Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls

2018 ◽  
Vol 33 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Mark Levitan ◽  
Madelyn P. Law ◽  
Richard Ferron ◽  
Karen Lutz-Graul
Keyword(s):  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Emergency Services ◽  
Life Support ◽  
Systems Approach ◽  
Prehospital Care ◽  
Trauma Patients ◽  
Publication Type ◽  
Complex Adaptive ◽  
Facilitators And Barriers

AbstractIntroductionAccording to Ontario, Canada’s Basic Life Support Patient Care Standards, Emergency Medical Services (EMS) on-scene time (OST) for trauma calls should not exceed 10 minutes, unless there are extenuating circumstances. The time to definitive care can have a significant impact on the morbidity and mortality of trauma patients. This is the first Canadian study to investigate why this is the case by giving a voice to those most involved in prehospital care: the paramedics themselves. It is also the first study to explore this issue from a complex, adaptive systems approach which recognizes that OSTs may be impacted by local, contextual features.ProblemResearch addressed the following problem: what are the facilitators and barriers to achieving 10-minute OSTs?MethodsThis project used a descriptive, qualitative design to examine facilitators and barriers to achieving 10-minute OSTs on trauma calls, from the perspective of paramedics. Paramedics from a regional Emergency Services organization were interviewed extensively over the course of one year, using qualitative interviewing techniques developed by experts in that field. All interviews were recorded, transcribed, and entered into NVivo for Mac (QSR International; Victoria, Australia) software that supports qualitative research, for ease of data analysis. Researcher triangulation was used to ensure credibility of the data.ResultsThirteen percent of the calls had OSTs that were less than 10 minutes. The following six categories were outlined by the paramedics as impacting the duration of OSTs: (1) scene characteristics; (2) the presence and effectiveness of allied services; (3) communication with dispatch; (4) the paramedics’ ability to effectively manage the scene; (5) current policies; and (6) the quantity and design of equipment.ConclusionThese findings demonstrate the complexity of the prehospital environment and bring into question the feasibility of the 10-minute OST standard.LevitanM,LawMP,FerronR,Lutz-GraulK.Paramedics’ perspectives on factors impacting on-scene times for trauma calls.Prehosp Disaster Med.2018;33(3):250–255.

scholarly journals A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement: the School Health Research Network (SHRN) in Wales

2018 ◽  
Vol 22 (1) ◽  
pp. 50-61 ◽  
Author(s):  
Simon Murphy ◽  
Hannah Littlecott ◽  
Gillian Hewitt ◽  
Sarah MacDonald ◽  
Joan Roberts ◽  
...  
Keyword(s):  
Complex Adaptive Systems ◽  
Health Research ◽  
Adaptive Systems ◽  
School Health ◽  
Systems Approach ◽  
Research Network ◽  
Health Improvement ◽  
Policy And Practice ◽  
Complex Adaptive ◽  
Culture Of Prevention

AbstractThe paper reflects on a transdisciplinary complex adaptive systems (T-CAS) approach to the development of a school health research network (SHRN) in Wales for a national culture of prevention for health improvement in schools. A T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The theory highlights the importance of establishing transdisciplinary strategic partnerships to identify and develop opportunities for system reorientation. Investment in and the linking of resources develops the capacity for key social agents to take advantage of disruption points in the re-orientated system, and engagement activities develop the network to facilitate new social interactions and opportunities for transdisciplinary activities. A focus on transdisciplinary action research to co-produce interventions, generate research evidence and inform policy and practice is shown to play an important part in developing new normative processes that act to self-regulate the emerging system. Finally, the provision of reciprocal network benefits provides critical feedback loops that stabilise the emerging adaptive system and promote the network cycle. SHRN is shown to have embedded itself in the system by securing sustainability funding from health and education, a key role in national and regional planning and recruiting every eligible school to the network. It has begun to reorient the system to one of evidence generation (56 research studies co-produced) and opportunities for data-led practice at multiple levels. Further capacity development will be required to capitalise on these. The advantages of a complex systems approach to address barriers to change and the transferability of a T-CAS network approach across settings and cultures are highlighted.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

2014 ◽  
Vol 29 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Mohammad Paravar ◽  
Mehrdad Hosseinpour ◽  
Mahdi Mohammadzadeh ◽  
Azade Sadat Mirzadeh
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Publication Type ◽  
Transport Time ◽  
Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

scholarly journals Close-to-nature silviculture in eastern Quebec: Advances over the last decade

2021 ◽  
pp. 1-13
Author(s):  
Robert Schneider ◽  
Laurie Dupont-Leduc ◽  
Vincent Gauthray-Guyénet ◽  
Nicolas Cattaneo ◽  
LaraMelo ◽  
...  
Keyword(s):  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Stand Structure ◽  
Systems Approach ◽  
Natural Disturbances ◽  
Management Scenarios ◽  
Forest Management Planning ◽  
Forest Resilience ◽  
Complex Adaptive ◽  
Harvesting Systems

The increase in intensity of the harvesting of eastern Quebec’s forests has resulted in profound compositional changes at the stand level. The composition and structure of presettlement stands provide key benchmarks when implementing ecosystem-based management (EBM). A core principle of EBM is the emulation of natural disturbances, and it is hypothesized that forest resilience will be maintained. Managers have thus adapted some of their silvicultural activities to better mimic the main natural disturbances in eastern Quebec. These adaptations include using variable retention harvesting systems instead of clear-cuts and converting even-aged stands. Nevertheless, other close-to-nature silvicultural practices must be developed, as gaps between managed and unmanaged stands persist. Most importantly, there is a need to consider global change within EBM, which could be accomplished by prioritizing forest functions rather than composition or structure when establishing silvicultural objectives. Elements of the complex adaptive systems approach to increasing forest resilience can be incorporated into the larger-scale EBM approach. This could be done by considering the functional complementarity of species, forest function, and stand structure in forest management planning. These efforts must not be constrained, however, to allowable annual cut calculations, as these are not sufficiently sensitive to compare different management scenarios.

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