Use of coercion in the Emergency Medical Service -a qualitative study from the ambulance service of the Oslo University Hospital

Master's thesis in Pre-hospital critical careHelsehjelp skal være basert på pasientens samtykke. Helselovgivningens unntaksbestemmelser hjemler bruk av tvang i spesielle tilfeller. Det finnes lite forskning på bruk av tvang prehospitalt. Studiens hensikt var å beskrive ambulansepersonells forståelse av hva tvang er, erfaring med bruk av tvang, i hvilke situasjoner de har brukt tvang og hvilken form for tvang som er brukt. Studien er kvalitativ med bruk av fokusgruppeintervju hvor åtte ambulansefagarbeidere fra Oslo universitetssykehus deltok. Dataene er analysert med systematisk tekstkondensering. Respondentene forstår tvang i hovedsak som bruk av fysisk makt. Former for makt/tvang beskrevet kan sorters i overtalelse, pragmatisk makt, fysisk makt, farmakologisk tvang og sikring under transport. Respondentene beskriver at de har erfaring med bruk av tvang i situasjoner knyttet til hjelpeplikt, nødrett og i situasjoner hvor pasienter avviser helsehjelp. Respondentene opplever at det er en konflikt mellom pasientens rett til selvbestemmelse og avdelingens retningslinjer. De opplever at lovverket er vanskelig overførbart til praksis og de er usikre på hvordan de skal vurdere samtykkekompetanse. Denne usikkerheten i kombinasjon med en opplevelse av manglende støtte fra ledelsen ser ut til å øke respondentenes villighet til å utøve tvang for å få pasienter med til lege. Legetilsyn blir brukt av respondentene som et middel for å dekke sin egen rygg. Videre undersøkelser bør avdekke om det utøves tvang uten lovhjemmel og om økt kunnskap kan redusere bruken av tvang

Norwegian Emergency Medicine Systems’ Training and Equipment for Penetrating Injuries: A National Survey-Based Study

Objective: Recent terror attacks led the Norwegian government to develop a procedure for emergency and law enforcement services cooperation during Active Violent Incidents (AVI, abbreviated PLIVO in Norwegian). To address further national initiatives to improve preparedness for mass casualty events and penetrating injuries among emergency medical services (EMS) in Norway, training and equipment status were mapped. Methods: All EMS regions in Norway were invited to participate in an electronic nation-wide survey about practical medical training in PLIVO scenario training and specific training in hemorrhage control and penetrating injuries. Results: Ninety percent (842/938) had attended at least 1 PLIVO training scenario. Of these, 76% (642/938) reported only evacuation training during the exercise, while only 20% (168/938) had practiced hemorrhage control. Eighty-one percent (760/938) respondents reported that they were equipped with tourniquets and 91% (853/938) were equipped with gauze to pack wounds. However, only 52% (487/938) and 48% (450/938) reported practical training in tourniquet application and wound packing, respectively, while 30% (280/938) reported that they had no training or only theoretical education in tourniquet application. Supervised practical training on penetrating thoracic injuries was reported by <20%, and <50% reported practical training in needle decompression of a tension pneumothorax. Conclusions: Enhanced focus on training in hemorrhage control and penetrating injuries is needed. This supports the recent decision from the Norwegian government to strengthen the training for EMS in AVI (PLIVO) exercises, by focusing on medical procedures in addition to evacuation training. Although the estimated response rate is 17%, we believe the large number of respondents still make the results valuable.publishedVersio

Norwegian Emergency Medicine Systems’ Training and Equipment for Penetrating Injuries: A National Survey-Based Study

