Emergency Staff Research Articles

Emergency medical staffs\u2019 knowledge and attitude about organ donation after circulatory determined death (DCD) and its related factors

BackgroundAdverse attitudes and insufficient knowledge about organ donation after Circulatory Determined Death (DCD) among emergency staff can have important consequences for the proper identification of potential DCD donors. This is aided by the constant application of donation after Circulatory Determined Death policies, and the relative strength of support for this type of donation. Therefore, this study was conducted to investigate the awareness and attitude of emergency personnel about organ donation after Circulatory Determined Death.MethodsThis descriptive study was carried out with the participation of 49 physicians and 145 nurses working in the emergency departments of educational and medical centers of Tabriz University of Medical Sciences. Nurses were selected by simple random sampling, and all physicians working in the emergency departments were included in the study. The questionnaire of Knowledge and Attitude regarding Organ Donation after Circulatory Determined Death designed by Rodrigue et al. was used. Data were analyzed using descriptive statistics and independent samples t-test, one-way ANOVA, and chi-square test.ResultsMost of the nurses (62.8%) and physicians (66.7%) had a high level of knowledge about organ donation after circulatory determined death. The mean attitude score was 101.84 (SD: 9.88) out of 170 for nurses and 106.53 (SD: 11.77) for physicians. Physicians who carried organ donation cards had a more positive attitude toward organ donation after circulatory determined death.ConclusionAccording to this study findings, knowledge and attitude of the emergency staff about organ donation was both high and positive. It is recommended to devise necessary guidelines for organ donation in Iranian emergency departments to assist in the training of colleagues in organ donation ensuring no necessary measures are missed. The results of this study would support the development of guidelines for the successful introduction of DCD in Iran.

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

PERFORMANCE ANALYSIS OF THE IOPES SEAMLESS INDOOR-OUTDOOR POSITIONING APPROACH

Abstract. Tracking the members of civil protection or emergency teams is still an open issue. Although outdoors tracking is routinely performed using well-seasoned techniques such as GNSS, this same problem must be still solved for indoors situations. There exist several approaches for indoor positioning, but these are not appropriate for tracking emergency staff in real-time: some of these approaches rely on existing infrastructures; others have not been tested in light devices in real-time; none offers a combined solution. The IOPES project seeks to solve or at least alleviate this problem by building a portable, unobtrusive, lightweight device combining GNSS for outdoor positioning and visual-inertial odometry / SLAM for the indoors case. This work, the third of the IOPES series, presents the analysis of the performance results obtained after developing and testing the first IOPES prototype. To do it, the operational aspects of the prototype, the real-life scenarios where the tests took place and the actual results thus obtained are described.

Development and Implementation of an Emergent Documentation Aggression Rating Tool: Quality Improvement

IntroductionWorkplace violence is prevalent in the emergency department, putting patients and staff at risk for harm. An ED-specific standardized tool is needed to promote a consistent assessment process to strengthen documentation of escalating patient behaviors, give justification for de-escalating interventions, and reduce restraints. The purpose of this project was to design, implement, and evaluate feasibility of an ED-specific tool to help nurses proactively identify and intervene with patients’ escalating behaviors, capture better documentation of aggressive/violent patient events, and reduce restraint usage. MethodsA quality improvement design was used. The Emergent Documentation Aggression Rating Tool was constructed by combining evidence-based behavioral cues for potential aggression/violence with observed behaviors and successfully implemented interventions in patients. Nurses were trained on how to use the tool to rate patients’ behaviors and take necessary action. Chart data were collected from August 2018 to December 2019 at a Midwestern suburban hospital emergency department. Chart audits and just-in-time education were conducted after implementation. Survey data were collected to evaluate nurses’ perception of the tool's usefulness. ResultsUse of the novel Emergent Documentation Aggression Rating Tool increased over time (67.36% in Quarter 3 2018 to 97.55% in Quarter 4 2019). After Emergent Documentation Aggression Rating Tool implementation, visual inspection of the time series indicated a decrease in percent restraints, and there was an overall increase in documented escalations de-escalations over time. The patients that escalated most frequently had diagnoses of alcohol use, suicidal ideations, pain-related complaints, or mental health issues. ConclusionThe Emergent Documentation Aggression Rating Tool was feasible for emergency nurses to proactively identify and intervene with patients at risk for aggression/violence.

Endovascular Treatment of Acute Ischemic Stroke in Clinical Practice: Analysis of Workflow and Outcome in a Tertiary Care Center.

