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Political efforts in the Nordic countries aim to promote gender equality. However, an assumption is that patriarchal structures remain embedded in EMS organizations, often leading to a ‘glass ceiling’ effect for women. The Emergency Medical Services (EMS), generally positioned at the intersection of safety authorities and healthcare, operates within environments often shaped by masculine values and norms. Concurrently, the service also connects strongly to compassion, caring and nursing, which have been historically female-dominant professions and working environments. In recent decades, more females have entered the EMS. Despite the growing number of female paramedics, challenges persist, particularly in relation to gender inequality and workplace culture. Females in EMS field continue to face gender stereotypes, which may contribute to inequality. Gender stereotypes, combined with research describing sexual harassment and bias, underscore the need for further discussions and research on the impact of gender on paramedic work environments and career pathways for women working in the service.

The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events.

Background: The risk of high-energy trauma injuries on construction sites is relatively high. A delayed response time could affect outcomes after severe injury. This study assessed if an advanced first aid course for first aid response for laypersons (employees or apprentices) in the construction industry or real-time video communication and support with ambulance personnel, or neither, together with access to an advanced medical kit, would have an effect on immediate layperson vital responses in a severe injury scenario.

Method: This was a controlled simulation study. Employees or apprentices at a construction site were recruited and randomly allocated into a group with video support or not, and advanced first aid course or not, and where one group had both. The primary outcomes were correct behavior to recognize and manage an occluded airway and correct behavior to stop life-threatening bleeding from a lower extremity injury. Secondary outcomes included head-to-toe assessment performed, placement of a pelvic sling, and application of remote vital signs monitors.

Results: Ninety participants were included in 10 groups of 3 for each of 4 exposures. One group was tested first as a baseline group, and then later after having done the training course. Live video support was effective in controlling bleeding. A first aid course given beforehand did not seem to be as effective on controlling bleeding. Video support and the first aid course previously given improved the ability of bystanders to manage the airway, the combination of the two being no better than each of the interventions taken in isolation. Course exposure and video support together were not superior to the course by itself or video by itself, except regarding placing the biosensors on the injured after video support. Secondary results showed an association between video support and completing a head-to-toe assessment. Both interventions were associated with applying a pelvic sling.

Conclusion: These findings show that laypersons, here construction industry employees, can be supported to achieve good performance as first responders in a major injury scenario. Prior training, but especially live video support without prior training, improves layperson performance in this setting.

Background: Nurses working in prehospital emergency care (PEC) encounter patients with all types of health conditions. Increasingly, they are encountering patients suffering from mental illness and this trend reflects the worldwide increase in mental illness. There is very little current knowledge of encounters between nurses and patients with mental illness in ‘PEC’, especially from the nurses’ perspectives.

Aim: The aim of the study is to investigate nurses’ experiences of encountering patients with mental illness in ‘PEC’.

Methods: The participants were recruited in a region in southeast Sweden (that covers approximately 5600 km2 and has 300,000 inhabitants). In total, 17 nurses consented to participate. The participants were asked to narrate their individual experience of encountering patients with mental illness. The interviews were transcribed verbatim, then analysed with qualitative content analysis.

Results: The result is presented in terms of three themes and eight sub-themes. The main themes are ‘Lacking trust in the patient and one’s own abilities’, ‘Being under internal and external influences’ and ‘Moving towards a genuine nurse-patient relationship’.

Conclusion: The results show that nurses strive to lay the foundation for a trusting relationship. Simultaneously nurses encountering is characterized by a mistrust and it is influenced by pre-understanding and emotions when they take care for patients. The findings could be used to develop nurses’ readiness and capability to encounter patients with mental illness and to respond appropriately to the patients somatic and mental care needs.

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Ett systematiskt traumaomhändertagande på olycksplats har stor betydelse för patienters överlevnad. Syftet med denna studie var att observera sjuksköters­kor i ambulanssjukvården och följsamhet till konceptet »prehospital trauma life support« vid traumaomhändertagande i en simuleringssituation. Ett observationsprotokoll utformades för att analysera videoinspelningar. Resultatet visar på brister i det systematiska omhändertagandet och ett ineffektivt omhändertagande på skadeplats. Användandet av observationsprotokoll i traumasimulering kan kvalitetssäkra sjuksköterskors följsamhet till vedertagna koncept.

The purpose of this study was to survey the EMS (emergency medical services) personnel preparedness for major incidents in the underground mining industry in Sweden. Every year, a high number of incidents, workplace accidents and fires are reported from the Swedish mining industry. Taking care of patients located in an underground mine represents a challenge to EMS personnel. Today, knowledge about EMS personnel preparedness for major incidents in the mining industry is limited. The study design was a cross-sectional survey. The questionnaires were distributed to EMS personnel working in ambulance stations geographically located near an underground mine. Thirteen ambulance stations were included and 137 of 258 personnel answered. Demographic data were analyzed using descriptive statistics. Differences among groups were analyzed with the Chi-Squared test, continuity correction and t-test. Results showed about half of the participants reported that they do not feel prepared to work in a major incident in an underground mine. The majority wished to receive educational training to enhance their preparedness. The most commonly requested type of education was practical drills on the scene, in an underground mine. The reported preparedness was significantly higher among the participants who had received some kind of education, or had authentic experience of a mission in an underground mine than those who did not. This study reveals shortcomings in the preparedness of EMS personnel. The perceived low preparedness of EMS personnel may affect their ability to work in a major incident in the mining industry. Study findings may be used in planning the future education, including practical drills, of EMS personnel.

The purpose of the study was to describe the opinions of ambulance personnel regarding differences between using a heated mattress and a standard ambulance mattress. This study was an intervention study with pre- and post-evaluation. Evaluations of the opinions of personnel regarding the standard unheated mattress were conducted initially. After the intervention with new heated mattresses, follow-up evaluations were conducted. Ambulance personnel (n=64) from an ambulance station in northern Sweden took part in the study, which ran from October 2014 until February 2016. There were differences in opinions regarding the standard unheated mattress and the new heated mattress. The evaluation of the proxy ratings by the personnel showed that the heated mattress was warmer than the standard mattress, more pleasant to lie on and that patients were happier and more relaxed than when the standard mattress was used. The ambulance personnel in this study rated the experience of working with the heated mattress as very positive and proxy rated that it had a good effect on patient comfort. A heated mattress can be recommended for patients in ambulance care, even if more research is needed to receive sufficient evidence.

Background

Patients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.

Aim

The overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.

Method

Study I:

Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.

Study II:

In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.

Study III:

Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.

Study IV:

A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.

Results

Study I:

Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.

Study II:

Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.

Study III:

A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.

Study IV:

Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.

Conclusion

The ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia

BACKGROUND: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care.

METHODS: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures.

RESULTS: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes.

CONCLUSIONS: The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.