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Dissertations / Theses on the topic 'Paramedic'
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1
Jensen, Jan L. "Paramedic Clinical Decision Making." BMC Emergency Medicine, 2009. http://hdl.handle.net/10222/12738.
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Paramedics are responsible for the care of patients requiring emergency assistance in the out of hospital setting. These health care providers need to make many decisions during the course of an emergency call. This thesis on paramedic clinical decision-making includes two studies, intended to determine which decisions paramedics make that are most important for patient safety and clinical outcome, and what thinking strategies paramedics rely on to make decisions. Forty-two decisions were found to be most important for outcome and safety. The highest decision density of an emergency call is during the on-scene treatment phase. Paramedics use a mix of thinking strategies, including rule out worst scenario, algorithmic, and exhaustive thinking. The results of these studies have implications for future research, paramedic practice and training.
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Devenish, Anthony Scott. "Experiences in becoming a paramedic : a qualitative study examining the professional socialisation of university qualified paramedics." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/78442/1/Anthony_Devenish_Thesis.pdf.
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This thesis used qualitative methods to investigate the professional socialisation of university educated paramedics from Australia and the United Kingdom. The study tested existing professional socialisation theories, taken from other health disciplines, against the paramedical context and developed of a specific model depicting the professional socialisation of university educated paramedics.
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Cowell, John. "Placement Experiences and Clinical Reasoning of Undergraduate University Paramedic Science Students in Victoria, Australia." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/365838.
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Paramedic science students undergo additional clinical training in hands-on skills and clinical reasoning by attending clinical placements. Little is known of the efficacy of paramedic clinical placements or the student’s clinical reasoning skills during training. This study documents the paramedic placement experience and the clinical reasoning responses of paramedic science students. Two instruments were introduced: the Clinical Placement Questionnaire (CPQ), which measures placement experiences; and the Sequence of Learning Instrument (SOLI) and accompanying plotting technique, which allow mapping of clinical reasoning and responding. Clinical placement should provide a positive and enjoyable learning environment that supports the development of clinical reasoning, and clinical reasoning and responding should proceed sequentially in line with clinical practice guidelines. The study comprises Part 1–Clinical placement, a cross-sectional study using quantitative and qualitative methods concurrently; and Part 2–Clinical reasoning, an analytical cross-sectional study using qualitative (interview) methods with repeated measures to counterbalance two mock emergency call-out conditions: pain and MVA trauma.Thesis (Masters)
Master of Philosophy (MPhil)
School of Medical Science
Griffith Health
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Alverson, Sylvia M. "Physical fitness training for paramedic students." CSUSB ScholarWorks, 1987. https://scholarworks.lib.csusb.edu/etd-project/399.
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Bryan, Cornelia A. "The Career Success of Paramedic Program Directors." Youngstown State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1434454119.
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Freeman-May, Andrew. "The nature and development of paramedic expertise." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.570724.
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This research seeks to identify the knowledge, skills, personal qualities and understanding underpinning expert practice in response to emergency calls, the core role of the paramedic, and to explore how paramedics believe their expertise was a role I developed. In-depth interviews grounded in recalled incidents (calls) were employed to generate data from which deductions were made about the underlying capabilities and guiding principles of the work of paramedics. This was supplemented by a questionnaire and the data analysed using a range of theoretical lenses. Responding to a call is described through a sequential series of key activities that, in practice, merge into each other, often in an iterative way: information gathering, managing situations and people and treating patients. Such a description leads to an identification of expertise used in the early stages of responding to a call, such as focusing on reducing and managing ambiguity through the utilisation of situated knowledge to generate tentative hypotheses about the nature of the call and the development of initial plans for action. Such hypotheses are left open and modifiable in the light of new information actively sought by the expert practitioner and are guided by capabilities such as: communication, planning and organising, decision making / problem solving and learning from experience. Additionally, expert paramedic practice is characterised by high levels of resilience and flexibility needed to leave plans incomplete for further development in the heat of practice. This thesis therefore characterises the expertise underpinning the work of experienced paramedics in a way that transcends attempts to describe paramedic practice through lists of skills, knowledge or competencies to be acquired. In so doing the thesis contributes to the evidence base about the knowledge and skill used by paramedics in practice, and how and where this is developed.
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Liu, Yang. "Intelligent Stereo Video Monitoring System for Paramedic Helmet." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36652.
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During the first aid process, when patients are threatened by poor medical conditions, ambulance paramedics are required to administer emergency treatment based on instruc- tions provided by a remote emergency doctor through voice communication. However, such voice communication is always limited in expressing abundant detailed information for the patient.
This thesis presents a framework for a stereoscopic and intelligent telemedicine sys- tem that can provide 3D live video communication between paramedics and emergency doctors. The proposed system captures 3D video from the paramedic headset carried by the paramedics, transmits the video through wireless live streaming, and displays the video with a 3D effect for emergency doctors in the hospital. The video can be analyzed to extract information about the patient through embedded algorithm such as face de- tection algorithm. In this thesis, the hardware, functional mechanism and face detection algorithm are introduced separately.
The hardware of the system consists of a paramedic headset, a server box and a 3D PC, which are used to capture 3D video, transmit video through live streaming and display video with a stereo effect, respectively. The functional mechanism includes two subsystems, which work for pushing the stereo video to multiple live streams and displaying the 3D video from the live stream. In order to detect the patient information from the video, a multi-task face detection algorithm is applied to analyze the stereo video using deep learning technology. We improved the neural networks of face detection by utilizing 1 ⇥ 1 convolutional layers and retrain the network based on the transfer learning to achieve better and faster performance.
This system has achieved good and stable performance in network delay (0.0489ms) and objective video quality evaluations. The face detection algorithm has achieved no- table accuracy (91.78% In FDDB dataset) and efficiency (19.71 ms/frame).
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Clarke, Vincent. "The theory-practice relationship in paramedic undergraduate education." Thesis, University of Hertfordshire, 2018. http://hdl.handle.net/2299/21089.
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A theory-practice gap has previously been proposed as existing in paramedic education. This proposal has been based on the literature, predominantly drawn from nursing, which describes the phenomenon as being a detrimental lack of congruence between the theory that is taught in the classroom and the experiences of students in the practice environment. This submission proposes, rather, that there is a 'paramedic praxis' where the relationship between theory and practice is such that the 'gaps' discussed in the nursing literature do not manifest in the same, potentially problematic, way. Paramedic students' views of theory were found to be centred around the components of their programme taught at university, including simulated practice and procedural approaches to skills-based interventions. Practice was predominantly seen as engaging with 'real' patients in the out-of-hospital environment, where theory was utilised in varying degrees based on the curriculum area to which the theory related. Practice was also considered by some participants to include university-based practical workshops and simulation exercises. Therefore, the resultant views of theory and practice included 'border areas' where no discrete delineation could be found to exist between the two concepts. Paramedic students perceived varying degrees of inconsistency when relating their practice-based experiences to the theoretical components of their programme. These inconsistencies were found to be due predominantly to the contextual and situational challenges associated with the undertaking of paramedic practice, challenges which were considered by the students to be an expected part of practice-based learning and not detrimental to their learning experience. There was found to be a clear appreciation among students that theory can never be exactly matched by their experiences of practice, and not all aspects of practice-based experiences can be fully 'unpicked' by reviewing the associated theory, particularly when considering aspects of practice related to the social sciences. Paramedic Practice Educators considered themselves to be a catalyst for learning, a view shared by their students who considered that the role was of greatest benefit when the Practice Educator was an active, engaged partner in the learning process. Learning was, however, also found to have taken place in the absence of an actively engaged Practice Educator. The model of Paramedic Praxis developed through this research has informed the implementation of practices to enhance existing undergraduate paramedic and Practice Educator educational programmes. The model has been utilised when preparing students for practice placements with greater attention being given to encouraging students to better prepare themselves to make the links between theory and practice. Approaches to reflection and reflective practice have been made more practical and applicable to the realities of practice-based learning, supporting students to enter the practice environment with a clearer individual strategy of learning already considered. Practice Educator education has also been developed, both locally and nationally. The model of Paramedic Praxis has informed the development of curricula for academically accredited, paramedic-specific, Practice Educator short courses. The Zip Analogy component of the model has been incorporated as a core concept by the College of Paramedics in its promotion of the role of the Practice Educator as a facilitator of learning. Continued development of these approaches, based on the findings of this research, will go to supporting the development of student paramedics into lifelong learners who will, themselves, become the Practice Educators of the future.