Objective: Recent terror attacks led the Norwegian government to develop a procedure for emergency and law enforcement services cooperation during Active Violent Incidents (AVI, abbreviated PLIVO in Norwegian). To address further national initiatives to improve preparedness for mass casualty events and penetrating injuries among emergency medical services (EMS) in Norway, training and equipment status were mapped. Methods: All EMS regions in Norway were invited to participate in an electronic nation-wide survey about practical medical training in PLIVO scenario training and specific training in hemorrhage control and penetrating injuries. Results: Ninety percent (842/938) had attended at least 1 PLIVO training scenario. Of these, 76% (642/938) reported only evacuation training during the exercise, while only 20% (168/938) had practiced hemorrhage control. Eighty-one percent (760/938) respondents reported that they were equipped with tourniquets and 91% (853/938) were equipped with gauze to pack wounds. However, only 52% (487/938) and 48% (450/938) reported practical training in tourniquet application and wound packing, respectively, while 30% (280/938) reported that they had no training or only theoretical education in tourniquet application. Supervised practical training on penetrating thoracic injuries was reported by Conclusions: Enhanced focus on training in hemorrhage control and penetrating injuries is needed. This supports the recent decision from the Norwegian government to strengthen the training for EMS in AVI (PLIVO) exercises, by focusing on medical procedures in addition to evacuation training. Although the estimated response rate is 17%, we believe the large number of respondents still make the results valuable

Implementation of new guidelines in the prehospital services: a nationwide survey of Norway

Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline.publishedVersio

Ambulance personnel use of coercion and use of safety belts in Norway

Abstract Background Providing health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance transport patients are fastened to the stretcher with safety straps. However, patients who wriggle out of, or unfasten, their safety straps pose a threat to him/herself and escorting personnel in the ambulance compartment in case of an accident. To prevent harm, ambulance personnel sometimes restrain the patient or unfasten their own seatbelts to keep the patient safe on the stretcher. The prevalence of coercive measures, and the relationship between the use of mechanical restraints comparable to coercion and seatbelt use, are scarcely investigated. Use of coercion normally requires a specific statutory basis. However, coercive measures needed to ensure safety in a moving vehicle while providing healthcare is hardly discussed in the literature. The aim of this study is to explore the use of coercion in ambulance services, the use of safety belts among escorts in situations where they need to keep the patient calm during transportation, and to analyse the relationship between safety belt non-compliance and coercion in these situations. Methods This is a retrospective, cross-sectional study using a self-administered, online survey aiming to investigate the use of coercion and use of seatbelts during ambulance transport. Approximately 3,400 ambulance personnel from all 18 Health Trusts in Norway were invited to participate between Oct 2021 and Nov 2022. Descriptive analyses were used to describe the sample and the prevalence of findings, while multiple linear regressions were used to investigate associations. Results Altogether, 681 (20%) ambulance personnel completed the survey where 488 (72.4%) stated that they had used coercion during the last six months and 375 (55.7%) had experienced ambulance personnel or escorting personnel working with unfastened seatbelts during transport. The majority of respondents experienced coercion as being unpleasant and more negative feelings were associated with less use of seatbelts. Conclusions Coercion seems to be used by ambulance personnel frequently. For the study participants, keeping the patient securely fastened was prioritized above escorting personnel’s traffic safety, despite feeling uncomfortable doing so. Because coercive measures have negative consequences for patients, is associated with negative feelings for health personnel, and is not discussed ethically and legally in relation to the prehospital context, there is an urgent need for more research on the topic, and for legal preparatory work to address the unique perspectives of the prehospital context in which traffic safety also is an important factor

Uten tvangshjemmel kan liv og helse settes i fare

Source at https://www.dagensmedisin.no/uten-tvangshjemmel-kan-liv-og-helse-settes-i-fare/510939.Det finnes et «hjemmel-tomt» rom som hindrer ambulansepersonell i å utøve jobben forsvarlig og trygt, og som fører til unødvendig bruk av politibistand. At ambulansepersonell mangler hjemmel til å bruke tvang, kan sette pasienters liv og helse i fare

Additional file 1 of Ambulance personnel use of coercion and use of safety belts in Norway

Additional file 1