Emergency Service Work

Deliryum, akut başlangıçlı ve değişmiş mental durum ile karakterize bir klinik sendromdur. Deliryum hastaneye yatırılan yaşlıların % 14-56'sında görülür. Bu yazıda, hipokalsemiye bağlı deliryum gelişen 78 yaşında bir kadın olgu sunuldu ve konu güncel literatür bilgileri ile tartışıldı.

Özet Opioid antagonistleri yalnız kimyasal ve farmakolojik özellikler olarak değil aynı zamanda klinik kullanımdaki etkinleri anlamında da eşsiz bir ilaç grubudur. Bu sınıf içinde özellikle Nalokson yaygın olarak kardiyopulmoner arrest vakalarında opioid ile indüklenen solunum depresyonunu geriye döndürmek için kullanılmaktadır. Kanıta dayalı tıpta Nalokson uygulamaları önemli yer tutar. Klinik etkinliğini ve populeritesi sonucu Naloksonun farklı ilaç formulasyonları geliştirilmiş ve farklı Nalokson uygulamaları çalışılmıştır. Nalokson intramüsküler, intranazal, subkutan, nebülize veya endotrakeal verilebilen bir ilaçtır. Uygun doz ve konsantrasyonlar ilacın verilme yoluna göre farklılık gösterir. Bu derleme en son indikasyonlar ile opioid antagonistlerinin hastane içi veya dışındaki kullanımlarını özetlemek için yazılmıştır.

Özet: Ajitasyon, pek çok psikiyatrik ve tıbbi durumun seyri sırasında ortaya çıkabilen yaşamı tehdit edebilen bir durumdur. Ajitasyon, bir kişinin, kendisi ya da yakın çevresinin güvenliğini tehlikeye sokan her türlü sesli, sözlü ve/veya motor davranışlar kümesidir. Saldırgan davranışların gelişiminde biyolojik, sosyal, çevresel etkenler gibi birçok etmen rol oynar. Öncesinde psikiyatrik hastalık öyküsü olmayan aniden ortaya çıkan ajitasyon, saldırgan davranış ve dürtüsellik gösteren hastalarda, psikiyatri dışı tıbbi durumların mutlaka dışlanması gerekir. Klinisyenler açısından da tanı ve tedavi yöntemleri konusunda bazı güçlüklere yol açabilen ajitasyonun izlemi önemlidir. Bu nedenle klinisyenlerin ajitasyonu olan olgulara yaklaşımı, risk faktörlerini konusunda bilgi sahibi olmaları yaşam kurtarıcı olabilir. Bu derlemede ajite davranış açısından riskli bireylere yaklaşım ve tedavi süreçleri konusunda mevcut literatür bilgilerinin gözden geçirilmesi amaçlanmıştır. Çalışma için PubMed, Google Scholar, Türk Psikiyatri Dizini gibi arama motorları taranmış ve konu ile ilgili İngilizce, Türkçe dillerinde yazılmış tam metin olarak ulaşılabilen yayınlar çalışmaya dahil edilmiştir. Sağlık çalışanlarının ajitasyonu olan hastanın yönetimi konusunda eğitilmesi, bilgilendirilmesi gereklidir. Sağlık çalışanlarına ve hasta yakınlarına zor anlar yaşatan saldırgan davranış nedeni ile başvuran olgular için öncelikle güvenlik tedbirleri alınmalıdır. Saldırgan hastaların tedavisinde çevresel düzenleme, yatıştırma, bedensel tespit veya tecrit ve farmakolojik yaklaşım uygulanır.

