Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents

ObjectivesIncreased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a senior ambulance officer (SAO) within the emergency medical services (EMS) has been introduced to support the regular force during major incidents. The aim of this paper was to explore the perceptions and experiences of the SAO’s new management role in challenging incidents, such as those occurring in road tunnels.DesignA qualitative interview study.SettingThe study was carried out from February to June 2019 in Gothenburg, Sweden, which is a municipality with several road tunnels and a population of approximately 580 000 people. SAOs collaborate with the corresponding function within the police and fire brigade, both having senior officers at major incident sites.ParticipantsTwelve SAOs.MethodsThe study used semistructured interviews. The collected data were analysed using qualitative content analysis.ResultsAccording to SAOs’ experience, prehospital medical management included not only leadership, but also planning, training and indepth knowledge of, for example, tunnel environments. Furthermore, SAOs adopted an encouraging and teaching role for their colleagues. SAOs’ responsibilities also included proactive planning together with the fire brigade and police, which was regarded as enhancing interorganisational collaboration. An overall theme emerged which the SAOs described as ‘A new holistic approach to EMS leadership and management’.ConclusionsThe participants considered that the new SAO role not only seems to improve the prehospital medical management, but also makes the EMS command structure during challenging incidents symmetrical with the fire brigade and police command structure. The implementation of national guidelines is desirable and is requested by the SAOs.

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Patients’ perceptions of safety in emergency medical services: an interview study

BMJ Open ◽

10.1136/bmjopen-2020-037488 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037488

Author(s):

Anu Venesoja ◽

Maaret Castrén ◽

Susanna Tella ◽

Veronica Lindström

Keyword(s):

Patient Safety ◽

Emergency Medical Services ◽

Professional Competence ◽

Qualitative Content Analysis ◽

Medical Services ◽

Individual Interviews ◽

Driving Skills ◽

Emergency Medical ◽

Perceptions Of Safety

BackgroundResearch on patient safety in emergency medical services (EMS) has mainly focused on the organisation’s and/or the EMS personnel’s perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients’ experiences of their sense of safety in EMS.MethodsA qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used.ResultsPatients’ experiences of EMS personnel’s ability or inability to show or use their medical, technical and driving skills affected the patients’ sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients’ perceptions of safety in EMS were connected to their confidence in the EMS personnel.ConclusionsOverall, patients felt safe during their EMS encounter, but the EMS personnel’s professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients’ perceptions of safety can be used in improving safety in EMS.

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The impact of a mass gathering events with an on-site medical management team on municipal 911 emergency medical services

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2012.08.036 ◽

2013 ◽

Vol 31 (1) ◽

pp. 256-257 ◽

Cited By ~ 3

Author(s):

Michael J. Heiby ◽

William Barnhardt ◽

Thomas Berry ◽

Melanie Welcher ◽

William J. Brady

Keyword(s):

Emergency Medical Services ◽

Medical Management ◽

Management Team ◽

Medical Services ◽

Mass Gathering ◽

Emergency Medical ◽

The Impact

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IMPACT OF AGING POPULATIONS ON MUNICIPAL EMERGENCY MEDICAL SERVICES

Innovation in Aging ◽

10.1093/geroni/igz038.3468 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S956-S956

Author(s):

Nidya Velasco Roldan ◽

Caitlin E Coyle ◽

Michael Ward ◽

Jan Mutchler

Keyword(s):

Emergency Medical Services ◽

Assisted Living ◽

Local Governments ◽

Emergency Services ◽

Medical Services ◽

Assisted Living Facilities ◽

Older Population ◽

Emergency Medical ◽

Age Related ◽

Aging Populations

Abstract The services that residents require from their local governments vary depending on the demographics of their populations. While municipalities have long sought to consider how changes in the young population may impact their school system needs, few systematic considerations have been developed relating to how aging populations may impact municipal service provision. This study aims to address this issue by focusing on demands on emergency services at the municipal level. Using data from the Massachusetts Ambulance Trip Record Information System (MATRIS) we explore the association between emergency medical services (EMS) demand and population age-structure. The data shows an overrepresentation of older people among EMS users. People age 65 and older represent 16% of Massachusetts’ population but account for 31% of the transported emergent calls —e.g., 911 calls— and 60% of the scheduled transports. Results from the OLS regression analysis suggest that communities with larger shares of older residents have significantly higher numbers of EMS calls. The type of community and other age-related community features such as the percentage of older residents living alone and the percentage of older population dually eligible for Medicare and Medicaid are also significantly associated with the number of EMS calls. Contrary to our expectations, other resources available in the community such nursing homes or assisted living facilities were not significantly associated with number of EMS calls. Our research indicates that if growth in the older population occurs as projected, the demand placed on the EMS system by older populations will grow considerably in coming decades.

