approaches that may better protect the health and wellbeing of ambulance operational personnel.

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38

Lo, Shun-tong, e 羅信堂. "A feasibility study on privatization of emergency ambulance services in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31966287.

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39

Wong, Ho-ting, e 黃浩霆. "Biometeorological modelling and forecasting of ambulance demand for Hong Kong: a spatio-temporal approach". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B4775297X.

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The demand for emergency ambulance services in Hong Kong is on the rise. Issues such as climate change, ageing population, constrained space, and limited resource capacity mean that the present way of meeting service demand by injecting more resources will reach its limit in the near future and unlikely to be sustainable. There is an urgent need to develop a more realistic forecast model to account for the anticipated demand for emergency ambulance services to enable better strategic planning of resources and more effective logistic arrangement. In this connection, the research objectives of this thesis include the following: 1. To examine relationships between weather and ambulance demand, with specific reference to temperature effects on demographic and admission characteristics of patients. 2. To establish a quantitative model for short-term (1-7 days ahead) forecast of ambulance demand in Hong Kong. 3. To estimate the longer-term demand for ambulance services by sub areas in Hong Kong, taking into account projected weather and population changes in 2019 and 2036. The research concurs with the findings of other researchers that temperature was the most important weather factor affecting the daily ambulance demand in 2006-2009, accounting for 49% of the demand variance. An even higher demand variance of 74% could be explained among people aged 65 and above. The incorporation of 1-7 day forecast data of the average temperature improved the forecast accuracy of daily ambulance demand on average by 33% in terms of R2 and 11% in terms of root mean square error (RMSE). Moreover, the forecast accuracy could be further improved by as much as 4% for both R2 and RMSE through spatial sub models. For demand projection of a longer-term, significant underestimation was observed if changes in the population demographics were not considered. The underestimation of annual ambulance demand for 2019 and 2036 was 16% and 38% respectively. The research has practical and methodological implications. First, the quantitative model for short-term forecast can inform demand in the next few days to enable logistic deployment of ambulance services beforehand, which, in turn, ensures that potential victims can be served in a swift and efficient manner. Second, the longer-term projection on the demand for ambulance services enables better preparation and planning for the expected rise in demand in time and space. Unbudgeted or unnecessary purchases of ambulances can be prevented without compromising preparedness and service quality. Third, the methodology is adaptable and the model can be reconstituted when more accurate projections on weather and population changes become available.
published_or_final_version
Geography
Doctoral
Doctor of Philosophy

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40

Paz, Avila Luis Albert 1964. "Algorithm development for solving the emergency vehicle location problem with stochastic travel times and unequal vehicle utilizations". Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276917.

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This thesis deals with the problem of locating emergency vehicles in an urban area. An optimization model is formulated that extends previous work by allowing stochastic travel times, unequal vehicle utilizations, and backup service. The heart of the model is a procedure similar to the Hypercube approximation model. Ten pair-wise interchange heuristics are developed and tested on 240 test problems. Demand and service time components of the test data have been generated using characteristics of the Tucson Emergency Medical System. Geographical components of the test data have been generated using actual city shapes as models. It is believed that these test problems are more indicative of actual emergency vehicle location problems than those previously presented in the literature.

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41

Shakespeare-Finch, Jane E. "Posttraumatic growth in emergency ambulance personnel: The roles of personality and coping". Thesis, Queensland University of Technology, 2003. https://eprints.qut.edu.au/117969/1/36793_Digitised%20Thesis.pdf.

