Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
171,730
result(s) for
"Ambulance"
Sort by:
Ambulances : a first look
\"Ambulances make lots of noise and have flashing lights, but they also help people. Full-color photographs and easy text give young readers a front-row seat into these life-saving vehicles\"-- Provided by publisher.
BOOK
A review on ambulance offload delay literature
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.
Journal Article
American sirens : the incredible story of the Black men who became America's first paramedics
\"Up until 1968, if you suffered a medical crisis, your chances of survival were minimal. That all changed with the Freedom House EMS in Pittsburgh, a group of Black men who became America's first paramedics and set the gold standard for emergency medicine around the world, only to have their legacy erased-until now. Born from the vision of a Nobel Prize-nominated physician, the needs of a country in pain, and the ashes of Pittsburgh's downturn in the 1960s, Freedom House brought together a group of young, uneducated Black men to forge a new frontier in health care. Their job was grueling, the rules made up as they went along, and their mandate nearly impossible: prove to a skeptical public and the politicians that paramedics were a noble and valuable endeavor and, most importantly, that they themselves were worthy professionals performing a crucial public service. Despite the long odds and attempts to shut them down, they succeeded spectacularly. In American Sirens, acclaimed journalist and paramedic Kevin Hazzard tells a dramatic story of heroes and villains, of brutal attempts to stifle hope, and the resilience of a community that fought back. He follows a rich cast of characters that includes John Moon, an orphan who found his calling as a paramedic; Peter Safar, the Nobel Prize-nominated physician who invented CPR and realized his vision for a trained ambulance service; and Nancy Caroline, the idealistic young doctor young doctor who turned a scrappy team into an international leader. At every turn they battled racism-from the community, the police, and the government. Never-before revealed in full, this is a rich and troubling hidden history of the Black origins of America's paramedics, a special band of dedicated essential workers, who stand ready to serve day and night on the line between life and death for every one of us\"-- Provided by publisher.
BOOK
The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research
Background
High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce.
Methods
This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being.
Results
Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.
Conclusions
Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
Journal Article
Paramedics on and off the streets : emergency medical services in the age of technological governance
\"In Paramedics On and Off the Streets, Michael K. Corman embarks on an institutional ethnography of the complex, mundane, intricate, and exhilarating work of paramedics in Calgary, Alberta. Corman's comprehensive research includes more than 200 hours of participant observation ride-alongs with paramedics over a period of eleven months, more than one hundred first hand interviews with paramedics, and thirty-six interviews with other emergency medical personnel including administrators, call-takers and dispatchers, nurses, and doctors. At the heart of this ethnography are questions about the role of paramedics in urban environments, the role of information and communication technologies in contemporary health care governance, and the organization and accountability of pre-hospital medical services. Paramedics On and Off the Streets is the first institutional ethnography to explore the role and increasing importance of paramedics in our healthcare system. It takes readers on a journey into the everyday lives of EMS personnel and provides an in-depth sociological analysis of the work of pre-hospital health care professionals in the twenty-first century.\"-- Provided by publisher.
Book
PP39 Are our ambulance services effective and efficient? Exploration of ambulance non-conveyance: an investigation into organisational variance
BackgroundOver the past 20 years, academic and professional papers have identified unwarranted variance in the ambulance service. The aim of this study was to investigate factors and practices which could explain and if necessary, reduce the variance in non-conveyance between ambulance services. The objectives were: Identify different types of non-conveyance in ambulance services; explore variation of non-conveyance between English ambulance services; understand the reasons for variation in non-conveyance from the experience and perceptions of ambulance service managers, clinicians and control room staff in two ambulance trusts; investigate the application of a quality framework, to understand the impact of variance on quality in non-conveyance, in two ambulance trusts; create a framework to identify variation and develop service delivery models to maximise Hear & Treat and See & Treat.MethodsThis research takes an in-depth case study approach to highlight variance in the context of performance and quality. Initially, Ambulance Quality Indicators (AQI’s) were analysed across the reference period to highlight the variance between trusts in non-conveyance. The results of this were used to create the research questions which would be answered by 27 participants, from varying roles in two ambulance services, who took part in semi-structured interviews or focus groups. A thematic analysis was undertaken on the transcripts using the Six Domains of Healthcare (IoM, 2001) excellence model, which was chosen following a review of various models and frameworks. The results of the analysis were used to create operational models, which if implemented could maximise non-conveyance.ResultsPerformance and quality appear to be very closely linked in this setting, with the terms crossing over. It can be argued that Ambulance Quality Indicators are performance targets. There was variation in strategies used by ambulance trusts to reduce conveyance to the ED, sometimes influenced by external factors. Patient centred care was at the heart of these strategies, but the effectiveness and efficiency of strategies was variable. Improvement models were created from those strategies which delivered quality, based on the context of the quality model.ConclusionThere is currently a postcode lottery as to the way in which a 999 call is dealt with across the country. Some of the strategies in place are effective and efficient, but others are not. The wider NHS system needs to offer a more consistent approach to alternative pathways, supporting the ambulance service to safely reduce conveyance to the ED. Ambulance services should review their current non-conveyance strategy for effectiveness and efficiency and share best practice. There are opportunities to improve the quality of non-conveyance, but this may require changes to current emergency and urgent care practices.