Background and Purpose: Pre- and intra-hospital workflow in mechanical recanalization of large cervicocephalic arteries in patients with acute ischemic stroke still needs optimization. In this study, we analyze workflow and outcome in our routine care of stroke patients undergoing mechanical thrombectomy as a precondition for such optimization.Methods: Processes of pre- and intra-hospital management, causes of treatment delay, imaging results (Alberta Stroke Program Early Computed Tomography Score, localization of vessel occlusion), recanalization (modified thrombolysis in cerebral infarction score), and patient outcome (modified Rankin scale at discharge and at the end of inpatient rehabilitation) were analyzed for all patients who underwent mechanical thrombectomy between April 1, 2016, and September 30, 2018, at our site.Results: Finally, data of 282 patients were considered, of whom 150 (53%) had been referred from external hospitals. Recanalization success and patient outcome were similar to randomized controlled thrombectomy studies and registries. Delay in treatment occurred when medical treatment of a hypertensive crisis, epileptic fits, vomiting, or agitation was mandatory but also due to missing prenotification of the hospital emergency staff by the rescue service, multiple mode or repeated brain imaging, and transfer from another hospital. Even transfer from external hospitals located within a 10-km radius of our endovascular treatment center led to a median increase of the onset-to-groin time of ~60 min.Conclusion: The analysis revealed several starting points for an improvement in the workflow of thrombectomy in our center. Analyses of workflow and treatment results should be carried out regularly to identify the potential for optimization of operational procedures and selection criteria for patients who could benefit from endovascular treatment.

“Free” food with a side of shame? Combating stigma in emergency food assistance programs in the quest for food justice

Anti-hunger advocates and food geographers have often overlooked the role of emergency food assistance in struggles for food justice, dismissing food assistance as addressing symptoms rather than root causes of food insecurity. Yet, the vast network of food pantries and other free food programs are more than a stop-gap measure for millions of Americans — and thus warrant a closer look at how their practices, policies and spaces feel in practice and with what implications towards food justice goals. In this paper, we argue that barriers to emotionally-accessible food, in the form of neoliberal stigma around “free” food, play a prominent role in shaping peoples’ experiences with food assistance. Based on participatory research with a food redistribution non-profit in Boulder, Colorado, we discuss how the emotional burdens of food insecurity manifest in individual experiences with emergency food assistance programs and staff, leading to isolation and disconnection which actively inhibit more inclusive food systems. This research responds to scholarship in geographies of food and emotion, contributing analysis into how discomforts of (lacking/receiving) food are experienced viscerally. Furthermore, we discuss implications of the emotional (dis)comforts of food assistance when examining the role of emergency food assistance in broader struggles for food justice. To this end, we point to alternative practices in food assistance programs which might actively counteract narratives of neoliberal subjectivities, while simultaneously broadening the food justice community in terms of who feels comfortable participating in, and shaping, more equitable food systems.

Research on Smart Mattress Based on Fiber Unbalanced Sagnac Loop

Because the contact vital sign detection system is monitored through skin contact, it affects the user’s comfort and causes inconvenience. And most of the non-contact equipment is not high precision, or the cost is too high. To solve the above problems, this article is based on the physiological activity of slight vibration in multimode optical fiber micro bending deformation which result in the change of light intensity principle, considering the structure of the optical fiber Sagnac loop sensor has simple structure, low cost, but the signal to noise ratio is poor and is not sensitive to low frequency signal, this paper designed a based on intelligent mattress of non-equilibrium sagnac loop structure. The mattress can obtain the heart impact map signal in real time by changing the small light intensity, and obtain the heart rate, respiration rate and other information through the algorithm processing the signal. Mattress in the design of the sensing optical fiber module will be connected to two different types of optical fiber of Unbalanced Sagnac loop structure, solve the balance Sagnac loop structure of optical fiber access signal noise is bigger, poor sensitivity were weakness, go through the serpentine line way of embedded mattress, and using the mattress cover material for optical fiber micro bending cycle critical mechanical adjustment cycle, the mattress is of high sensibility. Cardiac and respiratory signals obtained in the laboratory were compared with those obtained from the balanced Sagnac loop, and through the fast Fourier transform (FFT) in frequency domain signal is analyzed, the vital signs of signal more clearly this mattress stable and less noise, change the tester for many times after tests, get the signal of high accuracy, the error is very small. The experiment shows that the mattress can realize the non-sensory vital signs signal detection, convenient for users to monitor their physical conditions in real time in daily work and life, and can timely notify the family members and medical staff in emergency, to avoid the occurrence of accidents.