Unlike general clinics, aggression is a frequently encountered condition in psychiatry clinics. Interventions made in cases where aggression cannot be managed threaten patient-worker safety and disrupt the therapeutic environment; reduces the motivation of employees and the quality of care they provide. In this study, it is aimed to evaluate the pre-restriction aggression symptoms of patients receiving treatment by health professionals (psychiatrists, nurses) who decided to restrict by using multi-criteria decision making techniques. This descriptive and cross-sectional study was conducted with 40 nurses and psychiatrists working in a state hospital in Istanbul, between May and July 2021. The data were collected using a digital questionnaire consisting of two parts, the Socio-demographic Data Form and the Aggression Symptoms Evaluation Form. In the analysis of the data, the weights of the criteria were calculated by using the Analytical Hierarchy Process Technique. Among all the criteria, self-harming and harming the environment were determined as the most important criteria. Fall hazard, confusion/delirium, and excessive agitation are of equal importance and are ranked third in the weights of the criteria. However, there is no significant difference in the priority order of the criteria in terms of occupations. The results of this study show which of the aggression behaviors exhibited before PCM (Professional Containment Methods) is more important; It is important in terms of revealing which criteria can actually be considered as signs of aggression. Thanks to the data obtained as a result of the study, it is thought that unnecessary PCM use will be prevented. The results of the study can be used in planning the trainings for PCM given in in-service training programs for candidates who are just starting their profession.

Substance dependency is a serious problem that should be taken into consideration in an emergency service. Patients with substance dependence are seen by emergency services in many different clinical situations. Studies show that emergency service personnel are faced with substance-dependents most frequently. For this reason, substance dependency is a very important topic for emergency service personnel. A number of approaches have been reported regarding substance dependency treatment in the literature. The aim of this article is to review research about the management of substance dependency in an emergency service.

Datura stramonium is a hallucinogenic plant which is a member of belladona alkaloids. The toxic effects of Datura stramonium most often include visual and auditory hallucinations, confusion and agitation in higher doses. We presented an 37-year-old woman who presented to emergency department with psychiatric symptoms and diagnosed datura stramonium poisoning.

Datura stramonium is a hallucinogenic plant which is a member of belladona alkaloids. The toxic effects of Datura stramonium most often include visual and auditory hallucinations, confusion and agitation in higher doses. We presented an 37-year-old woman who presented to emergency department with psychiatric symptoms and diagnosed datura stramonium poisoning.

Serotonin sendromu serotonerjik etkili ilaçların tek başına veya birlikte kullanılmaları sonucu beyinde serotonin aktivitesinin artması sonucu gelişen bir ilaç ilişkili toksik tablodur. Bilinç değişikliği, otonomik instabilite ve nöromusküler anormallikler ile karakterize nadir görülen bir hastalıktır. Biz serotonerjik etkili ilaçların birlikte kullanımı sonucu 16 yaşındaki bir erkek çocukta gelişen serotonerjik sendrom olgusunu sunmak istedik.

This paper derives from a study undertaken at an emergency service centre by researchers at the Blekinge Institute of Technology, Sweden. It forms part of a project involving partners at the university and in Swedish emergency service centres. The focus in this project was on the possibility of developing new technology for use in these centres. One vision for the new technology is to support distribution of calls and handling of cases across several centres. Historically the work has been conducted in a number of different centres, where responsibilities are thus primarily geographically localised and where, as a result, practices in the different centres may be distinctively local. The study has focused on features of work familiar to the CSCW community, including documenting and analysing current work practices, understanding the properties of the technology in question, and perhaps most importantly how the technology functions in use. Our focus in this paper exemplifies these themes through the analysis of three cases. In the first, the issue in question is the way in which an emergency is identified and dealt with, it being the case that a typical problem to be dealt with by operators, and more commonly in the days of mobile telephony, is that of multiple reporting of a single case. Of particular interest here is the phenomenon of listening-in, which is a function in the Computer Aided Dispatch system and by contrast that of 'overhearing', which is not. The second and third cases focus on the relevance of large paper maps, given the existence of computerized maps in these centres. Based on our own analysis and on work done by others in similar contexts, we develop an argument for a sense of organizational relevance that hopefully integrates existing analytic interests in emergency service work.

