Volunteer Ambulance Research Articles

Abstract 109: Emergency Medical Services Strategies for Reducing First Medical Contact to Device Times in ST-Elevated Myocardial Infarction Patients in South Dakota

Background and Objectives: Mission: Lifeline STEMI is a strategic initiative to save lives and reduce disability by improving emergency personnel readiness and response to heart attack patients, specifically focusing on ST-elevation myocardial infarctions (STEMIs) - the deadliest type. South Dakota ranks among the top ten states with the highest STEMI death rates. The Emergency Medical Services (EMS) objective is to reduce the time from First Medical Contact (FMC) in the field to device placement in a Percutaneous Coronary Intervention (PCI) capable hospital. Reduction in time results in improved patient outcomes. Several factors can impede the timely delivery of optimal care to STEMI patients, particularly in rural states like South Dakota, which has 66 counties covering nearly 76,000 square miles. Unequal dispersion of PCI-capable facilities throughout the state results in transport distances that can exceed 200 miles, while response times vary greatly dependent weather. South Dakota is heavily dependent upon volunteer ambulance services, and the capabilities of non-PCI referral hospitals to receive the STEMI patient and transfer in a timely manner. Methods: In order to improve the state STEMI system, all 133 EMS agencies were offered funding for 12-Lead equipment in order to capture and transmit ECGs from the field. Education was provided that included the signs and symptoms of a STEMI and proper utilization of the 12-Lead. Stakeholder meetings were held to develop the infrastructure of the statewide system. Results: 133 EMS agencies in South Dakota are now 12-Lead capture and transmit capable and education has been offered to all agencies. Additional education is planned throughout the next year. Since 2010, ECG transmissions from the field have nearly tripled. In Q1 2012 FMC to PCI less than 90 minutes occurred with 58.3% of STEMI patients in South Dakota. In Q2 2012, this increased to 78.6% of STEMI patients. Conclusions: EMS training programs and increased 12-Lead use has yielded marked improvement in FMC to device times. In order to maintain an effective and efficient system of care for STEMI patients in South Dakota, a sustainability plan is under development.

Classical Spies: American Archaeologists with the OSS in World War II Greece (review)

Reviewed by: Classical Spies: American Archaeologists with the OSS in World War II Greece Nota Pantzou Susan Heuck Allen . Classical Spies: American Archaeologists with the OSS in World War II Greece. Ann Arbor: The University of Michigan Press, 2011. Pp. xiii + 430. 24 illustrations, 2 maps. Cloth. $40.00. Classical Spies: American Archaeologists with the OSS in World War II Greece, by Susan Heuck Allen, describes the adventures of American male and female members of the American School of Classical Studies at Athens (ASCSA) just before and during their tenure with the Office of Strategic Service (OSS), the precursor to the CIA. The book unfolds in an almost cinematic manner to tell a rather obscure and definitely heretofore relatively unknown chapter of the history of ASCSA, of American secret intelligence, and of the field of archaeology in general. Even though archaeologists and archaeological schools' involvement in espionage during World War II (and earlier) has been confirmed by several scholars' memoirs and other accounts, this is the first detailed and well-documented study of this kind. Allen, an archaeologist herself, studied under the late John L. Caskey (University of Cincinnati), director of the Lerna and Kea excavations, from whom she drew inspiration for this book. Her professor's narration of an anecdotal World War II spy story, one summer night on the island of Kea, gave Allen the impetus to initiate this research, which lasted for almost a decade. In compiling this comprehensive and thorough account of American archaeologists' secret intelligence activities in World War II-era Greece, she consulted numerous institutional archives, as well as private collections. Fortunately, Allen's research coincided with the declassification of archives and, as a result, she was able to reconstruct events and sketch out the leading figures, engaging in what she describes as an "archival excavation." This study was further enhanced by the memories of people who befriended, are related to, or had worked with the protagonists. These first person accounts attribute to Allen's book its immediacy and freshness. The book comprises an introduction, fourteen chapters, an epilogue, and four very informative appendices ("Internal Assessment," "Who's Who," "OSS Greek Desk Missions," "OSS Bases and Secret Harbors or Coded Targets"). The first five chapters follow closely the story of Rodney Young, a Princeton graduate and later Professor of Classical Archaeology at the University of Pennsylvania. By narrating his wanderings as a volunteer ambulance driver at the Greek-Albanian front in 1941, his injury and subsequent hospitalization at Evangelismos Hospital in Athens, his return to the United States, and his eventual recruitment by the [End Page 345] Foreign Nationalities Branch, the author delineates the events that led up to these scholars' involvement with American intelligence and the efforts to set up the Greek Desk of the OSS. From chapter six onwards, the biography of "the Greek Desk" unfolds. Allen discusses the missions, hardships, and successes of a community of men and women who embarked on an audacious journey from 1942 until 1945. Their stories are supported by historical information, allowing the reader to picture the Mediterranean theater of World War II operations, the alliances, and the pre-Cold War political upheavals. The clear and vivid descriptions of the bold undertakings of this group of archaeologists offer fresh insight and an alternative perspective into major World War II events such as the Battle of Crete (1941), the Greek army's and government's escape to Egypt (1941), the Dodecanese Campaign (1943), and the Dekemvriana events in Athens (1944). Most important, Allen's research reveals female archaeologists' vital part in OSS operations at a time when both archaeology and intelligence work were male-dominated. She concludes her book by briefly citing the post-war whereabouts of Caskey (University of Cincinnati) and Young (University of Pennsylvania), along with Jerome L. Sperling, Dorothy Cox, and Margaret Crosby (all three at Yale University) and Virginia Grace (Bryn Mawr College), among others. So why do archaeologists make good spies? According to Allen, the skills that archaeologists had developed through excavation and research, along with the experiences and deep understanding of the place and its people that they had acquired while in the field, made them ideal candidates to become secret...