Journal Article
PP40 Co-design and refinement of a logic model describing case management for people who frequently call ambulance services – the stretched evaluation
BackgroundMulti-agency case management across the UK addresses the needs of those who call 999 ambulance services frequently (≥5 times in a month, or ≥12 times in a three-month period). However, there is little evidence about what works and how. STRETCHED (Strategies to Manage Emergency Ambulance Telephone Callers with Sustained High needs – an Evaluation using Linked Data) evaluated case management using mixed methods. One objective was to develop and refine a logic model to describe cross-sectoral case management and its expected impacts, as a basis for evaluation.MethodsStage 1: We conducted a stakeholder event with 37 people from Wales, England and Northern Ireland including public partners (with lived experience) and relevant staff to develop an initial logic model.Stage 2: Following the main data collection and analysis phases of the study, we reviewed and refined the logic model in the light of findings.ResultsThe logic model summarises in graphic form:Inputs: resources and activitiesMechanisms of change: at organisational and individual levelImpacts: on service users, ambulance services, individual staff, and wider service networks.Study findings showed that: case management initiatives varied considerably between sites; patients had a high level of need with high mortality and rates of hospital admission; the conditions of many patients are not amenable to individual behaviour change.We then revised the logic model to show:the range of contextual/mediating factors shaping local initiativesvariation in case management activities between sitesa reduced emphasis on individual behaviour change.ConclusionIn this challenging and complex area of health care, a logic model can be an essential tool to support evaluation, and refined on the basis of study insights.
Journal Article
PP11 A cluster randomised controlled feasibility trial of prehospital optimal shock energy for defibrillation (POSED)
BackgroundDespite defibrillation being proven to increase patients’ chances of survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythm, the best shock energies are unknown. Literature comprises studies with outdated resuscitation protocols and a variety of endpoints. We explored the feasibility of a trial of optimal shock energy for OCHA. Our primary objective was to establish the number of eligible and recruited patients; secondary outcomes were adherence and data completeness.MethodsWe conducted a three-arm parallel group cluster randomised controlled trial in South Central ambulance service. Adult patients in OHCA treated for a shockable rhythm were included. Zoll X series defibrillators (clusters) were randomised to deliver 120–150–200 J, 150–200–200 J, or 200–200–200 J shock strategies.ResultsBetween March 2022 and February 2023, we randomised 38 eligible patients (120–150–200 J (n = 12), 150–200–200 J (n = 10), 200–200– 200 J (n = 16)). The recruitment rate (cluster/month) was 0.07 . Treatment adherence was 93% and completeness of secondary outcomes was 86%. At 30 days, 3/36 (8.3%) patients survived. Due to the limited data storage on defibrillators, the window of opportunity for data collection was short. Data collection was challenging when defibrillators became separated from their allocated vehicles.ConclusionWe demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We identified strategies that would aid data collection. The location of study defibrillators could be monitored using Bluetooth tracking or radio frequency identification (RFID) scanning. Remote upload to a data repository or download to a USB device at the end of each shift would help to ensure that defibrillator data were obtained before being overwritten.
Journal Article