Özet: Ajitasyon, pek çok psikiyatrik ve tıbbi durumun seyri sırasında ortaya çıkabilen yaşamı tehdit edebilen bir durumdur. Ajitasyon, bir kişinin, kendisi ya da yakın çevresinin güvenliğini tehlikeye sokan her türlü sesli, sözlü ve/veya motor davranışlar kümesidir. Saldırgan davranışların gelişiminde biyolojik, sosyal, çevresel etkenler gibi birçok etmen rol oynar. Öncesinde psikiyatrik hastalık öyküsü olmayan aniden ortaya çıkan ajitasyon, saldırgan davranış ve dürtüsellik gösteren hastalarda, psikiyatri dışı tıbbi durumların mutlaka dışlanması gerekir. Klinisyenler açısından da tanı ve tedavi yöntemleri konusunda bazı güçlüklere yol açabilen ajitasyonun izlemi önemlidir. Bu nedenle klinisyenlerin ajitasyonu olan olgulara yaklaşımı, risk faktörlerini konusunda bilgi sahibi olmaları yaşam kurtarıcı olabilir. Bu derlemede ajite davranış açısından riskli bireylere yaklaşım ve tedavi süreçleri konusunda mevcut literatür bilgilerinin gözden geçirilmesi amaçlanmıştır. Çalışma için PubMed, Google Scholar, Türk Psikiyatri Dizini gibi arama motorları taranmış ve konu ile ilgili İngilizce, Türkçe dillerinde yazılmış tam metin olarak ulaşılabilen yayınlar çalışmaya dahil edilmiştir. Sağlık çalışanlarının ajitasyonu olan hastanın yönetimi konusunda eğitilmesi, bilgilendirilmesi gereklidir. Sağlık çalışanlarına ve hasta yakınlarına zor anlar yaşatan saldırgan davranış nedeni ile başvuran olgular için öncelikle güvenlik tedbirleri alınmalıdır. Saldırgan hastaların tedavisinde çevresel düzenleme, yatıştırma, bedensel tespit veya tecrit ve farmakolojik yaklaşım uygulanır.

Opioid bağımlılığı, tüm kültürleri etkileyen, sosyal problemler yaratan, bireyin sağlık durumunu etkileyerek ölüme yol açan dünyanın en büyük sağlık ve sosyal problemlerinden biridir. Opiyatların bağımlılığının tedavisinde çok seçenekli ilaç çeşitleri bulunmaktadır. Buprenorfin ve Metadon opioid bağımlılığının tedavisinde başlıca ve en etkin kullanılan iki ajandır. Her iki ajanın da yapısal olarak birbirine benzemekle beraber kullanımında avantajları olduğu gibi dezavantajları da bulunmaktadır. Bu ilaçlar doğru kullanıldığında, bağımlıların opiyatların kullanımına olan isteklerini azaltmaktadırlar. Metadon ile Buprenorfin aşırı doz kullanım olasılığı düşük olduğu için opiyatların bağımlılığının tedavisinde daha güvenli bir seçenek olarak görülmektedir. Özellikle psikososyal müdahalelerle birlikte kullanıldığında, opioid bağımlılığı için hem Metadon hem de Buprenorfin diğer tüm tedavi türlerinden daha etkili olduğu gösterilmiştir. Bu derlemenin amacı Buprenorfin ve Metadonun benzerliklerini, farklılıklarını ve birbirine yönelik üstünlüklerini tartışarak opioid bağımlılığı tedavisindeki her iki ilacın da rolünü bilimsel olarak ele almaktır. Böylece opioid bağımlılığı tedavisi ile ilgili uzmanlara, araştırmacılara ve politika geliştiricilerine genel bir bilgi sunarak bağımlılar için etkin ve çok seçenekli tedavi yöntemlerine katkı koymak hedeflenmiştir.

Am ma aç ç: : An ti ko li ner jik ilaç lar la ze hir len me ler acil ser vis ler de sık gö rü len ve ya şa mı teh dit eden ze hir len me ler dir. Bu ilaç -la rın kalp hı zı de ği şik lik le ri, ri tim bo zuk luk la rı ve ile ti ge cik me le ri gi bi kalp üze ri ne cid di yan et ki le ri var dır. Ça lış ma mız da -ki amaç QTc≥0,45 olan tri sik lik an ti dep re san (TSA) ve TSA dı şı an ti ko li ner jik ilaç lar la ze hir len me ler de kalp üze ri ne olan di ğer olum suz et ki le rin ben zer özel lik te olup ol ma dı ğı nın be lir len me si ve stan dart NaH CO 3 te da vi si nin tüm an ti ko li ner jik ilaç ze hir len me le rin de QRS ge niş le me si dı şın da QTc uza ma sın da da et kin li ği nin kar şı laş tı rıl ma sı dır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : İle ri ye dö nük ola rak plan la nan va ka kon trol ni te li ğin de ki ça lış ma mı za 07.06.2005-30.11.2006 ta rih le ri ara sın da Çu ku ro va Üni ver si -te si Tıp Fa kül te si acil ser vi se TSA ve TSA d...

