Picture Quiz: Know your anatomy.

A 25 year old man was brought into the emergency
department by ambulance. He was involved in a road
traffic incident and had an obvious site of blood loss from
a fracture of an upper limb. On his arrival at the
emergency department, you are told that the ambulance
paramedic was unable to gain intravenous access and
are asked by the person in charge of resuscitation to try
to gain access. You are unable to find any peripheral
veins because he is hypovolemic. You attempt to put in a
central line via the femoral vein (fig 1).

What counts and what is being counted – The social organization of knowledge on the front lines of emergency medical services.

Paramedics are trained to use specialized medical knowledge and a variety of medical procedures and pharmaceutical interventions to “save patients and prevent further damage” in emergency situations, both as members of “health-care teams” in hospital emergency departments (Swanson, 2005: 96) and on the streets – unstandardized contexts “rife with chaotic, dangerous, and often uncontrollable elements” (Campeau, 2008: 3). The paramedic’s unique skill-set and ability to function in diverse situations have resulted in the occupation becoming ever more important to health care systems (Alberta Health and Wellness, 2008: 12).
Today, prehospital emergency services, while varying, exist in every major city and many rural areas throughout North America (Paramedics Association of Canada, 2008) and other countries around the world (Roudsari et al., 2007). Services in North America, for instance, treat and/or transport 2 million Canadians (over 250,000 in Alberta alone ) and between 25 and 30 million Americans annually (Emergency Medical Services Chiefs of Canada, 2006; National EMS Research Agenda, 2001). In Canada, paramedics make up one of the largest groups of health care professionals, with numbers exceeding 20,000 (Pike and Gibbons, 2008; Paramedics Association of Canada, 2008). However, there is little known about the work practices of paramedics, especially in light of recent changes to how their work is organized, making the profession “rich with unexplored opportunities for research on the full range of paramedic work” (Campeau, 2008: 2).

This presentation reports on findings from an institutional ethnography that explored the work of paramedics and different technologies of knowledge and governance that intersect with and organize their work practices. More specifically, my tentative focus of this presentation is on discussing some of the ruling discourses central to many of the technologies used on the front lines of EMS in Alberta and the consequences of such governance practices for both the front line workers and their patients. In doing so, I will demonstrate how IE can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709).

Assessment Work of Paramedics on the Front lines of Emergency Health Services

This article draws on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. More specifically, I focus on the multiplicity of interfacing social, demographic, locational, situational, and institutional factors that shape and organize the work of paramedics. In doing so, this article provides insights into how paramedics orient to the social context in which their work occurs and contrasts this actual work with how their work is institutionally reported and made visible; what gets counted institutionally is not necessarily the same as what counts for the paramedics. This article problematizes this demarcation between what is known institutionally and “systematic practices of ‘not knowing’” (DeVault, 2008, p. 290).

La perception du rôle et les attitudes de cynisme et de désengagement chez le technicien ambulancier paramédic québécois dans le contexte des interventions non urgentes

Problématique : Le rôle des paramédics se transforme partout dans le monde. Les besoins des aînés et des malades chroniques entraînent une forte proportion d’interventions préhospitalières non urgentes. La confrontation entre la perception et l’expérience du rôle peut entraîner un conflit correspondant à un stress organisationnel modéré et chronique chez ces travailleurs. Pour y faire face, différentes stratégies d’adaptation peuvent être adoptées. Objectifs : Cette étude vise à dépeindre la réalité des interventions préhospitalières non urgentes des paramédics québécois et à explorer son influence sur leur perception du rôle et les manifestations de cynisme et de désengagement. Méthode : Les données qualitatives obtenues en entrevues semi-structurées ont été codifiées et analysées à partir d’un modèle adapté des théories en psychosociologie du travail et d’administration de la santé (n=13, 3 régions, intervenants de - de 3 à + de 20 ans de carrière). Résultats : Les paramédics reconnaissent vivre un conflit de rôle alors que la formation et la définition de leur pratique se rapportent exclusivement à l’urgence, au contraire de leur expérience. Ils manifestent des attitudes de cynisme et de désengagement affectant la qualité des services, précisant qu’il s’agit d’une réalité inhérente à leur expérience professionnelle intimement reliée à l’épuisement professionnel, plus qu’à un manque fondamental de professionnalisme. Conclusion : Les paramédics décrivent différents mécanismes à instaurer qui visent à reconnaître la dualité conflictuelle de leur pratique dont, la mise en valeur de leur aptitude clinique à intervenir en première ligne dans un cadre préhospitalier non urgent ainsi que l’ajustement et le rehaussement des programmes de formation.