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It is the contention of the thesis that the experience of work-related trauma in emergency service personnel (i.e., Ambulance Officers) has the potential to act as a catalyst for significant positive changes (posttraumatic growth [PTG]). The research provides insight into a number of areas including socio-structural, personality, and coping variables, that are apparently related to these perceptions of PTG. A series of four studies, utilising a mixed-method design, investigated the presence, correlates, predictors, and dimensions of posttraumatic growth, in samples of Queensland Ambulance Service (QAS) officers (N = 566). The first study examined the prevalence of positive and negative post-trauma outcomes in the QAS, the co-variation of these outcomes, and the extent to which positive changes can occur following the expe1ience of a work-related traumatic event. Results from both cross-sectional (n = 526 'seasoned' officers) and longitudinal (n = 23 'new recruits') data, demonstrated the presence of PTO in the officers as well as the co-existence of positive and negative post-trauma perceptions. Having established the presence and prevalence of PTG in the QAS, the second and third studies aimed to identify variables related to PTG. These studies used the sample of 'seasoned' officers in the examination of socio-structural, personality, and coping variables, and their relationship to PTG. In the second study, certain socio-structural variables were demonstrated to produce significant mean differences in levels of PTG (e.g., women reported higher levels of PTG than men). Further, significant positive relationships were found between PTG and higher levels of extraversion, openness to experience, agreeableness, conscientiousness, optimism, hope, self-efficacy, and coping resources. In the third study, factor analytic techniques were used to ascertain dimensions of coping and growth in the seasoned officer sample. Study three findings supported the multi-dimensional nature of coping and PTG and also demonstrated significant relationships between the four factors extracted from the Coping Responses in Rescue Workers Inventory (CRRWI), with all three of the Posttraumatic Growth Inventory (PTGI) factors present in this population. Additionally, the results provided evidence for significant relationships between vaiious personality dispositions and particular dimensions of coping, and between personality dispositions and the dimensions of PTG. The third study also included the development and testing of a model of PTG in the QAS. A second order factor analysis provided statistical support for coping and PTO to remain measurement constructs in the proposed model of growth. A series of regressions were conducted establishing that total coping levels mediated between personality dispositions and total PTO levels. Structural Equation Modelling (SEM) was then used to investigate the strength of relationships between variables and the hypothesised pathway from personality dispositions to PTO, mediated by levels of coping. Results supported a very good data fit. A multisample SEM was then conducted to test the data fit with two groups of QAS officers divided on the basis of their experiences of trauma. No differences were detected between groups, supporting the salience of relationships between personality dispositions, coping, and PTO. The fourth study in the series further explored coping in the QAS using matched pairs data (n = 80: 40 'new recruits and 40 'seasoned' officers) and the longitudinal data set (n = 23). The frequency with which 'seasoned' ambulance officers and 'new recruits' to the service use various coping resources, were found to differ between. However, following the first 18 months of service, the distinction between seasoned officers and new recruit frequency of use of coping resources, was no longer evident. The thesis results support previous research about PTO with direct survivors of a traumatic experience, and studies examining personality and coping variables in emergency service populations, that were conducted within a deprivation approach to trauma research. Results also support the theoretical frameworks that have proposed an indirect relationship between personality factors, through coping, to PTO. Contributions to knowledge and practical applications provide implications for education and training programs in emergency services.

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42

Kam, Hok-lai, e 金學禮. "Analysis of the needs for training and development of ambulance officers in Fire Services Department". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46780658.

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43

Bone, Eric Allen. "An initial reflection to develop a maintenance of competence process for the British Columbia Ambulance Service". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0003/MQ41792.pdf.

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44

Andersson, Lena, e Karin Lundberg. "Patienters upplevelser av prehospital sjukvård : -En litteraturstudie". Thesis, University of Kalmar, School of Human Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hik:diva-1250.

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Introduction: In Sweden the definition of ambulance nursing is the examination and treatment of sick or injured people done by ambulance nurses during transport. This means not only focus on the illness or injury but also the human being treated. The paramedic service must be based on the presumption that the medical needs of the patients are guaranteed, and that the expectations and demands of the public are satisfied. Competence and availability are basic terms for a well-functional paramedic service. There is a lot of pressure put on the people working with pre-hospital nursing. One mistake can lead to serious consequences for the patient. Purpose: The purpose of this study is describing patient’s experience of pre-hospital nursing. Method: The study is based on ten scientific articles. The articles were found on the internet by searching in the databases Academic Search Elite, Cinahl and MedLine. Results: The following themes have been identified: a feeling of uncertainty of the patient – how ill am I?, ambulance or own car?, the patients worry about if the ambulance will arrive in time, voluntary self-surrender, patients experience of the competence of the staff, lack of understanding that an ambulance is more than a transport service. Discussion: Since the study is based on such a limited material it's not reasonable to draw any extensive conclusions. Still the results are so unanimous so we think that they are well worth to take into consideration.

