Browsing by Author "Nandasena, L.G.S."

Now showing 1 - 3 of 3

The attitudes and practices, regarding pre hospital care and emergency medicine, among ambulance drivers and minor employees accompany patients in ambulances
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe, the attitudes and practices, regarding pre hospital care and emergency medicine among the ambulance drivers and minor employees. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka from 15th August to 13th October 2008. The staff arrived in 409 ambulances (from any part of the country), consisting of 335 drivers and 675 minor employees were recruited. All were given an interviewer administered questionnaire to assess attitudes and practices. Likert scale was used to assess the level of attitudes. Practices were self reported ones. The analysis was done by using chi square test. RESULTS: Good attitudes towards, training needed in pre hospital care among drivers was 99.7% (n=334), low cost involved in adopting certain life saving measures, 50.4% (n=169) and positive outcome of pre hospital care in terms of survival, 4.8% (n=16). Among minor employees the respective figures were 96.8%(n=654), 36%(n=243) and 2.4%(n=16). Twenty four percent (n=164) of minor employees has had training in pre hospital care. Of them 84.8% ^=139) have used their knowledge to assist other ambulance staff in emergencies. Twenty three percent (n=95) of drivers wore seat belts and 6.4%(n=26) wore gloves. Among minor employees, 53%(n=360) used gloves, 45.2%(n=305) face masks, 5.9%(n=40) safety boots and 2.2% (n=15) safety caps. There is no statistically significant difference in attitudes of drivers and minor employees according to age, sex, education level, hospital they work, or training they had received. CONCLUSION: Attitudes towards training needed in pre hospital care were good, but with regard to low cost and positive outcome of pre hospital care, attitudes were relatively poor. The use of personal protective equipment during work was poor among all staff categories.
Availability of facilities and equipment, in ambulances that provide care in pre hospital set up
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe available facilities and equipment, in ambulances that provide care in pre hospital set up. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka (NHSL) from 15th August to 13th October 2008. All ambulances that arrived at the NHSL during the study period with an emergency patient were selected as study sample (n=409). A check list was used to assess in situ facilities and equipment that are available in the ambulance. RESULTS: Most of the ambulances were equipped only with very basic facilities such as wheeled stretcher (95.4%; n=390), ABC fire extinguishers (75.3%; n=308) and warning sirens (94.4%; n=386). Among ventilation and air way equipment required for basic life support, oxygen cylinders showed highest percentage (68.7%; n=281) of availability where as oropharyngeal air ways were available only in 4.9% (n=20) of ambulances. Availabilty of ventilation and air way equipment required for advanced life support ranged from 0.7% each (n=3) of adult endotracheal tubes and portable ventilators to 0.2% each (n=l) of peadiatric endotracheal tubes and Magill forceps. Patient assessment equipment such as pen lights and blood pressure apparatus were available only in 19.6%(n=80) and 2.2%(n=9) respectively. Communication equipment, obstetric supplies, splinting equipment, surgical items, drug delivery devices, and intravenous equipment, were available only among less than 5% of all ambulances. Most of the ambulances were equipped with safety and accessory equipment, except child safety seat 0.5% (n=2), triage tags 1.7% (n=7) and hack saw 0.7% (n=3), which were available only in less than 2% of all ambulances. Body substance isolation equipment were available only in less than 30% of all ambulances. CONCLUSION: The facilities that should be available for basic and advanced life support were poor in ambulances. From equipment that should be available for basic life support, most of the ambulances contained more basic elements only, which have no direct impact on patient care. Most of the equipments required for advanced life support were available only in less than 1% of ambulances.
Quality of ambulance care available for transfer of emergency patients to the National Hospital of Sri Lanka
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe quality of ambulance care available for transfer of emergency patients to the National Hospital of Sri Lanka. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka (NHSL) from 15th August to 13th October 2008. All ambulances that arrived at the NHSL during the study period with-an emergency patient were selected. A self administered questionnaire was used to assess the knowledge, attitudes and skills of medical staff (n=35) who accompanied the patients in the ambulances. Knowledge was assessed according to internationally accepted three levels defined for Emergency Medical Technicians (EMT). Data related to delays during transportation were obtained from drivers (n=395) using an interviewer administered questionnaire. RESULTS: Of the 409 ambulances included, the patient was accompanied by a doctor in 4%(n=16), a nurse in 4%(n=15) and EMTs in 1%(n= 4) of the occasions. Knowledge of medical staff was 74.3 % (n:=26) each for EMT basic and intermediate levels and 65.7%(n=23) for paramedic levels (EMT third level). Self reported skills in performing laryngoscopy and intubation was 31.4 %(n=11) and defibrillation 48.6% (n=17). Good attitudes towards training needed in pre hospital care was 97%(n= 34), low cost involved in adopting certain life saving measures was 77%(n=27) and being optimistic of adopting life saving measures was 25.7%(n= 9). More than 15 minutes each had been spent between receipt of message and transferring the patient from the scene/ward to the ambulance and from latter to commencement of the journey on 19%(n= 75) and 6.9%(n=27) of the occasions respectively. Problems experienced by medical staff during transportation were, traffic delays in 40%(n=10), non availability of necessary equipment/drugs/facilities in the ambulance to manage the patient in 28%(n=7), lack of knowledge and skills regarding patient management in 36%(n=9) and deterioration of patient's condition during transportation in 36%(n=9) of occasions. CONCLUSION: In general, Knowledge in pre hospital and emergency medicine was good among doctors, nurses and EMTs, but some areas of knowledge and skills need to be improved. Attitudes in outcome of pre hospital care were relatively poor, compared to the attitudes in training and cost. Most problems encountered during transit are preventable.