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Herron, Holly Lynn. "Paramedic Students' Perceived Self-Efficacy at Airway Management." Otterbein University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1399291921.
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Long, David N. "Out of the silo: A qualitative study of paramedic transition to a specialist role in community paramedicine." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/114997/1/114997_9249303_david_long_thesis.pdf.
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Community paramedicine is an evolving specialist stream of paramedic practice and aims to provide patients in the community with options to navigate more efficiently the healthcare system and avoid unnecessary presentations to a hospital emergency department. This study examined the transition of paramedics from a work role in traditional paramedicine to a specialist work role in community paramedicine. The unique knowledge generated by this study allows for additional targeted intervention points for paramedics to better engage in the transition process and may decrease the time frame to deploy high-quality and ready-to-work paramedics in the community.
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Gädtke, Franziska. "Auf dem Weg zu einer Didaktik des Rettungsdienstes – Eine bildungstheoretische Perspektive für die Notfallsanitäter-Ausbildung." Bachelor's thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-170144.
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Die derzeit geführten Diskussionen zu pädagogischen Neuerungen für die Notfallsanitäter-Ausbildung in Deutschland finden auf der Grundlage aktueller bildungsstruktureller Rahmenbedingungen des Notfallsanitäter-Gesetzes einschließlich der Ausbildungs- und Prüfungsverordnung für Notfallsanitäter sowie vor dem Hintergrund berufspädagogischer, berufsfelddidaktischer und allgemeindidaktischer Ansätze statt. Es geht vor allem um die Einführung eines umfassenden Berufsbildungskonzeptes, wenn eine zukunftsfähige Notfallsanitäter-Ausbildung auf wissenschaftliche, gesellschaftliche, wirtschaftliche sowie kulturelle Herausforderungen vorbereiten will. Dieser Beitrag zielt darauf ab, bildungstheoretische Überlegungen einschließlich kritischer Dimensionen im Kontext der Handlungsschwerpunkte von Notfallsanitätern zur Überwindung einer auf ausschließlich berufliche Verwertbarkeit gerichtete Bildung für die Notfallsanitäter-Ausbildung aufzugreifen. Dazu wurde ein Bestimmungsversuch rettungsdienstlichen Handelns mit Ableitung einer bildungstheoretischen Notwendigkeit unternommen. Daher war es naheliegend, eine geisteswissenschaftliche Haltung einzunehmen und das Verstehen des Sachverhaltes in den Mittelpunkt zu rücken. Folglich wurde sich bei der Erkenntnisgewinnung auf eine hermeneutische Theoriearbeit mit theoretischem Argumentieren unter Einbezug der aktuellen, gesetzlichen Ausbildungsrahmen bezogen. Die Beschreibungen zeigen auf, dass die Besonderheiten rettungsdienstlichen Handelns und die gesellschaftlichen sowie bildungsstrukturellen Rahmenbedingungen einer bildungstheoretischen Sicht als Grundlage für die Notfallsanitäter-Ausbildung bedürfen. Der Beitrag diskutiert, wie sich ein Bildungsbegriff als Metaparadigma der Notfallsanitäter-Ausbildung darstellen könnte und welche Konsequenzen sich hieraus trotz nicht zu verachtender Hürden für die pädagogischen Handlungsfelder und die zukünftige Forschung in diesem Bereich ergebenThe current discussions on educational innovations concerning paramedic training programmes in Germany take place in accordance with the present conditional framework for education of the paramedics act, including training and examination regulations for paramedical health care professionals. Furthermore, approaches to vocational education, subject- related didactics and general didactics are taken into account. The focus will mainly be on the introduction of a complex vocational training concept in order to meet the requirements of paramedic training that will prepare for scientific, social, economic and cultural challenges. This article aims at discussing considerations concerning education theory, including critical analysis, and putting it into the context of the professional field of the paramedical discipline. However, this paper will not be limited to aspects of education that are directly linked to practical usage – but it will rather go beyond it. For this reason, it has been tried to identify the professional field of the paramedics and – for it will be necessary – to deduce information that might serve the needs of education theory. It seemed therefore to be obvious to take the position within humanities, and to put emphasis on the understanding of the issue. Consequently, as far as gaining knowledge is concerned, hermeneutic theory work and theoretical reasoning were taken into account, also involving the current legal requirements for the training framework. Descriptions show that, when it comes to the specific nature of the professional field of the paramedical discipline, and the social and the conditional framework for education, there is, as far as paramedic training is concerned, a need for taking a perspective that is based on education theory. The article discusses how an educational concept could be represented as a meta-paradigm for the paramedic training, and which consequences will arise in this respect, despite considerable obstacles to the educational fields of action and any future research in this area
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Hobbs, Lisa Rose. "Australasian paramedic attitudes and perceptions about continuing professional development." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134081/1/Lisa%20Rose%20Hobbs%20Thesis_Redacted.pdf.
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This study utilised constructivist grounded theory to explore the attitudes, engagement and perception of current Australasian paramedics in relation to CPD. The study found paramedics have not significantly modified their engagement in CPD/LLL despite professional registration. There is, however some confusion surrounding what constitutes CPD. Furthermore, education appears to be a new form of hierarchical stigmatisation within the paramedic culture. The study facilitated the creation of a framework of paramedic CPD, which includes CPD models; PDP; reflective practices; and LLL. The framework acknowledges professional, industrial, social, personal, political, organisational and economic factors which influence or change paramedic engagement in CPD.
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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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Betts, Bronwyn Elizabeth. "Patient refusal of paramedic treatment: Promoting paramedic decision making through use of a legal framework to assess the validity of refusals in the pre-hospital setting." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/200321/1/Bronwyn_Betts_Thesis.pdf.
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This research quantitatively examined the frequency, clinical circumstances and demographic characteristics of patients that refuse paramedic treatment; contextually reviewed the regulatory framework in which these decisions are made; critically evaluated paramedics' knowledge and application of the law when responding to patients who refuse treatment; and identified discrepancies that exist between the law and paramedic practice. The findings of this study will inform, guide and promote paramedic decision-making through use of a legal framework when responding to patients that refuse treatment and transport against advice.
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Holmes, Lisa. "Exploring the preparedness of novice (student) paramedics for the mental health challenges of the paramedic profession: Using the wisdom of the Elders." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2102.
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This study investigates the preparedness of novice (student) paramedics for the mental health challenges of the paramedic profession and identifies the coping strategies used by veteran paramedics to successfully meet these challenges. The lived experience of veteran paramedics is utilised to provide this important assistance.
Initially, two surveys were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate degree paramedicine courses across Australia and New Zealand, to identify the perceived need (for preparation) within the curriculum. In addition, the anticipations, confidence and fears of novice (student) paramedics, course coordinators and veteran paramedics were also collected as a means to facilitate the preparedness through self-evaluation, reflection and discussion.
