Ambulance Nurses Research Articles

Patient satisfaction with prehospital emergency care following a hip fracture: a prospective questionnaire-based study

BackgroundOlder patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met.The aim of this study was to investigate patient satisfaction with prehospital emergency care following a hip fracture by comparing two similar emergency care contexts.MethodsThe study was conducted using the Consumer Emergency Care Satisfaction Scale (CECSS) on patients treated for hip fracture in prehospital emergency care. The data were collected within a randomized controlled study for the purpose of comparing prehospital fast track care (PFTC) and the traditional type of transport to an accident and emergency department (A&E).ResultsQuestionnaire data from 287 patients, 188 women (66%) and 99 men (34%) with a mean age of 80.9 years, were analysed. More than 80% of the patients selected the most positive response alternatives, but 16% were dissatisfied with the nursing information provided. Patients in PFTC responded more positively on specific caring behaviour than those transported to the A&E department in the traditional way.ConclusionPatient satisfaction with prehospital emergency care following a hip fracture is an important outcome and this study highlights the fact that patients expressed a high level of satisfaction with the prehospital emergency care provided by ambulance nurses in both care contexts under study. However, some areas need to be improved in terms of nursing information.

The ambulance nurse experiences of non-conveying patients.

Aims and objectivesTo explore ambulance nurses' (ANs) experiences of non‐conveying patients to alternate levels of care.BackgroundIncreases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.DesignA qualitative interview study was conducted using an inductive research approach.MethodsThe study was conducted in a region in the middle of Sweden during 2016–2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.ResultsThe ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.ConclusionIf ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.Relevance to clinical practiceThis study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

Knowledge, attitude, and practice of ambulance nurses in prehospital care in Malang, Indonesia

BackgroundNurses are responsible for staffing ambulances in Indonesia. However, those nurses may have limited knowledge and skills in prehospital care because the Indonesian nursing curriculum focuses mostly on in-hospital care. This study investigated the perceived knowledge, attitude, and practice of ambulance nurses in prehospital care in Malang, Indonesia. MethodThis was a cross-sectional study consisting of a paper-based survey involving 465 participants from 45 health care services in Malang, Indonesia. ResultsParticipants’ attitude score for prehospital care was the highest and knowledge of prehospital care was the lowest score. This study revealed that knowledge (p=0.022), attitude (p=0.012), and practice scores (p=0.026) were significantly different based on the training experience. The education level of participants contributed significantly to the difference in attitude (p=0.001) and practice scores (p=0.034). Participants’ experience had a significant contribution to the difference in attitude score (p=0.002). The knowledge (p=0.001) and practice (p=0.002) for prehospital care of hospital-based ambulance nurses were significantly higher than puskesmas-based ambulance nurses. ConclusionsThis study revealed that Indonesian ambulance nurses lacked prehospital care knowledge and skills. The findings from this study provide information to establish a national regulation covering human resources for prehospital care in Indonesia both for educational and clinical levels.

Ambulance Nurses' Competence and Perception of Competence in Prehospital Trauma Care.

Introduction We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. Results Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. Discussion This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Relationship between occupational stress, uncertain endurance and job burnout of pre-hospital emergency nurses

Objective To investigate the correlation between occupational stress, uncertain endurance and job burnout of pre-hospital emergency nurses. Methods A total of 380 pre-hospital emergency nurses were recruited by stratified cluster sampling method.The occupational burnout scale (MBI) including emotional exhaustion (EE), depersonalization (D) and diminished personal accomplishment (PA), the Intolerance of Uncertainty Scale (IUS), the Nursing Stressor Scale (NSS) including stresses associated with nurse expectations (NSS1), with family (NSS2), with interpersonal relationship (NSS3), with nature of work (NSS4), with patient (NSS5) and with work load (NSS6) were applied for all subjects. Results The pre-hospital emergency nurses who had worked less than 3 years got the higher EE score (33.58±4.34) and higher PA score (26.98±4.31) than those who had worked 3 to 10 year(22.33±4.05, 16.14±4.28, P<0.05) or longer than 10 years(21.50±4.36, 16.81±4.36, P<0.05). Nurses got higher EE score (33.82±4.28, 22.96±4.39, 21.04±4.62, P<0.05), and higher PA scores(27.02±4.21, 16.04±4.31, 16.01±4.30, P<0.05) than the nurse practitioner or above levels.People whose monthly income were below 0.3 million got higher PA scores than those whose monthly income were 0.3 million or more (26.75±4.24, 16.47±4.27, 17.11±4.34, P<0.05). People who got degrees of bachelor or above had PA scores which was more than people who got degrees under bachelor(26.33±4.36, 17.24±4.28, P<0.05). Regression analysis showed that the multiplication score between IUS and NSS1 had the interaction effect with EE and D scores(β=0.33, 0.33, P<0.05); the multiplication score between IUS and NSS5 had the interaction effect with EE and D scores (β=0.31, 0.30, P<0.05) and the multiplication score between IUS and NSS3 had the interaction effect with D scores(β=0.34, P<0.05). Conclusion The pre-hospital emergency nurses' job burnout varies according to their length of service, job title, educational level and salary, and is also influenced by the combination of occupational stress and uncertain endurance. Key words: Burnout; Occupational stress; Intolerance of uncertainty; Factor analysis; Ambulance nurses

