Swedish Ambulance Research Articles

Large-scale modelling and forecasting of ambulance calls in northern Sweden using spatio-temporal log-Gaussian Cox processes

Although ambulance call data typically come in the form of spatio-temporal point patterns, point process-based modelling approaches presented in the literature are scarce. In this paper, we study a unique set of Swedish spatio-temporal ambulance call data, which consist of the spatial (GPS) locations of the calls (within the four northernmost regions of Sweden) and the associated days of occurrence of the calls (January 1, 2014–December 31, 2018). Motivated by the nature of the data, we here employ log-Gaussian Cox processes (LGCPs) for the spatio-temporal modelling and forecasting of the calls. To this end, we propose a K-means clustering based bandwidth selection method for the kernel estimation of the spatial component of the separable spatio-temporal intensity function. The temporal component of the intensity function is modelled by means of Poisson regression, using different calendar covariates, and the spatio-temporal random field component of the random intensity of the LGCP is fitted using the Metropolis-adjusted Langevin algorithm. Spatial hot-spots have been found in the south-eastern part of the study region, where most people in the region live and our fitted model/forecasts manage to capture this behaviour quite well. Also, there is a significant association between the expected number of calls and the day-of-the-week, and the season-of-the-year. A non-parametric second-order analysis indicates that LGCPs seem to be reasonable models for the data. Finally, we find that the fitted forecasts generate simulated future spatial event patterns which quite well resemble the actual future data.

Prehospital care nurses’ self reported competence: A cross-sectional study

BackgroundThe Swedish ambulance service has undergone major changes in recent decades due to advancements being made in medical and technical resources, professional competence, and patient care. Registered and specialist nurses share the same role, accountabilities, and responsibilities in the ambulance service, and their professional competence has not yet been evaluated. ObjectivesThe aim of the study was to investigate and compare self-reported professional competence among nurses working in the ambulance service and to explore associations between potentially predictive background factors and self-reported professional competence. MethodA cross-sectional study with a digital questionnaire was used for collecting data from 34 registered nurses and 71 specialist nurses. The Ambulance Nurse Competence Scale and the Research Utilization Questionnaire were used for data collection. ResultsSignificant differences were found among the nursing categories in terms of age, gender, education, and work experience. Prehospital emergency nurses reported the highest professional competence. Nurses with a master's degree did not report significantly higher professional competence than nurses with a bachelor's degree. ConclusionsThe findings indicated that there are differences in the professional competence of registered nurses and specialist nurses. Length of work experience in the ambulance service is an important factor associated with higher professional competence.

Specialist Ambulance Nurses' Perceptions of Nursing: A Phenomenographic Study.

Although nursing is the main area of interest in the curriculum of the specialist ambulance nursing program in the advanced level of education, there has been reported a lack of knowledge about nursing in within the ambulance service. The aim was to explore specialist ambulance nurses’ perceptions of nursing, which were explored by employing a phenomenographic approach. The study comprises individual interviews with 19 strategically selected specialist ambulance nurses. The results showed seven descriptive categories emerged detailing the variations in how the specialist ambulance nurses perceive, understand, and conceptualize the phenomenon of nursing in the Swedish Ambulance Service. Four categories revealed the specialist ambulance nurses’ qualitatively different perceptions of nursing, i.e., their role and responsibility, while three showed perceived barriers to assuming their role and responsibility, comprising culture and leadership, conditions, and framework. The seven categories are outlined in the outcome space. In conclusion, there is a very wide variety of perceptions of ambulance nursing within the Swedish Ambulance Service. There is a need for implement the nursing process both in the Specialist Nursing Pre-hospital Emergency Care education curriculum and within clinical practice. Further, there is a necessity to develop and implement nursing guidelines in the ambulance.

