Experiences of threats and violence in the Swedish ambulance service.

Ambulance personnel often meet people in a crisis situation that requires a readiness to act, and which takes for granted a broad knowledge in caring, together with an ability to size up the circumstances in each separate incident. The afflicted individual's first contact with a medic in an emergency situation is very often ambulance personnel and this first meeting can involve incidents that may radically change the existing state of things for the ill or injured and, maybe, even for near relatives. Sometimes these situations can lead to threats and acts of violence aimed at the ambulance staff. The aim of the study was to describe how ambulance personnel perceive, how they are subjected to, and are influenced by, threats and violence in their day-to-day work. The empirical study was descriptive and consisted of a questionnaire comprising a total of 13 questions. Answers from the 66 respondents revealed that 53 persons (80.3%) were subjected to threats and/or violence. The majority were of the opinion that the relationship between the paramedic and the patient was most certainly affected when threat or violence is a part of the situation. The study shows that many ambulance personnel have, on occasion, been subjected to one or several threats and/or situations involving the use of violence. The majority regarded this as an unpleasant experience.

Sharing international experiences in disasters: summary and action plan.

INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.

How do ambulance personnel experience work at a disaster site?

Working at a major accident site is a complex matter where knowledge from various fields must be put into practice. In addition, the different situations at emergency and disaster sites place a variety of demands on personnel, equipment and organization. The aim of the present study is to investigate how the ambulance personnel perceived their own action and the functioning of the whole emergency organization at a major accident site (large discotheque fire) in 1998. Working from a list obtained from the fire department, a questionnaire with 57 questions was sent to the personnel (n = 36) who had participated at the accident site either as ambulance crew members or as members of a medical team sent out from the hospital. The response rate was 80 per cent. Despite the extreme situation, most of the ambulance personnel involved were satisfied with their own preparedness as well as the medical and nursing care performed at the site. Those who where not satisfied reported that the main reason for dissatisfaction was lack of time to calm and comfort people who were not injured or had only minor injuries. The need of more medical support for the medical team members at the site was also emphasized with regard to the care of the severely injured. The ambulance service crews from the suburbs, in comparison with the local city rescue service, were, in general, less satisfied with the co-operation from other rescue units.

Nurse competence: advantageous in pre-hospital emergency care?

Aspects of the organization and function of pre-hospital emergency care services in western Sweden were assessed by interviewing physicians (n = 20) with administrative (n = 10) or/and active (n = 10) roles in the pre-hospital emergency care field. The data obtained indicate that although the present standard of care is acceptable, there is an obvious need for a more effective organization and the personnel involved should have a higher competence level. Ambulance personnel were not considered to have a high enough competence level. Therefore, a need for more nurses, preferably anaesthesia or intensive care nurses, was expressed. An awareness of the importance of research was noted among the physicians responsible for the services, and the research capability of nurses, along with their general competence in emergency medical service related problems, was considered an important argument for involving more nurses in pre-hospital emergency care. It was thought that by such an approach, a more scientific basis for assessing the efficacy of pre-hospital emergency care could be achieved.

Assessment of the quality improvement of prehospital emergency care in Sweden.

The optimal competence level of personnel involved in prehospital emergency care is a matter for discussion. In Sweden a national quality improvement process has been initiated including strict regulation of the authorization of ambulance personnel to administer drugs and increased involvement of registered nurses. The aim of the present study was to assess from a national survey the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. A questionnaire, detailing organizational, staffing, competence and functional aspects, was sent to all medical directors of prehospital EMS. The response frequency was 87.5%. Variations in the local organization of the prehospital care were observed. Only a limited number (20%) of the districts organized the ambulance services according to the competence level of the personnel. It was found that the competence level of the personnel involved in prehospital emergency care had improved considerably compared with the situation 5 years ago. A majority of the ambulancemen had increased their competence level by completing nurse assistant training and more registered nurses had been employed. The changes in the competence level and organization of the ambulance services and prehospital emergency care were considered to have had moderate (38.5%) or great (51.9%) impact on the quality of the services during the past 5 years. The effect was reported by 53.2% of the directors to be objectively verified from review of ambulance records, regular proficiency tests, patient survival data (cardiopulmonary resuscitation), and analyses of computer-based records. It is concluded that the present study clearly shows that quality improvement process initiated by the Swedish authorities has resulted in a considerable improvement of prehospital emergency care in Sweden during the past few years.

Acting at a disaster site: experiences expressed by Swedish nurses.

In a previous study the knowledge and views of nursing students on how they thought nurses, both in their professional role and as private persons, should act at a disaster site were evaluated. In the present study the practical functional role and experiences of nurses (n = 16) in two major disaster situations (one 'load and go' and one 'stay and play' type of emergency situation) were assessed from personal interviews along a standardized questionnaire. Nurses more routinely involved in emergency care and nurses with no or limited previous practical experience of disaster nursing were included in the study. Leadership-type actions, i.e. a systematic way of attempting to survey and to comprehend the situation, what has happened, and how many injured there may be at the site of the accident, were reported by most of the experienced nurses, while inexperienced nurses were involved mainly in the immediate care of injured according to directions given by more experienced members of the emergency team. Readiness for action, reflected by having a feeling of being prepared for work at the disaster site, was experienced more often by nurses with considerable previous experience of disaster nursing than by nurses with limited experience. Negative experiences, such as feelings of being insufficient, of unreality, mental strain, and problems in understanding the organization, were commonly mentioned by the inexperienced nurses. The present study stresses the importance, for all types of nurses, of more systematic training in disaster nursing.

Acting at a disaster site: views expressed by Swedish nursing students.

There is a common interest in Swedish society in preparing nurses well for disasters. A special course in the basic nurse education programme is devoted to disaster nursing. The aim of this study is to investigate nursing students' knowledge and views of their own action at the disaster site, both in their professional role and as private persons. The present study is a descriptive one based on the students' written answers. The result shows that the students emphasize contacting the overall disaster officer, surveying the situation and carrying out basic life-saving measures in Sweden known as the ABCs. They also stress the importance of staying calm and, to a lesser extent, seeing to the needs of the mentally shocked. Thus the nursing students seem to regard treatment of physical injuries as most important in the disaster situation.