Síntomas osteomusculares en el personal operativo de la empresa Emermédica S.A. en Bogotá D.C. 2012

Establecer la prevalencia de síntomas osteomusculares en el personal operativo de la empresa Emermédica S.A. durante los últimos 3 meses. Se realizó un estudio de corte trasversal en la empresa Emermédica S.A. de Bogotá en el año 2012, tomando una muestra de 75 trabajadores entre médicos, enfermeros y conductores del área operativa, a los cuales se les aplicó un instrumento de morbilidad sentida basada en el Cuestionario Nórdico y la Encuesta Europea, en búsqueda de síntomas osteomusculares asociados a la actividad desempeñada y a factores como edad, género, horas de trabajo por turno, tipo de vehículo, actividad deportiva, equipos utilizados y posturas adoptadas durante el desarrollo de sus actividades. Para el análisis de la información se creó una base de datos a partir de los cuestionarios contestados válidos y se utilizó el programa estadístico SPSS.

Cancellation of siren noise from two way voice communications inside emergency vehicles

Sirens used by police, fire and paramedic vehicles have been designed so that they can be heard over large distances, but unfortunately the siren noise enters the vehicle and corrupts intelligibility of voice communications from the emergency vehicle to the control room. Often the siren needs to be turned off to enable the control room to hear what is being said. This paper discusses a siren noise filter system that is capable of removing the siren noise picked up by the two-way radio microphone inside the vehicle. The removal of the siren noise improves the response time for emergency vehicles and thus save lives. To date, the system has been trialed within a fire tender in a non-emergency situation, with good results.

Results of a DSP based adaptive cancellation filter system for the chirp, pulsar and localiser sirens

Sirens’ used by police, fire and paramedic vehicles generate noise that propagates inside the vehicle cab that subsequently corrupts intelligibility of voice communications from the emergency vehicle to the control room. It is even common for the siren to be turned off to enable the control room to hear what is being said. Both fixed filter and adaptive filter systems have previously been developed to help cancel the transmission of the siren noise over the radio. Previous cancellation systems have only concentrated on the traditional 2-tone, wail and yelp sirens. This paper discusses an improvement to a previous adaptive filter system and presents the cancellation results to three new types of sirens; being chirp pulsar and localiser. A siren noise filter system has the capability to improve the response time for an emergency vehicle and thus help save lives. To date, this system has been tested using live recordings taken from a nonemergency situation with good results.

Mortality, malnutrition and the humanitarian response to the food crises in Lesotho

Background: At the height of the food crisis in southern Africa, the Government of Lesotho declared a state of famine and emergency in April 2002 and launched a Famine Relief Appeal for over $137 million. World Vision, in partnership with the World Food Program, became involved in December 2002 providing food aid to affected communities.
Objective: to document mortality rates, causes of death, malnutrition prevalence, and the proportion of lost pregnancies after almost three years of humanitarian response to the food crisis in Lesotho and to propose a way forward.
Design: A two-stage, 30 cluster household survey was undertaken in three districts from the 16th to the 26th of May 2005, with a sample size of 3610 people.
Results: The crude mortality rate (CMR) of 0.8/10,000/day (95%CI: 0.7-0.9). The reported CMR was significantly lower than the CMR emergency threshold (<1/10,000/day). Using 2000 as a pre-drought baseline, 38528 excess deaths occurred between 2000 and 2005. The under-five mortality rate (U5MR) of 3.2 deaths/10,000/day (95%CI: 2.8-3.6/10,000/day) was 4 times the reported CMR and 1.4 times higher the U5MR emergency threshold for sub-Saharan Africa (2.3/10,000/day). CMR was lower among food aid beneficiaries (0.68; 95%CI: 0.57-0.79) than non-beneficiaries (1.42; 95%CI: 1.13-1.70). This was also true for U5MR (2.94; 95%CI: 2.39-3.50 versus 6.44; 95%CI: 5.21-7.68). The prevalence of wasting increased from 5.4% to 12% while that of stunting declined from 45.4% to 36.2% between 2000 and 2005, but the nutritional status did not vary by beneficiary status.
Conclusion: Despite the alarming U5MR, findings suggest that the food aid program ensured survival mainly among adults. The situation could have been catastrophic in the absence of humanitarian assistance.

The teacher’s role in promoting online peer group learning

Teachers have a major responsibility to engage students online for successful learning in online distance education programs. Identifying key aspects of the teachers’ role is important. The study reported in this paper investigated an online course for paramedic students. Data were collected from the teachers and students and their online interactions were observed. The study has shown that students’ message posting is likely to be related to the cognitive demand and accessibility of discussion tasks that staff design and the quality of teacher facilitation of discussion.