Postoperatif uzun süre beslenme desteği alan bir hastada aniden ortaya çıkan tiamin (vitamin B1) eksikliğine bağlı Wernicke ensefalopatisi olgusu tariflenmiştir. Mide kanseri nedeniyle total gastrektomi yapılan 55 yaşındaki erkek hastada postoperatif gelişen intestinal fistül nedeniyle uzun süreli parenteral beslenme desteği verilirken ani başlayan konfüzyonel durum, oftalmoparezi, trunkal ataksi, hipotermi ve hipotansiyon semptomları ortaya çıkmıştır. Yapılan nörolojik değerlendirme ve manyetik rezonans incelemesi sonucu Wernicke ensefalopatisi tanısı konulmuştur. Hızla yapılan tiamin replasmanına dramatik cevap alınmış ve herhangi bir sekel kalmadan hasta taburcu edilmiştir. Cerrahi hastalarda gelişen nörolojik komplikasyonlarda, Wernicke ensefalopatisi ayırıcı tanıda düşünülmeli ve şüphelenildiğinde erken dönemde tiamin desteği sağlanmalıdır. Ayrıca parenteral beslenme solüsyonlarına rutin olarak vitamin preperatları eklenmelidir. Anahtar Kelimeler: Wernicke Ensefalopatisi; Parenteral Beslenme; Postoperatif Komplikasyon. Wernicke Encephalopathy as a Complication of Parenteral Nutrition Here we described a case of Wernicke's encephalopathy with thiamin (vitamin B1) deficiency after a prolonged postoperative parenteral nutritional. A 55-year-old male patient with total gastrectomy for gastric cancer had a postoperative intestinal fistula and required a long-term parenteral nutrition. During the treatment, he developed sudden confusional state, ophtalmoplegy, truncal ataxia, hypothermia and hypotension. Wernicke's encephalopathy was diagnosed after neurological evaluation and magnetic resonance imaging. We observed a dramatic response to thiamine replacement, his symptoms recovered quickly and the patient was discharged without any sequelae. Wernicke's encephalopathy should be considered in the differential diagnosis of the surgical patients with neurological complications, and when suspected early support of thiamine should be provided. In addition, vitamin preparations should be routinely added to solutions of parenteral nutrition.

Dyspnea due to thyroid storm in an emergency service Thyroid storm (TS) is a metabolic condition which is usually seen in patients with undiagnosed or poorly-treated hyperthyroid diseases. Although this condition is a common metabolic condition, the incidence of TS in emergency services is rare. Even though there has been advancement in treatment modalities, TS still has a mortality rate of 20-40%. This high mortality and morbidity rate could be reduced by early diagnosis and treatment. Here in we present a TS patient admitted to our emergency service due to dyspnea.

Objective: In this study, we aimed to identify the properties of patients who visited the emergency department and left of their own accord. Material and Methods: Patients who visited the emergency department and left by their own choice for any reason were evaluated retrospectively. Results: In this study, 1140 patients (57.7% male) were enrolled with a mean age of 40.5±14.9 years. Patients were admitted due to poisoning, abdominal pain and chest pain at rates of 23.2%, 16.4% and 15.1% respectively. It was found that 673 patients (59.0%) left because of being denied medical observation or treatment, and 215 patients (18.9%) left because of consultants running late. Conclusion: Necessary arrangements must be put in place to reduce the number of patients who leave the emergency department by choice, prior to being discharged by a clinician.

