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The objective of this thesis is to review the literature on ambulance collisions, focusing on their prevalence, characteristics, and risk factors, and to conduct a retrospective analysis of ambulance collisions in Quebec, Canada, between 2010 and 2020. To achieve this objective, a systematic review of 26 studies published in PubMed between January 1990 and July 2021 was performed, and a retrospective analysis of ambulance collisions in Quebec was conducted using data from the Société de l’assurance automobile du Québec (SAAQ) and Urgences-santé. The prevalence, characteristics, and risk factors of ambulance collisions were analyzed, and statistical tests, descriptive analysis, and logit regression were used to compare ambulance and general vehicle collisions in 17 regions of Quebec. The results (systematic review) showed that ambulance collisions were more prevalent and severe than collisions involving other professional drivers or similarly sized vehicles. Younger and less experienced drivers were more likely to be involved in ambulance collisions, which were more likely to occur in urban areas, at intersections, and while responding to emergency calls. The retrospective analysis revealed that ambulance collisions occurred most frequently near intersections or between intersections, in commercial areas, and on two-way roads. The severity of ambulance collisions was associated with factors such as asphalt conditions, collision types, and locations. In conclusion, ambulance collisions pose a significant risk to the safety of medical emergency responders, and tailored preventive policies and programs are needed to reduce the burden of these occupational collisions. Targeted interventions are required to reduce the risk of collisions at intersections and while responding to emergency calls, particularly for younger and less experienced paramedics who should be a particular focus of training and awareness programs. L'objectif de cette thèse est de passer en revue la lit

Introduction: Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords. Methods: For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021–May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate. Results: A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s)(95% confidence interval [CI] 43.7–56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7–31.0). The median difference between actual and perceived time was 18 s (interquartile range 6–30). We calculated hig

Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl’s framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancin

Objective: To explore quantitatively, using streamlined mathematics, how transmembrane potential differences across cell bodies of individual cortical neurons could act to produce the skin surface potentials of the electroencephalogram (EEG), and how ischemic stroke might be detected using EEGs in prehospital settings. Methods: From fundamental principles of electrostatics, anatomy, and physiology, one can characterize the strength of apparent dipoles created during activation of the cell bodies of individual cortical neurons. The transient dipole strength in a cortical neuron depends upon the size and surface area of its cell body, its capacitance, and the difference in transmembrane electrical potentials appearing across the cell body. The aggregate potentials of the EEG are a function of the many individual dipole strengths, directions, and distances from the electrode. Reduced activity and firing rates of cortical neurons model the effects of acute ischemia in tissue underlying one or both EEG electrodes. Results: Clinically realistic EEG records can be simulated if 25 cell bodies are randomly active in the 1 cm3 volumes of gray matter closest to skin surface electrodes at any instant in time. Complete cessation of neural activity under just one EEG electrode causes a modest decrease in aggregate EEG signal amplitude and frequency. However, reduction in neural activity to between 5 and 50 percent of normal under both EEG electrodes causes detectable 30% to 70% decreases in EEG amplitude, compared to normal. Conclusions: Such changes in electrical activity could be used in scenarios for rapid early detection of acute ischemic stroke, possibly expediting thrombolytic or reperfusion therapy, provided that both electrodes are located over the ischemic area and that the signals are compared to normal signals from the opposite side of the head.

The purpose of this mixed methods constructivist grounded theory (CGT) study is to explore how paramedics and medical directors (MD)s in the United States perceive outcomes feedback regarding its type, quality, and quantity. This type of feedback, which can influence their critical thinking skills, knowledge base, and job satisfaction, is crucial to their professional development. In this study, patient outcomes feedback refers to general patient information, including emergency department assessment, treatment, diagnosis, admission or discharge decisions, and the overall outcome of the patient's hospital experience. The conceptual framework, focusing on the perspectives of paramedics and medical directors, is based on Creswell and Poth's mixed methods research. This framework shaped the study, survey, and interview questions about MDs' and paramedics' experiences with feedback on outcomes, influencing factors, and the feedback processes' effects on participants. This study addresses the lack of research on feedback on patient outcomes for paramedics, offering an emerging perspective and potential to enhance paramedics' critical thinking skills. MDs and paramedics were purposively recruited for interviews using snowball and convenience survey sampling. Data collection involved interviews, memoing, and theoretical reflexivity, which informed the coding processes. The data were analyzed through initial coding, category development, and theoretical coding and then merged with quantitative and qualitative survey data to inform the CGT on outcomes feedback. The convergence of these processes resulted in a finalized theory that links the knowledge gap from a constructivist perspective to EMS feedback, enhancing clinical decision-making and resilience.

The demographic makeup of fire departments, including firefighters and paramedics, often does not reflect communities. This thesis poses the following research question: What factors support and inhibit the recruitment and retention of African American firefighters and paramedics in the United States? The research relied on documented open-source information and data from fire and emergency medical service (EMS) departments in the United States. In examining issues affecting the recruitment and retention of African Americans in the profession, this study considers the history of the fire service and EMS, along with other internal and external factors that could support or inhibit the recruitment and retention of African Americans. The research offers several recommendations to remedy this issue, including mandating Courageous Conversations workshops, creating a diverse full-time recruiting team, developing pipeline partnerships, and changing hiring and training processes., Civilian, Memphis Fire Department, Approved for public release. Distribution is unlimited.

Bakgrund: Ambulanssjuksköterskors uppdrag handlar till stora delar om att undersöka, bedöma, triagera och behandla patienter. Sjukdomsbilden spänner från svårt sjuka till enkla åkommor eller ibland helt oskadda patienter. Att hänvisa till rätt vårdnivå är viktigt då sjukvårdens resurser är begränsade och behöver användas på rätt sätt till rätt patienter. Rätt vårdnivå kan ibland innebära att patienten kvarstannar i hemmet, med råd till egenvård, eller att ta sig till vårdinstans med närståendes hjälp eller sjukresa, så kallad non-conveyance. Syfte: Syftet var att beskriva ambulanssjuksköterskors upplevelser av non-conveyance i glesbygdsmiljö. Metod: Kvalitativ studie med induktiv ansats. Från fem ambulansstationer i norra Sverige rekryterades åtta deltagare. Datainsamlingen utfördes genom individuella semistrukturerade intervjuer. Därefter analyserades intervjuerna utifrån kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i två kategorier, “Avståndet är en betydande del i beslutet” och “Stärka mötet vid non-conveyance genom omvårdnad”. Dessa två kategorier innehåller fem underkategorier “Beslutet att lämna hemma på gott och ont”, “Utmaningarna ökar med avstånd”, “Möta motstånd och bemöta det”, “Viljan att göra mer och det lilla extra” och “Ta hjälp av hemtjänst eller närstående när patienten inte medföljer”. Slutsats: Erfarenhet och god kunskap är viktigt för att kunna genomföra en god undersökning och bedömning. Avståndet är också en betydande faktor i beslutet att lämna hemma, dessutom är viljan att göra det lilla extra en betydande del i arbetet i glesbygdsmiljö. Att göra bedömningar och ta beslutet att inte transportera patienten upplevs som både utmanande och svårt.

