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International Emergency Nursing Nov 2023Sexual assault and harassment of ambulance personnel in the workplace is widespread. Prevention via body worn cameras and legal efforts have been positive, however... (Review)
Review
INTRODUCTION
Sexual assault and harassment of ambulance personnel in the workplace is widespread. Prevention via body worn cameras and legal efforts have been positive, however improvement is still needed to ensure the protection of staff from the negative impact of sexual violence at work.
METHODS
A rapid evidence review was conducted following the Cochrane Rapid Review guidance. MEDLINE and CINAHL Complete were searched from inception to February 2023. Screening and data extraction was conducted by one author and verified by the other. Included studies were appraised using a variety of critical appraisal checklists and a narrative synthesis was conducted.
RESULTS
From 46 articles screened, 7 were included in the review representing 3994 ambulance personnel from Australia, Canada, the United States, the United Kingdom and South Korea. Seven themes were identified, including a need for more training, education and resources regarding sexual assault and harassment, differences in perpetrators, poor experiences with organisations, effects on victims outside the workplace, effects on victims within the workplace, barriers to reporting, and increased prevalence of sexual assault and harassment against women.
CONCLUSION
The effect of sexual assault and harassment has far-reaching negative impact on victims' lives. More training and resources are recommended.
Topics: Humans; Female; United States; Sexual Harassment; Ambulances; Sex Offenses; Workplace; Australia
PubMed: 37972520
DOI: 10.1016/j.ienj.2023.101376 -
European Journal of Public Health Aug 2020Syndromic surveillance can supplement conventional health surveillance by analyzing less-specific, near-real-time data for an indication of disease occurrence. Emergency... (Review)
Review
BACKGROUND
Syndromic surveillance can supplement conventional health surveillance by analyzing less-specific, near-real-time data for an indication of disease occurrence. Emergency medical call centre dispatch and ambulance data are examples of routinely and efficiently collected syndromic data that might assist in infectious disease surveillance. Scientific literature on the subject is scarce and an overview of results is lacking.
METHODS
A scoping review including (i) review of the peer-reviewed literature, (ii) review of grey literature and (iii) interviews with key informants.
RESULTS
Forty-four records were selected: 20 peer reviewed and 24 grey publications describing 44 studies and systems. Most publications focused on detecting respiratory illnesses or on outbreak detection at mass gatherings. Most used retrospective data; some described outcomes of temporary systems; only two described continuously active dispatch- and ambulance-based syndromic surveillance. Key informants interviewed valued dispatch- and ambulance-based syndromic surveillance as a potentially useful addition to infectious disease surveillance. Perceived benefits were its potential timeliness, standardization of data and clinical value of the data.
CONCLUSIONS
Various dispatch- and ambulance-based syndromic surveillance systems for infectious diseases have been reported, although only roughly half are documented in peer-reviewed literature and most concerned retrospective research instead of continuously active surveillance systems. Dispatch- and ambulance-based syndromic data were mostly assessed in relation to respiratory illnesses; reported use for other infectious disease syndromes is limited. They are perceived by experts in the field of emergency surveillance to achieve time gains in detection of infectious disease outbreaks and to provide a useful addition to traditional surveillance efforts.
Topics: Ambulances; Call Centers; Communicable Disease Control; Communicable Diseases; Data Collection; Disease Outbreaks; Emergency Medical Services; Emergency Service, Hospital; Humans; Sentinel Surveillance; Triage
PubMed: 31605491
DOI: 10.1093/eurpub/ckz177 -
Scandinavian Journal of Trauma,... Nov 2023Fixed-wing air ambulances play an important role in healthcare in rural Iceland. More frequent use of helicopter ambulances has been suggested to shorten response times...
BACKGROUND
Fixed-wing air ambulances play an important role in healthcare in rural Iceland. More frequent use of helicopter ambulances has been suggested to shorten response times and increase equity in access to advanced emergency care. In finding optimal base locations, the objective is often efficiency-maximizing the number of individuals who can be reached within a given time. This approach benefits people in densely populated areas more than people living in remote areas and the solution is not necessarily fair. This study aimed to find efficient and fair helicopter ambulance base locations in Iceland.
METHODS
We used high-resolution population and incident location data to estimate the service demand for helicopter ambulances, with possible base locations limited to twenty-one airports and landing strips around the country. Base locations were estimated using both the maximal covering location problem (MCLP) optimization model, which aimed for maximal coverage of demand, and the fringe sensitive location problem (FSLP) model, which also considered uncovered demand (i.e., beyond the response time threshold). We explored the percentage of the population and incidents covered by one to three helicopter bases within 45-, 60-, and 75-min response time thresholds, conditioned or not, on the single existing base located at Reykjavík Airport. This resulted in a total of eighteen combinations of conditions for each model. The models were implemented in R and solved using Gurobi.
