Andreas Rantala

The meaning of significant others’ encounter with the ambulance clinicians in a non-emergency care context

The ambulance service is often summoned by a significant other. Therefore the ambulance clinician is expected to establish a trusting relationship with her/him and not focus solely on the patient. The aim of this study was to illuminate the meaning of significant others’ encounter with ambulance clinicians in a non-emergency ambulance care context, where patients were triaged to a level of care below that of the Accident and Emergency Department. The design was inductive. We used the phenomenological hermeneutic method developed by Lindseth and Norberg. Eleven significant others were interviewed using an open-ended method. A structural analysis resulted in a total of seven themes, covering the meaning of being de-burdened or the absence of de-burdening. When de-burdened, the significant other was empowered, irrespective of the outcome of the medical assessment and triage process. In the absence of de-burdening, the significant other felt inferior, petty, de-powered and not taken seriously by the ambulance clinicians. The majority of ambulance assignments are considered non-emergency care. The ambulance clinicians are the first to encounter significant others in these situations and therefore have a huge obligation to understand and handle their basic needs.

Acute abdominal pain; prehospital evaluation of Ketobemidone administration

Abdominal pain is a frequent condition among patients in ambulance care and, each patient should receive optimal doses for pain relief. The aim of this study was to evaluate pain scores at admission to hospital and relationship to age, in pre-hospital patients with treated acute abdominal pain. Pain was scored with a Numeric Rating Scale (NRS) by each patient at the rescue scene (NRSs). Ketobemidone was then administered intravenously in incremental doses to achieve NRS-values of four or less, and then NRS was re-evaluated at admission to hospital (NRSh). The results from 64 patients demonstrated statistical significant differences between median NRSs and NRSh scores; 7.0 and 3.5 respectively (p<0.05). Mean ketobedmidone doses were 3.7±1.9 mg. There was a negative correlation between age and pain scores (p<0.01), and NRSs correlated with NRSh which means that patients with high scores for initial pain also scored higher on arrival in the emergency room (p<0.05). This study describes that the general dose of pain-relieving medications with ketobemidone seems to be adequate since the patientssubjective assessments of pain achieve a NRS value less than four at admission to hospital. The study also demonstrate that older the patients, less pain was reported both on the rescue scene and on admission at the hospital.