Stress Response in Swedish Ambulance Personnel during Priority-1 Alarms

Introduction Ambulance personnel consider themselves as being healthy, but studies show they often suffer from stress-related illnesses. However, research on the causes of these stress-related illnesses is limited. This study aimed to examine the stress response of Swedish of ambulance personnel during priority-1 alarms. Methods During 90 priority-1 alarms salivary cortisol concentrations were measured at alarm and after end of alarm, and heart rates measured every 15 seconds. Thirteen men and six women participated in the study. A questionnaire with background data was collected. Non-parametric statistical tests were used. Results Elevated heart rate (median +34.7%) was associated with the actual priority-1 alarm, and during the alarm for women. Median salivary cortisol concentrations at alarm and after end of alarm (14.0 and 14.2 nmol/L respectively) showed non-significant differences. There were individual non-identical responses to the alarms. Alarms concerning traffic accidents, fast track and children generated the highest cortisol concentrations. The stress response showed non-significant differences in age, gender or level of education. Salivary cortisol concentrations and response were lower in the afternoon shift (2pm to 8pm). Conclusion The alarm causes increased heart rate at the group level but with individual different responses. Predefined fast track schedules and traffic accidents appear to generate measurable stress. Cortisol concentration follows normal diurnal variation of cortisol regarding time point for priority-1 alarms. Time of day does not affect the heart rate

Significant others' perceptions of being taken seriously by the Swedish Ambulance Service when the patient is assessed as nonurgent.

At least 50% of all ambulance assignments are deemed nonurgent, while 47-96% are initiated by someone other than the patient. Previous research has highlighted the importance of being taken seriously. However, additional knowledge of how significant others experience the situation when a patient is assessed as nonurgent is needed. The aim of this study was to explore the person-centred climate in the Ambulance Service from the perspective of significant others by means of the Person-centred Climate Questionnaire - Family version (PCQ-F), to psychometrically investigate the construct validity of additional items intended to measure perceptions of being taken seriously and to explore possible relationships between the person-centred climate and these additional items. A retrospective, explorative, cross-sectional survey design was employed. In total, 241 questionnaires were distributed. Descriptive and comparative statistics and a factor analysis of eight items possibly constructing person-centredness are presented. The 100 respondents experienced the climate as very person-centred. Relationships were found between the items that might constitute person-centredness and the PCQ-F. The PCQ-F can explain perceived person-centredness through the additional items that may constitute person-centredness in the Ambulance Service context. Significant others consider eight aspects of being taken seriously as the core of person-centredness in nonurgent Ambulance Service assignments. There is a relationship between the psychosocial climate and the additional items that might constitute person-centredness.

Cross-cultural encounters in prehospital care: An analysis of interviews with Swedish ambulance nurse specialists about their experience with ethnic minority patients

Cross-cultural encounters in prehospital care : An analysis of interviews with Swedish ambulance nurse specialists about their experience with ethnic minority patients

"We are already person-centred in our practice"-A Qualitative Study of Ambulance Clinicians' Experiences of Person-Centred Care.

The concept of person-centred care (PCC) is considered one of the core competencies in Swedish healthcare. It has increasingly spread and involves treating the patient as a person who is decision-competent and part of the team. The PCC concept has been introduced in the Swedish Ambulance Service setting, but as there has been no previous research on PCC in this context, the aim of the present study was to illuminate ambulance clinicians’ experiences of the introduction of PCC in a Swedish Ambulance Service setting. Data collection took the form of interviews with 15 ambulance clinicians in the southernmost part of Sweden. Qualitative content analysis was employed to analyse the interviews, wherein two categories emerged: organisational perspective and contextual culture. The latent meaning was interpreted as the theme: Seeing the individual in need of care as a person instead of a patient. In conclusion, the concept of PCC was considered a barrier and there was some resistance to its introduction. While PCC enhanced the ambulance clinicians’ stance, e.g., when initiating a caring relationship and encouraging the patient to participate in her/his care, it was also described as a catchphrase that is not applicable to the Ambulance Service as it contributes nothing new to the standard of treatment.

Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

ObjectivesTo combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients’ need for conveyance to hospital, and this is creating new and challenging...