Twenty semi-structured interviews with veteran paramedics, each with a minimum 15 years paramedic experience from across Australia and New Zealand, were conducted to gain an understanding of their experiences, mental health coping strategies and advice for novice (student) paramedics. Results from the interviews were validated by three focus groups comprised of six veteran paramedics each, representative of the geographic spread.
All 16 course coordinators and 302 novice (student) paramedics responded to the surveys. Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession within accredited undergraduate paramedic courses with 100% of course coordinators and 97% of students recognising this need.
The semi-structured interviews with veteran paramedics provided valuable insights into the experiences and strategies used to aid the survival of the veterans throughout their careers. Within the interviews 70% of participants expressed a sincere love for theparamedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues.
In addition, extensive advice was given to novice (student) paramedics based on the veterans lived experiences. This advice focused comprised of three themes; support, health and the profession.
The findings of the study indicate that the preparation of novice (student) paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. By utilising the relatable data collected on the anticipation, confidence and fears of novices, course coordinators and veterans, the advice offered by the veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the lived experiences of the veteran paramedics. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion to the paramedic curriculum have been prepared to facilitate the knowledge and commence the development of conscious coping strategies by novice (student) paramedics during their learning phase.
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Nugent, Michael G. "Analysis of minority student recruiting within the Denver Health Paramedic School." [Denver, Colo.] : Regis University, 2006. http://165.236.235.140/lib/MNugent2006.pdf.
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Schröder-Groenewald, Annelene. "Pastoral counselling of the paramedic in the working environment / Annelene Schröder." Thesis, North-West University, 2012. http://hdl.handle.net/10394/9833.
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Paramedics are exposed to high levels of stress and trauma in their working environment. Research has its focus on the coping mechanisms and trauma incidents escalating into Posttraumatic Stress Disorder. This study examines the paramedics’ working environment in relation to the help available, and suggests a pastoral counselling method which may be utilized as an effective method of assisting in the coping process and prevention of PTSD. Emergency Medical Services as a helping profession is mainly concerned with the welfare of their patients. This study has its focus on helping the helper, with the main focus on assisting the paramedic to cope with his working environment. Implications of the research include kerugmatik counselling and narrative therapy, incorporated in a pastoral counselling method to assist the paramedic with the healing process. The main findings were that stress and coping of the paramedic in his working environment was a reality which was often overlooked, as these paramedics had their focus on caring for their patients. In most cases there is help available, but the paramedic is hesitant to seek it out. Paramedics are mostly self-reliant in their coping mechanisms as their understanding and relationship with God and with the church had been damaged. The researcher followed the four tasks of practical theology as theoretical framework, as explained by Osmer:
Descriptive-empirical Task – Priestly listening
Interpretive Task – Sagely wisdom
Normative Task – Prophetic discernment
Pragmatic Task – Servant LeadershipThesis (MA (Pastoral Studies))--North-West University, Potchefstroom Campus, 2013.
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Lyman, Katie J. "The Relationship of Affective Domains and Cognitive Performance in Paramedic Students." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5259.
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No universal approach for application procedures has been established for paramedic curriculum programs. The field of pre-hospital, Emergency Medical Services (EMS) has evolved quickly from its inception to present date. The educational components of EMS are still in their infancy and lack evidence-based protocols (Drees, 2006). Predicting success in an allied health program typically concentrates on some type of academic instrument. The use of personality inventories has been underexplored; however, literature reveals they may be more reliable in determining academic and employment success compared with other non-cognitive tools (Groves, Gordon, & Ryan, 2007; Marrin et al., 2004; McManus & Richards, 1986; Sadler, 2003).
The purpose of this study was to explore the relationship of affective domains to cognitive scores in entrance and exit examinations of paramedic students (Fisdap, 2013). Comparing the results of affective domains to areas of cognition should enable administrators in pre-hospital health care systems to make admission recommendations based on evidence-based research rather than intuition. Identifying the candidates who have a higher potential of success for completing an academic program and the possibility of contributing to the profession is necessary for the advancement of emergency medical service programs.
A quantitative, retrospective study using data collected by Fisdap® was used to test four separate research questions. The general premise of the four research questions can be combined by asking: Is there a relationship between selected affective domains and the sub-categories and totals of an entrance and comprehensive exam?
Pearson product-moment correlation coefficients were used for data analysis in all four research questions. As was analyzed through Pearson correlations, the selected affective domains did not show any statistically significant relationship to any of the cognitive portions of the EE or the PRE3. However, an additional multiple regression concluded that the EE positively predict the PRE3.
This research project was the first to explore the relationship of affective domains and cognitive ability in paramedic students. Although no statistically significant data for the four proposed research questions was reportable, future publications from this project will assist administrators and educators associated with emergency medical education.
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Loudon, Wayne. "An investigation of the prehospital diagnosis and triage of ischaemic hyper-acute stroke to recommended Reperfusion therapies." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/229538/1/Wayne_Loudon_Thesis.pdf.
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Stroke places a significant burden on society and is devastating for individuals and their families. This thesis investigates the prehospital factors that impact on acute stroke identification and treatment to ensure clinicians and stroke systems of care can respond efficiently and ensure best possible outcomes. It examines paramedic knowledge of stroke, looks at what role clinical and system factors have on diagnostic precision and explores how these impact on the delivery of acute stroke cares. The results of the thesis have been used to guide and inform improvements in prehospital stroke care in Queensland.
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Villers, Lance Carlton. "Influences of situated cognition on tracheal intubation skill acquisition in paramedic education." [College Station, Tex. : Texas A&M University, 2008. http://hdl.handle.net/1969.1/ETD-TAMU-2714.
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Rizwan, Atikha. "Recovering from distress : the impact of critical incidents on paramedic work performance." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/118524.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2018.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 35-36).
In many service operations settings, the difficulty of jobs is unpredictable. Examples include police officers or paramedics routinely responding to calls with only limited understanding of the situations awaiting them. In such settings, a worker may occasionally encounter a critical incident (CI), defined as a task or situation which is sufficiently disturbing to challenge or overwhelm the workers' usual coping mechanisms. We study the impact of complex, stress-inducing tasks on operational task performance of the ambulance crew at the London Ambulance Services (LAS). Our metric for operational performance is cycle times, an important driver of system utilization. Shorter cycle times indicate better performance. From analyzing the LAS data, we found that following a Cl, a crew's cycle times increase and the effect gets worse for teams which face more CIs within the same shift. We find that this effect is non-uniform over sub-components of cycle times. In particular, the impact is more significant on operational performance of complex and less standardized tasks. We also did a robustness check for varying definitions of a Cl and the results hold and are consistent.
by Atikha Rizwan.
S.M. in Engineering and Management
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Maurin, Söderholm Hanna. "Emergency visualized : exploring visual technology for paramedic-physician collaboration in emergency care." Doctoral thesis, Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-3658.