Extending the paramedic role in rural Australia: a story of flexibility and innovation

This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model. A multiple case study methodology was employed to examine the evolution of rural paramedic practice. Paramedics, volunteer ambulance officers and other health professionals were interviewed in four rural regions of south-eastern Australia where innovative models of rural paramedic practice were claimed to exist. The research team collected and thematically analysed the data using the filter of a sociological framework throughout 2005 and 2006. The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care. Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model's key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics' scope of practice offers the potential to improve patient care and the general health of rural communities.

Factors influencing the successful integration of ambulance volunteers and first responders into ambulance services

This study identifies the factors associated with the successful integration of ambulance volunteers and first responders into major ambulance services in Australia and New Zealand and then proposes a model of volunteer management for ambulance services. All ten members of the Australasian Council of Ambulance Authorities completed a questionnaire describing their volunteer and first-responder staff, their numbers and deployment, and the management and integration of volunteers within their respective organisations. Eight senior managers responsible for ambulance volunteers and first responders from six States of Australia and one region of New Zealand subsequently participated in semistructured interviews. Analysis of interview transcripts and publicly available data revealed facilitative factors associated with strong, vibrant ambulance volunteer systems. These facilitative factors are commitment to volunteer models of service delivery; a degree of management decentralisation and volunteer input into decision-making; commitment of resources towards the volunteer model; and the organisational integration of volunteers into the ambulance service. The proposed facilitative model of volunteer management developed aims to encourage the adoption of positive and innovative strategies to improve the integration of ambulance volunteers and first responders in ambulance services. The model consists of four components: leadership; integrative processes; resource commitment; and relative autonomy. The first three of these relate directly to the organisation, while the fourth concerns the volunteers themselves. If these approaches were replicated more widely, a viable and effective volunteer emergency health response system could be established in those areas where it is uneconomic or impractical to provide a salaried ambulance service staffed with professionally qualified paramedics.

Validation of the Four-Dimensional Connectedness Scale in a Multisample Volunteer Study: A Distinct Construct from Work Engagement and Organisational Commitment

This study examines the psychometric properties of a new self-report instrument to measure organisational connectedness (The Four-Dimensional Connectedness Scale; 4DCS) in two volunteer samples: state emergency service volunteers and volunteer ambulance workers. Confirmatory factor analyses in both studies supported the proposed four-factor structure of the 4DCS (other workers, recipients, task and values). In addition, confirmatory factor analyses showed that connectedness, commitment and engagement were separate constructs—a three-factor model with a Connectedness factor, a Commitment factor and an Engagement factor fitted best to the data. Moreover, hierarchical multiple regression analyses revealed that connectedness and engagement each shared unique variance with job satisfaction and intention to continue. The results confirm the factorial, discriminant and predictive validity of connectedness relative to engagement and commitment. It is concluded that the 4DCS has acceptable psychometric properties and that the instrument can be used to study volunteer wellbeing.

'Nurses lead at every level here'.

Five million hours are donated each year by 40,000 St John Ambulance volunteers, and the organisation's recently retired chief nurse Alison Leary offered 4,200 of them over her three-year term of office.