Bakgrund: Kommunikationen över radio och på skadeplats har en avgörande roll för kvaliteten på samverkan mellan blåljuspersonal. Utbildning och övning är nödvändigt för att upprätthålla och förbättra förmågan till kommunikation i syfte att kunna hantera allvarliga händelser. Motiv: Behovet av god samverkan mellan ambulanspersonal och polis ökar. En god samverkan främjar patientsäkerheten och minskar patientmortaliteten på skadeplats. Syfte: Kartlägga ambulanspersonalens och polisers uppfattning om hur kommunikationen fungerar mellan dem under samverkansuppdrag. Metod: Studien är en kvantitativ webbaserad enkätstudie. Studien inkluderade personal från Polismyndigheten och ambulanssjukvården i Stockholm samt Dalarna. Totalt deltog 200 respondenter. Variabler som yrkesroll, region/område, kön, yrkeserfarenhet, kommunikation över radio och på skadeplats samt antalet samverkansövningar respondenterna medverkat i studerades. Data analyserades i SPSS Statistics och presenteras beskrivande med medianer och procentsatser samtjämförande med Chi2-test. Resultat: Majoriteten av respondenterna ansåg att kommunikationen över radio (n=129, 64,5%) samt på skadeplats (n=151, 75,5%) mellan organisationerna var välfungerande under samverkansuppdrag. Majoriteten (n=144, 72%) ansåg att svarsfrekvensen av den andra organisationen över radio var bristande. Samband påvisades mellan yrkesroll och hur kommunikationen uppfattades på skadeplats (p<0,001) samt uppfattningen av att liknande radiospråk/begrepp används (p=0,009). Samband påvisades mellan antal samverkansövningar och uppfattningen om svarsfrekvensen över radio av den andra organisationen (p=0,007). Konklusion: Kommunikationen mellan ambulanspersonal och poliser uppfattades mestadels som välfungerande av båda organisationerna. Samband påvisades mellan yrkesroll och uppfattningen av kommunikation samt mellan samverkansövningar och svarsfrekvensen över radio. Kunskapen om kommunikation mellan organisationerna kan förhoppningsv, Background: Communication has a decisive role for the quality of collaboration between first responders. Education and training are necessary to maintain and improve the ability to communicate in order to handle serious incidents. Motive: The demand for good collaboration between paramedics and police officers is increasing. A good collaboration between first responders increases patient safety and reduces patient mortality at the scene of the accident. Aim: The aim of the study is to identify how the communication between paramedics and police officers works during cooperation. Methods: The study is a quantitative web-based survey study. The study included personnel from the Police Authority and the ambulance service in Stockholm and Dalarna (Sweden). 200 respondents participated in the study. Variables that were studied were professional role, region/area, gender, work experience, communication through the radio and at the scene of the accident and the amount of cooperation exercises the respondents participated in. Data were analyzed using SPSS Statistics and presented descriptively with medians and percentages and comparatively with Chi-squared tests. Result: The majority of the respondents indicated that the communication through the radio (n=129, 64,5%) and at the scene of the accident (n=151, 75,5%) was well-functioning. The majority (n=144, 72%) also stated that the response rate from the other organization through the radio was lacking. A relation was discovered between profession and how communication was experienced at the scene of the accident (p<0,001) likewise the experience of similar radio-language/terms being used (p=0,009). A relation was indicated between the amount of collaboration exercises and the perceived response rate through the radio (p=0,007). Conclusion: The communication between paramedics and police officers was broadly perceived as well-functioning by both organizations. A relation was demonstrated between profession and how t

Bakgrund: Kommunikationen över radio och på skadeplats har en avgörande roll för kvaliteten på samverkan mellan blåljuspersonal. Utbildning och övning är nödvändigt för att upprätthålla och förbättra förmågan till kommunikation i syfte att kunna hantera allvarliga händelser. Motiv: Behovet av god samverkan mellan ambulanspersonal och polis ökar. En god samverkan främjar patientsäkerheten och minskar patientmortaliteten på skadeplats. Syfte: Kartlägga ambulanspersonalens och polisers uppfattning om hur kommunikationen fungerar mellan dem under samverkansuppdrag. Metod: Studien är en kvantitativ webbaserad enkätstudie. Studien inkluderade personal från Polismyndigheten och ambulanssjukvården i Stockholm samt Dalarna. Totalt deltog 200 respondenter. Variabler som yrkesroll, region/område, kön, yrkeserfarenhet, kommunikation över radio och på skadeplats samt antalet samverkansövningar respondenterna medverkat i studerades. Data analyserades i SPSS Statistics och presenteras beskrivande med medianer och procentsatser samtjämförande med Chi2-test. Resultat: Majoriteten av respondenterna ansåg att kommunikationen över radio (n=129, 64,5%) samt på skadeplats (n=151, 75,5%) mellan organisationerna var välfungerande under samverkansuppdrag. Majoriteten (n=144, 72%) ansåg att svarsfrekvensen av den andra organisationen över radio var bristande. Samband påvisades mellan yrkesroll och hur kommunikationen uppfattades på skadeplats (p<0,001) samt uppfattningen av att liknande radiospråk/begrepp används (p=0,009). Samband påvisades mellan antal samverkansövningar och uppfattningen om svarsfrekvensen över radio av den andra organisationen (p=0,007). Konklusion: Kommunikationen mellan ambulanspersonal och poliser uppfattades mestadels som välfungerande av båda organisationerna. Samband påvisades mellan yrkesroll och uppfattningen av kommunikation samt mellan samverkansövningar och svarsfrekvensen över radio. Kunskapen om kommunikation mellan organisationerna kan förhoppningsv, Background: Communication has a decisive role for the quality of collaboration between first responders. Education and training are necessary to maintain and improve the ability to communicate in order to handle serious incidents. Motive: The demand for good collaboration between paramedics and police officers is increasing. A good collaboration between first responders increases patient safety and reduces patient mortality at the scene of the accident. Aim: The aim of the study is to identify how the communication between paramedics and police officers works during cooperation. Methods: The study is a quantitative web-based survey study. The study included personnel from the Police Authority and the ambulance service in Stockholm and Dalarna (Sweden). 200 respondents participated in the study. Variables that were studied were professional role, region/area, gender, work experience, communication through the radio and at the scene of the accident and the amount of cooperation exercises the respondents participated in. Data were analyzed using SPSS Statistics and presented descriptively with medians and percentages and comparatively with Chi-squared tests. Result: The majority of the respondents indicated that the communication through the radio (n=129, 64,5%) and at the scene of the accident (n=151, 75,5%) was well-functioning. The majority (n=144, 72%) also stated that the response rate from the other organization through the radio was lacking. A relation was discovered between profession and how communication was experienced at the scene of the accident (p<0,001) likewise the experience of similar radio-language/terms being used (p=0,009). A relation was indicated between the amount of collaboration exercises and the perceived response rate through the radio (p=0,007). Conclusion: The communication between paramedics and police officers was broadly perceived as well-functioning by both organizations. A relation was demonstrated between profession and how t

Bakgrund: Ambulanssjuksköterskors uppdrag handlar till stora delar om att undersöka, bedöma, triagera och behandla patienter. Sjukdomsbilden spänner från svårt sjuka till enkla åkommor eller ibland helt oskadda patienter. Att hänvisa till rätt vårdnivå är viktigt då sjukvårdens resurser är begränsade och behöver användas på rätt sätt till rätt patienter. Rätt vårdnivå kan ibland innebära att patienten kvarstannar i hemmet, med råd till egenvård, eller att ta sig till vårdinstans med närståendes hjälp eller sjukresa, så kallad non-conveyance. Syfte: Syftet var att beskriva ambulanssjuksköterskors upplevelser av non-conveyance i glesbygdsmiljö. Metod: Kvalitativ studie med induktiv ansats. Från fem ambulansstationer i norra Sverige rekryterades åtta deltagare. Datainsamlingen utfördes genom individuella semistrukturerade intervjuer. Därefter analyserades intervjuerna utifrån kvalitativ innehållsanalys med manifest ansats. Resultat: Analysen resulterade i två kategorier, “Avståndet är en betydande del i beslutet” och “Stärka mötet vid non-conveyance genom omvårdnad”. Dessa två kategorier innehåller fem underkategorier “Beslutet att lämna hemma på gott och ont”, “Utmaningarna ökar med avstånd”, “Möta motstånd och bemöta det”, “Viljan att göra mer och det lilla extra” och “Ta hjälp av hemtjänst eller närstående när patienten inte medföljer”. Slutsats: Erfarenhet och god kunskap är viktigt för att kunna genomföra en god undersökning och bedömning. Avståndet är också en betydande faktor i beslutet att lämna hemma, dessutom är viljan att göra det lilla extra en betydande del i arbetet i glesbygdsmiljö. Att göra bedömningar och ta beslutet att inte transportera patienten upplevs som både utmanande och svårt.