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This thesis explores the potential of visual information and communication technologies (ICTs) for collaboration in emergency care. The thesis consists of four studies exploring future technology, 3D telepresence technology for medical consultation (3DMC), from several different methodological and analytical perspectives. Together the studies provide a broad view of the potential benefits, risks and implications of using visual technologies for collaboration in emergency care. The results show that paramedic-physician collaboration via 3DMC might have some benefits for patient care, both in the immediate patient care situation and beyond, for example, when coordinating transport and resources; improving understanding between different actors; and in developing paramedic competence and confidence in their skills. However, collaboration is heavily impacted by physicians’ and paramedics’ respective work practices which are situated in very different physical, professional and organizational contexts. Adding a visual dimension to this collaboration presents unique challenges for the overall design, development, implementation, and appropriation process. Thus, the thesis emphasizes the importance of understanding both the individual users as well as the complex overall image which, although often neglected or ignored, is crucial to understand when developing and introducing new technology that is successful and justified in the overall context while also being useful and meaningful for the individual users.Academic dissertation for the Degree of Doctor of Philosophy in Library and Information Science at the University of Gothenburg and the University of Borås to be publicly defended on Thursday 19 September 2013 at 13:15 in the auditorium at Simonsland, University of Borås, Skaraborgsvägen 3, Borås.
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Taylor, Natasha. "Fear, performance and power : a study of simulation learning in paramedic education." Thesis, University of East Anglia, 2012. https://ueaeprints.uea.ac.uk/42405/.
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Simulation or scenario learning is an integral part of student paramedic development and, despite the increasing amount of paramedic research, very little is known about how students and tutors experience it. Current literature regards simulation as invaluable without exploring why this may be the case and this study aims to address this. This is a compressed time mode ethnographic approach study that incorporates data from student paramedics during and immediately after simulation learning events and tutor views of facilitating the simulation experience. This, along with a comprehensive literature review, provides an overview of simulation in the student paramedic development pathway. This thesis exposes how student paramedics find the simulation process anxiety provoking and explores the many reasons for this. The performance aspect of scenarios is echoed in the dramaturgical language used when talking about simulation learning events and the similarities between simulation learning events and simulation assessment events merely adds to this stress. Using the lens of critical pedagogy, issues of power (control and hierarchy) within the educational and organisational structures are examined and offered as another possible explanation for the high levels of anxiety in simulation learning. The thesis ends with the question of whether simulation learning can be changed for the better and if so, how.
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Do, Lien, Brieanna Flores-Keown, Alicia Vu, and Terri Warholak. "Qualitative Evaluation of the Rio Rico Fire Department Community Integrated Paramedic Program." The University of Arizona, 2016. http://hdl.handle.net/10150/613964.
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Class of 2016 Abstract and ReportObjectives: Specific Aim #1: Assess the impact of the Community Integrated Paramedic program on the participants. Our working hypothesis is that the participants will find the program to be impactful in many aspects and beneficial. Specific Aim #2: The impact of the program on the participating paramedics. Our working hypothesis is that the paramedics will report positive themes as a result of participation in the program. Methods: 5 individuals who were enrolled in the paramedicine program and 6 volunteer paramedics participated in semi-structured face-to-face interviews. Interviews were transcribed data was grouped into categories and subcategories to identify common themes associated with participation in a community paramedicine program for both participants and paramedics. Results: Three primary themes emerged for participants: disease-self management, safety and support. Disease-self management included 7 subdomains: medication management, exercise, diet, resources and utilization, communication with providers, disease education, and self-awareness. Safety included 4 subdomains: medication safety, home safety, fall prevention, and environmental hazards. Support included 2 subdomains: physical and emotional. One primary theme emerged for volunteer paramedics: job satisfaction. Job satisfaction included 8 subdomains: helping people, decreasing emergencies, learning new skills, educating people, expand knowledge base, rewarding experience, building relationships, and documenting impact. Conclusions: A community paramedicine program is positively correlated with emotional support, disease management and safety for participants involved. Additionally, the program is associated with increased job satisfaction for paramedics.
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Rotter, Erica, and Schröder Ann Dolk. "Yrkesutförandet och ambulanspersonalens fysiska hälsa : En beskrivande litteraturstudie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-20678.
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Sammanfattning Bakgrund; Inom ambulansyrket utsätts personalen dagligen för tunga lyft, ofta i icke ergonomiska arbetsställningar samt i många fall under tidspress. Dessutom arbetar ambulanspersonal i regel skift och ibland hela dygn vilket medför en rubbad dygnsrytm. Syfte; Att beskriva hur yrkesutförandet påverkar den fysiska hälsan hos ambulanspersonalen, samt att beskriva vilken urvalsmetod som använts i valda artiklar. Metod; Litteraturstudien har en deskriptiv design och består av tolv vetenskapliga artiklar hämtade från databaserna Cinahl och Scopus. I tio av artiklarna har en kvantitativ ansats använts och de andra två består av en mixad ansats. Artiklarna har granskats utifrån likheter. I den metodologiska aspekten urvalsmetod har skillnader och likheter granskats. Resultat; Resultatet visade att ambulanspersonal i högre utsträckning än normgrupper lider av muskuloskeletala besvär. Vilket kan relateras till hög fysisk belastning samt icke ergonomiska arbetsställningar. Ambulanspersonal upplever dessutom högt stresspåslag i arbetet. Resultatet visar även att de oregelbundna arbetstiderna påverkar ambulanspersonalens sömnkvalitét samt kost och motionsvanor negativt. De urvalsmetoder som använts i artiklarna är; slumpmässigt urval, stratifierat sannolikhetsurval, totalurval samt bekvämlighetsurval. Slutsats; Såväl muskelsmärta, störd dygnsrytm, sömnbrist, samt ökat stresspåslag hos ambulanspersonal kan relateras till yrkesutförandet. Oregelbundenheten i arbetet försämrar möjligheten att äta hälsosamt och träna regelbundet. Ambulanspersonal skulle gynnas av bättre träningsmöjligheter på arbetet, längre återhämtningstid och bättre möjligheter till regelbundna måltider.Abstract Background; Ambulance personnel are in their work exposed for heavy lifting, often in non-ergonomic postures, and in many cases under time pressure. Ambulance personnel also work in shifts and sometimes 24-hours, resulting in a circadian rhythm. Aim; Describe how professional performence affects the physical healt of ambulance personnel and to describe wich sampling method, used in included articles. Method; The literature study has a descriptive design and consists of 12 scientific articles, selected from Cinahl and Scopus databases. In 10 of the articles there is a quantitative approach and 2 of them has a mixed approach. The articles were audited on the basis of similarities. In the methodologocal aspect; sampling method, diffrences and similarities has been audited. Results; The result showed that ambulance personnel in greater occurence than norm groups, suffer from muscle pain. Which can be related to high physical exposure and non-ergonomic postures. Ambulance personnel also experiencing high level of stress in their work. The result also showed that irregular working hours affect the ambulance personnel´s quality of sleep aswell as diet and exercise habits negatively. The sampling method used are; Randomized sampling, stratified probability sampling, total sampling and convenience sampling. Conclusion; Musclepain aswell as disruption of circadian cycles, lack of sleep and increased level of stress in the ambulance personnel can be related to professional performence. The irregularity in the work impair possibilities to eat healthy and exercise regularly. Ambulance personnel would benefit from better exercise opportunities at work, longer recovery and better possibilities to regular meals.
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Gompert, Katherine Marie, and Katherine Marie Gompert. "Need and Readiness for a Nurse Practitioner-Paramedic Unit in Rural Yuma, Arizona." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/622960.
