Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

Noah Benevolent Society records, undated, 1852-1979.

Collection consists of several versions of the constitution; minute books of the membership meetings (1852-1856, 1868-1907, 1914-1971; until 1907 in German, afterwards in English); minute books of meetings of the trustees (1852-1858, 1876-1974, until 1912 in German); an index to and summary of the trustees minutes (1927-1944); several anniversary journals starting with the 50th, which was also "the first extant history of the Noah Benevolent Society"; membership books (1861-1892, 1930-1965, until 1892 in German; the books after 1930 contain detailed information concerning each member's age, occupation, family, military service, etc.); financial records (1862-1870, 1964-1967, 1972); quarterly accountant's reports (bound with the membership minutes); monthly financial and statistical reports of the Mordechai Federal Credit Union (March 1959-June 1960) established by the Society; lists and addresses of members; newsletters (1927-1979) and other material and photographs reflecting the Society's activities.

Naomi Block Manners Stern collection of Eleanor Roosevelt correspondence undated, 1941-1962, 1972, 1974, 1976, 1984, 2003

This collection is mainly composed of correspondence between Ms. Stern and Mrs. Roosevelt, spanning the years from their first acquaintance in 1941 to Mrs. Roosevelt's decease in 1962. Letters that hold particular interest concern Ms. Stern's experience at the Summer Student Leadership Institute, and the White House. Additional material in the collection encompasses articles, newsclippings, programs, press releases, and photographs. The articles and newsclippings folder contains information pertaining to Ms. Stern's college career, the first Summer Student Leadership Institute, Mrs. Roosevelt's talk at Community Day, National Youth Association, and a donation of an ambulance to the war effort by Hunter college students. Naomi Block Manners Stern personal folder contains an article Naomi Block wrote in her college magazine, "Echo," describing her perceptions of President Roosevelt and Prime Minister Winston Churchill during her first visit at the White House. Also included is her graduation program, listing Mrs. Roosevelt as the main speaker, a commemoration of President Roosevelt in 1972 in which Ms. Stern took part, an article and press release describing Ms. Stern's career at Revlon, and a 2003 written summary of Ms. Stern's relationship with Mrs. Roosevelt. Photographs were taken by Naomi Block and others at the Summer Leadership Institute in 1941 portray identified fellow students, Mrs. Roosevelt, James Roosevelt, the Roosevelt home in Campobello, and Felix Frankfurter.

Experiences in becoming a paramedic: The professional socialization of university qualified paramedics

In this article, the professional socialization of university educated paramedics from the United Kingdom and Australia is discussed using the anticipatory, formal and post-formal phases of socialization. Participants for this research were from universities and ambulance services in Australia and the United Kingdom, and the data were collected and analyzed by qualitative methods. The anticipatory, formal and post-formal phases were deemed to be relevant to the professional socialization of university paramedics. However a fourth phase, called the post-internship phase was identified which better accounted for the paramedic training and practice model. The findings from this research led to the development of a four phase model of professional socialization to describe the experiences of university educated paramedics making the transition from university students to qualified paramedics.

Diseño y desarrollo de una aplicación de 112 de nueva generación

[ES]Este proyecto trata acerca de diseñar y desarrollar una nueva aplicación de 112 de nueva generación. Para ello, se realiza un estudio de todas las alternativas posibles y se establece como objetivo la creación de una aplicación que se base en las redes de nueva generación, más conocidas como NGN. Esta aplicación se conectará con los servicios de emergencia (ambulancias, bomberos, policía…), proporcionando la localización del usuario y, en base a ello, contactar con el servicio más cercano posible. Además, se trata de comprobar si las nuevas tecnologías emergentes pueden ser utilizadas cualquier otro fin.

