Veronica Vicente

Randomized controlled trial of a prehospital decision system by emergency medical services to ensure optimal treatment for older adults in Sweden

To evaluate the feasibility and appropriateness of a prehospital system allowing ambulance nurses to transport older adults directly to geriatric care at a community‐based hospital (CH) or to an emergency department (ED).

Elderly patients’ participation in emergency medical services when offered an alternative care pathway

As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patients medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as “There was a ray of hope about a caring encounter and about being treated like a unique human being”. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.

Developing a decision support system for geriatric patients in prehospital care.

Objectives To develop a feasible and safe prehospital decision support system (DSS) for the emergency medical services (EMS), facilitating safe steering of geriatric patients to an optimal level of healthcare. Methods The development process involves four consecutive steps. The first step was gathering data from patients transported by EMS, with the electronic patient care record, to retrospectively identify appropriate patient categories for steering. The second step was to allow a group of medical experts to give advice and suggestions for further development of the DSS. The third step was validation of the decision support tool and the fourth step was validation of the entire prehospital DSS in a pilot study. Results The patient categories relevant to steering were those medical conditions that the geriatric clinicians felt confident in receiving from the EMS. A prehospital DSS was then developed for these 11 medical conditions. The evaluation and validation of the DSS showed a high degree of compliance with the patients’ final level of healthcare. The pilot study included 110 randomized patients; 33.9% were triaged to an alternative level of healthcare, that is geriatric care or primary care. No medical inaccuracies or secondary transports from alternative care to the hospital emergency department were identified. Conclusion Using this prehospital DSS – developed for 11 medical conditions – the Swedish prehospital nurse can safely decide on the level of healthcare to which an elderly patient can be steered.

The Emergency Medical Service personnel's perception of the transportation of young children

To our knowledge no previous studies have been made which describe the Emergency Medical Service (EMS) personnels perceptions of transporting children and the care encounter between the child, the parent and the EMS personnel when separating the child and the parent specifically in an ambulance. The aim of this study was to gain an understanding of how EMS personnel perceive ambulance transport of children. The study was carried out in 2012 at one of three ambulance contractors in Stockholm. Twelve semi-structured interviews were conducted and the content analysis showed that transporting children induces stress and is deemed a precarious task by EMS personnel mainly because children are considered more vulnerable than adults and because of the necessity to separate the child from the parent during transport. There is a conflict between medical- and emotional wellbeing and traffic-safety during the transportation of children and a fear of insufficient ability to care for the child. The EMS personnels vulnerability is evident in the complicated care situation associated with transporting children in an ambulance. These findings may be considered a first step in assessing if action is needed to improve care and patient safety during ambulance transportation of children.

Caring science research in the ambulance services: an integrative systematic review

Background The ambulance services are associated with emergency medicine, traumatology and disaster medicine, which is also reflected in previous research. Caring science research is limited and, since no systematic reviews have yet been produced, its focus is unclear. This makes it difficult for researchers to identify current knowledge gaps and clinicians to implement research findings. Aim This integrative systematic review aims to describe caring science research content and scope in the ambulance services. Data sources Databases included were MEDLINE (PubMed), CINAHL, Web of Science, ProQDiss, LibrisDiss and The Cochrane Library. The electronic search strategy was carried out between March and April 2015. The review was conducted in line with the standards of the PRISMA statement, registration number: PROSPERO 2016:CRD42016034156. Review methods The review process involved problem identification, literature search, data evaluation, data analysis and reporting. Thematic data analysis was undertaken using a five‐stage method. Studies included were evaluated with methodological and/or theoretical rigour on a 3‐level scale, and data relevance was evaluated on a 2‐level scale. Results After the screening process, a total of 78 studies were included. The majority of these were conducted in Sweden (n = 42), fourteen in the United States and eleven in the United Kingdom. The number of study participants varied, from a case study with one participant to a survey with 2420 participants, and 28 (36%) of the studies were directly related to patients. The findings were identified under the themes: Caregiving in unpredictable situations; Independent and shared decision‐making; Public environment and patient safety; Life‐changing situations; and Ethics and values. Conclusion Caring science research with an explicit patient perspective is limited. Areas of particular interest for future research are the impact of unpredictable encounters on openness and sensitivity in the professional–patient relation, with special focus on value conflicts in emergency situations.

Developing a decision support system for patients with severe infection conditions in pre-hospital care

OBJECTIVE To develop and validate a pre-hospital decision support system (DSS) for the emergency medical services (EMS), enabling the identification and steering of patients with critical infectious conditions (i.e., severe respiratory tract infections, severe central nervous system (CNS) infections, and sepsis) to a specialized emergency department (ED) for infectious diseases. METHODS The development process involved four consecutive steps. The first step was gathering data from the electronic patient care record system (ePCR) on patients transported by the EMS, in order to identify retrospectively appropriate patient categories for steering. The second step was to let a group of medical experts give advice and suggestions for further development of the DSS. The third and fourth steps were the evaluation and validation, respectively, of the whole pre-hospital DSS in a pilot study. RESULTS A pre-hospital decision support tool (DST) was developed for three medical conditions: severe respiratory infection, severe CNS infection, and sepsis. The pilot study included 72 patients, of whom 60% were triaged to a highly specialized emergency department (ED-Spec) with an attending infectious disease physician (ID physician). The results demonstrated that the pre-hospital emergency nurses (PENs) adhered to the DST in 66 of 72 patient cases (91.6%). For those patients steered to the ED-Spec, the assessment made by PENs and the ID physician at the ED was concordant in 94% of cases. CONCLUSIONS The development of a specific DSS aiming to identify patients with three different severe infectious diseases appears to give accurate decision support to PENs when steering patients to the optimal level of care.

7 We need support

Aim New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. Method A classical Delphi technique in four rounds was used. A purposeful sample and snowball technique was used and generated an expert panel of 32 registered nurses with 12–36 months of EMS experience. In round one telephone interviews were undertaken to identify what support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded 70 items which were developed into a questionnaire. In subsequent three rounds the experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75 percent. Results Desirable support was categorised into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organisation and other support. The experts agree on the level of importance on 64 items regarding desirable support. Of these, 63 items were considered important, graded 4 or 5. One item was considered not important, graded 1 or 2. Conclusion Even with requested formal competence of the professionals, the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented. Conflict of interest None Funding Academic EMS in Stockholm.

Specialist nurses’ experiences when caring for preverbal children in pain in the prehospital context in Sweden

The United Nations Convention on the Rights of the Child (UNCRC) [33] defines a child as any person below 18 years of age. All children are equal and have the same rights including the right to good health. Prehospital services encounter people in need of all ages and with all kinds of health problems. Pain is a common reason for seeking prehospital care. Crucial to patients in pain is how prehospital emergency nurses (PENs) most effectively alleviate their pain.