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Background: The expansion of health care coverage, overuse, misuse, and overcrowding of emergency departments, inappropriate use of emergency medical services, and issues pertaining to rural dwelling, call for the development of new models of care to improve patient outcomes, bridge care gaps, and meet community needs. One such model that may be instrumental in overcoming these issues it that of the Nurse Practitioner-Paramedic Unit (NPPU). Purpose: This doctor of nursing practice project comprises a needs and readiness assessment with input from key stakeholders regarding resources required and the need for a NPPU in Yuma, Arizona. The ultimate goal of this needs and readiness assessment is to inform the future development of a new model of care, the NPPU for Yuma, Arizona. Methods: Surveys were distributed via Qualtrics to 86 individuals to include local physicians, nurse practitioners, and paramedics, amongst others. The survey contained nine open-ended questions to inform the future development of a NPPU. A total of 17 completed surveys were submitted between 9/11/16 to 10/9/16. Response were grouped by question number and analyzed for themes. Results: Eighty-two percent of respondents felt that a NPPU was needed in Yuma, Arizona. Respondents identified more benefits than negatives of an NPPU. Resources needed were identified to include hospital buy-in, provider trust and buy-in, coordination between the hospital and fire departments, medical equipment, transport vehicle, funding, scheduling, and education. The most common care situations considered appropriate for a NPPU were identified as low acuity (47%), transitional care and/or chronic health issues (35%), and behavioral health (29%). The importance of protocols was noted by 65% of respondents. 94% of respondents expressed that an NPPU would increase patient satisfaction. Improved patient outcomes due to an NPPU was identified by 24% of respondents. Overall, 94% of respondents stated that they would support an NPPU and were interested in being part of a working group. Conclusions: The results of this project support the need for a NPPU by stakeholders in the community and will guide the future development of an NPPU for Yuma.
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Holbrook, James Robert. "A study to determine a new paradigm for paramedic education in San Bernardino County." CSUSB ScholarWorks, 1994. https://scholarworks.lib.csusb.edu/etd-project/857.
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Wakefield, Courtenay. "An exploration of how LGBTQ+ paramedic experiences of exclusion and inclusion can inform policy and cultural safety in a state funded ambulance service." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/208190/1/Courtenay_Wakefield_Thesis.pdf.
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This research is a qualitative study which explores the workplace experiences of LGBTQ+ paramedics through narrative based interviews and thematic analysis. This research also compares the workplace policies, procedures and strategies related to inclusion in the workplace against three existing benchmarking tools. The model of cultural safety is applied as a post analytical lens and recommendations for improving the workplace inclusion of LGBTQ+ paramedics are discussed.
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Dickison, Philip DuWayne. "Using Computer-Based Clinical Simulations to Improve Student Scores on the Paramedic National Credenti1aling Examination." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1272488998.
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Christen, Henry Tiffany. "Community college educators' perceptions of the instructional infrastructure needed for high-fidelity paramedic training simulations." [Pensacola, Fla.] : University of West Florida, 2009. http://purl.fcla.edu/fcla/etd/WFE0000150.
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Day, Alison. "Planning for chaos : developing the concept of emergency preparedness through the experience of the paramedic." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/79582/.
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This thesis aimed to develop an understanding of the concept of emergency preparedness through the lived experiences of paramedics, utilising an interpretative phenomenological analysis (IPA) methodology. Emergency preparedness is a developing speciality, with a limited evidence base. Current research is mainly atheoretical, with the majority of literature comprising of anecdotal reports, government guidance, clinical protocols, audit and clinical policy. The published literature offers little more than opinion and a retrospective view of experience, with few studies examining and understanding the individual lived experience within this area. To address the identified gaps in the literature and in line with the idiographic focus of IPA, thirteen paramedics were recruited and face-to-face interviews explored their individual experiences of emergency preparedness. Through data analysis, the following superordinate themes were identified for further discussion:- self determination, control and experience-based practice. Participants appeared to value their role and the unpredictable environment that they worked in. Personal resilience, an area that they suggested is not covered effectively within individual preparation, was viewed as important. The participants articulated that risk, threat, uncertainty, safety, trust and control were important concepts within individual preparedness. These paramedics valued practice-based knowledge and education as credible and transferrable to their clinical work. Additionally, storytelling appeared as a preferred method of conveying knowledge in an area with minimal real-life experience. Dimensions of individual preparedness are presented, with the paramedic central to the experience within a conceptual model (the DiEP model), creating a new form of emergency preparedness that reflects the individual paramedic’s experience.
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Crowe, Remle. "An Assessment of Burnout among Emergency Medical Services Professionals." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531751856368551.
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Horrocks, Peter. "Preparing Australian paramedics for effective health disaster response: Identifying core competency and a phenomenographic examination of current disaster response education." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/202714/1/Peter_Horrocks_Thesis.pdf.
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The education and training of paramedics in disaster response is an essential part of preparedness within the disaster management cycle. While it is clear that disaster and major incident capabilities may differ depending on location, disasters in any state of Australia can potentially require a national response. As such, those paramedics responding to these events should have the same standardised core knowledge, competency and alibility. This project utilised a convergent mixed-method approach to analyse four discrete studies designed to examine the current state of disaster response education for Australian first responder paramedics and to make recommendations for future improvement.
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Rhodes, Jamie N. "Does the attendance of a critical care paramedic at an adult cardiac arrest in Queensland improve patient outcomes?" Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/95941/1/Jamie_Rhodes_Thesis.pdf.
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This project aimed to determine if the attendance of Critical Care Paramedics at out-of-hospital cardiac arrests in Queensland was still associated with a survival benefit despite the diminishing gap in the skill set between Critical Care and Advanced Care Paramedics. The study found that amongst patients with the greatest chance of survival, those patients who were attended by Critical Care Paramedics were more than twice as likely to survive to hospital discharge.
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Brown, Elizabeth Emma. "The Epidemiology of Trauma Patients Attended by a Paramedic Staffed Emergency Medical Service in Perth, Western Australia." Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/77545.
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This thesis examined the characteristics and outcomes of adult trauma patients attended by paramedics in the metropolitan area. An increase in the incidence rate of trauma especially in older adults was found, with more than half of those transported to hospital being over 51 years of age. Falls from standing were found to be the most common cause of major trauma and older age was associated with a significantly reduced likelihood of Trauma Centre transport.
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Ramis, Mary-Anne. "Factors that influence and predict undergraduate nursing and paramedic students' intention and use of evidence-based practice." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/109614/1/Mary-Anne_Ramis_Thesis.pdf.
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Despite professional requirements, educational research across disciplines, provides limited evidence indicating undergraduate health students, are confident with or intend to use evidence in their clinical practice after graduation. Using Bandura's self-efficacy theory, this research investigated factors influencing undergraduate nursing and paramedicine students' intention to use and their current use of evidence-based practice (EBP). Through development and validation of two multivariate prediction models, the study identified EBP self-efficacy as one important factor necessary for supporting students' intentions to translate EBP into clinical contexts. The research results provide theoretically-based components for curriculum developers when designing strategies to support students' advancement in EBP.
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Bowles, Ronald Robin. "From diagnosis to discernment : fostering the development of clinical judgment of paramedic learners in immersive high fidelity simulations." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44556.
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Paramedic educators are challenged to produce greater numbers of graduates who are better prepared to function in an evolving health care system. The growth of high fidelity simulation (HFS) holds promise for reducing reliance on the practicum environment, long a crucial step between the classroom and field practice. Yet, despite significant investment in simulation infrastructure, HFS is still seen as an adjunct to, but not a replacement for, practicum placement. The practical problem addressed in this study, then, was the presumption that HF simulation can reduce reliance on practicum placement. The research question explored how HFS influences the development of clinical competence and clinical judgment. This multiple-case study employed a multi-vocal approach, gathering data from 75 classroom and HF simulations. An iterative, inductive process of analysis provided a phenomenological exploration of participants’ experiences and interactions and a critical analysis of their judgments and decision making. The findings in this study suggest that existing paramedic simulations and the practicum represent radically different learning environments, each with its own sets of roles, expectations, patterns of practice, and methods of evaluation that call on different epistemological and ontological conceptions of what constitutes competent practice, what knowledge matters most, and how learning occurs. The varied learning activities in this study fostered different ways of knowing as learners moved from the consistency of context-independent skill performance to the socially constructed adaptation of procedures and protocols in dynamic simulations, and, finally, to the socially negotiated understandings arising from co-emergent activity in a field setting. Effective simulations require situational blends of fidelity to create environments realistic enough to meet their pedagogic goals. Simulations intended to foster clinical competence and clinical judgment must provide occasions for discernment; they must create a milieu involving complex interpersonal interactions and genuine opportunities for clinical decision making. Thus, paramedic simulations must be as concerned with role, environmental, interpersonal, and social/cultural fidelity as with physiological and procedural fidelity. In this sense, populating HFS more richly with actors and authentic interdisciplinary responders may often be as important as the use of HF mannequins and standardized patients.
