How do ambulance personnel experience work at a disaster site?

Emergency Management and Preparedness Training for Youth (EMPTY): The Results of the First Swedish Pilot Study

OBJECTIVE

To examine the impact of a simulation training in raising a group of young students' personal and situational awareness in disasters and emergencies.

METHODS

In total, 25 young students participated in two simulation scenarios representing two actual events, fire, and shooting, using a combination of two validated simulation training (Emergency Management and Preparedness Training for Youth [EMPTY]). The changes in their knowledge and awareness were evaluated by using questionnaires and the whole simulation was evaluated by three independent observers and a reference group.

RESULTS

New concepts of emergency management, for example, evacuation, and barricading, could be trained in a safe environment. There was a significant increase in students' personal and situational awareness and their active engagement in the management of emergencies.

CONCLUSION

EMPTY could raise the youth basic knowledge and ability to understand the concept of preparedness by being mentally prepared, available for collaboration, gaining a higher confidence, understanding the physical and psychological consequences of a major incident and the importance of their own safety. (Disaster Med Public Health Preparedness. 2018;12:685-688).

The Prehospital assessment of severe trauma patients` performed by the specialist ambulance nurse in Sweden - a phenomenographic study

Background

A common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse’s ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses’ perceptions of assessing patients exposed to severe trauma.

Methods

This study had a phenomenographic approach and was performed in 2011 as an interview study. 15 specialist ambulance nurses with a minimum of 2.5 years of experience from praxis were included. The analysis of data was performed using phenomenography according to Marton.

Results

The perceptions of assessing patients exposed to severe trauma were divided into: To be prepared for emergency situations, Confidence in one’s own leadership and Developing professional knowledge.

Conclusions

This study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed.

The discotheque fire in Gothenburg 1998. A tragedy among teenagers

The fire disaster in Gothenburg, Sweden, 1998 killing 63 and wounding 213 teenagers was caused by arson committed by a youth from the same community. The fire was started in the basement of an overcrowded discotheque and made, due to unfortunate circumstances, devastating progress. The ensuing rescue work performed by other youth, fire fighters, police and medical staff was prompt and must be seen in the light of a very difficult situation. As a result of these orchestrated efforts and the fact that this disaster occurred in a major city with substantial resources, all the injured were able to be hospitalized within 2h. The load on four local hospitals was initially severe due to the large number of injured and the limited number of staff on night duty. The situation was contained by relocating patients from the intensive care units to ordinary wards and by transporting several of the most severe burn injuries by helicopter to burn units in other parts of Sweden and to Norway. Hundreds of relatives and friends gathered at the local hospitals. This was a new experience for the hospitals and staff, involving many positive aspects as well as some negative aspects such as violence, threats and rumors. As a result of the large number of injuries vast psychosocial rehabilitation program was initiated by health care staff, religious communions, schools and the community, has continued over the past years. Such a disaster emphasises a requirement for extensive preparation not only in the rescue and medical services, but also in the ways and areas to rehabilitate patients in society.

The meaning of traumatic events as described by nurses in ambulance service

Ambulance personnel are working with the injured and dead and are therefore exposed to a variety of stressors that can lead to the development of physical, psychological and social reactions. Stress among ambulance personnel can be regarded as a natural behaviour and reaction when experiencing a traumatic event. The aim of this phenomenological study is to uncover the essence of traumatic events experienced by Swedish ambulance personnel. Knowledge about such events contributes to the awareness of risk for post-traumatic stress symptom and serves as a platform for developing measures to handle such stress. In this study, written stories from 52 of 223 ambulance nurses and ambulance technicians describing an experienced traumatic event, are analysed by the method of van Kaam. Findings indicate that the nurses and technicians have a strong identification with the victims and it is impossible to prepare for events that are unforeseen and meaningless. To handle the overwhelming feelings of identification, the personnel have to gain understanding through talking about those feelings. Therefore it is important that ambulance management, following stressful events, provide the opportunity and time for ambulance personnel to share their feelings. Teaching ways of decreasing identification and emotional involvement with the victim may also be an effective preventive measure.

Experiences of threats and violence in the Swedish ambulance service

Ambulance personnel often meet people in a crisis situation that requires a readiness to act, and which takes for granted a broad knowledge in caring, together with an ability to size up the circumstances in each separate incident. The afflicted individual's first contact with a medic in an emergency situation is very often ambulance personnel and this first meeting can involve incidents that may radically change the existing state of things for the ill or injured and, maybe, even for near relatives. Sometimes these situations can lead to threats and acts of violence aimed at the ambulance staff. The aim of the study was to describe how ambulance personnel perceive, how they are subjected to, and are influenced by, threats and violence in their day-to-day work. The empirical study was descriptive and consisted of a questionnaire comprising a total of 13 questions. Answers from the 66 respondents revealed that 53 persons (80.3%) were subjected to threats and/or violence. The majority were of the opinion that the relationship between the paramedic and the patient was most certainly affected when threat or violence is a part of the situation. The study shows that many ambulance personnel have, on occasion, been subjected to one or several threats and/or situations involving the use of violence. The majority regarded this as an unpleasant experience.