Research Background and Aims Patient experience is considered an integral part of high-quality healthcare. The paramedic profession is developing rapidly and understanding how and what patients experience during a paramedic intervention is an essential part of further development of practice. Patient experience of paramedic interventions during a perceived emergency has not previously been described in research. The aim of this research is to explore patients' experience of paramedic interventions and understand published key performance indicators (KPI) considering that experience. Little is known about the patient's perspective of their experience and most research considers satisfaction, or the fulfilment of expectations, synonymous with experience. Despite the limited interpretation, previous research has demonstrated that patients are satisfied with paramedic care and that assistance in negotiating complex care assists in maintaining satisfaction. Furthermore, previous research indicates that clarity and certainty are sought by most patients during an interaction. By utilising a holistic, case study approach, this research provides insight into patient experience of paramedic interventions in southern England in a manner that no other research to date has achieved. This understanding of patient experience is important to the development of the profession as it strives for new and unique contributions to health and emergency care. [...], Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Medicine & Dentistry, Griffith Health, Full Text

Tato bakalářská práce se zabývá hodnocením bolesti v přednemocniční péči. V teoretické části se dozvíme základní informace o bolesti, jako je její definice, či dělení. Dále je zde vysvětleno hodnocení bolesti a uvedeny hodnotící škály. V praktické části, jsou zpracována data z pozorování, které probíhalo na zdravotnické záchranné službě. Sledovanými znaky byly základní anamnestické údaje o bolesti a hodnocení bolesti v přednemocniční péči., This bachelor's thesis deals with the assessment of pain in pre-hospital care. In the theoretical part, we learn basic information about pain, such as its definition and distribution. Furthermore, pain assessment and rating scales are explained here. In the practical part data from observations that took place at the medical emergency service. The observed characteristics were basic anamnestic data on pain and pain assessment in prehospital care., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato práce se zabývá zkušenostmi a postoji studentů oboru zdravotnický záchranář k agresi pacientů. V teoretické části je popsána agresivita a agrese, její druhy, příčiny vzniku vůči zdravotnickým záchranářům, metody zvládání, ale i neprofesionální chování členů zdravotnické záchranné služby. V praktické části jsou pomocí kvantitativního šetření zkoumány zkušenosti a postoje studentů oboru zdravotnický záchranář k agresi pacientů, se kterou se setkali v průběhu své praxe a návrhy na zkvalitnění práce zdravotnického záchranáře v budoucnu., This paper explores the experiences and attitudes of paramedic students towards patient aggression. The theoretical part describes aggressiveness and aggression, its types, causes of aggression towards paramedics, methods of coping, as well as unprofessional behavior of members of the paramedic service. In the practical part, the experiences, and attitudes of paramedic students towards patient aggression encountered in the course of their practice and suggestions for improving the quality of paramedic work in the future are investigated by means of a quantitative survey., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Práce se zabývá motivací studentů ke studiu prezenčního oboru zdravotnické záchranářství na Fakultě zdravotnických studií Univerzity Pardubice. Práce je rozdělena na teoretickou a průzkumnou část. Teoretická část práce je zaměřená na motivaci a typologii osobnosti. Dále je v ní popsáno vzdělávání studentů oboru zdravotnické záchranářství, přiblížení profese zdravotnický záchranář a jeho kompetence. Průzkumná část je založená na kvantitativním průzkumu. Výsledky v něm porovnávají motivační faktory studentů 1. ročníku a 3. ročníku studijního oboru zdravotnický záchranář na Fakultě zdravotnických studií Univerzity Pardubice. V průzkumném šetření byla zjištěna vysoká motivace pro studium daného oboru u studentů obou ročníků. Studium splnilo očekávání a studenti byli se studiem daného oboru spokojeni., The thesis deals with the motivation of students to study full-time in the field of paramedicine at the Faculty of Health Studies of the University of Pardubice. The thesis is divided into a theoretical and an exploratory part. The theoretical part of the thesis is focused on motivation and personality typology. Furthermore, it describes the education of students in the field of paramedic studies, an introduction to the profession of paramedic and its competences. The exploratory part is based on a quantitative survey. The results compare the motivational factors of 1st year and 3rd year students of the medical paramedic studies at the Faculty of Medical Studies, University of Pardubice. The survey found high motivation for studying the field among students of both years. The study met the expectations and the students were satisfied with the study of the field., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

The present study determined if the current AHS EMS call alert was startling to paramedics and if a prepulse moderated the magnitude of the startle response. Fifty paramedics were exposed to four call alerts (two with and two without a prepulse) in counterbalanced order. Participants’ responses were measured using EMG blink magnitude, heart rate, perceived signal intensity, and perceived dislike. Paramedics responded to the call alert with a significant magnitude startle reflex blink and an increase in heart rate. Adding a prepulse caused a significant reduction in the magnitude of the startle blink, perceived sound intensity, and perception of dislike of the call alert. This study demonstrates that the call alert is startling to paramedics and that adding a prepulse can moderate the response., 2023-04, 2023-04-06T20:38:29Z

The present study determined if the current AHS EMS call alert was startling to paramedics and if a prepulse moderated the magnitude of the startle response. Fifty paramedics were exposed to four call alerts (two with and two without a prepulse) in counterbalanced order. Participants’ responses were measured using EMG blink magnitude, heart rate, perceived signal intensity, and perceived dislike. Paramedics responded to the call alert with a significant magnitude startle reflex blink and an increase in heart rate. Adding a prepulse caused a significant reduction in the magnitude of the startle blink, perceived sound intensity, and perception of dislike of the call alert. This study demonstrates that the call alert is startling to paramedics and that adding a prepulse can moderate the response., 2023-04

Stroke places a significant burden on society and is devastating for individuals and their families. This thesis investigates the prehospital factors that impact on acute stroke identification and treatment to ensure clinicians and stroke systems of care can respond efficiently and ensure best possible outcomes. It examines paramedic knowledge of stroke, looks at what role clinical and system factors have on diagnostic precision and explores how these impact on the delivery of acute stroke cares. The results of the thesis have been used to guide and inform improvements in prehospital stroke care in Queensland.

When paramedics attend incidents of domestic violence, and children are present, they are simultaneously positioned to identify and respond to children exposed to domestic violence. Few paramedics report children exposed to domestic violence to either domestic violence or child protection services, typically citing uncertainty over reporting and referral responsibility. The spectrum of repercussions for children creates challenges as well as opportunities for paramedics to be educated and trained on optimal ways to respond. This article considers the role of the paramedic when they encounter children exposed to domestic violence. It is informed by research on parental characteristics related to mental illness, drug and alcohol misuse and domestic violence that often accompany other forms of child maltreatment. The article reports the results of a qualitative study of Queensland Ambulance Service paramedics, examining challenges and barriers impacting paramedics when they encounter children exposed to domestic violence. Research participants revealed key barriers to effective responses, these included breaching the privacy of families, their interpretation of mandatory reporting laws, limited time on scene and uncertainty on how to respond based on an absence of clear policy guidelines and training on child maltreatment in the context of domestic violence. Analysis of the experiences, and the ways paramedics understand child exposure to domestic violence, provides an opportunity to consider strategies to respond in such situations. Recommendations are made for ambulance services to develop policy incorporating education and training on the role of paramedics when they encounter children exposed to domestic violence.