RESULTS
Model solutions for base locations differed between the demand datasets for two out of eighteen combinations, both with the lowest service standard. Base locations differed between the MCLP and FSLP models for one combination involving a single base, and for two combinations involving two bases. Three bases covered all or almost all demand with longer response time thresholds, and the models differed in four of six combinations. The two helicopter ambulance bases can possibly obtain 97% coverage within 60 min, with bases in Húsafell and Grímsstaðir. Bases at Reykjavík Airport and Akureyri would cover 94.2%, whereas bases at Reykjavík Airport and Egilsstaðir would cover 88.5% of demand.
CONCLUSION
An efficient and fair solution would be to locate bases at Reykjavík Airport and in Akureyri or Egilsstaðir.
Topics: Humans; Air Ambulances; Iceland; Time Factors; Emergency Medical Services; Aircraft
PubMed: 37915061
DOI: 10.1186/s13049-023-01114-9 -
Journal of Religion and Health Feb 2023Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about...
Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about retaining chaplains, little is actually known about their role and value within Ambulance services. The aim of this paper is to present the key findings from interviews with chaplains about their role and value of being ambulance chaplains. These findings are then compared with those of paramedics derived from an earlier phase of this study. Thirteen chaplains participated in semi-structured interviews, and data were analysed using framework analysis. The results indicated that ambulance chaplains provided paramedic-centred emotional and spiritual care through proactively and reactively supporting paramedics in their work. Chaplains saw value in their relational approach which facilitated trust and access, did not seek to 'fix' or diagnose but instead offered physical and emotional presence, and promoted supportive conversations. Chaplains and paramedics valued operationally trained and equipped ambulance chaplains who provided a relational, around the clock, 'frontline' staff support presence in paramedic workplaces, regardless of the paramedic's personal religious/spiritual beliefs.
Topics: Humans; Ambulances; Clergy; Paramedics; Australia; Emotions
PubMed: 36402854
DOI: 10.1007/s10943-022-01685-4 -
BMC Emergency Medicine Jun 2022Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to...
BACKGROUND
Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to investigate the lived experience of potentially traumatic work events between Saudi and UK ambulance personnel.
METHODS
Semi-structured interviews with 16 ambulance workers from Saudi Arabia and the United Kingdom (8 participants from each country) were conducted to explore their lived experiences of potentially traumatic events at work. Data were analyzed using thematic analysis.
RESULTS
Four key themes were identified from interviews: (1) some events are inherently more stressful than others; (2) pressure of organizational and interpersonal stressors; (3) convergence and divergence in cross-cultural coping strategies; and (4) preferring formal and confidential support.
CONCLUSIONS
There were differences in the nature of traumatic events and the ways of coping between the two cultures, but paramedics in both cultures had an agreement about their preference for individual and formal support. The results of this study may help inform the development of interventions and PTSD prevention programs for ambulance personnel.
Topics: Adaptation, Psychological; Ambulances; Cross-Cultural Comparison; Humans; Saudi Arabia; Stress Disorders, Post-Traumatic; United Kingdom
PubMed: 35761202
DOI: 10.1186/s12873-022-00666-w -
JAMA Network Open Feb 2024The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services....
IMPORTANCE
The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services. Understanding ground ambulance OON and balance billing patterns from previous years could guide legislation aimed to protect patients following ground ambulance use.
OBJECTIVE
To characterize OON billing from ground ambulance services by evaluating whether OON billing risk differs by the site of ambulance origination (home, hospital, nonhospital medical facility, or scene of incident).
DESIGN, SETTING, AND PARTICIPANTS
Cross-sectional study of the Merative MarketScan dataset between January 1, 2015, and December 31, 2020, using claims-based data from employer-based private health insurance plans in the US. Participants included patients who utilized ground ambulances during the study period. Data were analyzed from June to December 2023.
EXPOSURE
Medical encounter requiring ground ambulance transportation.
MAIN OUTCOMES AND MEASURES
Ground ambulance OON billing prevalence was calcuated. Linear probability models adjusted for state-level mixed effects were fit to evaluate OON billing probability across ambulance origins. Secondary outcomes included the allowed payment, patient cost-sharing amounts, and potential balance bills for OON ambulances.
RESULTS
Among 2 031 937 ground ambulance services (1 375 977 unique patients) meeting the inclusion and exclusion criteria, 1 072 791 (52.8%) rides transported men, and the mean (SD) patient age was 41 (18) years. Of all services, 1 113 676 (54.8%) were billed OON. OON billing probabilities for ambulances originating from home or scene were higher by 12.0 percentage points (PP) (95% CI, 11.8-12.2 PP; P < .001 for home; 95% CI, 11.7-12.2 PP; P < .001 for scene) vs those originating from hospitals. Mean (SD) total financial burden, including cost-sharing and potential balance bills per ambulance service, was $434.70 ($415.99) per service billed OON vs $132.21 ($244.92) per service billed in-network.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of over 2 million ground ambulance services, ambulances originating from home, the scene of an incident, and nonhospital medical facilities were more likely to result in OON bills. Legislation is needed to protect patients from surprise billing following use of ground ambulances, more than half of which resulted in OON billing. Future legislation should at minimum offer protections for these subsets of patients often calling for an ambulance in urgent or emergent situations.
