Akuttmedisinsk handsaming i ein utkantkommune

Scand J Trauma Resusc Emerg Med

Zakariassen

Wisborg

2014

BackgroundTogether with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting.MethodsWe conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation.ResultsThe EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis.ConclusionsEMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call.

Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

Scand J Trauma Resusc Emerg Med

Zakariassen

Wisborg

2014

“…[11] Studies have found that GPs improve patient care by improving diagnostics and decision making. [9–11] Significant medical expertise was also found to be the important reason for the presence of a doctor in an observational study from Bergen in 2015. [15] We found that GPs relate the improvement in patient care to local knowledge of patients’ lives.…”

Section: Discussionmentioning

confidence: 99%

“…[2] A study from 2013 showed that the EMCC assessment was downgraded in 42% of cases and upgraded in 11% of cases when the patient was seen by a GP. [9] The problem of under triage was also shown in a systematic review of telephone triage in out-of-hours care. [17] Interestingly, the GPs we interviewed mentioned under-triage to some extent, but most of their concern dealt with the possibility of over triage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rural GPs’ attitudes toward participating in emergency medicine: a qualitative study

Scandinavian Journal of Primary Health Care

Halvorsen

Risør

2016

ObjectiveHealth authorities want to increase general practitioner (GP) participation in emergency medicine, but the role of the GP in this context controversial. We explored GPs’ attitudes toward emergency medicine and call outs.DesignThematic analysis of focus group interviews.SettingFour rural casualty clinics in Norway.ParticipantsGPs with experience ranging from one to 32 years.ResultsThe GPs felt that their role had changed from being the only provider of emergency care to being one of many. In particular, the emergency medical technician teams (EMT) have evolved and often manage well without a physician. Consequently, the GPs get less experience and feel more uncertain when encountering emergencies. Nevertheless, the GPs want to participate in call outs. They believed that their presence contributes to better patient care, and the community appreciates it. Taking part in call outs is seen as being vital to maintaining skills. The GPs had difficulties explaining how to decide whether to participate in call outs. Decisions were perceived as difficult due to insufficient information. The GPs assessed factors, such as distance from the patient and crowding at the casualty clinic, differently when discussing participation in call outs.ConclusionAlthough their role may have changed, GPs argue that they still play a part in emergency medicine. The GPs claim that by participating in call outs, they maintain their skills and improve patient care, but further research is needed to help policy makers and clinicians decide when the presence of a GP really counts.Norwegian health authorities want to increase participation by general practitioners (GPs) in emergency medicine, but the role of the GP in this context is controversial. KEY POINTSThe role of the GP has changed, but GPs argue that they still play an important role in emergency medicine.GPs believe that their presence on call outs improve patient care, but they find it defensible that patients are tended to by emergency medical technicians (EMTs) only.GPs offered different assessments regarding whether to participate in call outs in seemingly similar cases.

Self reported involvement in emergency medicine among GPs in Norway

Scandinavian Journal of Primary Health Care

Zakariassen

Halvorsen

2018

Objective: To examine general practitioners’ (GPs’) perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs’ involvement in emergency medicine.Design: Cross-sectional online survey.Setting: General practice.Subjects: General practitioners in Norway (n = 1002).Main outcome measures: Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation.Results: Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital.Conclusion: Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies.Key Points Health authorities and other stakeholders have raised concerns about general practitioner’s (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves. • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs. • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs. • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.