Work-related ill health in doctors working in Great Britain: incidence rates and trends.

BackgroundDoctors have a higher prevalence of mental ill health compared with other professional occupations but incidence rates are poorly studied.AimsTo determine incidence rates and trends of work-related ill health (WRIH) and work-related mental ill health (WRMIH) in doctors compared with other professions in Great Britain.MethodIncidence rates were calculated using an occupational physician reporting scheme from 2005-2010. Multilevel regression was use to study incidence rates from 2001 to 2014.ResultsAnnual incidence rates for WRIH and WRIMH in doctors were 515 and 431 per 100 000 people employed, respectively. Higher incidence rates for WRIH and WRMIH were observed for ambulance staff and nurses, respectively. Doctors demonstrated an annual average incidence rates increase for WRIH and WRMIH, especially in women, whereas the other occupations demonstrated a decreasing or static trend. The difference in trends between the occupations was statistically significant.ConclusionsWRIH and WRMIH incidence rate are increasing in doctors, especially in women, warranting further research.

The Second Opinion Dispatch- Evaluating Decisions Made by an Ambulance Dispatch Center

BACKGROUND: The efficacy and precision of dispatching right ambulance to right patient demands a proper decision-making. Wrong decisions may lead to overloading of emergency departments and shortage of ambulances. The aim of this study was to evaluate and improve the process of prehospital resource allocation conducted by a Swedish ambulance dispatch center.METHODS: A team of three experienced ambulance and dispatch nurses evaluated the decisions made by the dispatch center. The method chosen was “Action Research” divided into five actions during 76 days. In the first action, the team listened passively to the calls. The team gradually increased its involvement in the process of decision-making during the actions.RESULTS: During the actions, specific keywords indicating a need for evaluation were identified. The results showed a need to change the primary decisions in 486 cases out of 24,800 calls (2%). The most common measure after an evaluation was to change an ordinary ambulance transportation to an assessment vehicle staffed by a nurse or a physician who would select an appropriate care level (hospital vs. primary healthcare).CONCLUSION: This model not only optimized the prehospital resources but also changed the process of decision-making at the dispatch center and improved their staffs’ ability to optimize the allocation of emergency resources.

Ethical dilemmas during cardiac arrest incidents in the patient's home.

The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care

IntroductionAcute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients’ outcome. MethodsThis study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008–2010. ResultsIn all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI). ConclusionThis study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs’ assessment and that special education in cardiovascular nursing is required.

PreHospital Ambulance Stroke Test - pilot study of a novel stroke test

BackgroundThere is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS).MethodsThe PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0–19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting. Regardless of the results after PreHAST testing the patients were triaged with a provisional stroke diagnosis. The PreHAST scores were compared with the final diagnosis and the ability to differentiate stroke and transient ischemic attacks (TIA) with ongoing symptoms at evaluation from non-stroke patients was analysed.Results69 patients were included in the study, 26 had stroke/TIA and 43 other diagnoses. All stroke/TIA patients were identified by PreHAST (sensitivity 100% (95% CI; 87-100%)). The specificity increased with higher PreHAST scores and the discriminative capacity for PreHAST for different cut off values showed an area under the curve of 0.77 (95%CI; 0.66-0.88) in the receiver operating characteristic (ROC) analysis.DiscussionPreHAST is designed for high sensitivity, screening for a broad range of stroke symptoms including most key components of NIHSS. The promising sensitivity between 87 and 100% in our study has to be confirmed in a larger study also including multiple centres. Higher PreHAST scores implied more typical patterns of stroke and accordingly the proportion of stroke mimics decrease with higher scores. However, also stroke mimics with epilepsy/seizure and patients with deficit after prior stroke could show higher PreHAST scores. Other prehospital stroke tests that evaluate stroke severity have been designed with the main purpose to screen for large vessel occlusion. The advantage of PreHAST is the dual purpose not only to evaluate stroke severity but also to screen for stroke in general.ConclusionsPreHAST is a new screening test of stroke adapted for ambulance services that in addition to high sensitivity for stroke, provides a grading system with increasing specificity with higher scores.