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Black, Sarah Louise. "Factors influencing pre-hospital decisions not to convey : a mixed methods study." Thesis, University of Exeter, 2017. http://hdl.handle.net/10871/32600.
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This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.
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Crowe, Remle P. "An Assessment of Burnout among Nationally-Certified Emergency Medical Services Professionals." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1452245440.
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Testa, Valerie. "Implementation of a First Responder Operational Stress Injury Clinic Using the TDF-II and CFIR Frameworks: A Paramedic Perspective." Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41918.
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Background: First responders (firefighters, paramedics, and police officers) are often exposed to potentially psychologically traumatic events. When combined with insufficient social support and reduced help-seeking behaviours, such exposures may increase the risk of mental health challenges, particularly among paramedics who report the highest rates of mental disorders. Objective: The current study used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify critical barriers and facilitators to help-seeking and accessing mental health care, and the feasibility and sustainability of a first responder clinic. Methods: Semi-structured qualitative interviews included 11 paramedics (frontline, mid-and-senior management, and union), recruited using purposive and snowball sampling. Interviews were analyzed using content and thematic analyses. The TDF and CFIR guided study design, interview content, data collection, and analysis. Results: Barriers included the complexities of stigma, confidentiality, cultural competency, and trust. Conclusions: The findings will be instrumental in developing evidence-based approaches to mental health care for paramedics.
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Dalski, Chester L. "Paramedic professional and leadership development using high-fidelity healthcare simulation and audiovisual feedback| One Michigan community college case study." Thesis, Andrews University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3667814.
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Problem: Paramedic educators have a short time frame (840 didactic/laboratory plus 500 clinical/internship hours) and limited resources to prepare their students to have competent clinical skills, safe medical practice, and appropriate leadership and teamwork skills. New learning approaches including simulation, audiovisual feedback, and structured debriefing have been suggested as a way to meet this challenge within paramedic education. While some individual components have been studied, no study has examined these three technologies together in paramedic training programs. The overarching research question that guided this study was: What and how do paramedic students learn in a high-fidelity healthcare simulation program that includes audio/video and instructor-facilitated feedback?
Method: The investigation was a mixed methods study; however, the study tended towards qualitative methods primarily using intrinsic case study methodology based on the work of Yin and Stake. The investigation reviewed the outcomes achieved through the use of high-fidelity healthcare simulation coupled with audio-visual feedback, when implemented within a paramedic education program. A variety of data was collected including audio-visual recordings of briefs, simulations, and debriefs, multiple student documents and logs, and copious researcher notes and documents.
Results: The simulation laboratory was a realistic, safe, controlled setting allowing students to make autonomous decisions without potential harm to human life as a consequence of errors. Simulation technology augmented traditional clinical experiences by providing more uniformity of experiences between students, providing less familiar clinical experiences, and acting as a time-efficient method for achieving deficit competencies. In evaluating student skill performance, simulation provided better quantified measures and observation accuracy.
Leadership skills were developed in simulation by taking advantage of safe learning aspects; an environment to learn from mistakes which used leadership skill autonomous practice. Participation as a leader and follower allowed the learner a better understanding of the leadership role when exposed to well-crafted scenarios. Simulation was a unique methodology facilitating safe learning from errors committed by students, a result of knowledge gaps within individual learning. Simulation was unlike traditional learning methods such as lecture, laboratory, or clinical experiences.
The facilitator/debriefer assisted the paramedic in learning within the simulation environment by: creating a safe learning environment, helping learners identify what knowledge was needed, reinforcing identified needed learning, assisting participants to identify correct actions in response to individualized errors, and promoting learner reflection. A debriefing provided the environment whereby the bulk of learning took place in the simulation experience. The simulation environment contributed to student growth in three domains (cognitive, psychomotor and affective) of learning identifying knowledge or performance gaps for students in the specific practice of assessment, leadership, treatments, planning, evaluation, situational awareness, communications, and teamwork. Simulation provided an alternate method for achieving clinical experiences not available in the actual setting. During the debriefing, the audio-visual feedback and interactive probing procedures worked together to promote student learning. The audio-visual component provided a "big picture" viewpoint for the learner used by the debriefer during interactive probing to help students identify errors and alternate actions.
A learning model was constructed which represented how students learn. The use of simulation allowed the participant to determine unknown knowledge gaps from previous learning through processes of simulation experience, identification during debriefing, and reflection on alternate-decision pathways. Learning occurred in learning process conclusion: the application of alternate pathways in behavior. The learning process has been summarized in a simulation learning model presented in this study. The simulation learning model is applicable for cognitive, affective, and psychomotor elements.
Within the study, analysis developed emergent themes. Emergent themes included: Context Is Vital, We Often Don't Know What We Don't Know, Learning From Mistakes, Learners Must Have a Safe Learning Environment, Learning Lessons From Other Industries, and Teaching Leadership Challenges for Paramedics.
Conclusions and Recommendations: Students often don't know what they don't know in individualized previous learned knowledge; thus, a learning mechanism is required, such as simulation with facilitated debriefing interactive audiovisual feedback. Simulation technology acts as a safe and non-threatening environment to allow learning from mistakes without a human cost. Valid fidelity healthcare simulations augment traditional clinical experiences by providing unfamiliar virtual realities in a uniform way to strengthen the participants' overall experience repertoire. This study recommends that the Emergency Medical Services (EMS) industry, educators, and policy makers establish standards requiring simulation learning within initial training programs to decrease the potential for loss of human lives as a result of human error.
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Bergström, Gunnar, and Anders Lundberg. "Ambulanssjuksköterskans bemötande av suicidnära patienter : En intervjustudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-154944.