Introduction: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake.Methods: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression.Results: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of

Bakgrund: En ambulans är en bil som är utrustad för att kunna utföra ambulanssjukvård och transportera akut sjuka patienter till sjukhus. Arbetsrelaterad stress innebär sambandet mellan anställda och arbetsmiljö på arbetsplatser. Det uppkommer när kraven på de anställda överstiger vad de egentligen klarar av. Sjuksköterskans kärnkompetenser bygger på ett ansvar att upprätthålla en god personcentrerad omvårdnad. Metod: Metoden var en kvalitativ empirisk intervjustudie. 2 ambulanssjuksköterskor och 2 sjuksköterskor som arbetar inom ambulanssjukvården intervjuades. Materialet analyserades genom Graneheim och Lundmans (2003) kvalitativa innehållsanalys. Syfte: Syftet med studien var att undersöka om och hur arbetsrelaterad stress påverkar den personcentrerade omvårdnaden till patienter inom ambulanssjukvården. Resultat: Genom den kvalitativa innehållsanalysen identifierades 2 kategorier: Upp till bevis och två sidor av samma mynt. Underkategorier till respektive tema identifierades. Resultatet visade att sjuksköterskorna som intervjuades menade att kollegor har en stor betydelse, erfarenhet och kompetens är viktigt för att känna trygghet, de upplevde en annan typ av stress när de var nya och att anhöriga kan bidra till den stressen som sjuksköterskan kan uppleva. Konklusion: Arbetsrelaterad stress är något som sjuksköterskor i ambulanssjukvården upplever. Syftet med denna studien var att undersöka hur detta kan påverka den personcentrerade omvårdnaden för patienten. Slutsatsen är att sjuksköterskorna inte upplever stress för patienten utan faktorer runt omkring., Background: An ambulance is a car that is equipped to carry out prehospital care and transport acutely ill patients to hospitals. Work-related stress is defined as the relationship between employees and the work environment in workplaces. This occurs when the work load for employees exceed what they are actually capable of. The nurse in the ambulance is responsible for ensuring that good care is maintained as stated in the nurse's core competencies. Method: The method was a qualitative empirical interview study. 2 ambulance nurses and 2 nurses working in the ambulance service were interviewed. The material was analyzed through Graneheim and Lundman's(2003) qualitative content analysis. Aim: The aim of this study was to examine if work-related stress affects the person centered care to patients in prehospital care. Findings: Through the qualitative content analysis, 2 categories were identified: Earn your stripes and two sides of the same coin. Subcategories of each theme were identified. The results showed that the nurses interviewed meant that colleagues have a great importance, experience and competence are important to feel safe, they experienced a different type of stress when they were new and that relatives can contribute to the stress that the nurse can experience. Conclusion: Work-related stress is something that nurses experience. The aim was to investigate how this can affect the person-centered care for the patient. The conclusion is that the nurse´s do notexperience stress for the patients, but factors around.

Bakgrund: Sjuksköterskor som arbetar prehospitalt ska kunna bedöma om en patient är kritiskt sjuk samt kunna påbörja en adekvat behandling. Det är sällsynt med komplikationer vid luftvägshantering men det kan i stället ha allvarliga konsekvenser. Tidigare forskning presenterar att det visar en brist på utbildning vid luftvägshantering inom de prehospitala verksamheterna, där utbildning saknas för att bibehålla en viss kompetens hos sjuksköterskorna. Syfte: Syftet var att undersöka hur utbildning påverkar sjuksköterskans hantering av en ofri luftväg prehospitalt. Metod: En litteraturstudie med kvantitativ ansats med elva vetenskapliga studier. Datainsamlingen hämtades i databaserna PubMed och Cinahl. Resultat: Genom utbildning ökade kunskap och självkänslan hos sjuksköterskor som arbetar prehospitalt. Utbildningen bör hållas frekvent för att bibehålla kompetensen hos de prehospitala sjuksköterskorna. Efter utbildning av supraglottiska enheter för luftvägshantering, insåg personalen som arbetar prehospitalt att den är både lättare att hantera och går snabbare att använda jämfört med endotrakeal intubation. Konklusion: Det är nödvändigt med en fortsatt kontinuerlig forskning i den prehospitala vården för att kunna ge och upprätthålla en säker vård till patienterna., Background: The pre-hospital nurses must be able to assess if a patient is critically ill, as well as start adequate treatment for the patient. Complications in respiratory management are rare but can have serious consequences. Previous research indicate that airway management is worsening in pre-hospital settings, where there is a lack of training to maintain a certain level of competence within the nurse staff. Aim: The aim of the study was to investigate how training affects the nurse’s management of an airway obstruction in a pre-hospital setting. Method: A literature review based on eleven scientific studies. The data collection was collected from the databases PubMed and Cinahl. Results: The training increased the knowledge and self-esteem of the pre-hospital nurses and should be offered regularly to maintain the competence of the staff. After the training period with supraglottic airway management devices, the pre-hospital nurses realized that the devices were easier to manage and faster to use compared to endotracheal intubation. Conclusion: Continuous research in prehospital care is necessary in order to provide and maintain safe care to patients.

Introduction: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake.Methods: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression.Results: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of

Bakgrund: Sjuksköterskor som arbetar prehospitalt ska kunna bedöma om en patient är kritiskt sjuk samt kunna påbörja en adekvat behandling. Det är sällsynt med komplikationer vid luftvägshantering men det kan i stället ha allvarliga konsekvenser. Tidigare forskning presenterar att det visar en brist på utbildning vid luftvägshantering inom de prehospitala verksamheterna, där utbildning saknas för att bibehålla en viss kompetens hos sjuksköterskorna. Syfte: Syftet var att undersöka hur utbildning påverkar sjuksköterskans hantering av en ofri luftväg prehospitalt. Metod: En litteraturstudie med kvantitativ ansats med elva vetenskapliga studier. Datainsamlingen hämtades i databaserna PubMed och Cinahl. Resultat: Genom utbildning ökade kunskap och självkänslan hos sjuksköterskor som arbetar prehospitalt. Utbildningen bör hållas frekvent för att bibehålla kompetensen hos de prehospitala sjuksköterskorna. Efter utbildning av supraglottiska enheter för luftvägshantering, insåg personalen som arbetar prehospitalt att den är både lättare att hantera och går snabbare att använda jämfört med endotrakeal intubation. Konklusion: Det är nödvändigt med en fortsatt kontinuerlig forskning i den prehospitala vården för att kunna ge och upprätthålla en säker vård till patienterna., Background: The pre-hospital nurses must be able to assess if a patient is critically ill, as well as start adequate treatment for the patient. Complications in respiratory management are rare but can have serious consequences. Previous research indicate that airway management is worsening in pre-hospital settings, where there is a lack of training to maintain a certain level of competence within the nurse staff. Aim: The aim of the study was to investigate how training affects the nurse’s management of an airway obstruction in a pre-hospital setting. Method: A literature review based on eleven scientific studies. The data collection was collected from the databases PubMed and Cinahl. Results: The training increased the knowledge and self-esteem of the pre-hospital nurses and should be offered regularly to maintain the competence of the staff. After the training period with supraglottic airway management devices, the pre-hospital nurses realized that the devices were easier to manage and faster to use compared to endotracheal intubation. Conclusion: Continuous research in prehospital care is necessary in order to provide and maintain safe care to patients.

Bakgrund: Prehospital förlossning är ett ovanligt uppdrag för sjuksköterskan i ambulanssjukvården. Utbildningen inom obstetrik är begränsad för allmänsjuksköterskor och ambulanssjuksköterskor. Ambulanspersonalen har en viktig roll i det första vårdmötet och behöver vara beredd på att möta det oväntade. Syfte: Att undersöka sjuksköterskors upplevelser av prehospital förlossning. Metod: En kvalitativ empirisk intervjustudie. Fyra allmänsjuksköterskor och fem specialistsjuksköterskorintervjuades. Data analyserades genom kvalitativ innehållsanalys. Resultat: I resultatet framkom fyra kategorier: utmaningar i arbetet, betydelsefull förberedelse, att ge och ta stöd samt snabbt växlande känslor. Resultatet visade att informanterna upplevde bristande erfarenhet och begränsad utbildning. Patientsäkerheten äventyras och det finns svårigheter med att vårda två patienter. Informanterna förbereder sig på det värsta och belyser vikten av förberedelser. Informanterna upplever att anhöriga har ett behov av stöd samt att informanterna själva söker stöd hos barnmorskor och kollegor. Den prehospitala förlossningen upplevs som en känslomässig berg- och dalbana. Konklusion: Den prehospitala förlossningen medför varierade känslor hos sjuksköterskor i ambulansen. Förslag på förbättring har framkommit för att öka patientsäkerheten och arbetsmiljön för sjuksköterskorna. Vikten av kollegialt stöd samt information har identifierats., Background: Prehospital childbirth is an unusual task for the nurse in the ambulance. Education in obstetrics for general nurses and ambulance nurses is limited. The ambulance staff have an important role in the first care encounter and need to be prepared for the unexpected. Aim: To examine nurse's experiences of prehospital childbirth. Method: A qualitative empirical interview study. Four general nurses and five specialist nurses were interviewed. The data was analyzed through qualitative content analysis. Findings: In the result, four categories emerged: challenges at work,significant preparations, to give and take support and rapidly changing emotions. The results showed that the informants experienced lack of experience and limited education. Patient safety is compromised and there are difficulties in caring for two patients. The informants prepare for the worst and illustrate the importance of preparation. The informants experience that relatives have a need for support and that the informants themselves seek support from midwives and colleagues. The prehospital childbirth is experienced as an emotional roller coaster. Conclusion: Prehospital childbirth causes different feelings for nurses in the ambulance. Suggestions for improvement have emerged to increase patient safety and the working environment for nurses. The importance of peer support and information was identified.