Mobilização do corpo-si na gestão da atividade de motoristas de ambulâncias

Esta tese busca explorar as possibilidades contidas do corpo na gestão da atividade de trabalho de motoristas de ambulâncias. Trata-se de uma concepção de corpo, não oponente a alma, que se notabiliza pelo pensamento, pela inteligência, pelo sistema nervoso, pela história: um corpo-si. O diálogo mantido com a perspectiva ergológica, aqui convocada, opera-se a partir da concepção de vida, saúde-doença em George Canguilhem, da contribuição ergonômica, dos referenciais da linguagem e trabalho e da etnografia. Para configuração do campo empírico, adotaram-se métodos e técnicas apropriados de pesquisa em situação concreta de trabalho, denominadas visitas, instrumentalizadas com técnicas de entrevistas dialógicas e observações da atividade, além de uma pesquisa bibliográfica e análise global do trabalho. A pesquisa contou com a participação de motoristas de UTI móvel de uma empresa de transportes de ambulâncias da cidade do Rio de Janeiro. A análise das situações de trabalho foi inspirada na ergonomia da atividade e nas contribuições da perspectiva dialógica. Dentre os resultados obtidos destacamos: problemas de comunicação na relação de trabalho entre motoristas e a Central de Atendimento (Call Center), estado de má conservação e de desconforto das ambulâncias, riscos de doenças no contato com o usuário, insuficiência salarial e atraso no pagamento, indeterminação de pausas durante a jornada, contraintes temporais decorrentes da pilotagem em casos de urgência e emergência, ameaças de multas por excesso de velocidade, além de obstáculos emanados do trânsito: engarrafamentos, barulhos, semáforos, etc. Enfim, um conjunto de variabilidades e infidelidades do meio de trabalho, que permite aos motoristas produzirem novos usos de si, porque mobilizam a integralidade do corpo para chegar a modos operatórios que deem conta dessas situações de trabalho, considerando, sobretudo, a gestão da dinâmica entre as exigências de produtividade e qualidade com saúde, segurança e fiabilidade.

O princípio da Integralidade e o SAMU

A partir de 2002 o Estado assume o esforço de normatizar a atenção às urgências com edição de Portarias e documentos. O SAMU foi o primeiro componente da política implantado. Ele opera com ambulâncias com ou sem médico e com recursos tecnológicos diversos. Este estudo teve como objetivo analisar o potencial de prática de integralidade no SAMU. Para tal, foram realizadas três etapas de trabalho. Analisou-se a política de urgência a partir dos documentos e Portarias que a compõem. No trabalho de campo foram entrevistados seis gestores dos três níveis de governo e avaliadas as práticas de regulação nos SAMU do Estado do Rio de Janeiro. A metodologia utilizou o referencial da análise da conduta estratégica da Teoria da Estruturação de Giddens (1984) relacionando as capacidades cognitivas dos agentes e suas estratégias de ação, com as dimensões estruturais. Para o campo, além da teoria de Giddens, busquei no referencial da avaliação, indicadores (incluindo os da política), dialogando com a análise d situação do serviço. A Política de Urgência tece como marcos os financiamento federal, a regionalização, a capacitação dos profissionais, a função do SAMU de observatório da rede; e a gestão por comitês de urgência. A integralidade é proposta como valor, na indicação de utilizar o conceito ampliado de urgência, através da regionalização e da comunicação entre os serviços. A capacitação não foi instituída no estado e os vínculos empregatícios eram precários. Foi constatada a inoperância do Comitê Gestor Nacional de Urgências e a ausência do Comitê Estadual. Não há assistência integrada tendo entre as causas a insuficiência estrutural da rede, representada pela ausência da atenção básica e pela precariedade nos hospitais de referência. Não há produção e utilização de informação e o SAMU não cumpre a função de observatório de saúde. Os três SAMUs têm estruturas diferenciadas. Foram analisados 206 atendimentos e sua categirazação destacou: o SAMU bem sucedido, com práticas de integralidade no seu componente individual e de acesso aos serviços; sua função de observatório de rede, que refletiu o vazio assistencial do PSF e média complexidade e a restrição do acesso hospitalar; a insuficiência de recursos, com uso inadequado de ambulâncias; e demandas não reconhecidas, onde casos de urgência não reconhecida foram recusados. Destaca-se a prevalência da urgência clínica. Conclusão: a legitimação da regulação esteve presente na atitude dos entrevistados e de alguns profissionais nos casos do SAMU bem sucedido. A densidade das propostas documentais foi a vertente facilitadora do recurso estrutural. A mobilização de recursos autoritativos e alocativos mostrou fragilidades. Não houve mudança significativa nas práticas tipicamente excludentes do SUS, mas acreditamos no efeito cumulativo dos pequenos desvios que têm na ética e na solidariedade a base da aplicação do conhecimento técnico.