The field of our study takes place in the Swedish emergency service centre. The operators receive emergency calls and are responsible for the coordination and dispatch of ambulances and rescue services. Emergency literature has treated its materials in the mode of catastrophe. Operators' mundane work and technological environment for handling the unexpected changes have been often addressed in terms of error, mistakes, mishandling and other misunderstandings. Our paper wants to show that operator's work practice sustained a comprehensive approach of technology use such as to keep full ability to handle unexpected change. This point is crucial to understand technology in action. It is precisely the good handling of technology that allows taking into account the most unexpected change with great success. Our paper shows how story eliciting is bounded to technological possibilities and as such is part of everyday professional conduct of call taker and dispatchers. The challenge of this paper is to show that technology is a crucial part of their mode of action. As such, it cannot be separated from the ongoing course of case handling. Our particular case is a story where a caller requests an ambulance on behalf of an unconscious friend. The operator decides to proceed to the dispatch of an ambulance. In the sustained conversation with the caller, it turns out that the friend in question recovered her consciousness. We show in this paper that the story elicitation, remote conversation and scenic background information, are working tools that keep access with the reality of the caller. The main point is that emergency can turn out to be health care advice without any major problems. We will show that all key access to the scenic feature of the caller are monitored through and through by technological artefacts that will be examined.

Am ma aç ç: : An ti ko li ner jik ilaç lar la ze hir len me ler acil ser vis ler de sık gö rü len ve ya şa mı teh dit eden ze hir len me ler dir. Bu ilaç -la rın kalp hı zı de ği şik lik le ri, ri tim bo zuk luk la rı ve ile ti ge cik me le ri gi bi kalp üze ri ne cid di yan et ki le ri var dır. Ça lış ma mız da -ki amaç QTc≥0,45 olan tri sik lik an ti dep re san (TSA) ve TSA dı şı an ti ko li ner jik ilaç lar la ze hir len me ler de kalp üze ri ne olan di ğer olum suz et ki le rin ben zer özel lik te olup ol ma dı ğı nın be lir len me si ve stan dart NaH CO 3 te da vi si nin tüm an ti ko li ner jik ilaç ze hir len me le rin de QRS ge niş le me si dı şın da QTc uza ma sın da da et kin li ği nin kar şı laş tı rıl ma sı dır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : İle ri ye dö nük ola rak plan la nan va ka kon trol ni te li ğin de ki ça lış ma mı za 07.06.2005-30.11.2006 ta rih le ri ara sın da Çu ku ro va Üni ver si -te si Tıp Fa kül te si acil ser vi se TSA ve TSA d...

Serotonin sendromu serotonerjik etkili ilaçların tek başına veya birlikte kullanılmaları sonucu beyinde serotonin aktivitesinin artması sonucu gelişen bir ilaç ilişkili toksik tablodur. Bilinç değişikliği, otonomik instabilite ve nöromusküler anormallikler ile karakterize nadir görülen bir hastalıktır. Biz serotonerjik etkili ilaçların birlikte kullanımı sonucu 16 yaşındaki bir erkek çocukta gelişen serotonerjik sendrom olgusunu sunmak istedik.

Psikiyatrik hastalarda saldırganlık ve saldırgan hastaya yaklaşım Psikiyatrik hasta saldırıları ruh sağlığı alanında çalışanların mesleki uygulamada karşılaştıkları önemli olaylardandır. Bu saldırılar yaralanma, geçici veya kalıcı sakatlıklar, travma sonrası stres bozukluğu dahil ciddi sorunlar meydana getirmekte ve hatta bazen ölümle sonuçlanabilmekte, ayrıca klinik ve ekonomik yüke neden olmaktadır. Konu, önemine oranla az ilgi görmektedir çünkü saldırılar, mağdur personel tarafından, görevinin bir parçası olarak kabul görmekte, dile getirilmemekte ve yasal işleme başvurulmamaktadır. Psikiyatristlerin %5-48'inin hasta ve/veya hasta yakınları tarafından şiddet gördüğü, 4 yıllık asistanlık eğitimi boyunca asistanların %40-50'sinin fiziksel saldırıya uğradığı gösterilmiştir. Yardımcı sağlık personeli de hastalar, hasta yakınları ve ziyaretçiler tarafından sıklıkla duygusal, sözel ve fiziksel şiddete maruz kalmaktadır. Saldırıya maruz kalma riski yüksek olan personelin güvenliğinin sağlanması önemlidir ve çalışanlara bu konularda devamlı eğitim verilmelidir. Bu yazıda hasta saldırılarının nedenleri ve saldırgan hastaya yaklaşım (farmakolojik tedavi ve diğer önlemler) gözden geçirilmiştir.

