Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

OBJECTIVE: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number. METHODS: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient). RESULTS: A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919-0.934). CONCLUSIONS: The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.

Feeling safe or unsafe in prehospital emergency care: A qualitative study of the experiences of patients, carers and healthcare professionals.

AIMS AND OBJECTIVES: To determine the feelings of safety among patients taken to hospital after requesting urgent care, based on their experiences and those of their carers and prehospital emergency care professionals. BACKGROUND: Little research has been performed into the perception of safety in prehospital emergency care settings worldwide, from either the perspective of the patients or from that of healthcare professionals. DESIGN: Exploratory qualitative study using focus groups in Spain. METHODS: The participants were patients that requested care through the emergency telephone service, their carers and the professionals of the emergency care teams. The structured sampling design was based on an intentional, nonprobability selection following pragmatic criteria. Seven groups of patients/carers and two groups of professionals were formed (65 participants). The recordings were fully transcribed before their validation and codes were assigned to ensure anonymity. The ATLAS.ti software was used for the analysis. The authors took into account the COREQ checklist for qualitative studies. FINDINGS: Neither group provided a clear definition of the meaning of feeling safe. It appeared easier to give examples that had a positive or negative influence on their perception of feeling safe. During the analysis of the discourse, six categories were detected after grouping the related codes. CONCLUSIONS: For most of the patients' feeling of being safe or very safe arose from the perception of calmness, trust and protection. Defining the perception of safety was not easy. The factors with the greatest effect on feeling safe were related to Information and communication, Person-centred care and Professional competency, without losing sight of other factors such as Accessibility and response times of the emergency teams, Equipment and Healthcare setting. RELEVANCE TO CLINICAL PRACTICE: The findings could be used as a knowledge base in future research and for implementing procedures for improving perceptions of safety among patients.

Esterilidad de sueros purgados. Antes de su uso en urgencias y emergencias extrahospitalarias / Sterility in drained serums; before their use in emergency wards and in non-hospital emergency use

Se detallan las características de esterilidad de los sueros purgados y ubicados dentro de una UVI-móvil, y se determina cuánto tiempo pueden mantener las condiciones óptimas para su uso, mediante un ensayo clínico controlado y aleatorizado, triple ciego, donde las unidades de estudio fueron sueros preparados con sistema de infusión y llave de tres vías. Se recogieron datos durante un periodo de estudio de 12 meses. Se diseñaron seis grupos de intervención en función del tiempo de exposición y su ubicación. Tamaño muestral de 672 unidades. Se realizaron 12 cultivos microbiológicos a cada una, para bacterias y hongos, tanto aerobios como anaerobios. Se contrastó hipótesis con un modelo de regresión logística multivariante para la variable "esterilidad". Se consideró significativo un valor de p < 0,05. Se obtuvieron resultados de 669 sueros (98,82%). Existió colonización en 1,7% de los 8.028 cultivos realizados, encontrando más de 10 UFC/ml sólo en dos casos. Esta colonización correspondió a 103 sueros que se clasificaron como "no estériles". Para la esterilidad, el modelo de regresión logística no mostró asociación significativa con los diferentes grupos de intervención, controlando mediante dos variables posiblemente confusoras. No se encontraron evidencias de que el suero recién purgado fuera diferente, desde el punto de vista de esterilidad, a los expuestos durante 24, 48 o 72 horas pero, a igualdad de grupos, las incidencias de los sueros triplicaban el riesgo de colonización. Se concluyó que podríamos utilizar sueros preparados con antelación, garantizando una esterilidad similar a los recién purgados(AU)

The authors detail the characteristics for the sterility of drained serums placed in a mobile emergency service unit and they determine how much time they can maintain optimum conditions for the use of these serums by means of a controlled, random, triple blind clinical test in which the units studied were serums prepared by an infusion system and a three-way valve. Data were gathered during a 12 month study period. The authors designed six operating groups based on their exposure time and where they were kept. These samples totaled 672 units. The authors carried out 12 microbiological cultural analyses for each unit; these analyses were tested for bacteria and fungi, both aerobic and anaerobic. The authors contrasted their hypothesis with a multivariable logistic regression model used as the variable for sterility. A value of p < 0.05 was considered to be significant. Results were obtained on 669 serums, 98.82% of samples. Colonization was found in 1.7% of the 8028 cultures analyzed; in only 2 cases was there a register greater than 10 UFC/ml. This colonization corresponded to 103 serums which were then classified as non-sterile. For sterility, the logistic regression model did not show any significant association with the various operating groups, which were controlled by means of two possible variable methods. The authors did not find evidence that recently drained serums were different, from the point of view of sterility, than the serums exposed during 24, 48 or 72 hours but, as well as for the groups, the incidences of these serums tripled the risk of colonization. The authors concluded they could use serums prepared previously and these serums sterility were guaranteed to the same degree as recently drained serums(AU)

Physico-chemical stability and sterility of previously prepared saline infusion solutions for use in out-of-hospital emergencies.

OBJECTIVE: The topic of this research was to determine whether out-of-hospital emergency teams could make use of previously prepared saline solutions (SS). The objective was to discover the physical, chemical and sterility characteristics of previously prepared saline infusions stored in ambulances and ascertain how long they remained in optimum condition. METHOD: Randomised clinical trial, triple blind, where study units consisted of saline solutions prepared with an infusion system and a three-way valve. The duration of the study was 12 months. Six intervention groups were designed on the basis of time of exposure and location. Samples consisted of 672 units. Twelve microbiological cultures were made and the pH, density, viscosity and CINa concentration were determined. We compared hypotheses with four models of linear regression for the variables and a model of logistic regression for the variables. A value of P < 0.05 was considered significant. RESULTS: We obtained results from 669 saline solutions (98.82%). Neither multivariant analysis nor ANOVA tests showed any significant association for a power greater than 99% with regard to the physical-chemical characteristics. The model of logistic regression also did not find any significant association for sterility. Colonisation was present in 1.7% of the 8,028 cultures made and more than 5 CFU per millilitre was found in only two cases. CONCLUSION: There is no evidence to suggest that recently prepared saline infusion solutions are any different from a physical-chemical and sterility point of view than those exposed for 24, 48, or 72 h. It was concluded that use can be made of previously prepared saline solutions with a guarantee their stability and sterility.