Out‐of‐hospital emergency care providers' work and challenges in a changing care environment

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Health care is faced with ever‐increasing requirements in several countries. Population growth and ageing 1 increase the workloads and demand for health services, which is also reflected in patient transport and out‐of‐hospital emergency care services. The continuous growth of healthcare costs has led to a search for ways of achieving savings in health services 3. In the past, patients requiring emergency care were almost exclusively transported by ambulance to a hospital for further treatment 5. However, many patients not requiring urgent care can be treated on site and do not necessarily need immediate hospital care 3. Emergency department congestion is a global problem 11. If more patients were treated by out‐of‐hospital emergency care providers on site, the number of patients at emergency departments could be reduced 10 and patients in need of urgent treated more quickly.
A change in out‐of‐hospital emergency care providers' job description has been reported in a few countries, for example in the UK and the USA 12. Nowadays, an assessment of the situation is conducted on the basis of the patient's condition in order to identify the possibility of treating the patient on site instead of hospital 10. It has been reported that out‐of‐hospital emergency care providers have treated patients without transportation to hospital in cases where the patient had a minor trauma, blunt injury to the head or face or no illness or injury 10.
Emergency care providers respond to tasks assigned by emergency medical dispatchers 8, and they are often a patient's first contact with health services. The ambulance and emergency care services are responsible for ensuring that suddenly ill or injured patients are appropriately assessed and treated on site and during transport 16. Out‐of‐hospital emergency care providers' work is varied; their tasks vary on a daily basis. They have been trained to manage emergency incidents including accidents, sudden illness, falls and childbirths. Thus, care providers need to be able to deal with pressure and have wide‐ranging expertise 8. The work is physically and mentally demanding 19 and dominated by unpredictable situations. It is carried out in the most diverse working environments 15 and it includes administering out‐of‐hospital emergency care to patients of all ages 15. Especially incidents involving children, for example children's accidents or deaths, or administering life support to children, have been found to be stressful to care providers 21. Training 18 and support 20 are important in ensuring that out‐of‐hospital emergency care staff can cope in their challenging work.
In Finland, regional hospital districts are responsible for providing emergency medical services 22. There are two levels of ambulance service: basic life support vehicles, in which care providers monitor the patient and start simple life‐saving procedures during transport, and advanced life vehicles for more sophisticated procedures carried out to secure the patient's vital functions. The crew in basic‐level ambulances may consist of emergency medical technicians or practical nurses, whereas advanced emergency care vehicles are often staffed by two emergency nurses or general nurses 23.
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