It forms part of a project involving partners at the university and in Swedish emergency service centres. The focus in this project was on the possibility of developing new technology for use in these centres. One vision for the new technology is to support distribution of calls and handling of cases across several centres. Historically the work has been conducted in a number of different centres, where responsibilities are thus primarily geographically localised and where, as a result, practices in the different centres may be distinctively local. The study has focused on features of work familiar to the CSCW community, including documenting and analysing current work practices, understanding the properties of the technology in question, and perhaps most importantly how the technology functions in use. Our focus in this paper exemplifies these themes through the analysis of three cases. In the first, the issue in question is the way in which an emergency is identified and dealt with, it being the case that a typical problem to be dealt with by operators, and more commonly in the days of mobile telephony, is that of multiple reporting of a single case. Of particular interest here is the phenomenon of listening-in, which is a function in the Computer Aided Dispatch system and by contrast that of 'overhearing', which is not. The second and third cases focus on the relevance of large paper maps, given the existence of computerized maps in these centres. Based on our own analysis and on work done by others in similar contexts, we develop an argument for a sense of organizational relevance that hopefully integrates existing analytic interests in emergency service work.

Dyspnea due to thyroid storm in an emergency service Thyroid storm (TS) is a metabolic condition which is usually seen in patients with undiagnosed or poorly-treated hyperthyroid diseases. Although this condition is a common metabolic condition, the incidence of TS in emergency services is rare. Even though there has been advancement in treatment modalities, TS still has a mortality rate of 20-40%. This high mortality and morbidity rate could be reduced by early diagnosis and treatment. Here in we present a TS patient admitted to our emergency service due to dyspnea.

We have analyzed some examples of communication and cooperation in an emergency control centre. The distribution of information and the distribution of tasks is a complex cognitive activity. In some cases, this activity is regulated by institutional rules, in other cases, the persons involved have to decide when to call upon another person, how to transfer data and how to feed back data about activities performed. For time-critical complex tasks like this, strict rule-based behaviour seems to be insufficient, as much of the cooperation and success of managing this dynamic task seem to depend upon flexibility and what we coin cognitive empathy.

We have analyzed some examples of communication and cooperation in an emergency control centre. The distribution of information and the distribution of tasks is a complex cognitive activity. In some cases, this activity is regulated by institutional rules, in other cases, the persons involved have to decide when to call upon another person, how to transfer data and how to feed back data about activities performed. For time-critical complex tasks like this, strict rule-based behaviour seems to be insufficient, as much of the cooperation and success of managing this dynamic task seem to depend upon flexibility and what we coin cognitive empathy.

Objective: In this study it was aimed to analyse the demographic features of the patients over 65 years old. Material and Methods: All the patients over 65 years old were included in this retrospective study. Admission dates (month, season), ages, sex, admission types, diagnosis, duration of hospitalisation, outcome in the emergency department of the patients were recorded. Data were analysed with student T test and Chi square test by using SPSS 17.0. Results: Of the total of 238,222 admissions to the emergency department, 8.793 (3.6%) patients were over 65 years old. Of these, 58 % were female and 42% were male. COPD and respiratory problems in males, and hypertension with cardiac problems in females were found high and this was statistically significant. The highest admission rate was in the autumn months. The chief reason for admission to the emergency department was cardiac problems (21.7%). This was followed by neurological problems, trauma, respiratory system problems and urinary tract infections, respectively. The highest mortality rate was 45% in the general intensive care unit. The most frequent reason for mortality was cardiac problems. Conclusion: Cardiac problems was the main reason in admissions to the emergency, hospitalisation and mortality causes in geriatric patients. Conducted studies for determining the geriatric admission rate, most observed illness might be helpful in order to constitute the special care areas and special scannings. (JAEM 2012(JAEM doi:10.5152/jaem.2013

Toxication caused by pesticides is a serious health problem in our country. Organophosphates are the leading cause of pesticide toxications in our country, as they are worldwide. These compounds lead to acetylcholine deposition by blocking acetylcholine esterase enzyme, causing muscarinic, nicotinic and central nervous symptoms due to continuous stimulation of the receptors. Mortality occurs in the early period due to acute cholinergic crisis or later in patients with intermediate syndrome. Death is caused by heart conduction disturbances and respiratory failure during the acute cholinergic crisis period, whereas it is due to respiratory failure in patients with an intermediate syndrome. Management of patients with pesticide poisoning should start by providing adequate respiratory and circulatory support followed by antidotes and other medical therapies. In this review, we have aimed to explain the properties and mechanisms of action of organophosphate compounds;with causes of mortality in the poisoning of these compounds and recent approaches for management of toxication. (JAEM 2012; 11: 176-82)

