In 2016, a selective preventive spinal immobilization protocol for emergency medical service (EMS) nurses was introduced in the Netherlands. This protocol leaves more room for autonomous decision-making in the pre-hospital phase regarding preventive spinal immobilization (PSI), compared to the previous strict protocol. In this study, we explored the experiences and perspectives of EMS nurses on decision making about PSI after the change from a strict to a selective PSI protocol. Methods: We used a qualitative design with semi structured face-to-face interviews. Thematic analysis was applied. The capability-opportunity-motivation behavior-model was used to interpret the experiences and perspectives. Results: Thirteen EMS nurses from three emergency medical services were interviewed. Respondents appreciated autonomous decision-making as there was more room for patient-centered informed decision-making. However, autonomous decision-making required optimized knowledge and skills and elicited the need to receive feedback on their decision not to apply PSI. When nurses anticipated resistance to selective PSI from receiving hospitals, they were doubtful to apply it. Conclusion: Nurses appreciate the increased autonomy in decision-making, encouraging them to focus on patient-centered care. Increased autonomy also places higher demands on knowledge and skills, calling for training and feedback. Anticipated resistance to receiving hospitals based on mutual protocol discrepancies could lead to PSI application by EMS nurses while not deemed necessary. Recommendations: To enhance PSI procedures, optimizing the knowledge and skills of EMS nurses that facilitate on-scene decision-making may be indicated. A learning loop for feedback between the EMS nurses and the involved hospitals may add to their professional performance. More efforts are needed to create support for the changed Emergency Medical Services strategy in PSI to prevent unnecessary PSI and practice variation.
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Designers move more and more in the direction of Service Design, in which frequently a participatory or co-design approach is used to involve service providers in the design process. The designerprovider relationship in such Service Design processes differs in four aspects from traditional client-relationships: The relationship is 1) more dynamic and interactive, 2) based on collaboratively evolving ideas and ambitions, 3) focusing on the process of innovation, rather than on the outcome, and 4) frequently based on extrinsic motivation for innovation or on fuzzy starting points. Designers experience difficulties in persuading service providers of the importance of such a collaborative approach, while providers are not familiar with this kind of approach and their organizations are not ready for such a kind of collaboration. This paper positions designer-provider relationship in Service Design processes in literature and describes a research proposal for the development of an efficient and effective participatory design intervention that stimulates collaboration between designers and service providers.
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Introduction: From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. Methods and analysis: A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). Ethics and dissemination: This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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Nederland kent ongeveer 220.000 bedrijfsongevallen per jaar (met 60 mensen die overlijden). Vandaar dat elke werkgever verplicht is om bedrijfshulpverlening (BHV) te organiseren, waaronder BHV-trainingen. Desondanks brengt slechts een-derde van alle bedrijven de arbeidsrisico’s in kaart via een Risico-Inventarisatie & Evaluatie (RI&E) en blijft het aandeel werknemers met een arbeidsongeval hoog. Daarom wordt er continu geïnnoveerd om BHV-trainingen te optimaliseren, o.a. door middel van Virtual Reality (VR). VR is niet nieuw, maar is wel doorontwikkeld en betaalbaarder geworden. VR biedt de mogelijkheid om veilige realistische BHV-noodsimulaties te ontwikkelen waarbij de cursist het gevoel heeft daar echt te zijn. Ondanks de toename in VR-BHV-trainingen, is er weinig onderzoek gedaan naar het effect van VR in BHV-trainingen en zijn resultaten tegenstrijdig. Daarnaast zijn er nieuwe technologische ontwikkelingen die het mogelijk maken om kijkgedrag te meten in VR m.b.v. Eye-Tracking. Tijdens een BHV-training kan met Eye-Tracking gemeten worden hoe een instructie wordt opgevolgd, of cursisten worden afgeleid en belangrijke elementen (gevaar en oplossingen) waarnemen tijdens de simulatie. Echter, een BHV-training met VR en Eye-Tracking (interacties) bestaat niet. In dit project wordt een prototype ontwikkeld waarin Eye-Tracking wordt verwerkt in een 2021 ontwikkelde VR-BHV-training, waarin noodsituaties zoals een kantoorbrand worden gesimuleerd (de BHVR-toepassing). Door middel van een experiment zal het prototype getest worden om zo voor een deel de vraag te beantwoorden in hoeverre en op welke manier Eye-Tracking in VR een meerwaarde biedt voor (RI&E) BHV-trainingen. Dit project sluit daarmee aan op het missie-gedreven innovatiebeleid ‘De Veiligheidsprofessional’ en helpt het MKB dat vaak middelen en kennis ontbreekt voor onderzoek naar effectiviteit rondom innovatieve-technologieën in educatie/training. Het project levert onder meer een prototype op, een productie-rapport en onderzoeks-artikel, en staat open voor nieuwe deelnemers bij het schrijven van een grotere aanvraag rondom de toepassing en effect van VR en Eye-Tracking in BHV-trainingen.
In the SensEQuake project, the Research Centre for Built Environment NoorderRuimte of Hanze University of Applied Sciences, StabiAlert, Target Holding and NHL Stenden Leeuwarden are investigating the following question:How can we provide relevant and understandable information to support decision makers when an earthquake has occurred?In case of a crisis such as an earthquake, parties such as the provincial government, large company sites, airports or hospitals need information on the scope and severity of the effect of the crisis.Systematic updates of the actual situation on site are of the essence for emergency services. At present only a small amount of the data necessary for this information needed is being collected. And the data that is collected is not processed into relevant and easily understandable information for the decision makers. This project aims to fill this gap.The objective of the project is to integrate the existing sensor technologies into a decision support system, allowing a wider and more immediate use of sensor data for public interest, particularly in crisis times.A heat-map will be produced based on scenario earthquakes and loss (hazard and risk assessment) estimation tools. After running several scenario quakes, critical points in respect to the expected damages and the distribution of existing sensors will be defined. More sensors in critical locations will also be placed to create a high enough resolution.
