Abstract

Background: “Orientation” is an important phase when joining a new institution. It is the period when someone builds an understanding of their role/responsibilities in a new setting, and for colleagues to gauge someone's level of knowledge and competence. HMCAS recruits mostly overseas nursing qualified staff with variable experience and transforms them into Ambulance Paramedics (AP) all providing the same level of care in accordance to our Clinical Practice Guidelines. Methods: Skills assessment using a 17–20 stations Objective Structured Clinical Examination (OSCE) process was introduced in the Training Department during a week-long instructor development workshop in 2013. Instructors were coached to develop practical/theoretical OSCE stations and took part in pilot sessions as examiners with new APs. The OSCE is now a core AP training programme component with weekly sessions to assess new staff on what they have been taught up to that point in time. Results: Over 120 OSCE sessions have occurred in 2 years exposing about 600 staff to a minimum of 3 sessions each. A bank of over 40 stations has been developed and validated, and a team of trained examiners is used. As determined by the course evaluation form, although seen as a stressful experience, instructors and staff find it a very beneficial and effective assessment modality to prepare them for clinical practice. It motivates staff to study and they even request to have an OSCE per year as part of their continuing professional development. Conclusion: We are committed and have processes in place to sustain the facilitation of OSCE sessions as it is a very practical way of assessing a wide range of skills over a set time period and gauging staff progress through consecutive sessions. The initial preparation is time consuming but we encourage other departments to explore this approach as part of their orientation/training programme.

Abstract-Reactor performance affected through augments caused a total alkalinity diminution in the effluent; while the system buffer capacity was sufficient to overcome such instability, as the ratio of partial alkalinity/total alkalinity confirmed. Removal of COD decreased up to 15% when higher doses were added in comparison to acclimation period. Addition of lower doses in reactor influent affected adversely its performance; although, did not cause entire inhibition to anaerobic microbes..

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Background: Worldwide ambulances are regularly involved in accidents as staff may not anticipate other drivers' actions, suffer from fatigue, or overestimate their driving privileges. An ambulance driving safety campaign started in June 2015 targeting some 935 registered HMCAS drivers. We aim to determine if our approach is effective in changing behaviours and believes, and reducing the number of accidents involving HMCAS vehicles. Methods: This study was ethically approved as a quality improvement project and is still ongoing. The campaign made use of ambulance dashboard stickers and posters at ambulance stations' exits with respectively 4 and 6 key messages covering frequent issues resulting in collisions. An official circular also informed staff of the campaign. A month later a survey started to be distributed to staff. Results: In two month, 189 anonymous online or paper questionnaires were fully completed. 69.2% of respondents had an HMCAS driving qualification (13.7% of qualified HMCAS drivers). On average, they reported having been involved in 0.90 accident requiring vehicle repair. Using a 5-point Likert scale (1 = very unsafe, 5 = very safe) respondents rated themselves as being safe drivers (4.24/5) and underestimated the monthly number of accidents with HMCAS vehicles to be 15.3 (Actual 21.2/month registered in 2014). Other data about self-reported driving behaviour and comparison between their perception about accidents and real data was analysed along with visibility and memorisation of the key messages. Conclusions: Staff underestimated the number of accidents. Campaign material has been noticed by most staff except for the stickers inside the ambulances driving compartment which is not accessed by 23.2% of the respondents. Staff who saw the posters and stickers remembered nearly half of the information it contained. Although a significant decline accidents occurrences was noticed in September, the impact of the campaign cannot yet be reliably assessed over this relatively short period of time.