Wayfinding in Complex Medical Facilities: The Indexicality of Directional Arrows.

OBJECTIVES, PURPOSE, OR AIM: The aim of this article is to contribute to the better design of wayfinding systems by explicating the indexical properties of directional arrows and their consequences for wayfinding behavior. BACKGROUND: The challenges associated with designing for the wayfinding needs of the different groups of users continue to be documented with the poor design of built environments being largely to blame for the wayfinders' inability to navigate complex settings. Directional arrows have been found to be especially problematic in such settings. METHODS: Ethnographic data were collected and analyzed over a period of 3 years in three overlapping phases. The unique adequacy requirement of methods, which stipulates that the methods used to produce a description of a situation should originate from the situation they describe, was adopted. RESULTS: Directional arrows derive their meaning from the position they occupy within the physical environment and from three sources: the spatial configuration of the setting, the positioning of the sign within the setting, and the directional arrow itself. The affordance closest to the sign will be taken as the one which the sign refers to. Wayfinders treat that affordance as being indicated by the arrow until such time as it becomes apparent that it is not. CONCLUSIONS: In response to the need to find lasting solutions to the enduring problems of wayfinding, this article demonstrates how better design of wayfinding systems can be achieved by explicating the indexical properties of directional arrows and their consequences for wayfinding behavior.

Accuracy of dispatch and prehospital triage performance in poisonings - A retrospective study from northern Finland.

BACKGROUND: Increasing numbers of dispatches place a burden on EMS; this study sought to assess the prehospital evaluation of poisoned patients transported to hospital. The primary aim of this study was to measure dispatch centre and EMS provider performance as well as factors contributing to the recognition of poisoning among prehospital patients. The secondary aim was to compare triage performance between dispatch centres and EMS providers. METHODS: A retrospective single-centre study in Northern Finland was conducted. Patients suspected as poisonings by dispatch centres as well as other EMS-transported patients who received a diagnosis of poisoning in hospital between June 1, 2015 and June 1, 2017, were included. RESULTS: There were a total of 1668 poisoning-related EMS missions. Dispatch centres suspected poisonings with sensitivity of 79.9% (95% CI 76.7-82.9) and specificity of 98.9% (95% CI 98.9-99.0) when all EMS missions were taken into account. In a logistic regression model, decreased state of consciousness as dispatch code (OR 7.18, 95% CI 1.90-27.05) and intravenous fluid resuscitation (OR 6.58, 95% CI 1.34-32.37) were associated with EMS transport providers not recognizing poisoning. Overtriage rate appeared significantly higher (33.6%, 95% CI 28.6-39.2) for dispatch when compared with transport (17.8%, 95% CI 13.9-22.6). CONCLUSION: Dispatch centres seem to suspect poisonings fairly accurately. Poisonings unrecognized by EMS providers may be linked with intravenous fluid resuscitation and decreased patient consciousness. Overtriage appears to resolve somewhat from dispatch to transport. There were no fatal poisonings in this study population.

How does socioeconomic status affect the incidence of hospital-treated poisonings? A retrospective study.

BACKGROUND: Hospital-treated poisonings have a good outcome in general. The role of regional differences and socioeconomic status has been established in intensive care admissions and various causes of death, but not yet in hospital-treated poisonings. We set out to determine whether the incidence of hospital-treated poisonings is affected by the annual income of the residential area. METHODS: All poisonings in Northern Ostrobothnia region of Finland treated in Oulu University Hospital during 2013-2016 were studied. Oulu University Hospital is the primary hospital in the area. Postal code areas of the county were categorized on the basis of their median annual net income as low-, middle- and high-income areas. RESULTS: A total of 2142 poisoning cases were studied. The number of individual patients was 1525. In the low-income areas, the crude incidence of poisonings was more than 2-fold when compared with the middle- and high-income areas. In adolescents aged 13 to 17 years, the incidence in the low-income areas was almost 3-fold compared with the other two categories at 335/100 000/year (95% CI, 236-463). Four patients (0.2%) died during the hospital stay and 50 patients (2.3%) died within 6 months from the last admission. CONCLUSIONS: The incidence of hospital-treated poisoning was at least 2-fold in low-income areas when compared with middle- or high-income areas. For adolescent population from 13 to 17 years, the incidence in low-income areas was almost 3-fold when compared with other areas.

Fatal poisonings in Northern Finland: causes, incidence, and rural-urban differences.

BACKGROUND: In this study we evaluate differences between rural and urban areas in the causes and incidence of fatal poisonings. METHODS: Data from all fatal poisonings that occurred in Northern Finland from 2007 to 2011 were retrieved from Cause of Death Registry death certificates provided by Statistics Finland. The demographics and causes of fatalities were compared between rural and urban areas. Incidences were calculated based on the population data. RESULTS: There were a total of 684 fatal poisonings during the study period and 57.9% (n = 396) occurred in the urban population. Ethanol was the most common primary poisoning agent in cases of fatal poisoning, accounting for 47.5% of cases in urban areas and 68.1% in rural areas (P < 0.001). Fatal poisonings caused by psychoactive pharmaceutical products and opioids were more common in urban areas (28.3% compared to 18.0%, P < 0.001). The crude incidence of fatal poisonings in the study area was 18.8 (17.4-20.2) per 100,000 inhabitants per year and there was no difference in incidence between urban and rural areas. In the youngest age group (15 to 24 years), the incidence of fatal poisonings observed in urban areas was two times higher than that in rural areas. DISCUSSION: Higher rate of fatal ethanol poisonings in rural areas could be linked to higher alcohol consumption in rural areas and also differences in drinking behaviour. Higher incidence of poisoning suicides in urban areas could be due to availability of different toxic agents as a suicidal method. Preventive measures could be key in reducing the number of fatal poisonings in both areas, as most of the fatal poisonings still occur outside hospital. CONCLUSION: There was a higher rate of fatal ethanol poisoning in rural areas and higher rate of fatal poisoning related to psychoactive pharmaceutical products and opioids in urban areas. There were twice as many fatal poisonings in the youngest age group (15-24 years) in urban areas compared to rural areas, and suicide was more common in urban areas.

Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis.

BACKGROUND: Most fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths. METHODS: All fatal poisonings that occurred in Northern Finland in 2007-2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events. RESULTS: A total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths. DISCUSSION: Most of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning. CONCLUSIONS: The majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.