Collective Agency for Service Volunteers

Policy makers promote volunteering in part because it is a powerful mechanism for expanding local community services. Volunteers, however, are subject to processes and power dynamics within organizations, which limit their collective agency. This article reports key findings of a study of rural ambulance volunteers’ agency. The study demonstrated that collective identity is part of the ensemble of power that allows volunteers’ interests to be marginalized within organizations. Findings highlighted barriers for volunteers who were unhappy with the organizational support they received. A critical realist analysis revealed that rural location and community discourses underpinned the volunteers’ lack of collective agency.

Pre-hospital management in terrorist MCI's in Punjab, Pakistan-Year 2009

BackgroundPakistan has seen a huge surge in terrorist attacks in the last two years which has led to extensive loss of life and property. Major disaster events have resulted due...

Going the extra mile: health care for marathon runners

At last year's London Marathon, St John Ambulance (SJA) volunteers treated almost 6,200 casualties from among more than 35,000 runners. In this article, emergency nurse Hazel Mortimer, who regularly works as a volunteer emergency nurse with the SJA, describes her experiences at this year's event and her expectations of the 2012 Olympics.

Multidisciplinary Practice in Action: The Rural Paramedic – It's not Only Lights and Sirens

Objectives This paper examines the Tasmanian portion of a four state study commissioned by the Australian Council of Ambulance Authorities in order to examine the expanded scope of practice for Australian rural paramedics. The objectives of this paper were to describe the expanded role for the rural paramedic on the East Coast of Tasmania and determine what factors facilitate this role. Methods This study uses qualitative methods. Three sources of data were used for this study: a) semi-structured interviews with key informants; b) direct observation of key processes and events, and c) review of documents describing the paramedic role and required organisational and educational support. The semi-structured interviews included questions relating to the role of the paramedic, involvement with other health disciplines, and interactions within the general community. Findings The study revealed how paramedics on the East Coast of Tasmania have developed a multidisciplinary and multifaceted approach to health care. Emergency care does not end at the hospital doorstep and involves co-operation between paramedics and hospital staff in ongoing care. Doctors and other health professionals who have previously been involved in after hours call outs, training of volunteer ambulance personnel are now free from these additional and often time-consuming tasks. Paramedics have been welcomed as part of the health care team in the area and have been responsible for development of effective working relationships with hospital staff and doctors, volunteers and community members. An important part of these relationships is the health education provided by paramedics. Conclusion Emergency response in rural areas is only a small part of paramedic practice. This study has identified elements of rural paramedic practice that highlight the importance of a multidisciplinary and community based response to patient care in rural areas namely community involvement, organisational support, professional support, and appropriate education and training. Much of these are rooted in a footing of informality. The move from informality to a more formal framework will perhaps enable rural paramedic practice to emerge as a discipline in its own right, as an integral part of a rural multidisciplinary health care team.

"Out Here at the Front": The World War I Letters of Nora Saltonstall (review)

Reviewed by: “Out Here at the Front”: The World War I Letters of Nora Saltonstall Robert B. Bruce “Out Here at the Front”: The World War I Letters of Nora Saltonstall. Edited by Judith S. Graham. Boston, Mass.: Northeastern University Press, 2004. ISBN 1-55553-598-4. Photographs. Appendix. Notes. Glossary. Index. Pp. xv, 296. $19.95. The experience of war as told through the diaries and letters of participants in the conflict is a fascinating genre of military history, but most such works are limited to the writings of combat soldiers. In her work "Out Here at the Front," Judith Graham gives us a different facet of first-hand experience of conflict by presenting the war-time letters of Nora Saltonstall. She was a young lady from a wealthy and prominent Boston family, and the younger sister of Leverett Saltonstall who later became a powerful Republican leader in the U.S. Senate. [End Page 589] Shortly after America's entry into the First World War the twenty-three year old Nora went overseas to do her part for the Allied war effort. Arriving in France, Saltonstall worked in Paris with various volunteer organizations such as the Red Cross but always wanted to be more involved and closer to the scene of action. She got her wish in early 1918 when she managed to get assigned to a mobile field hospital in the British sector of the line shortly before the opening of the great German offensives of that year. The battles of 1918, and her close proximity and exposure to the backwash of wounded and stragglers behind Allied lines, makes this section of Saltonstall's letters the most interesting reading in the work from a military history perspective. In it, she describes her emotions and thoughts following the German breakthrough on 21 March 1918 and the chaos and fear which consumed the Allies at that time. Her unshakeable confidence in the ultimate triumph of the Allied forces at this dark moment for their cause makes for an interesting commentary on the overall attitude of the Allies as they struggled to regain their feet after the initial German successes. Graham provides commentary to the letters, but often interjects it as a general summation in the midst of a chapter. The commentary itself is enlightening, although I found its mode of presentation to be awkward. Graham's comments on military events is sparse, simple, and straightforward, which is for the best as this is not her area of expertise. The rest of Graham's observations are insightful and reveal a deep understanding and empathy for her subject. Saltonstall is very much an unconventional lady for her day, and one can see in her the youth and energy which would transform the role of women in American society in the following decade. Thus the book also offers a fascinating glimpse into changing gender roles in modern America. It is also interesting to note that Saltonstall came from a patrician background, and in this sense she is part of the disproportionate number of sons and daughters from wealthy American families who served as volunteer ambulance drivers or nurses, or volunteered for active military service with the Allied armies even before America had entered the war. It would have been interesting to see Graham provide some thoughts on this issue and discuss the social mores and societal pressures of the day which contributed to this outburst of enthusiastic and active support for the Allied cause from America's social elite. Graham is to be commended for the superb work she has done in editing these letters and not only bringing her subject to life, but also using her as a vehicle to explore deeper issues such as the experience of war and the evolving role of women in American society at this critical moment of the twentieth century. Robert B. Bruce Sam Houston State University Huntsville, Texas Copyright © 2005 Society for Military History