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Varje år genomför cirka 1100 personer i Sverige ett suicid. Varje suicid föregås av i genomsnitt 10 suicidförsök. Detta orsakar förutom kostnader i form av oerhörda summor pengar för samhället också otroligt mycket lidande för anhöriga. Ambulanssjuksköterskan är många gånger den första resursen i vårdkedjan som den suicidnära kommer i kontakt med. Detta ställer stora krav på bemötandet av patienten men också krav på kunskap om medicinska åtgärder för att rädda personen till livet. Detta arbete avser att studera ambulanssjuksköterskans bemötande och egna upplevelser av mötet med den suicidnära patienten genom att intervjua ambulanssjuksköterskor i Uppsala. Studien visar att få ambulanssjuksköterskor upplever sig ha tillräcklig kompetens för att bemöta den här typen av patienter. Vidare framgår att ambulanssjuksköterskan i mycket stor utsträckning känner en misstro till den vård som patienten erhåller från psykiatrin och att det förekommer stora skillnader i hur ambulanssjuksköterskan resonerar kring sin egen säkerhet i mötet med patienten. Studien visar också att de flesta av ambulanssjuksköterskorna bemöter patienterna enligt POSP-riktlinjerna (Prehospitalt Omhändertagande av Suicidnära Patienter). Patienten skriker ofta efter hjälp i samband med ett suicidförsök och vågar man identifiera syftet med handlingen så möts man ofta med tacksamhet.Annually around 1100 individuals in Sweden end their lives by committing suicide. Prior to every completed suicide estimate shows that 10 attempts have been made. This results in both high costs for the society and unmeasurable suffering for their relatives. The nurses that are working in the Swedish ambulance system are often the first medical resources with whom the suicidal patient has contact. This means high demands are placed on the nurse both regarding the meeting itself with the patient but also with the medical knowledge that could prove to be lifesaving in an acute situation. This paper seeks to study the professional interaction and the strategies that the nurse uses to help the suicidal patients and their own experiences of the meeting by interviewing nurses working in the Uppsala ambulance service. This study shows that the nursing staff experiences a lack of knowledge in the meeting with the patients and a clear disbelief in the care that the patients receive at the psychiatric ward. Furthermore the study shows that most nurses in the study interact with the patients in accordance with the POSP-guidelines. The patient is often crying for help in connection to a suicide attempt and if the nurse has the courage to identify the purpose with the action one is most often met with gratitude.
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Carlsten, Annelie, and Ulrika Lindqvist. "Akut : En analys av begreppets karaktäristika, förutsättningar och konsekvenser inom ambulanssjukvården." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-14713.
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Syftet var att studera begreppet akut i avsikt att identifiera dess karaktäristika, förutsättningar och konsekvenser inom ambulanssjukvården. Intresset väcktes då begreppet används i flera olika sammanhang och är individuellt upplevt, vilket kan missuppfattas i kontakten med patient och annan vårdpersonal. Metoden utgjordes av en begreppsanalys och datamaterialet av vetenskapliga artiklar, tidskrifter, läroböcker, uppslagsverk med mera som har med begreppet att göra. I en begreppsanalys förtydligas begreppet genom att man synliggör dess karaktäristika. Genom tydliggöring av begreppets karaktäristika blir det tydligt vad begreppet innebär och vad det inte innebär. Att klargöra ord som ibland används i många sammanhang eller att det är ett vagt begrepp är vanligt inom vårdvetenskapen och kan behöva förtydligas enligt Walker och Avant (2011), för att få fram betydelsen och förhoppningsvis få fram en gemensam innebörd för begreppet. I den lexikala genomgången har lexikon och ordböcker använts. Sammantaget kan man säga att det gemensamma för svenskans och engelskans innebörd av begreppet är främst skarp. Under den litterära analysen har flera utmärkande karaktäristika av begreppet identifierats, detta genom tolkning av de utvalda vetenskapliga artiklarna. I sammanfattningen av begreppet ’akut’ framkommer att det kan beskrivas som en subjektiv upplevelse relaterat till en sjukdom eller tillstånd hos den hjälpsökande personen.
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Bentley, Melissa Ann. "An Assessment of Depression, Anxiety, and Stress among Nationally Certified EMS Professionals." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306521665.
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Stephens, Joanne. "Meeting the needs of children with autism and their parents during out of hospital interactions with paramedics." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122961/1/Joanne_Stephens_Thesis.pdf.
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This study explored the needs of children with autism and their parents during out-of-hospital interactions with paramedics. Paramedics and parents of children with autism provided rich accounts of their interactions and experiences through semi-structured interviews. The study concluded that paramedics are meeting the emergency health needs of the children on the spectrum and are willing to link children and their families to the other services they need. Parents value the development of individualised emergency care plans and can offer expertise about their child's needs. The development of systems navigation, health literacy and advocacy skills was vital for both families and their care providers.
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Wells, Bridget. "Implementation of computerised clinical decision support (CCDS) in a prehospital setting : processes of adoption and impact on paramedic role and practice." Thesis, Swansea University, 2013. https://cronfa.swan.ac.uk/Record/cronfa43112.
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Aim: To examine the adoption of CCDS by paramedics, including the impact of CCDS on paramedic role and practice. Methods: Systematic review of CCDS in emergency care followed by a cluster-randomised controlled trial (C-RCT) of CCDS with a qualitative component involving 42 paramedics at two study sites. Results: 19/20 studies identified for inclusion in the systematic review were from the Emergency Department setting, with no studies from prehospital care. The focus of the studies was on process of care (19/20) rather than patient outcomes (5/20). Positive impacts were reported in 15/19 (79%) process of care studies. Only two patient outcome studies were able to report findings (one positive, one negative). Results relating to CCDS implementation were reported as an ad hoc response to problems encountered. In this C-RCT paramedics used CCDS with 12% of eligible patients (site one: 2%; site two: 24%). Intervention paramedics were twice as likely to refer patients to a falls service as those in the control group (usual care) (relative risk = 2.0; 95% Cl 1.1 to 3.7) although conveyance rates were unaltered (relative risk = 1.1; 95% Cl 0.8 to 1.5) and episode of care was unchanged (-5.7 minutes; 95% Cl -38.5 to 27.2). When CCDS was used patient referral to falls services was three times as likely (relative risk = 3.1; 95% Cl 1.4 to 6.9), and non-conveyance was twice as likely (risk = 2.1; 95% Cl 1.1 to 3.9) and overall episode of care fell by 114 minutes (95% Cl from 77.2 to 150.3). Reasons given for not using CCDS included technical problems, lack of integration, it was not sophisticated enough to influence decision making. Paramedics adapted when and how they used CCDS to suit context and patient condition. Conclusion: There is little existing evidence in relation to CCDS use in the emergency care setting, and the prehospital emergency care setting in particular. Studies of CCDS undertaken in emergency departments have shown benefit, particularly in relation to process of care. The C-RCT found that CCDS use by paramedics was low, particularly at site one, but use was associated with higher rates of patient referral and non-conveyance, and shorter episodes of care. There were encouraging signs that CCDS can support a new decision making role for paramedics. The study provides useful lessons for policy makers, practitioners and researchers about the potential benefits of CCDS and the challenges to adoption of new technology in emergency prehospital care.
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Alfredsson, Ola, and Jennie Andersson. "Prehospital Psykiatrisk Resurs - Bedömning och behandling av patienter med psykiatriska symtom prehospitalt : En kvantitativ studie." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-10089.