بررسی آگاهی و عملکرد کارکنان اورژانس پیش بیمارستانی شهرستان شهرکرد نسبت به رعایت اصول کنترل عفونت: یک مطالعه مقطعی- تحلیلی:

Introduction: Providing pre-hospital emergency services always puts employees at risk of infectious diseases and spreading the infection in the community. Observing the principles of infection control plays an important role in the continuity of the performance of these employees. The aim of this study was to assess the knowledge and performance of pre-hospital emergency staff in Shahrekord regarding the principles of infection control. Methods: This cross-sectional analytical study was carried out on 100 of pre-hospital emergency staff working in emergency operations unit of Shahrekord city. Convenience sampling was used in this study. Data was collected using a reliable and valid questionnaire on knowledge and performance of the staff regarding standard precautions for infection control. Data were analyzed using SPSS software version 15. Results: The mean age of the participants was 30.21±8.34 years. 30% of the participants had a history of needle stick. There was no significant relationship between knowledge and performance of the staff (p>0.05), but there was a significant relationship between their knowledge and level of education (p<0.05). The mean knowledge score of the participants regarding infection control standard precautions was at a low level (45.16±75.25) and the mean score of their performance was at a moderate level (51.48±41.97). Conclusion: According to the results of the present study, it is necessary to plan for improving the awareness and performance of pre-hospital emergency personnel regarding observation of the principles of infection control by holding in-service training courses and preparing training packages.

Examining Evacuee Response to Emergency Communications with Agent-Based Simulations

To improve communication during emergencies, this research introduces an agent-based modeling (ABM) method to test the effect of psychological emergency communication strategies on evacuation performance. We follow a generative social science approach in which agent-based simulations allow for testing different candidate solutions. Unlike traditional methods, such as laboratory experiments and field observations, ABM simulation allows high-risk and infrequent scenarios to be empirically examined before applying the lessons in the real world. This is essential, as emergency communication with diverse crowds can be challenging due to language barriers, conflicting social identities, different cultural mindsets, and crowd demographics. Improving emergency communication could therefore improve evacuations, reduce injuries, and ultimately save lives. We demonstrate this ABM method by determining the effectiveness of three communication strategies for different crowd compositions in transport terminals: (1) dynamic emergency exit floor lighting directing people to exits, (2) staff guiding people to exits with verbal and physical instructions, and (3) public announcements in English. The simulation results indicated that dynamic emergency exit floor lighting and staff guiding people to exits were only beneficial for high-density crowds and those unfamiliar with the environment. Furthermore, English public announcements actually slowed the evacuation for mainly English-speaking crowds, due to simultaneous egress causing congestion at exits, but improved evacuation speed in multicultural, multilingual crowds. Based on these results, we make recommendations about which communication strategies to apply in the real world to demonstrate the utility of this ABM simulation approach for risk assessment practice.

Covid-19 1 year on: The challenge for low-middle income countries.

Covid-19 1 year on: The challenge for low-middle income countries.

Video in situ simulation for medical student education during the COVID-19 pandemic.

Implication StatementThe COVID-19 pandemic has limited in-person experiences for medical students, especially in situations involving aerosol-generating procedures. We designed a video in situ simulation to orient students to critical steps in COVID-19 intubation algorithms. Small groups of students were paired virtually with facilitators (faculty and residents) and watched a video of an in situ simulation of emergency staff performing a protected intubation, with discussion points appearing on screen at discrete times. The simple design drives engagement, discussion and allows for scheduling flexibility with no risk to the learners. It can be adapted to several different scenarios or levels of training.

Occupational stress and mental suffering among emergency staff

IntroductionIn emergency departments, workers regularly report unfavorable working conditions. It’s a stressful workplace with excessive workloads, high demands on patient care including exposure to violence, time pressures and overcrowding.Objectives-Identify the prevalence of violence, psychological distress and job stress in the emergency department. -Investigate risk factors of aggression among emergency department staff.MethodsThis study is a descriptive-cross sectional analysis study conducted on emergency department staff. Data were collected through a questionnaire including sociodemographic information, circumstances of the aggression, the Karasek questionnaire, and the GHQ-12 (General Health Questionnaire).ResultsOur study included 62 health workers. Half of the population were physicians. The prevalence of assault was estimated at 59.6%. Psychological distress was noted in 64.5% of cases. Occupational stress was estimated at 75.8%. The most common type of assault was verbal aggression (86.4%). The aggressor was most often an accompanying person. The occurrence of violence was not associated with the worker’s psychological distress or job stress. On the other hand, we noted an association between aggression and variable work schedule.ConclusionsViolence against healthcare workers in the emergency department is an important phenomenon. Preventive actions should be taken to improve health professional wellbeing at work.DisclosureNo significant relationships.