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Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey

PLoS ONE ◽

10.1371/journal.pone.0171436 ◽

2017 ◽

Vol 12 (2) ◽

pp. e0171436 ◽

Cited By ~ 9

Author(s):

Anne Siri Johnsen ◽

Stephen J. M. Sollid ◽

Trond Vigerust ◽

Morten Jystad ◽

Marius Rehn

Keyword(s):

Emergency Medical Services ◽

Medical Services ◽

Major Incident ◽

Incident Management ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Helicopter Emergency Medical Services ◽

Emergency Medical

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A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services

Central European Journal of Operations Research ◽

10.1007/s10100-021-00769-y ◽

2021 ◽

Author(s):

Niki Matinrad ◽

Melanie Reuter-Oppermann

Keyword(s):

Emergency Medical Services ◽

Emergency Services ◽

Response Times ◽

Medical Emergency ◽

Medical Services ◽

Staff Shortage ◽

Medical Response ◽

Emergency Medical ◽

Emergency Managers ◽

Medical Emergencies

AbstractEmergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage–creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic–as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.

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Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda

Global Health Innovation ◽

10.15641/ghi.v3i2.986 ◽

2020 ◽

Vol 3 (2) ◽

pp. 1-5

Author(s):

Ashley Rosenberg ◽

◽

Rob Rickard ◽

Fraterne Zephyrin Uwinshuti ◽

Gabin Mbanjumucyo ◽

...

Keyword(s):

Emergency Medical Services ◽

Emergency Services ◽

Prehospital Care ◽

Capital City ◽

Medical Services ◽

Middle Income ◽

Golden Hour ◽

Middle Income Countries ◽

Emergency Medical ◽

Prehospital Emergency

The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.

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Implementation and development of guidelines in the emergency services in Kosovo – PARIHS framework

European Journal of Public Health ◽

10.1093/eurpub/ckz186.410 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Hodza-Beganovic ◽

H Carlsson ◽

H Lidberg ◽

V Blaku ◽

P Berggren

Keyword(s):

Emergency Medical Services ◽

Emergency Services ◽

Treatment Guidelines ◽

Medical Services ◽

Local Context ◽

Implementation Outcomes ◽

Emergency Medical ◽

External Facilitator ◽

Core Components ◽

Parihs Framework

Abstract Background The aim of this project is to create understanding on the determinant factors enhancing adherence to treatment guidelines for the emergency medical services in Kosovo (EMSK). Focus is on barriers, and enablers while introducing the guidelines. It is aiming to create clearance and understanding of how and why the implementation outcomes are achieved. The factors influencing implementation will be mapped in three main domains. The domains are part of the determinant framework Promoting Action on Research Implementation in Health Services (PARIHS). Each of the domains is further divided into sub-constructs. Methods The process of implementing treatment guidelines into the emergency medical services in Kosovo was observed and documented by 4 researchers, using a participatory research design. The PARIHS framework that consists of three core components: evidence, context, and facilitation was applied to make clarity on what works better and why, in order to achieve the outcomes of the implemented guidelines. Results The preliminary results have shown that the three constructs have an important role in the process of implementation. The domain evidence determined the way the evidence based practice is conceived in this particular setting. The domain context concerns the organization and teamwork shaped challenges and possibilities for adherence to the guidelines. The role of an external facilitator was of specific importance. Conclusions The PARIHS framework serves in both practical and theoretical planning of an intervention. In the present project it provides clarity on planning of the process, while also offer understanding of the elements that contribute to the sustainability of the intervention. Finally the lessons from the approach can be replicated in similar context. Key messages Implementation projects can be more successful suing a framework to direct the effort. Such interventions should be premised with clarity on the evidence, the local context, and facilitation factors.

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Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study

BMJ Open ◽

10.1136/bmjopen-2019-030626 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030626 ◽

Cited By ~ 4

Author(s):

Helge Haugland ◽

Anna Olkinuora ◽

Leif Rognås ◽

David Ohlen ◽

Andreas Krüger

Keyword(s):

Adverse Events ◽

Emergency Medical Services ◽

Quality Indicators ◽

Emergency Services ◽

Quality Measurement ◽

Medical Services ◽

Total Quality ◽

Emergency Medical ◽

Sentinel Events ◽

Quality Measurements

ObjectivesA consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these QIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS.DesignIn this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four QI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset.SettingNordic physician-staffed helicopter emergency medical services.Participants16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway.ResultsThe dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All QIs were feasible to obtain. The variability of 14 out of 15 QIs was adequate. Rankability was adequate for all QIs. Actionability was assessed as being adequate for 10 QIs. Documentation was adequate for 14 QIs. Benchmarks for all QIs were proposed.ConclusionsAll 15 QIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI ‘Adverse Events’ with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs ‘Able to respond immediately when alarmed’, ‘Time to arrival of P-EMS’, ‘Time to preferred destination’, ‘Provision of advanced treatment’ and ‘Significant logistical contribution’ was assessed as being poor. Benchmarks for the QIs and a total quality score are proposed for future quality measurements.

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Gunshot Injuries in Children Served by Emergency Services

10.1542/9781610022750-gunshot ◽

2017 ◽

pp. 127-137

Author(s):

Craig D. Newgard ◽

Nathan Kuppermann ◽

James F. Holmes ◽

Jason S. Haukoos ◽

Brian Wetzel ◽

...

Keyword(s):

Emergency Medical Services ◽

Injury Severity ◽

Emergency Services ◽

Population Based ◽

Adverse Outcomes ◽

Medical Services ◽

Major Surgery ◽

Gunshot Injuries ◽

Emergency Medical ◽

Injury Mechanisms

OBJECTIVE To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs ($28 510 per patient, 95% CI 22 193–34 827). CONCLUSIONS Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children.

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