Bakgrund: Prehospital förlossning är ett ovanligt uppdrag för sjuksköterskan i ambulanssjukvården. Utbildningen inom obstetrik är begränsad för allmänsjuksköterskor och ambulanssjuksköterskor. Ambulanspersonalen har en viktig roll i det första vårdmötet och behöver vara beredd på att möta det oväntade. Syfte: Att undersöka sjuksköterskors upplevelser av prehospital förlossning. Metod: En kvalitativ empirisk intervjustudie. Fyra allmänsjuksköterskor och fem specialistsjuksköterskorintervjuades. Data analyserades genom kvalitativ innehållsanalys. Resultat: I resultatet framkom fyra kategorier: utmaningar i arbetet, betydelsefull förberedelse, att ge och ta stöd samt snabbt växlande känslor. Resultatet visade att informanterna upplevde bristande erfarenhet och begränsad utbildning. Patientsäkerheten äventyras och det finns svårigheter med att vårda två patienter. Informanterna förbereder sig på det värsta och belyser vikten av förberedelser. Informanterna upplever att anhöriga har ett behov av stöd samt att informanterna själva söker stöd hos barnmorskor och kollegor. Den prehospitala förlossningen upplevs som en känslomässig berg- och dalbana. Konklusion: Den prehospitala förlossningen medför varierade känslor hos sjuksköterskor i ambulansen. Förslag på förbättring har framkommit för att öka patientsäkerheten och arbetsmiljön för sjuksköterskorna. Vikten av kollegialt stöd samt information har identifierats., Background: Prehospital childbirth is an unusual task for the nurse in the ambulance. Education in obstetrics for general nurses and ambulance nurses is limited. The ambulance staff have an important role in the first care encounter and need to be prepared for the unexpected. Aim: To examine nurse's experiences of prehospital childbirth. Method: A qualitative empirical interview study. Four general nurses and five specialist nurses were interviewed. The data was analyzed through qualitative content analysis. Findings: In the result, four categories emerged: challenges at work,significant preparations, to give and take support and rapidly changing emotions. The results showed that the informants experienced lack of experience and limited education. Patient safety is compromised and there are difficulties in caring for two patients. The informants prepare for the worst and illustrate the importance of preparation. The informants experience that relatives have a need for support and that the informants themselves seek support from midwives and colleagues. The prehospital childbirth is experienced as an emotional roller coaster. Conclusion: Prehospital childbirth causes different feelings for nurses in the ambulance. Suggestions for improvement have emerged to increase patient safety and the working environment for nurses. The importance of peer support and information was identified.

Bakgrund: En ambulans är en bil som är utrustad för att kunna utföra ambulanssjukvård och transportera akut sjuka patienter till sjukhus. Arbetsrelaterad stress innebär sambandet mellan anställda och arbetsmiljö på arbetsplatser. Det uppkommer när kraven på de anställda överstiger vad de egentligen klarar av. Sjuksköterskans kärnkompetenser bygger på ett ansvar att upprätthålla en god personcentrerad omvårdnad. Metod: Metoden var en kvalitativ empirisk intervjustudie. 2 ambulanssjuksköterskor och 2 sjuksköterskor som arbetar inom ambulanssjukvården intervjuades. Materialet analyserades genom Graneheim och Lundmans (2003) kvalitativa innehållsanalys. Syfte: Syftet med studien var att undersöka om och hur arbetsrelaterad stress påverkar den personcentrerade omvårdnaden till patienter inom ambulanssjukvården. Resultat: Genom den kvalitativa innehållsanalysen identifierades 2 kategorier: Upp till bevis och två sidor av samma mynt. Underkategorier till respektive tema identifierades. Resultatet visade att sjuksköterskorna som intervjuades menade att kollegor har en stor betydelse, erfarenhet och kompetens är viktigt för att känna trygghet, de upplevde en annan typ av stress när de var nya och att anhöriga kan bidra till den stressen som sjuksköterskan kan uppleva. Konklusion: Arbetsrelaterad stress är något som sjuksköterskor i ambulanssjukvården upplever. Syftet med denna studien var att undersöka hur detta kan påverka den personcentrerade omvårdnaden för patienten. Slutsatsen är att sjuksköterskorna inte upplever stress för patienten utan faktorer runt omkring., Background: An ambulance is a car that is equipped to carry out prehospital care and transport acutely ill patients to hospitals. Work-related stress is defined as the relationship between employees and the work environment in workplaces. This occurs when the work load for employees exceed what they are actually capable of. The nurse in the ambulance is responsible for ensuring that good care is maintained as stated in the nurse's core competencies. Method: The method was a qualitative empirical interview study. 2 ambulance nurses and 2 nurses working in the ambulance service were interviewed. The material was analyzed through Graneheim and Lundman's(2003) qualitative content analysis. Aim: The aim of this study was to examine if work-related stress affects the person centered care to patients in prehospital care. Findings: Through the qualitative content analysis, 2 categories were identified: Earn your stripes and two sides of the same coin. Subcategories of each theme were identified. The results showed that the nurses interviewed meant that colleagues have a great importance, experience and competence are important to feel safe, they experienced a different type of stress when they were new and that relatives can contribute to the stress that the nurse can experience. Conclusion: Work-related stress is something that nurses experience. The aim was to investigate how this can affect the person-centered care for the patient. The conclusion is that the nurse´s do notexperience stress for the patients, but factors around.