What can we do about occupational violence in emergency departments? A survey of emergency staff.

To explore and collate solutions for occupational violence from emergency department (ED) staff. Despite publications highlighting the progressively worsening issue of occupational violence in EDs and its detrimental impacts, few strategies aimed to reduce or manage it have been discussed in the literature. This was a cross-sectional study involving ED staff. Participants completed an electronic survey that prompted interventions for occupational violence. Free-text data were analysed and logically categorized using validated techniques. Participants (N=81) suggested 24 interventions: 12 were classified as prevention strategies, 10 as response strategies and two as recovery strategies. Prevention and response strategies for occupational violence targeted key participants: patients, staff and ED environment. Recovery strategies centred around staff management of the personal impacts of incidences of occupational violence and on systems in place to support them after occupational violence incidents. Solutions to occupational violence should be multifaceted encompassing prevention, response and recovery for patients, staff and the ED environment. No single, universal intervention can be endorsed to reduce or mitigate the impacts of occupational violence in EDs. However, a combination of the interventions (strategies) discussed in this paper can be recommended.

Patient triage system for supporting the operation of dispatch centres and rescue teams

BackgroundThe Thai medical application for patient triage, namely Triagist, is an mHealth application designed to support the pre-hospital process. However, since the functions of the application that are necessary for the pre-hospital process have been found not to be fully developed, the addition of a back-end system has been considered to increase its performance and usability.ObjectiveTo determine the ability of the previous version to effectively manage the pre-hospital process and analyse the current problems with the pre-hospital operation. Therefore, the new system was developed to support the connection of dispatch centres or operational centres to the Triagist mobile application and system evaluation.MethodDesign thinking methodology was used to analyse, design and develop a patient triage system to support the pre-hospital process in Thailand based on users’ requirements. 68 active members of the rescue teams and emergency medical staff in Chiang Mai and Lampang provinces were recruited to test the reliability of the system based on a prototype application.ResultsThe new medical mobile application for patient triage in Thailand was validated for use due to containing the two essential functions of Initial Dispatch Code (IDC) geolocation and IDC management. When the system was tested by emergency staff who were responsible for using it, those with the least experience were found to use it better than their highly experienced colleagues. Moreover, in cases where the system had been implemented, it was found to determine the frequency of symptoms, the time period during which cases occurred, and the density of cases in each area.ConclusionThis system, which has been developed based on the use of smart technology, will play an important role in supporting emergency services in Thailand by enhancing the efficiency of the pre-hospital process. Emergency centres will receive IDC information from the geolocation system so that they can determine patients’ location without undue delay. Emergency services will be able to rapidly prepare the necessary resources and administrative tasks will be supported by linking the dispatch centre to central rescue teams.

Frequency of Mental Behavioral Disorders in the Emergency Staff during the Care of Patients in the Covid-19 Pandemic

As the health personnel fight it spread of COVID-19, has acquired information of alterations psychological featured in professionals and technicians of the health that is in contact with patients infected by this virus. Of according to center carried out, the more alterations frequent in a 85% are: Anxiety, depression and Post-traumatic stress.

A Blockchain-Based Secret-Data Sharing Framework for Personal Health Records in Emergency Condition.

Blockchain technology is the most trusted all-in-one cryptosystem that provides a framework for securing transactions over networks due to its irreversibility and immutability characteristics. Blockchain network, as a decentralized infrastructure, has drawn the attention of various startups, administrators, and developers. This system preserves transactions from tampering and provides a tracking tool for tracing past network operations. A personal health record (PHR) system permits patients to control and share data concerning their health conditions by particular peoples. In the case of an emergency, the patient is unable to approve the emergency staff access to the PHR. Furthermore, a history record management system of the patient’s PHR is required, which exhibits hugely private personal data (e.g., modification date, name of user, last health condition, etc.). In this paper, we suggest a healthcare management framework that employs blockchain technology to provide a tamper protection application by considering safe policies. These policies involve identifying extensible access control, auditing, and tamper resistance in an emergency scenario. Our experiments demonstrated that the proposed framework affords superior performance compared to the state-of-the-art healthcare systems concerning accessibility, privacy, emergency access control, and data auditing.