Topics: Male; Humans; Adult; Ambulances; Cross-Sectional Studies; Cost Sharing; Financial Stress; Health Facilities
PubMed: 38381432
DOI: 10.1001/jamanetworkopen.2024.0118 -
Journal of Clinical Nursing Jan 2019To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.
AIMS AND OBJECTIVES
To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.
BACKGROUND
Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.
DESIGN
A qualitative interview study was conducted using an inductive research approach.
METHODS
The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.
RESULTS
The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.
CONCLUSION
If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.
RELEVANCE TO CLINICAL PRACTICE
This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.
Topics: Ambulances; Emergency Medical Services; Female; Humans; Male; Needs Assessment; Nurse's Role; Nurses; Qualitative Research; Sweden
PubMed: 30016570
DOI: 10.1111/jocn.14626 -
Emergency Medicine Journal : EMJ Feb 2005Indonesia is a huge, diverse, and developing country that until recently had no public ambulance service let alone a system of prehospital care. It commonly experiences... (Review)
Review
BACKGROUND
Indonesia is a huge, diverse, and developing country that until recently had no public ambulance service let alone a system of prehospital care. It commonly experiences many natural disasters, manmade conflicts, and violence as well as the daily emergencies seen worldwide.
CURRENT SYSTEM
Hospitals of varying standards are widespread but have no system of emergency ambulance or patient retrieval. Indonesia's only public emergency ambulance service, 118, is based in five of the biggest cities and is leading the way in paramedic training and prehospital care.
CHALLENGES AND DEVELOPMENTS
There are many challenges faced including the culture of acceptance, vast geographical areas, traffic, inadequate numbers of ambulances, and access to quality training resources. Recently there have been a number of encouraging developments including setting up of a disaster response brigade, better provision of ambulances, and development of paramedic training.
CONCLUSIONS
An integrated national regionalised hospital and prehospital system may seem fantastic but with the enthusiasm of those involved and perhaps some help from countries with access to training resources it may not be an unrealistic goal.
Topics: Ambulances; Delivery of Health Care, Integrated; Developing Countries; Disaster Planning; Emergency Medical Services; Emergency Medical Technicians; Humans; Indonesia
PubMed: 15662073
DOI: 10.1136/emj.2003.007757 -
Nursing Open Mar 2021To obtain the current perception of the knowledge and competence of pre-hospital emergency specialist nurses (ambulance) in attending patients with psychiatric symptoms.
AIMS AND OBJECTIVES
To obtain the current perception of the knowledge and competence of pre-hospital emergency specialist nurses (ambulance) in attending patients with psychiatric symptoms.
BACKGROUND
Psychiatric illnesses have increased throughout the population. Consequently, pre-hospital emergency services frequently attend individuals with suspected or known mental illnesses.
DESIGN
We employed a set of quantitative and qualitative methods to gain a deeper understanding of ambulance nurses' self-evaluated knowledge.
METHODS
Seven ambulance nurses received and completed a survey questionnaire prior commencing employment in November 2019. Then, we conducted interviews to explore ambulance nurses' perceptions of their own knowledge and competence when attending individuals with mental disorders. The surveys were analysed with descriptive statistics, followed by content analysis.
RESULTS
Three topics emerged: the encounter of patients with mental illness; the awareness of lacking knowledge about mental illnesses; and the expectations for future Prehospital Emergency Psychiatric Response Teams. Although ambulance nurses already possessed basic knowledge regarding psychiatric illnesses, it was insufficient, based on their perception of appropriate care. Ambulance nurses considered that combining pre-hospital and psychiatric expertise in the pre-hospital emergency unit would increase their in-depth knowledge about various psychiatric illnesses, the treatment options and the alternatives regarding where to deliver patients for continued care.
Topics: Ambulances; Emergency Service, Hospital; Humans; Mental Disorders; Nurses; Perception
PubMed: 33570281
DOI: 10.1002/nop2.703 -
BMC Medical Education Oct 2022Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides...
CONTEXT
Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective.
METHODS
We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12.
RESULTS
We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD - index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills.
CONCLUSION
MSFRs' attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.
Topics: Ambulances; Emergency Responders; Female; Humans; Male; Middle Aged; Students, Medical
PubMed: 36242030
DOI: 10.1186/s12909-022-03791-z