Tato bakalářská práce je zaměřena na informovanost a zkušenosti laické veřejnosti ohledně zdravotnické záchranné služby. V rámci teoretické části je stručně popsána zdravotnická záchranná služba a nelékařský zdravotnický pracovník, dále také linky tísňového volání a jako poslední jsou v práci představeny stavy, které jsou indikací k výjezdu zdravotnické záchranné služby. V praktické části této práce jsou na základě dotazníkového šetření popsány názory lidí z řad laické veřejnosti na zdravotnickou záchrannou službu a její působení., This thesis is focused on a general public's awareness and experiences of emergency medical service. The theoretical part briefly describes the emergency medical service, paramedics, as well as emergency numbers, and lastly, the thesis presents the states of health which are the indication for the emergency medical service. Practical part of this thesis describes general public's opinions on the emergency medical service and it's activity which are based on a questionnaire survey., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Bakalářská práce je prací teoreticko-průzkumnou a zabývá se tématikou žen v roli záchranáře. Cílem praktické části bakalářské práce je zjistit, jaký názor mají muži zdravotní záchranáři na ženy záchranářky z pohledu fyzické, psychické a vědomostní zdatnosti. Pro praktickou část je zvolen kvalitativní design s polostrukturovanými rozhovory s muži zdravotními záchranáři., The bachelor's thesis is a theoretical and exploratory work and deals with the issue of women in the role of rescuers. The aim of the practical part of the bachelor thesis is to find out what is the opinion of male paramedics about a female paramedic from the point of view of physical, mental and knowledge ablity. For the practical part is chosen , a qualitative design with semi- structured interviews with male paramedics., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato bakalářská práce je zaměřena na přednemocniční péči zdravotnických záchranářů u pacientů s cévní mozkovou příhodou diagnostikovanou na základě dotazníku FAST. Tímto dotazníkem záchranná služba disponuje v tabletu, ve kterém záchranáři píší výjezdový záznam přímo na místě události. Práce srovnává trvání jednotlivých úkonů posádek zdravotnické záchranné služby. Hodnotí, zda posádky ZZS komunikovaly s iktovým centrem, dále pak zda ve výjezdovém záznamu uvedly vybrané informace jako medikaci pacienta, se zaměřením na antikoagulační léčbu a údaj o začátku obtíží pacienta. Bakalářská práce také hodnotí směřování pacienta do zdravotnického zařízení a síť iktových center ve zkoumaném kraji., This bachelor thesis is focused on paramedical pre-hospital care of a patients with a stroke diagnosed based on the FAST questionnaire. The rescue service has the application in their tablets, where paramedics write the patient's record directly at the place of an incident. The process compares a duration of individual actions of the emergency medical service crew. It does assess situations, whether the EMS crew communicated with the stroke center or they listed selected information in the patient's record as his medication, focused on anticoagulant treatment and an indication of the onset of the patient's difficulties. The bachelor's thesis also evaluates the patient's journey to the medical facility and the network of stroke centers., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato bakalářská práce se zabývá problematikou epilepsie. Teoretická část práce představuje onemocnění epilepsie. Vysvětluje, co onemocnění způsobuje, jak se dělí, jaké jsou příznaky, následky, jaká je možnost a účinnost léčby a v neposlední řadě, jaká je možná první pomoc. Praktická část zjišťuje pomocí kvantitativního dotazníkového šetření, jaká je úroveň znalostí studentů 3. ročníků oboru Všeobecná sestra a Zdravotnický záchranář o epilepsii., This bachelor's thesis is deal with issue of epilepsy. The theoretical part introduces the disease of epilepsy. It explains, what is the cause, how it is divide, its symptoms, consequences, what is the possible and effect cure and finally the possible of first aid. Practical part finds out how is the level of knowledge among students of third year in the field of general nurse and paramedic, with using quantitative questionnaire research., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Introduction: Suicide claimed 47,173 lives in 2017 and is the second leading cause of death for individuals 15-34 years old. In 2017, rates of suicide in the United States (US) were double the rates of homicide. Despite significant research funding toward suicide prevention, rates of suicide have increased 38% from 2009 to 2017. Recent data suggests that emergency medical services (EMS) workers are at a higher risk of suicidal ideation and suicide attempts compared to the general public. The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population.Methods: We analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003–2004, and 2007–2013. Categorizing firefighters and EMTs by census industry and occupation code lists, we used the underlying cause of death to calculate the PMRs compared to the general US decedent population with a recorded occupation.Results: Overall, 298 firefighter and 84 EMT suicides were identified in our study. Firefighters died in significantly greater proportion from suicide compared to the US.working population with a PMR of 172 (95% confidence interval [CI], 153-193, P<0.01). EMTs also died from suicide in greater proportion with an elevated PMR of 124 (95% CI, 99-153), but this did not reach statistical significance. Among all subgroups, firefighters ages 65-90 were found to have the highest PMR of 234 (95% CI, 186-290), P<0.01) while the highest among EMTs was in the age group 18-64 with a PMR of 126 (95% CI, 100-156, P<0.05).Conclusion: In this multi-state study, we found that firefighters and EMTs had significantly higher proportionate mortality ratios for suicide compared to the general US working population. Firefighters ages 65-90 had a PMR more than double t

Introduction: Because of their frequent contact with compromised patients, vaccination against influenza is recommended for all healthcare workers. Recent studies suggest that vaccination decreases influenza transmission to patients and reduces worker illness and absenteeism. However, few emergency medical services (EMS) agencies provide annual vaccination, and the vaccination rate among EMS personnel remains low. Reticence among EMS agencies to provide influenza vaccination to their employees may be due in part to the unknown fiscal consequences of implementing a vaccination program. In this study, we sought to estimate the cost effectiveness of an employer-provided influenza vaccination program for EMS personnel. Methods: Using data from published reports on influenza vaccination, we developed a cost-effectiveness model of vaccination for a hypothesized EMS system of 100 employees. Model inputs included vaccination costs, vaccination rate, infection rate, costs associated with absenteeism, lost productivity due to working while ill (presenteeism), and medical care for treating illness. To assess the robustness of the model we performed a series of sensitivity analyses on the input variables. Results: The proportion of employees contracting influenza or influenza-like illness (ILI) was estimated at 19% among vaccinated employees compared to 26% among non-vaccinated employees. The costs of the vaccine, consumables, and employee time for vaccination totaled $44.19 per vaccinated employee, with a total system cost of $4,419. Compared to no vaccination, a mandatory vaccination program would save $20,745 in lost productivity and medical costs, or $16,325 in net savings after accounting for vaccination costs. The savings were 3.7 times the cost of the vaccination program and were derived from avoided absenteeism ($7,988), avoided presenteeism productivity losses ($10,303), and avoided medical costs of treating employees with influenza/ILI ($2,454). Through sensitivity an

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016-6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS-hospital mNIHSS) was 2.4, 95% limits of agreement (-5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26-0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38-0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.

Objective: To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries. Methods: A cross-sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury. Results: Of the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001). Conclusion: Deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid.

Occupational violence is a significant issue within the context of prehospital healthcare with the majority of paramedics reporting some form of abuse, intimidation, physical or sexual assault during their career. Though the paramedic literature acknowledges the severity of this issue, there is limited literature examining occupational violence mitigation strategies. Despite this, the operational and environmental similarities that exist between paramedics and other emergency service workers such as the police and firefighters, provide an opportunity to review relatable occupational violence mitigation strategies and experiences. This review used Joanna Briggs institute guidance for systematic reviews of both qualitative evidence and effectiveness. Studies included in this review incorporated those published in English from 1990 to January 2020. Two qualitative studies met the criteria for review. From these, a total of 22 findings were extracted and combined to form four categories from which two syntheses were developed. Twenty-four quantitative studies, encompassing six unique fields, met the criteria for review. Mitigation strategies for emergency service worker occupational violence are not easily defined. They are dynamic, multilayered and encompass a variety of complex social, medical and psychological influences. In spite of this, there are clear benefits to their application in regard to the approaches and training of violence mitigation. The paramedic environment would benefit from strategies that are flexible to the ongoing needs of the workers and the specific cultural, environmental and social factors that encompass the paramedic organisation.

Introduction As registered health professionals, Australian paramedics are required to abide by professional registration standards including the maintenance of continuing professional development (CPD). The broader health literature identifies facilitators, barriers and motivators for engaging in CPD, however the body of knowledge specific to paramedicine is weak. This research seeks to address this gap in the paramedicine body of knowledge. Methods This study adopts a constructivist grounded theory methodology. Data were collected through semi-structured interviews, and analysed using first and second cycle coding techniques. Paramedics from various state-based Australasian ambulance services and private industry (N=10) discussed their experiences specific to their attitudes, perceptions and engagement about CPD. Results Paramedic CPD goes beyond the traditional approach to mandatory training. Paramedics are motivated by factors such as modality of delivery, professional expectations, clinical/professional improvement and, sometimes, fear. Facilitators included organisational support, improved clinical knowledge, practitioner confidence, self-directed learning opportunities and perceived relevance of content. Barriers include cost, workload/fatigue, location, rostering, lack of incentive to engage, lack of employer support and technological problems. Conclusion By understanding what facilitates or motivates engagement in CPD activities, paramedics can navigate their CPD in conjunction with regulatory requirements. Although paramedics report some similar experiences to other health professionals, there are nuancethat appear specific to the discipline of paramedicine. Of interest, a unique finding related to fear influencing paramedic CPD engagement. The results of this study informs paramedic employers and paramedic CPD providers with insights to assist in the development of positive CPD experiences and interactions.

This research is a qualitative study which explores the workplace experiences of LGBTQ+ paramedics through narrative based interviews and thematic analysis. This research also compares the workplace policies, procedures and strategies related to inclusion in the workplace against three existing benchmarking tools. The model of cultural safety is applied as a post analytical lens and recommendations for improving the workplace inclusion of LGBTQ+ paramedics are discussed.