Introduktion: I Sverige definieras ambulanssjukvård med undersökningen och behandlingen av sjuka eller skadade människor, vilket utförs av ambulanspersonal i samband med transport. Ambulanssjukvården måste bygga på förutsättningen att patientens medicinska behov säkerställs och att allmänhetens förväntningar och krav blir tillgodosedda. Kompetens och tillgänglighet är grundläggande begrepp för en väl fungerande ambulanssjukvård. Det ställs stora krav på personalen inom den akuta prehospitala sjukvården. Ett enda felaktiga beslut kan få svåra konsekvenser för patienten. Syfte: Syftet med studien är att belysa patienters upplevelser av prehospital sjukvård. Metod: Litterturstudie vars resultat baseras på tio vetenskapliga artiklar publicerade 2003-2008. Litteratursökningen utfördes med de elektroniska databaserna Academic Serch Elite, CINAHL och MedLine. Resultat: De rubriker som identifierades var: en känsla av osäkerhet hos patienten, hur sjuk är jag?, ambulans eller egen bil?, oro hos patienten, när kommer ambulansen?, frivilligt "självöverlämnande", patienters upplevelse av personalens kompetens, och brist på insikt om att ambulans är mer än en transportservice. Diskussion: Att, utifrån ett begränsat material som det vi har arbetat med, dra några långtgående slutsatser är inte rimligt. Vi anser dock att samstämmigheten i resultatet är så god att vi vill klassa resultatet som väl värt att ta i beaktande.

Presentation är gjord via webben.

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45

Gunes, Ersan. "A kernel approach to the estimation of performance measures in a helicopter ambulance service with missing data". Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2005. http://library.nps.navy.mil/uhtbin/hyperion/05Jun%5FGunes.pdf.

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46

Karaman, Mesut. "A Genetic Algorithm For The Multi-level Maximal Covering Ambulance Location Problem". Master's thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/3/12610099/index.pdf.

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The emergency medical services (EMS) provide the preliminary assistance and transportation for patients in need of urgent medical care in order to decrease the mortality rate and reduce the non-reversible effects of injuries. Since the objective is directly related to the human life, the value of the proposed solutions in order to improve the performance of EMS is highly welcomed. Mainly, there are three problems that EMS managers face with: location, allocation and redeployment of the EMS facilities/vehicles. Most of the studies in EMS literature focus on accurately modeling the probabilistic nature of the availability of an ambulance when it is called for. However, trivial changes in model parameters or estimates could dramatically change the optimal allocations generated by the probabilistic models and hence make the model invalid. In this study, we formulate the ambulance location problem as a deterministic multi-level maximal coverage model by which the total demand is tried to be covered as many as possible at multiple levels. Both a mathematical programming model and genetic algorithm-based heuristic approaches are proposed for the problem. The results indicate that the genetic algorithm-based solutions give reliable (near-optimal) and robust results in reasonable computational times for the problem. Moreover, the tradeoffs between the two performance measures, &lsquo
responsiveness&rsquo
and &lsquo
preparedness&rsquo
, are searched for
and our approaches with multi-level coverage are compared against the multiple coverage approaches in terms of these performance measures.

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47

Harvey, C. Froggatt S. Lightowler B. and Hodge A., C. Harvey, S. Froggatt, Bryan Lightowler e A. Hodge. "The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences". Mark Allen Group, 2020. http://hdl.handle.net/10454/18604.

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No
The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. The three key themes from the interviews were variations in service demand, the service user’s expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

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48

Symons, Andy. "Is the treatment and transport of asystolic cardiac arrest patients to hospital by ambulance services appropriate?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/49.

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The Paramedic's role requires them to attend many patients in cardiac arrest. The victim' s survival depends on a variety of issues, such as previous medical history, pathological cause of cardiac arrest, presenting cardiac arrest dysrhythmias, and the time elapsed before medical aid is administered. The purpose of this present study was to review current practice advocated by St John Ambulance Service WA for the treatment of the cardiac arrest dysrhythmia `asystole'. At present, certain victims of an asystolic arrest are treated and transported to hospital irrespective of time in arrest. As such, questions are raised as to the suitability of transporting these patients with respect to actual or possible patient survival.

