Evaluation of emergency medical services systems: a classification to assist in determination of indicators

Abstract

Emergency medical services (EMS) systems, and prehospital care are difficult to evaluate. Accordingly, the true efficacy and value of such systems are difficult to determine. The multitude of variations and combinations of involved factors makes standardisation and comparison difficult, and universal indicators are hard to develop. Various attempts have been made to determine valid indicators of effectiveness, but there has been little success. Prehospital care has been seen by some as a single entity. As a result, experience from well resourced first world trauma centres has been taken, by many, to be applicable to all prehospital situations.This article attempts to assist in the development of valid EMS indicators of performance and effectiveness by categorising prehospital scenarios into a classification reflecting the reality of their conditions of practice.

Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

“…10 In the present study, the total time of prehospital care and the partial times, even when traditional cut-off points from the literature are used (10 minutes at the accident scene and 30 to 60 minutes of total time), 9 did not reach signifi cant association with survival.…”

“…Among these factors, there are aspects related to the victim and trauma mechanism, in addition to clinical aspects, such as the severity of injuries and their physiological repercussions, as well as the initial care provided. 9,10,[12][13][14] Among the technologies that have been employed in the initial care of the trauma patient, prehospital care stands out, [8][9][10][11] having two categories 11 -Basic Life Support, whose main characteristic is not to perform invasive, life-preserving procedures, and Advanced Life Support, which involves invasive procedures.…”

“…[8][9][10] However, to statistically verify the association between prehospital interventions and survival has been a diffi cult task for researchers worldwide, creating controversies over this resource's usefulness. 9,14 Instead of the fatality analysis, which examines the "alive or dead" dichotomy, survival analysis has been supported by researchers all over the world 6,7,10,13 to assess the prehospital care phase. Survival analysis considers survival time as a dependent variable and analyzes factors that may interfere with this result as independent variables.…”

Nursing diagnoses in trauma victims with fatal outcomes in the emergency scenario

“…The literature related to nursing diagnoses, the validation of data collection instruments, the evaluation of the trauma patient and the evaluation of the critical patient in an emergency situation defined the model (construction) of the data collection instrument (10)(11)(12)(13) . The NANDA2009-11 was used as a guide for selecting the diagnoses (5) .…”

The Reality of Non-Adversarial Justice: Principles and Practice

“…Problem-solving courts 'seek to use the authority of the courts to address the underlying problems of individual litigants, the structural problems of the justice system and the social problems of communities'. 66 The consensus-seeking model 67 is endorsed by the Victorian Government in the Attorney-General's Justice Statement 2, 68 where the promotion of ADR is seen as the way ahead for legal services delivery in Victoria because of ADR's ability to 'minimise costs, maintain relationships and "truly resolve disputes rather than just have them determined".' 69 According to Mr Hulls' comments at the March 2007 Restorative Justice forum, the growing emphasis on specialisation across various jurisdictionsfor example the Sexual Assault List in the County Court of Victoria -'demonstrates our collective acknowledgement that we must infuse greater compassion and understanding of the human experience into the arid air of the court'.…”