Aim: Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births. Methods: A retrospective analysis was undertaken of all OOH births between the 1st January 2018 and 31st December 2018 attended by the Queensland Ambulance Service. The demographic and epidemiological characteristics of patients that were administered oxytocin and the occurrence of adverse side effects were described. Results: In total, 350 OOH births were included in this study with the majority involving multigravidas women (94.3%) and all but two involving singleton pregnancies. Oxytocin was administered following 222 births (63.4%), while 67 patients (19.1%) declined administration preferring a physiological third stage of labor, and in 61 cases (17.4%) oxytocin was withheld by the attending paramedic. There were no documented adverse events or side effects following administration. Oxytocin administration occurred on average 14 minutes (interquartile range 9-25) following the time of birth. The median time from oxytocin administration to placenta delivery was 10 minutes (interquartile range 5-22). Conclusion: Oxytocin is well accepted and safe treatment adjunct for the management of the third stage of labor in OOH births and should be considered for routine practice by other emergency medical services.

Introduction: Suicide claimed 47,173 lives in 2017 and is the second leading cause of death for individuals 15-34 years old. In 2017, rates of suicide in the United States (US) were double the rates of homicide. Despite significant research funding toward suicide prevention, rates of suicide have increased 38% from 2009 to 2017. Recent data suggests that emergency medical services (EMS) workers are at a higher risk of suicidal ideation and suicide attempts compared to the general public. The objective of this study was to determine the proportionate mortality ratio (PMR) of suicide among firefighters and emergency medical technicians (EMT) compared to the general US working population.Methods: We analyzed over five million adult decedent death records from the National Occupational Mortality Surveillance database for 26 states over a 10-year non-consecutive period including 1999, 2003–2004, and 2007–2013. Categorizing firefighters and EMTs by census industry and occupation code lists, we used the underlying cause of death to calculate the PMRs compared to the general US decedent population with a recorded occupation.Results: Overall, 298 firefighter and 84 EMT suicides were identified in our study. Firefighters died in significantly greater proportion from suicide compared to the US.working population with a PMR of 172 (95% confidence interval [CI], 153-193, P<0.01). EMTs also died from suicide in greater proportion with an elevated PMR of 124 (95% CI, 99-153), but this did not reach statistical significance. Among all subgroups, firefighters ages 65-90 were found to have the highest PMR of 234 (95% CI, 186-290), P<0.01) while the highest among EMTs was in the age group 18-64 with a PMR of 126 (95% CI, 100-156, P<0.05).Conclusion: In this multi-state study, we found that firefighters and EMTs had significantly higher proportionate mortality ratios for suicide compared to the general US working population. Firefighters ages 65-90 had a PMR more than double t

Introduction: Because of their frequent contact with compromised patients, vaccination against influenza is recommended for all healthcare workers. Recent studies suggest that vaccination decreases influenza transmission to patients and reduces worker illness and absenteeism. However, few emergency medical services (EMS) agencies provide annual vaccination, and the vaccination rate among EMS personnel remains low. Reticence among EMS agencies to provide influenza vaccination to their employees may be due in part to the unknown fiscal consequences of implementing a vaccination program. In this study, we sought to estimate the cost effectiveness of an employer-provided influenza vaccination program for EMS personnel. Methods: Using data from published reports on influenza vaccination, we developed a cost-effectiveness model of vaccination for a hypothesized EMS system of 100 employees. Model inputs included vaccination costs, vaccination rate, infection rate, costs associated with absenteeism, lost productivity due to working while ill (presenteeism), and medical care for treating illness. To assess the robustness of the model we performed a series of sensitivity analyses on the input variables. Results: The proportion of employees contracting influenza or influenza-like illness (ILI) was estimated at 19% among vaccinated employees compared to 26% among non-vaccinated employees. The costs of the vaccine, consumables, and employee time for vaccination totaled $44.19 per vaccinated employee, with a total system cost of $4,419. Compared to no vaccination, a mandatory vaccination program would save $20,745 in lost productivity and medical costs, or $16,325 in net savings after accounting for vaccination costs. The savings were 3.7 times the cost of the vaccination program and were derived from avoided absenteeism ($7,988), avoided presenteeism productivity losses ($10,303), and avoided medical costs of treating employees with influenza/ILI ($2,454). Through sensitivity an

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016-6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS-hospital mNIHSS) was 2.4, 95% limits of agreement (-5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26-0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38-0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.

Central to every formal education qualification offered by any education and training institution is the aim to produce well-rounded graduates who have gained new knowledge, skills and professional attributes. Emergency medical care education and training programmes are no exception to this desire to produce highly skilled and well-trained graduates. Emergency Medical Services (EMS) workers are generally referred to as paramedics by members of the public; however, there are different levels in which they are categorised, depending on the level of training obtained and professional registration with the regulatory body. Currently, emergency care education and training in South Africa have finalised alignment with higher education after the National Emergency Care Education and Training (NECET) policy was promulgated by the minister of health. The need to review and realign EMS education and training was necessitated by the South African Qualifications Authority (SAQA) and the Higher Education Act. This review resulted in the development of a two-year, 240-credit National Certificate in Emergency Care Technician (ECT). The previous qualification, at National Qualifications Framework (NQF) Level 5, was phased out as per the revised Higher Education Qualifications Sub-framework (HEQSF) and was replaced by a Diploma NQF Level 6 qualification. The NQF Level 5 qualification produced graduates who were eligible to register in the professional category of advanced life support (ALS) with the Health Professions Council of South Africa (HPCSA). Graduates from the ECT programme reported being confronted by negative attitudes from experienced members of the profession and did not feel that they were being accepted during clinical practice shifts at EMS stations, especially in areas where other ALS paramedics were working. Some paramedics who had progressed to the ALS category through short courses expressed their lack of trust and confidence in ECT graduates and their capabiliti

Bakgrund: Hjärtstopp skördar årligen många liv. Goda kunskaper krävs för att identifiera hjärtstopp för att tidigt kunna inleda behandling. Sjuksköterskan behöver kärnkompetenser för att kunna identifiera problem och etiska dilemman genom ett personcentrarat förhållningssätt. Syfte: Syftet var att beskriva sjuksköterskans uppfattning av vad som påverkar beslutsfattandet vid hjärtstopp prehospitalt.Metod: Studien utfördes som en allmän litteraturstudie där åtta vetenskapliga artiklar granskades och analyserades. Resultat: Tre kategorier framkom: Sjuksköterskans kompetens och erfarenhet, tillgänglig information samt emotionellt ansvar. Tidigare erfarenheter av att ha behandlat patienter med hjärtstopp innebär en bearbetning av känslor och åsikter, vilket framöver kan påverka beslutsfattandet och kliniska åtgärder. Fullständig information måste vara insamlat innan ett avgörande beslut fattas om återupplivningsförsöket ska fortgå eller avslutas. Sjuksköterskor upplevde att erfarenheter av sorg kunde vara fördelaktigt både i samtalet med närstående men också i beslutsfattandet. Konklusion: Kompetens och erfarenhet påverkar sjuksköterskornas beslutsfattande. Information kring patientens sjukdomsbild och den förväntade livskvalitén kan influera sjuksköterskans uppfattning om insjuknandet vilket kan vara avgörande för beslutet., Background: Cardiac arrests kills many patients every year. Significant knowledge is required to identify cardiac arrests before being able to start early treatment. The nurse needs skills to be able to identify problems and ethical dilemmas trough a person-centered approach. Aim: The purpose was to describe the nurse's experiences of what influences decision-making in prehospital cardiac arrest. Method: The study was conducted as a general literature study where eight scientific articles were reviewed and analyzed. Results: Tree categories emerged: The nurse competence and experience, available information and emotional responsibility. Experience in treating cardiac arrest patients leads to the management of emotions and opinions that affects decision making and the quality of care. Complete information must be gathered before a decisive decision is made as to whether the resuscitation attempt should continue or be terminated. Nurses felt that experiences of grief could be beneficial both in the conversation with relatives but also in decision-making Conclusion: Competence and experience influence the nurses’ decision-making. Information about the patient's overall illness and the expected quality of life can influence the nurses’ perception of the illness, which can be vital for the decision.