Trust-Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety. © 2013 Society for Risk Analysis.

NHS Wales user needs study including knowledgebase tools report. Report for Informing Healthcare Strategy implementation programme.

Thomas, R., Spink, S., Durbin, J. & Urquhart, C. (2005). NHS Wales user needs study including knowledgebase tools report. Report for Informing Healthcare Strategy implementation programme. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: Informing Healthcare, NHS Wales

Qualitative evaluation of KA24 (Knowledge Access 24)

Durbin, J. & Urquhart, C. (2003). Qualitative evaluation of KA24 (Knowledge Access 24). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: Knowledge Access 24 (NHS)

Foundations for paramedic practice: a theoretical perspective

Written by leading paramedics and academic subject experts, with a foreword by Paul Bates, this is the first foundation level text to introduce the main theoretical subjects studied on the new higher education paramedic science programmes. It underpins practice and links ways of working to the crucial theory base. The numerous examples and case studies focus specifically on pre-hospital and emergency care. Key topics covered include: * NHS and ambulance service history * Ethics and law for the paramedic * Communication and reflective practice * Professional issues, including evidence-based practice, anti-discriminatory practice, clinical governance and clinical audit * Psychological perspectives on health and ill health * Safeguarding children * Sociological perspectives on health and ill health and social policy * Managing change and leadership theory * Continuing professional development The text prompts you to stop and think about what you have just read and relate this to your role. Throughout the book, the author carefully considers how the theory being discussed relates to the role of the ambulance clinician. Foundations for Paramedic Practice: A Theoretical Perspective is a core text for students of paramedic science and will also provide a valuable resource for students of allied health professions. This text provides a stepping stone to further reading and investigation. - Taken from the back cover of: Amanda Blaber - Foundations for paramedic practice: a theoretical perspective

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).

Impact of an intervention to control risk associated with patient transfer.

QUESTION UNDER STUDY: Hospitals transferring patients retain responsibility until admission to the new health care facility. We define safe transfer conditions, based on appropriate risk assessment, and evaluate the impact of this strategy as implemented at our institution. METHODS: An algorithm defining transfer categories according to destination, equipment monitoring, and medication was developed and tested prospectively over 6 months. Conformity with algorithm criteria was assessed for every transfer and transfer category. After introduction of a transfer coordination centre with transfer nurses, the algorithm was implemented and the same survey was carried out over 1 year. RESULTS: Over the whole study period, the number of transfers increased by 40%, chiefly by ambulance from the emergency department to other hospitals and private clinics. Transfers to rehabilitation centres and nursing homes were reassigned to conventional vehicles. The percentage of patients requiring equipment during transfer, such as an intravenous line, decreased from 34% to 15%, while oxygen or i.v. drug requirement remained stable. The percentage of transfers considered below theoretical safety decreased from 6% to 4%, while 20% of transfers were considered safer than necessary. A substantial number of planned transfers could be "downgraded" by mutual agreement to a lower degree of supervision, and the system was stable on a short-term basis. CONCLUSION: A coordinated transfer system based on an algorithm determining transfer categories, developed on the basis of simple but valid medical and nursing criteria, reduced unnecessary ambulance transfers and treatment during transfer, and increased adequate supervision.

Factors influencing emergency delays in acute stroke management.

Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Horton Family collection, 1912, 1919, 1924, n.d.

Dr. William Hamilton Merritt, Jr. was born in 1865 and died in 1924. He was the son of Jedidiah Prendergast Merritt and Emily Prescott, grandson of William Hamilton Merritt. In 1892 he was married to Maud Claudman Hudson of Memphis, Tennessee and had a daughter and a son. During World War I he commanded the 14th battery at Flanders and after becoming ill served as part of the 9th Canadian Field Ambulance, 3rd Canadian Division, serving at a military hospital in Orpington, Kent, England and in 1917 at a military hospital in France. Dr. Merritt served as alderman and mayor for the city of St. Catharines, Ont. He was also a vice-president of the Imperial Bank of Canada, and served on the board of the Niagara Falls Suspension Bridge. A memorial service was held in St. Thomas Church, St. Catharines, Ont. on April 24, 1924.