Early prehospital assessment of non-urgent patients and outcomes at the appropriate level of care: A prospective exploratory study

IntroductionThe Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. MethodsThe study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. Results394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. ConclusionThis prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.

Professional confidence in the roles as ambulance and medical incident commander

The aim was to investigate professional confidence in the roles of ambulance and medical incident commander (AIC and MIC), and how it influences achievement of performance indicators at an incident site. A web survey based on theoretical constructs (e.g., social identity, efficacy, accountability) and questions about prehospital emergency care connected to the roles were used (n = 426 Swedish ambulance nurses and emergency medical technicians). The results showed that social identity, independence and occupation were moderators for professional confidence. Organizational support, relational trust and independence were moderators for achieving performance indicators. Strengthening group identification and independence as MIC and independence and support for women as AIC together with a stronger organizational support can increase professional confidence and improve performance.

Utah and the Great War: The Beehive State and the World War I Experience. Edited by Allan Kent Powell

Allan Kent Powell’s edited anthology, Utah and the Great War, introduces and reprints seventeen articles about Utahns’ involvement in World War I. Most of the pieces were originally published in the Utah Historical Quarterly between 1978 and 2016. This volume increases their accessibility and provides a strong overview of Utah’s connections to World War I. Thirty-three clearly reproduced photographs enrich the volume. Inevitably, a collection of this nature contains some repetition and lacks a unifying voice or interpretive thesis. Despite gaps in coverage, reflecting lacunae in research to this point, the collection demonstrates that we understand Utah’s relationship to World War I much better today than we did in the 1970s. Four chapters explore the experiences of Utahns in the military and on the frontlines. Nearly twenty-one thousand served, and little is known about them, with the exception of nearly fifteen hundred who joined federalized units of the National Guard. Richard Roberts furnishes an excellent overview of the experiences of the Guardsmen, most of whom had just been ordered to the front when Germany surrendered. Miriam Murphy illuminates the roles and experiences of close to one hundred women who served at or near the frontlines in France as ambulance drivers and nurses. Brandon Johnson employs writings from a handful of soldiers to construct engaging “narrative snapshots” of the Meuse-Argonne killing fields (p. 53).

Factors Associated with Job Stress among Ambulance Nurses in Bangkok, Thailand.

OBJECTIVE: to explore the factors associated with job stress among the ambulancenurses in nine zones of Bangkok Emergency Medical Service (EMS).MATERIALS AND METHODS: Multistage random sampling was conductedbetween December 2015 and February 2016. Two hundred and forty-five ambulancenurses of network hospitals in nine zones of Bangkok EMS who had at least 40hours EMS training and at least six months work experiences on ambulance wereselected as study samples. A self-administered questionnaire with specific questionsto explore variables such as socio-demographics, work characteristics, generalwell-being, employee engagement, role and social support was used. Job stress wasevaluated using the Karasek’s Job Demand-Control model (JCQ). The predictivefactors influencing job stress were analyzed by using Chi-square and multiplelogistic regressions.RESULTS: A total of 245 ambulance nurses were enrolled in the study. One third(33.5%) of ambulance nurses developed high work stress. A statistically significantassociation was observed between job stress and older age (OR = 0.94, 95% CI:0.89 - 0.99), higher incomes (OR = 0.26, 95% CI: 0.09 - 0.69), higher educationlevel (OR = 4.17, 95% CI: 1.13 - 15.47), more work experience (OR = 0.32, 95%CI: 0.12 - 0.88), perception of urgent task (OR = 8.00, 95% CI: 1.44 - 44.73), poorgeneral well-being (OR = 2.36, 95% CI : 1.00 - 5.55), low superior support (OR =12.50, 95% CI: 4.62 - 33.78), low peer support (OR = 3.27, 95% CI: 1.30 - 8.21),role ambiguity (OR = 12.45, 95% CI: 4.77 - 32.51), and role conflict (OR = 14.48,95% CI: 5.14 - 40.82).CONCLUSION: The executive and nursing administrators should be aware of jobstrain among ambulance nurses particularly in the younger age group with less than5 years of working experience. Specific training programs with supervision and peersupport should be provided. Stress management should be commenced in nursingeducation. The clarity of role and duty together with appropriate work schedule shouldbe considered to avoid the stressful situation which in turn will reduce job stress. Thisstudy is the first investigation that quantifies the strength of association between jobstress and the various factors among ambulance nurses, thereby enabling themanagement to implement logical and preventive strategies regarding work-relatedstress and improve the quality of care in the future.