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Psykisk ohälsa är ett stort folkhälsoproblem i Sverige. Ångestsyndrom drabbar cirka 25% av befolkningen och årligen begår cirka 1100 personer suicid. Ambulanssjuksköterska har en bred kompetens gällande somatiska åkommor men i grund- och specialistutbildningen läggs liten vikt på psykisk ohälsa. Detta kan medföra att patienter med psykisk ohälsa ej bedöms och vårdas optimalt. Sahlgrenska Universitetssjukhus genomförde 1 oktober – 31 december 2015 ett projekt, Prehospital Psykiatrisk Resurs (PPR). Projektet innebar att en bedömningsbil, normalt enkelbemannad av en ambulanssjuksköterska, bemannades med en psykiatrisjuksköterska och en ambulanssjuksköterska. Psykiatrisjuksköterskan har triagerat patienterna med hjälp av psykRETTS och alla patienter inom projektet har sorterats utifrån symtom enigt Emergency Symtoms and Signs (ESS) och vitalparametrar. Denna enhet tilldelades ärenden där larmcentralen misstänkte att det förekom psykisk ohälsa. Syftet var att beskriva de psykiatriuppdrag enheten larmades ut på utifrån patientkarakteristiska, symtom och diagnos samt beskriva omhändertagandet som gavs av PPRsjuksköterskan. Under studiens period bedömdes 91 patienter, 46% lämnades hemma, med eller utan hänvisning till annan vårdinstans, och 54% transporterades till slutenvården. Det är en relativ ung population i denna patientgrupp och majoriteten av patienterna var kvinnor. Flertalet har haft kontakt med psykiatrin tidigare och hälften har en psykiatrisk diagnos. Ångest, suicidbedömning och missbruk var de vanligaste ESSkoderna. En minoritet av patienterna fick en fullständig bedömning av sitt somatiska tillstånd. Resultatet tyder på att ångest är en vanlig anledning till att söka akut hjälp. Förslag på utbildningsinsatser inom prehospital akutsjukvård gällande psykisk ohälsa kan bestå av utökade behandlingsriktlinjer (läkemedel), introduktion av bedömningsinstrument, t.ex. suicidstegen, samt införande av vårdkedjor för att slussa patienterna till rätt hjälp.Mental illness is a major public health problem in Sweden. Anxiety disorder affects approximately 25% of the population and every year about 1100 people commit suicide. An Ambulance nurse has a broad expertise concerning somatic complaints, but the basic and specialized training dedicats just a small part on mental health. This can lead to that patients with mental disorders are stigmatized. Sahlgrenska Universitetssjukhus preformed during October 1th until December 31th 2015 a project call Prehospital Psykiatrisk Resurs (PPR). The project meant that a assessmentcar which normally is manned with a single ambulance nurse, now were manned by a specialist trained psychiatric nurse and an ambulance nurse. The psychiatric nurse has triacted the patients using psykRETTS and all the patients have been sorted out by their symptoms , acccording to the Emergency Symtoms and Signs (ESS) and vital parameters. This unit was assigned with cases where the emergency call centre suspected existence of mental illness. The purpose was to describe which missions that the unit was sent on where patient had characteristic symptoms of mental dissorder, describe the diagnosis and the disposal which the PPR-nurse used. During the project were 91 patient assessed, 46% of these were left at home with or without no further information, 54% were transported to closed care. The population of the project were relatively young and the majority was women. Most of the patients had had former contact with the psychiatry care before and half had a psychiatric diagnosis. Anxiety, suicide assessment and alcohol and drug abuse were the most common ESScodes. The result indicates that anxiety is a common reason to seak emergency care. Training programs regarding mental illness can be done thorough expanded treatment guidelines, the introduction of assessment instruments and increase delegation of drugs.
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Shaban, Ramon Zenel. "Paramedic Clinical Judgement and Decision-Making of Mental Illness in the Pre-Hospital Emergency Care Setting: A Case Study of Accounts of Practice." Thesis, Griffith University, 2011. http://hdl.handle.net/10072/365994.
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The introduction of legislation governing the management of mental illness in Queensland led to complaints from paramedics and their industrial association to the Commissioner of the Queensland Ambulance Service regarding the inadequacy of education and training to fulfil their new practice obligations. The industrial association asserted that their members were ill-prepared, insufficiently skilled, and unsupported professionally to make clinical judgements and decisions about mental illness in the pre-hospital emergency care setting. Furthermore, they raised concerns that their members were at significant risk of harm from patients with mental illness, and that they were vulnerable to litigation for actions of negligence and breaches of duty of care that were a direct result of the inadequacy of their education and training. These concerns, coupled with a lack of published literature that might address them, highlighted the need for a deeper understanding of how paramedics accomplish clinical judgement and decision-making of mental illness in the field, and the factors that influence this aspect of their work. Integral to the concerns were questions about the relationship between the formal expectations of paramedic practice—in the form of legislation and clinical policy—and their actual judgement practice in the field. At issue in this study was the preparedness of paramedics to recognise, assess, and manage mental illness in everyday practice and the sufficiency of education and training programs, clinical standards, policy, and legislation for ensuring quality practice and accountability in the field.
To understand how paramedics accomplish clinical judgement and decision-making of mental illness in the Queensland pre-hospital emergency care setting and the factors that influence this aspect of their work, this thesis adopted a descriptive theoretical framework of judgement and decision-making (Bell, Raiffa, & Tversky, 1988a) and undertook an interpretive, naturalistic case study according to Stake (1995). In this study, the cases were paramedics, the context was the Queensland pre-hospital emergency care setting, and the issue was how they accomplished clinical judgement and decision-making of mental illness. The study of paramedic clinical judgement and decision-making of mental illness was conducted in two iterative and recursive phases.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Education and Professional Studies
Arts, Education and Law
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Olsson, Jimmy, and Tony Ek. "Sjuksköterskor inom ambulanssjukvårdens erfarenheter och upplevelser av hot och våld i arbetslivet." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-231149.
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Syfte: Undersöka sjuksköterskor inom ambulanssjukvårdens erfarenheter och upplevelser av hot och våld i arbetslivet. Metod: Empirisk studie med kvalitativ ansats. Sex semi-strukturerade intervjuer genomfördes. Materialet analyserades med en innehållsanalys. Resultat: Hot om våld och patienter med ett hotfullt beteende är en del av arbetet i ambulansen enligt informanterna. Med stöd av direktiv och riktlinjer från arbetsgivfaren prioriteras personalens säkerhet alltid först och vid varje patientkontakt görs en samlad analys av hotbilden. Ambulanssjuksköterskans bemötande är viktigt vid mötet av en hotfull patient. Studien ger en bild av att flera av informanterna beskriver att arbetet inom ambulanssjukvården kan upplevas otryggt eftersom man många gånger befinner sig i okända miljöer med begränsade resurser och vårdutrymmet i ambulansen upplevs som problematiskt då utrymmet är begränsat. På grund av en rädsla för att provocera patienten till ett våldsamt beteende görs endast de undersökningar som är mest nödvändiga. Undersökningar som gör ont eller som kan uppfattas provocerande av patienten eller andra närvarande utförs med försiktighet för att minska risken för att väcka agitation gentemot personalen. Kompletterande utbildning i hantering och bedömning av psykotiska och drogpåverkade ansågs relevant och efterfrågades. Några informanter påpekar även att larmcentralen bör bli bättre på att skicka med polis till misstänk hotfulla arbetsmiljöer. Slutsats: Prehospitalt arbete medför en stor risk att exponeras för hot och våld. Studien ger en bild av att ambulanssjuksköterskorna efterfrågar mer utbildning inom hantering och bemötande av hot och våld.Objective: To study paramedics’ experiences and views of threats and violence in their daily work. Method: Empirical study with a qualitative approach. Six semi-structured interviews were performed. Results: Threats, violence and people with threatning behavior are a part of paramedics' daily work according to the participants in the study. With the support of directives and guidelines from the employer the safety of the staff is always to be prioritized first. At each patient contact, an overall threat assessment is performed. Ambulance staff attitude is important in the meeting of a threatening patient. The study provides a picture where several of the participants describe that working within the ambulance service may feel unsafe. This is due to the fact that they often find themselves in unfamiliar environments with limited resources. Fear of causing violent behaviour in the patient limits the staff to only adressing the most important vital parameters. Examinations that cause pain or might be percieved as provocative by the patient or others present on the scene are performed with caution to minimize the risk for aggression towards the staff. Also, the workspace in the ambulance is perceived as problematic as space is limited. Additional training in handling and assessment of psychotic and intoxicated patients is considered relevant and requested. Some patricipants also point out that the monitoring center should be better at sending the police to work environments that can be potentially threatening. Conclusion: Prehospital work involves a large risk of exposure to threats and violence. The study provides a picture of the ambulance personnel asking for more training in handling and addressing threats and violence.
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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.
Full textAbstract:
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.