Evaluating the Impact of ACLS Scenario Based Resuscitation Simulation for Emergency Team

Introduction: Medical simulation has become increasingly important for education in emergency situations like resuscitation and improvising healthcare services.&#x0D; Methods: A prospective study was performed implementing ACLS resuscitation simulation with the Patan Hospital emergency team. The survey questionnaire was designed to evaluate participants’ communication skills, leadership, team dynamics, competency in ACLS and perception regarding simulation as a learning method. The paired t-tests were performed to compare pre and post simulation survey responses. The quantitative data were managed and analysed using Microsoft Excel.&#x0D; Results: Fifty seven emergency staffs participated in the study. In the communication domain pre-simulation survey mean likert score of close loop communication was 2.68, SBAR was 2.54 and PEARL was 2.25 while the post-simulation survey were 3.19, 3.05 and 2.96 respectively. In leadership pre-survey assessment of coordinating team members was 2.61 and summarising events skill was 2.58 while the post-survey scores were 2.91 and 3.02 respectively. The team dynamics pre-survey of the teamwork experience was 2.63 while post-survey was 3.07. The competency pre-survey of competency level in ACLS was 2.51 while the post-survey was 2.88. The pre-survey regarding considering simulation a good method of training was 3.32 while the post-survey was 3.56. All the survey questionnaires of each domain showed the increased difference that is statically significant with p-values &lt;0.001.&#x0D; Conclusions: Simulation training is an effective and useful educational technique for training the health personnel working in emergency service.

Contextualization of Psychological First Aid: An Integrative Literature Review.

Contextualization of psychological first aid (PFA) in different cultural, political, and socioeconomic contexts and in different population groups is essential. This review analyzes the efforts that have been made to contextualize PFA in different parts of the world for different disasters and emergencies. Integrative literature review. The major databases that were searched for related literature published until August 2019 included JBI, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), BIOSIS, ISI Web of Knowledge, Scopus, EBSCOhost, and PsycINFO. A total of 17 studies published in peer-reviewed journals were included. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, and the 6W3H tool was applied to synthesize the results. PFA has been adapted to various disasters and populations in different countries and regions. The organizations that administer PFA range from community level to national level. Professional or "outside helpers" who enter disaster-affected locations include psychologists, fire fighters, social workers, and nurses. "Inside helpers," who live and work in the disaster-affected areas, include HR staff, teachers, and peer emergency personnel. Only a few studies have reported the exact number of first responders who administered PFA. Some studies revised PFA as group based, and a few reported the classification of groups of victims. Notably, all adaptations adhered to the basic principles of PFA, and the time at which PFA was administered ranged from a few days to months after an incident. PFA was conducted on site in all studies. The selection of the location depended on the type of disaster and local situation with due consideration of safety. Only a few studies specified the rationale for revising the PFA. None of these 17 studies reported the cost, cost-benefit, or cost-effectiveness of PFA. Population-focused, context-specific, and group-based PFA is emerging worldwide. Nurses are actively playing a role in providing PFA. Research gaps exist in differentiating between the roles played by "outside" and "inside" responders, considering vulnerable age groups other than children, incorporating the major PFA concepts such as resilience, and evaluating the cost-effectiveness of PFA. It is imperative that nurses and other emergency staff consider the intersection of age, gender, cultural, political, social economic, and spiritual contexts when developing a context appropriate PFA.

Assessment patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia.

As the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia. An institution-based cross-sectional study was conducted from March 1-30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant. A total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively. The total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.

Building a Taxonomy to Understand Health Care Worker's Response to Workplace 'Pressure' in Complex, Volatile and Emergency Situations.

This research aims to better understand performance under pressure as experienced by health and emergency staff in the workplace. Three basic questions underpin the work: (1) how do health and emergency workers experience and make sense of the ‘pressures’ entailed in their jobs? (2) What impacts do these pressures have on their working lives and work performance, both positively and negatively? (3) Can we develop a useful explanatory model for ‘working under pressure’ in complex, volatile and emergency situations? The present article addresses the first question regarding the nature of pressure; a subsequent article will address the question of its impact on performance. Using detailed interviews with workers in a range of roles and from diverse settings across Ecuador, our analysis aims to better understand the genesis of pressure, how people respond to it and to gain insights into managing it more effectively, especially with a view to reducing workplace errors and staff burnout. Rather than imposing preformulated definitions of either ‘pressure’ or ‘performance’, we took an emic approach to gain a fresh understanding of how workers themselves experience, describe and make sense of workplace pressure. This article catalogues a wide range of pressures as experienced by our participants and maps relationships between them. We argue that while individuals are often held responsible for workplace errors, both ‘pressure’ and ‘performance’ are multifactorial, involving individuals, teams, case complexity, expertise and organizational systems and these must be considered in order to gain better understandings of performing under pressure.