Prevalence of Noise-Induced Hearing Loss in Ambulance Nurses.

OBJECTIVE: This study was conducted to investigate the prevalence of noiseinducedhearing loss of ambulance nurses and to assess working conditions related toloud noise levels in ambulances.MATERIALS AND METHODS: This study was a cross sectional study studying50 nurses, aged between 20-60 years working in the emergency department atBangkok Hospital headquarters during October to November 2015 with the inclusionquestionnaire, an otoscopic study was done and then audiometric examination toassess to the level of hearing. A sound level meter was used to measure the noise levelin the cabin of the ambulance and to measure the noise exposure of the nurse a noisedosimeter was attached to the nurse in the ambulance. The survey was conductedduring 20 roundtrips in Bangkok and 20 roundtrips in other provinces.RESULTS: The prevalence of noise induced hearing loss among 50 nurses was 6 %.CONCLUSION: The results showed that the samples did experience noise-inducedhearing loss and are exposed to loud noise.

Managing stress in prehospital care: Strategies used by ambulance nurses

BackgroundAmbulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. MethodsA qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories). Results and conclusionThe study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions.

Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial.

BackgroundCurrent research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses’ (ANs’) prehospital care of patients experiencing suspected ACS, related to pain intensity.MethodsThis is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria.ResultsThe pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine.ConclusionsAn educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials.Trial registrationThe ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).

Reflective and collaborative skills enhances Ambulance nurses’ competence – A study based on qualitative analysis of professional experiences

BackgroundThe Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses’ competence, including the perspective of professional experiences, seems to be essential. AimThe aim of this study was to elucidate ambulance nurses’ professional experiences and to describe aspects affecting their competence. MethodsFor data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. Results and conclusionThis study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development.

Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.

In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. A prospective observational study was carried out over a 2-month period, with one HEMS station covering six ambulance regions. Provider registration was recorded, supplemented by interviews of ambulance nurses and HEMS physicians. Competencies were categorized depending on whether the competency was specific for the nurse or physician, mutual or mutual with a qualitative difference. A total of 225 HEMS dispatches resulted in 117 cases with HEMS on-scene in the study region and 78 patients were included. In 35 (45%) patients, the HEMS physician provided additional treatment: in 19 (24%) patients, a physician-specific therapeutic competency, in nine (12%) patients, a mutual competency with a qualitative difference and in seven (9%) patients, both categories. The presence of the HEMS physician was considered more useful by both ambulance nurses (89 vs. 60%) and HEMS physicians (97 vs. 81%) when additional treatment was provided by the HEMS physician. HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.

The meaning of being triaged to non-emergency ambulance care as experienced by patients

BackgroundThe levels of care in the Swedish healthcare system comprise self-care, primary care as well as accident and emergency care. The Swedish system of specialist ambulance nurses enables referral by prehospital triage. However, little is known about patients' experiences of not being triaged to the emergency department. AimTo explore the subjective meaning of non-emergency ambulance care among patients who were triaged to levels of care below that of the Accident and Emergency Department. Approach/MethodsAn inductive design inspired by phenomenological hermeneutics. Twelve patients were interviewed using an open-ended method. FindingsTwo structural analyses resulted in three themes covering the subjective meaning of being taken seriously or not being taken seriously. When taken seriously, the patient was empowered irrespective of the outcome of the medical assessment and triage process. When not taken seriously the patient doubted her/his own judgement and felt guilty and ashamed about bothering the ambulance service. ConclusionN-EAC involves a strong need to be taken seriously and listened to when describing one's illness experience. When taken seriously, the patient feels as a competent person. Spending time with the patient is vital as well as listening to and inviting her/him to participate in the decision-making process. However not being taken seriously constitutes an infringement of personal autonomy.