Registered nurses’ experiences of near misses in ambulance care – A critical incident technique study

BackgroundIn hospitals, potentially harmful near misses occur daily exposing patients to adverse events and safety risks. The same applies to ambulance care, but it is unclear what the risks are and why near misses arise. AimTo explore registered nurses’ experiences and behaviours associated with near misses where patient safety in the ambulance service was jeopardized. MethodsBased on critical incident technique, a retrospective and descriptive design with individual qualitative interviews was used. Ten men and five women from the Swedish ambulance service participated. ResultsSeventy-three critical incidents of near misses constituted four main areas: Drug management; Human-technology interactions; Assessment and care and Patient protection actions. Incidents were found in drug management with incorrect drug mixing and dosage. In human-technology interactions, near misses were found in handling of electrocardiography, mechanical chest compression devices and other equipment. Misjudgement and delayed treatment were found in patient assessments and care measures while patient protection actions failed in transport safety, hygiene and local area knowledge. ConclusionsExperiencing near misses led to stress, guilt and shame. The typical behaviour in response to near misses was to immediately correct the action. Occasionally, however, the near miss was not discovered until later without causing any harm.

Stress Response in Swedish Ambulance Personnel Evaluated by Trier Social Stress Test

According to previous research, ambulance personnel often consider themselves as healthy, but at the same time several studies show that they suffer from several stress-related illnesses, take early retirement and even suffer early death. The aim of this study was to explore mental stress during the Trier Social Stress Test. Questions were whether heart rate measurement could replace cortisol concentration in saliva as an indicator of stress and if there were differences between genders. During 20 Trier Social Stress Tests heart rate and salivary cortisol concentrations were measured. Heart rate was measured every 15 seconds and salivary cortisol was collected at seven occasions. Fourteen men and six women (sixteen ambulance nurses and four paramedics) participated. A questionnaire with background data was collected. Statistical analysis used was non-parametric tests to adjust for misalignment. During the Trier Social Stress Test women had their highest salivary cortisol concentration before start of test while the maximum values for men were 10 to 20 minutes after start. In contrast, there was no difference in heart rhythm before, during and after test between genders. No correlation between heart rate and salivary cortisol was found. There was no significant difference in stress response according to personnel’s age or level of education. Women and men exhibit different hormonal stress responses when it comes to performing unfamiliar actions, something that has not been seen before. Since no correlation could be seen between heart rate and salivary cortisol concentration they cannot replace each other as indicators of stress.

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.

Person-centred climate and psychometrical exploration of person-centredness and among patients not conveyed by the Ambulance Care Service.

What already is known is that as many as 50% of all Swedish Ambulance Care Service assignments are considered as non-emergency. Therefore, due to medical protocols and triage system, patients are refused conveyance to the Accident and Emergency Department by the Ambulance Care Service. The aim of this study was to psychometrically explore the construct validity of a possible dimension of person-centredness, developed from a previous published qualitative study in a nonemergency ambulance care context. A second aim was to explore patients' experiences of the person-centred climate and to explore possible relationship between it and person-centredness. A retrospective, explorative, cross-sectional survey design with a convenience sample was employed. A total of 111 questionnaires were analysed using descriptive and comparative statistics. An explanatory factor analysis was also conducted. A one-factor solution for the specific items possibly constructing person-centredness was found. The responses to the Person-centred Climate Questionnaire-Patient version (PCQ-P) revealed that the climate was received as highly person-centred. Relationships were found between the specific items possibly constructing person-centredness and PCQ-P. A highly valid construct of person-centredness exists within nonurgent Ambulance Care Service assignments comprising eight aspects of being taken seriously. The climate in which nonemergency ambulance care is provided has great potential to facilitate person-centredness by means of taking patients seriously. The psychosocial aspects of PCQ-P and person-centredness are somewhat related to each other.

Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden.

New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

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.

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.

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.

Early Assessment of Patient's Medical Condition in Ambulance Care Affects the Level of Care of Non Urgent Patients.

The Rapid Emergency Triage and Treatment System (RETTS) is used by the Swedish ambulance care organization for assessment of patients medical condition. The aim of the present study was to evaluate prehospital assessment in collaboration with the ambulance nurse and primary health care physicians. If the patient's condition was priority GREEN by RETTS then the ambulance nurse decided to contact the primary care physicians for a dialogue and together they decided which level of care was the most appropriate for the patient's condition.

Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study

When a person with vague symptoms calls 112, the dispatchers often have difficulty prioritising the severity of the call. Their only alternative has been to send an ambulance. In Gothenburg, Sweden, a nurse-manned single responder (SR) was initiated to assess this patient group. The study aims to describe patient characteristics and assessment level made by the SR nurse among patients assessed by the dispatcher as low priority and/or vague symptoms. A consecutive journal review was conducted. During six months, 529 patients were assessed; 329 (62%) attended the emergency department (ED) or inpatient care (IC). Of these, 85 patients (26%) were assessed as high priority. Only 108 were assessed as being in need of ambulance transport. ED/IC patients were significantly older. Two hundred (38%) stayed at the scene (SS) (n = 142) or were referred to primary care (PC) (n = 58). Of the 200 SS/PC patients, 38 (19%) attended the ED within 72 hrs with residual symptoms, 20 of whom were admitted to a ward. Nine patients (4% of 200 SS/PC patients) required inpatient treatment and 11 patients stayed overnight for observation. These results suggest a relatively high level of patient safety and the usefulness of an SR among patients assessed by the dispatcher as low priority.

Swedish ambulance managers' descriptions of crisis support for ambulance staff after potentially traumatic events.

Ambulance staff face complex and sometimes stressful or potentially traumatic situations, not only in disasters but also in their routine daily work. The aim of this study was to survey ambulance managers' descriptions of crisis support interventions for ambulance staff after potential traumatic events (PTEs). Semistructured interviews with a qualitative descriptive design were conducted with six ambulance managers in a health care region in central Sweden. The data was analyzed using content analysis. Five categories were found in the result: (1) description of a PTE; (2) description and performance of crisis support interventions; (3) impact of working in potentially traumatic situations; (4) the ambulance managers' role in crisis support interventions; and (5) the ambulance managers' suggestions for improvement. Ambulance managers described crisis support interventions after a PTE as a single, mandatory group meeting with a structure reminiscent of debriefing. The ambulance managers also expressed doubts about the present structures for crisis support and mentioned an alternative approach which is more in line with present evidence-based recommendations. The results indicated a need for increased understanding of the importance of the managers' attitudes for ambulance staff; a need for further implementation of evidence-based recommendations for crisis support interventions was also highlighted.

Psychosocial Workload of Swedish Ambulance and Emergency Room Personnel with High Prevalence of Dying, Death and Grieving Relatives. A Descriptive and Comparison Study

Frequent caretaking of severely ill, dying, and dead people as well as bereaved close relatives could involve too much stress for emergency personnel to be satisfied with the job situation. Screening for critical aspects for work satisfaction and endurance at ambulance and emergency rooms would provide useful information to the workers themselves, their management, and for pre-hospital acute routines/programs. Two hundred and forty 40-item job-related, postal enquieries on demographical, as psychological, social, economical, and existential work aspects were sent to 26 clinical directors to be assessed by personnel at the ambulance and emergency rooms in Sweden. The response rate was 64%, the majority being nurses and nurse assistants, experiencing a very high, high, or rather high prevalence of severely ill or dead patients at their work place. The hospitals’ frequency of severely ill or dead patients predicted a higher mental workload experience in both ambulance and emergency room personnel. More personnel at the emergency rooms compared with ambulance workers expressed time pressure and were less satisfied with their caretaking, two of three reporting their job to be mentally straining as compared with one of three among the ambulance personnel. Change of work due to heavy workload was reported by one in three. The majority thought they could get used to a job with death and grieving, wellbeing however negatively affected. Still, the majority reported good health and little sick leave due to excessive workload. Several critical factors seemed important for job satisfaction among Swedish ambulance workers and personnel at the emergency rooms. Complaints about psychological stress, physically high workload, physical damage, many working hours, low salary, much shift- and night work, better vacation leave, more resources, too little time for recovery, crisis support and guidance, better routines, more explicit care programs including improved bereavement support for relatives, better possibilities for job control, self-efficacy, unit efficiency, and clearer work duties, and a family-non-conflicting job situation could favour work performance in both groups.