Kevin Broadbent - Volunteer ambulance officer of the Year 2004, St John Ambulance Wa

Kevin Broadbent - Volunteer ambulance officer of the Year 2004, St John Ambulance Wa

The Prehospital Community-Volunteer Model Has a Place in Rural Australia

Objectives Australian ambulance services rely on the community-volunteer model of prehospital care in many rural areas. The aim of this study was to conceptually describe the model as it operates in rural settings. Methods Soft Systems Methodology (SSM) was used to describe and critically appraise an abstract prehospital community-volunteer model within the context of rural Australia. The philosophical starting point was that local prehospital services should be self-reliant and autonomous. SSM was used to structure the elements of prehospital systems and the relationships between them into metaphors and pictures for analysis. Results The major characteristic of the prehospital community-volunteer model is the relatively uncomplicated processes used to deliver services. Key elements are a knowledgeable and empowered community, a dispatch system with local knowledge, adequate physical resources to meet community expectations, a volunteer-based staffing system, and direct communication with local health professionals. Culturally, the community-volunteer model has a very strong rural character, with opportunity for health professional, emergency worker and local community member involvement. This may be as a volunteer ambulance officer or as a participant in the local governance of the service. Conclusion The prehospital community-volunteer model is a strong and resilient model in communities where the relationship between the ambulance service and the community is based on a socially constructed framework. Advanced technology, rules, systems, procedures and policies are unable to sustain a community-volunteer ambulance service. In contrast to other models, it is held together through stories of the past, rituals and myths. Prehospital community-volunteer models will continue to be important providers of prehospital services in rural Australia. Successful community-volunteer ambulance services need to be integrated into a local urgent care system.

Flexible, Focused Training: Keeps Volunteer ambulance officers

This paper reports the training findings of the Stand Up and Be Counted Project, a study of Australian and New Zealand Volunteer Ambulance Officers (VAO), the first-line response to medical emergencies in rural and remote areas. VAO are a dwindling resource in regional and rural areas with a great need for such services due their isolation from other health services. The study, financed by Emergency Management Australia, aimed to devise strategies to improve the situation. The project surveyed 2,500 VAO from Western Australia, Queensland, Victoria, Tasmania, Northern Territory, South Australia and New Zealand's North and South islands. This research has a wider application for other emergency services as they undergo similar changes and pressures related to training volunteers under the new Australian Quality Training Framework. The new framework has increased the training and accreditation requirements for many volunteers, and anecdotal evidence before the research suggested that too much training was a disincentive for VAO, making it difficult for ambulance services to recruit or retain volunteers. Our research confirmed that training is important for VAO. The polarization in some responses were considered to have three causes: different training systems per jurisdiction; different levels of isolation and other regionalisation factors meant some units were better serviced than others; and individuals had different expectations and capacities. However the study found that as long as VAO are protected from excessive and onerous bureaucratic processes, and provided with quality training, a competency-based training with national standards is not a disincentive. If done well, training will be a strategic recruitment and retention tool by increasing the confidence and sense of achievement VAO feel.