In this paper we propose an approach called DiCoT (Distributed Cognition for Teamwork) that can be used for contextual analysis and design considerations. We analyse the London Ambulance Service (LAS) control room as a case study. This approach develops five models that guide data gathering, that provide points of reflection, and act as boundary objects between analysts, designers and stakeholders. Through using the method we find that information buffering and situation awareness are important for system performance. ...

Substance dependency is a serious problem that should be taken into consideration in an emergency service. Patients with substance dependence are seen by emergency services in many different clinical situations. Studies show that emergency service personnel are faced with substance-dependents most frequently. For this reason, substance dependency is a very important topic for emergency service personnel. A number of approaches have been reported regarding substance dependency treatment in the literature. The aim of this article is to review research about the management of substance dependency in an emergency service. (JAEM 2013; 12: 215-9)

This paper derives from a study undertaken at an emergency service centre by researchers at the Blekinge Institute of Technology, Sweden. It forms part of a project involving partners at the university and in Swedish emergency service centres. The focus in this project was on the possibility of developing new technology for use in these centres. One vision for the new technology is to support distribution of calls and handling of cases across several centres. Historically the work has been conducted in a number of different centres, where responsibilities are thus primarily geographically localised and where, as a result, practices in the different centres may be distinctively local.

This paper derives from a studyundertaken at an emergency service centre byresearchers at the Blekinge Institute ofTechnology, Sweden. It forms part of a projectinvolving partners at the university and inSwedish emergency service centres. The focus inthis project was on the possibility ofdeveloping new technology for use in thesecentres. One vision for the new technology isto support distribution of calls and handlingof cases across several centres. Historicallythe work has been conducted in a number ofdifferent centres, where responsibilities arethus primarily geographically localised andwhere, as a result, practices in the differentcentres may be distinctively local. The study has focused on features of workfamiliar to the CSCW community, includingdocumenting and analysing current workpractices, understanding the properties of thetechnology in question, and perhaps mostimportantly how the technology functions inuse. Our focus in this paper exemplifies thesethemes through the analysis of three cases. Inthe first, the issue in question is the way inwhich an emergency is identified and dealtwith, it being the case that a typical problemto be dealt with by operators, and morecommonly in the days of mobile telephony, isthat of multiple reporting of a single case. Ofparticular interest here is the phenomenon oflistening-in, which is a function in theComputer Aided Dispatch system and by contrastthat of `overhearing', which is not. The secondand third cases focus on the relevance of largepaper maps, given the existence of computerizedmaps in these centres. Based on our ownanalysis and on work done by others in similarcontexts, we develop an argument for a sense oforganizational relevance that hopefullyintegrates existing analytic interests inemergency service work.

This paper reports on a field study into the nature of decision making in the command and control of emergency ambulances at the London Ambulance Service (LAS). This paper will describe how real-time decisions are made by emergency medical dispatchers and the decision strategies they invoke as they assess the situation, plan and co-ordinate the dispatch of emergency ambulances.

ABSTRACT In this paper we propose an approach called DiCoT (Distributed Cognition for Teamwork) that can be used for contextual analysis and design considerations. We analyse the London Ambulance Service (LAS) control room as a case study. This approach develops five models that guide data gathering, that provide points of reflection, and act as boundary objects between analysts, designers and stakeholders.

This chapter reports on an investigation into the ordered, in situ production of "calls for service" in public safety communications centers. These centers are responsible for dispatching police, fire, and paramedic assistance in response to citizen reports, complaints, and requests that are phoned in on both 9-1-1 emergency and seven digit nonemergency lines. I will be concerned with the question of how such reports, complaints, and requests are locally constituted as "calls," as nameable and countable organizational events that warrant some form of official response. The analysis centers on how certain computer tools and artifacts utilized by communications center staff enter into this production in a fundamental way, serving as a "technology of order production" (Suchman, in press a), and on the embodied courses of practical action and practical reasoning involved in the competent use of that technology.