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49

McKenna, Wayne J. "Fatigue, ambulance perspectives in a comparative study between air and road transports". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2002. https://ro.ecu.edu.au/theses/727.

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The study of fatigue in the health and transport sectors has predominantly been focused on night shift or day shift operations. This study has been applied to the hours of operation of Ambulance Officers who perform both night and day shifts, while also being required for on-call. The Officer on-call is on stand-by between shifts, to be available to respond for duties from the completion of one shift until the commencement of the next, usually a ten-hour shift. Studies of a similar focus have not been identified so a comparison of these specific findings has not been possible. However trends in sleep debt, peaks in the drive for sleep and recognition of fatigue are consistent with findings of other studies. The initial impetus for the study, to compare the degree of fatigue between air and road long distance transports, provided no significant output. The data collected did however provide clear identification of the various precipitators of fatigue in the Ambulance Officers workplace. To adequately address the hazard of fatigue, the introduction of integrated systems that address sleep deprivation and circadian cycles are required to aid in managing fatigue. The identification and control of fatigue in the workplace is to the benefit of both the employer and the employee. The study consists of fourteen Ambulance Officers utilising both road and helicopter transport mechanisms to undertake transfers to major medical facilities. The Officers were required to answer questionnaires at the completion of each shift to record the precipitators and indicators of fatigue. Findings indicate there is no significant difference between the levels of fatigue induced by air or road transport. The influences of the time of day and the degree of sleep deprivation are however indicative of fatigue in the individual. Day shifts accounted for 70% of data collected with results of fatigue as more prevalent in the 1501-1800 hours period, coinciding with a trough in performance and alertness. Their adherence to non-performance indicators suggests an unwillingness to identify anomalies in their performance or an inability to self-determine a level of fatigue. Performance of duty during "on-call periods" induces sleep deprivation that may develop into a sleep debt if the restorative sleep is not obtained. Individuals generally function for 16-hollrs and sleep for 8-hours, to replenish the organism. When this ratio is redistributed the individual develops a sleep debt and left unaddressed develops into fatigue. Performance of long distance transports and reliance on on-call officers removes their ability to address their sleep debt. The introduction of rescheduling of transports and fatigue breaks reduces the influence of fatigue in the Ambulance Officers workplace. The magnitude of fatigue is only evident when the consequences are realised. Officers performing transfers on empty expressways can wander on the lanes with only a fright to remember the experience. However a patient, of the belief that they are safe when in an Ambulance, will have more to remember if the expressway has a car in the other lane. Fatigue is evident in the Ambulance Officers workplace and remedies to address it, which incorporate a Safety Management System, have been outlined in the recommendations of the study.

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50

Jenkins, Emily Jayne. "Conveyance and non-conveyance to the Emergency Department after self-harm : prevalence and ambulance service staff perspectives". Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18257/.

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Relatively little is known about people who self-harm and are not conveyed to the emergency department, or the experiences of ambulance service staff in working with people who self-harm and the conveyance decisions that they make. This research, with two linked studies, was conducted using a sequential mixed methods design. In Study 1, quantitative data was collected about episodes of self-harm that received an ambulance crew decision following a 999 call made in the Yorkshire region. The data collected included details of the episode of self-harm, demographic information, the care provided by ambulance staff, clinical outcomes (including conveyance rates), and explanations for care and conveyance decisions. In the sample there was a proportion of conveyance of 87% and only 13% non-conveyance. Method of self-harm was related to conveyance, with people who had cut themselves significantly less likely to be conveyed than those using other methods. Non-conveyance was associated with a longer duration of ambulance visit. The findings from Study 1 informed Study 2, which was a qualitative interview-based study with staff from the ambulance service. Six ambulance service staff were interviewed about their experiences of working with people who have self-harmed and about the decision-making around non-conveyance. There were six major themes identified using thematic analysis and the themes were presented as if they were clinicians’ thoughts to demonstrate the decision-making process around whether or not to convey the person who has self-harmed: ‘I’ll do my best to help’ but ‘I worry about getting it wrong’ because ‘I’m not sure what I’m doing’ and ‘I’m not supported’ so ‘It’s more than your job’s worth’, which contributes to an overall ‘conveyance culture’. There are a number of recommendations for future research and improving clinical practice, and the results are presented in relation to existing literature.

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