A Fraternity Of Danger

Abstract. Interviews and participation with members of rural volunteer fire departments (VFDs) in New York State, indicate that local communities in rural regions are structured around VFDs. Such “communities” involves both the fraternity of the fire house, resting on the teamwork essential to firefighting, and a wider locality, which the VFDs spatially define and symbolically integrate through a ritual of parades, fund raising efforts, and their example of community service. The working class, attached to the locality by stable residence and recruited intergenerationally into the fire service, supplies the majority of volunteers.Neoliberal modernization threatens this recruitment pattern. Problems have developed because the “new middle class” rejects VFD participation, except as ambulance volunteers. As localities compete for outside investment through the reduced cost of their services, they have exploited volunteers to provide fire protection at less cost than that of paid departments. This commodification of the VFDs risks destroying their character as a system of moral obligation unifying a locality and is an inequitable, and unsustainable, “tax” on working class volunteers. But innovative systems of emergency and other services can be used to attract the new male and female middle class into volunteer local activities.

Outcome of patients who refused out-of-hospital medical assistance

Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient. Telephone follow-up was conducted to determine the patient's condition and if the patient sought further care after RMA. Primary endpoints were whether the patient sought further care, was admitted to a hospital, or died subsequent to RMA. Follow-up was successfully obtained for 199 of 321 patients enrolled (62%). Of these 199 patients, 95 (48%) sought further medical care within 1 week for the same complaint, with 13 being admitted to the hospital. Six of the 13 admitted patients had chief complaints of a cardiac or respiratory nature. One patient died during hospital admission. Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.

Training St John Ambulance volunteers to use an automated external defibrillator

The key to improving survival from pre-hospital cardiac arrest lies in reducing the time interval between onset of cardiac arrest and defibrillation. Placing automated external defibrillators at strategic points in the community could potentially reduce this time interval, but would necessitate widespread training in defibrillation for lay people in addition to health care workers. There are unanswered questions regarding the ability of lay people to acquire and retain this skill when the training programme is, by necessity, very brief, (otherwise it would not be possible to train large enough numbers of people) and the skill is used infrequently. In this study, nurse and lay volunteer first-aiders were taught to use an automated external defibrillator, either by a 2-h, or a 4-h course, and their skills were assessed at training, and at 3 and 6 months afterwards. Using stringent assessment criteria, 54'% of volunteers passed the assessment at every session. Little difference in acquisition or retention of skills between the nurse and lay volunteers, and the 2- and 4-h course groups was found. It is concluded that brief training in defibrillation for volunteer first-aiders is feasible.

Nevinson's Elegy:Paths of Glory

Christopher Richard Wynne Nevinson (1889–1946) was among the first British artists to witness the horrors of the First World War. A volunteer ambulance driver on the western front, Nevinson observed the suffering and carnage resulting from the new trench warfare in the winter of 1914–15. He returned to the front in 1917 as a member of the British government's official war-artists' program. For the program Nevinson produced a controversial painting, Paths of Glory (fig. 1), that was banned from his one-person show at the Leicester Galleries, London, in March 1918.1 The exhibition took place at a time during the war when morale seemed at its lowest, and the government supposedly censored the painting because it portrayed dead British soldiers. Since other contemporaneous paintings and photographs of Allied and enemy war dead were shown in London galleries and reproduced in the British press, the reason for the censorship of Nevinson's Paths of Glory demands further investigation.

The impact of providing help: Emergency workers and cardiopulmonary resuscitation attempts

Although anecdotes suggest that emergency medical technicians often themselves have to cope with severe trauma as a result of their work, almost all empirical work has been concerned with the aftermath of disaster. Fourteen volunteer ambulance attendants were asked about resuscitation attempts in which they had been involved. It was found that many of these evidenced a persistent psychological aftermath. Some of these individuals experienced vivid, involuntary, and uncontrollable thoughts, feelings, and/or mental images concerning their attempt. Perceived control and coping responses were examined, and found to be related to the impact of the resuscitation attempt upon the ambulance personnel. Data from this preliminary investigation indicate the need for further work in the area, and with related populations, such as nonprofessionals who attempt cardiopulmonary resuscitation.

The impact of providing help: Emergency workers and cardiopulmonary resuscitation attempts

AbstractAlthough anecdotes suggest that emergency medical technicians often themselves have to cope with severe trauma as a result of their work, almost all empirical work has been concerned with the aftermath of disaster. Fourteen volunteer ambulance attendants were asked about resuscitation attempts in which they had been involved. It was found that many of these evidenced a persistent psychological aftermath. Some of these individuals experienced vivid, involuntary, and uncontrollable thoughts, feelings, and/or mental images concerning their attempt. Perceived control and coping responses were examined, and found to be related to the impact of the resuscitation attempt upon the ambulance personnel. Data from this preliminary investigation indicate the need for further work in the area, and with related populations, such as nonprofessionals who attempt cardiopulmonary resuscitation.