Bakgrund: Hjärtstopp skördar årligen många liv. Goda kunskaper krävs för att identifiera hjärtstopp för att tidigt kunna inleda behandling. Sjuksköterskan behöver kärnkompetenser för att kunna identifiera problem och etiska dilemman genom ett personcentrarat förhållningssätt. Syfte: Syftet var att beskriva sjuksköterskans uppfattning av vad som påverkar beslutsfattandet vid hjärtstopp prehospitalt.Metod: Studien utfördes som en allmän litteraturstudie där åtta vetenskapliga artiklar granskades och analyserades. Resultat: Tre kategorier framkom: Sjuksköterskans kompetens och erfarenhet, tillgänglig information samt emotionellt ansvar. Tidigare erfarenheter av att ha behandlat patienter med hjärtstopp innebär en bearbetning av känslor och åsikter, vilket framöver kan påverka beslutsfattandet och kliniska åtgärder. Fullständig information måste vara insamlat innan ett avgörande beslut fattas om återupplivningsförsöket ska fortgå eller avslutas. Sjuksköterskor upplevde att erfarenheter av sorg kunde vara fördelaktigt både i samtalet med närstående men också i beslutsfattandet. Konklusion: Kompetens och erfarenhet påverkar sjuksköterskornas beslutsfattande. Information kring patientens sjukdomsbild och den förväntade livskvalitén kan influera sjuksköterskans uppfattning om insjuknandet vilket kan vara avgörande för beslutet., Background: Cardiac arrests kills many patients every year. Significant knowledge is required to identify cardiac arrests before being able to start early treatment. The nurse needs skills to be able to identify problems and ethical dilemmas trough a person-centered approach. Aim: The purpose was to describe the nurse's experiences of what influences decision-making in prehospital cardiac arrest. Method: The study was conducted as a general literature study where eight scientific articles were reviewed and analyzed. Results: Tree categories emerged: The nurse competence and experience, available information and emotional responsibility. Experience in treating cardiac arrest patients leads to the management of emotions and opinions that affects decision making and the quality of care. Complete information must be gathered before a decisive decision is made as to whether the resuscitation attempt should continue or be terminated. Nurses felt that experiences of grief could be beneficial both in the conversation with relatives but also in decision-making Conclusion: Competence and experience influence the nurses’ decision-making. Information about the patient's overall illness and the expected quality of life can influence the nurses’ perception of the illness, which can be vital for the decision.

This study was conducted to assess for the predictive relationship between the number of patient encounters a paramedic student has during their initial education and their scores on a summative exam that has been linked to national exam pass rates. To date, little research has been conducted within the field of Emergency Medical Services (EMS) with a focus on education. Despite the lack of research, the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions has established recommended patient contact minimums that paramedic students must obtain during their initial education. The sample for this study included paramedic students who attended Blue Community College (a pseudonym) located in the eastern United States during academic years 2015 to 2018 who utilized Field Internship Student Data Acquisition Project’s (FISDAP) PRE4 exam and utilized FISDAP’s “Skills Tracker” system to record their clinical data. The N for this study was 66 students. This study utilized a non-experimental, correlational design, and a bivariate linear regression analysis was untiled to assess for a predictive relationship between the predictor and criterion variables of archival data. There was not a statistically significant correlation found between any of the predictor and criterion variables. Keywords: experiential learning, paramedic, education, clinicals, emergency medical services.

Bakalářská práce řeší problematiku krevních transfuzí. V teoretické části práce jsou uvedeny poznatky z historie krevních transfuzí, krevních skupin, transfuzních přípravků a krevních derivátů, předtransfuzního vyšetření, přípravy a samotného podání krevní transfuze, potransfuzních reakcí. Výzkumná část práce odhaluje znalosti studentů oboru zdravotnický záchranář na Fakultě zdravotnických studií Univerzity Pardubice o podávání transfuzních přípravků za pomoci anonymního dotazníkového šetření s prvky vědomostního testu. Toto šetření odhalilo silné i slabé stránky studentů., Bachelor thesis deals with problems of blood transfusion. In theoretical part of thesis are introduced pieces of knowledge from history of blood transfusion, blood groups, transfusion products and blood derivative, pre-transfusion physical examination, preparation of blood transfusion and transfusion, post-transfusion reactions. The research part of thesis detects knowledge of paramedic's students from Faculty of health studies, University Pardubice about blood transfusion using an anonymous questionnaire survey with knowledge test elements. This investigation discovered the strengths of students and weaknesses of students., Fakulta zdravotnických studií, Doplňující otázky k obhajobě: 1. V rámci jakého předmětu (kromě Ošetřovatelských postupů) byste zařadil problematiku krevních přípravků a krevních derivátů? 2. Byly výsledky z pilotní studie zařazeny i do finálních dat? Obhajoba bakalářské práce s prezentací velmi dobrá., Dokončená práce s úspěšnou obhajobou

Les programmes d’études techniques au collégial ont comme objectif d’amener leurs étudiantes et leurs étudiants à assumer pleinement leur rôle de travailleuse ou de travailleur sur le marché du travail. Plusieurs activités d’apprentissage basées sur un ensemble structuré de savoirs, d’habiletés et d’attitudes permettent aux étudiantes et aux étudiants de développer des compétences ciblées. Le ministère de l’Enseignement supérieur définit la compétence comme un pouvoir qui permet d’agir adéquatement, de réussir et de progresser. Mais, qu’en est-il du développement de l’autonomie professionnelle que plusieurs milieux de travail considèrent comme une composante essentielle liée à l’emploi ? Chaque profession possède ses propres particularités. En ce qui a trait au personnel ambulancier paramédical œuvrant dans le domaine des soins préhospitaliers d’urgence (SPU), les situations d’urgence, accompagnées de ressources matérielles et humaines limitées, exigent beaucoup d’autonomie professionnelle. Cette réalité nous amène au thème central de cet essai qui vise à accroître nos connaissances en examinant quelle est la place de l’autonomie professionnelle dans le programme d’études collégiales 181.A0 Soins préhospitaliers d’urgence. Puisque chaque établissement d’enseignement collégial dispensant un programme d’études peut y donner une couleur locale, le programme d’un seul collège a été ciblé, soit celui du Cégep de Shawinigan. Après nous être dotés d’un cadre de référence portant sur l’autonomie professionnelle et le développement de l’étudiante et de l’étudiant dans le cadre d’une formation collégiale technique, nous nous sommes fixé deux objectifs spécifiques pour répondre à la question générale de l’essai : 1) Déterminer quelle est la place de l’autonomie professionnelle dans la documentation institutionnelle du programme en SPU au Cégep de Shawinigan; 2) Déterminer si le cheminement des compétences du programme en SPU au Cégep de Shawinigan permet le développement de l’

Bakalářská práce je věnována tématu Shaken baby syndromu, který je součástí problematiky Syndromu týraného, zneužívaného a zanedbávaného dítěte. Jedná se o práci teoreticko-průzkumnou. V teoretické části je téma uvedeno s důrazem na přednemocniční péči a roli zdravotnických záchranářů. Průzkumná část práce popisuje dotazníkové šetření, realizované s cílem zjistit informovanost studentů studijního oboru Zdravotnický záchranář o Shaken baby syndromu., The bachelor thesis concerns the topic of the Shaken baby syndrome, which is included in the issue of the child abuse and neglect syndrome. The work is theoretical as well as exploratory. In the theoretical part the topic is presented in relation to the pre-hospital care and paramedic´s role. The research part describes a questionnaire survey conducted with the aim to learn about the paramedic students´ awareness of the shaken baby syndrome., Fakulta zdravotnických studií, Doplňující otázky pro obhajobu závěrečné práce: 1. Jak v BP zpracováváte důraz na význam ZZ a doporučené PNP, jak uvádíte v hlavním cíli? 2. Byl na vyplnění dotazníku stanoven nějaký konkrétní čas? 3. V metodice bylo uvedeno, že dotazník vyplnili ti, co byli ochotní. Máte nějaký přehled, kolik jich ochotných nebylo? Obhajoba bakalářské práce s prezentací velmi dobrá minus., Dokončená práce s úspěšnou obhajobou