Local emergency medical response after a terrorist attack in Norway: a qualitative study

被引：16

作者：

Brandrud, Aleidis S. ^{[1
,2
]}

Bretthauer, Michael ^{[3
,4
,5
]}

Brattebo, Guttorm ^{[6
,7
]}

Pedersen, May J. B. ^{[8
]}

Hapnes, Kent ^{[9
]}

Moller, Karin ^{[10
]}

Bjorge, Trond ^{[11
]}

Nyen, Bjornar ^{[12
]}

Strauman, Lars ^{[13
]}

Schreiner, Ada ^{[14
]}

Haldorsen, Gro S. ^{[15
]}

Bergli, Maria ^{[1
]}

Nelson, Eugene ^{[16
]}

Morgan, Tamara S. ^{[16
]}

Hjortdahl, Per ^{[17
]}

机构：

[1] Vestre Viken HF, Qual Dept, Drammen, Buskerud, Norway

[2] Univ Oslo, Inst Hlth & Soc, Fac Med, Oslo, Norway

[3] Univ Oslo, Inst Hlth & Soc, Clin Effectiveness Res Grp, Oslo, Norway

[4] Oslo Univ Hosp, Dept Transplantat Med, Oslo, Norway

[5] Oslo Univ Hosp, KG Jebsen Ctr Colorectal Canc Res, Oslo, Norway

[6] Oslo Univ Hosp, Norwegian Natl Advisory Unit Trauma, Div Emergencies & Crit Care, Oslo, Norway

[7] Haukeland Hosp, Dept Anaesthesia & Intens Care, Bergen, Norway

[8] Vestre Viken HF, Dept Gen & Orthoped Surg Obstet Anaesthesia & Int, Ringerike Hosp, Drammen, Buskerud, Norway

[9] Vestre Viken HF, Div Mental Hlth & Addict, Ringerike DPS, Drammen, Buskerud, Norway

[10] Municipal Ringerike, Dept Med, Honefoss, Buskerud, Norway

[11] Ostfold Hosp, Dept Pulm Dis, Kalnes, Ostfold, Norway

[12] Municipal Porsgrunn, Dept Med, Porsgrunn, Norway

[13] Nordland Hosp, Dept Med, Lofoten, Nordland, Norway

[14] Norwegian Federat Org Disabled People, Oslo, Norway

[15] South Eastern Norway Reg Hlth Author, Dept Qual Med & Patient Safety, Hamar, Norway

[16] Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH USA

[17] Univ Oslo, Dept Family Med, Fac Med, Inst Hlth & Soc, Oslo, Norway

来源：

BMJ QUALITY & SAFETY | 2017年 / 26卷 / 10期

关键词：

HEALTH-CARE; POSITIVE DEVIANCE; PATIENT SAFETY; IMPROVEMENT; PREPAREDNESS; MORTALITY; ORGANIZATIONS; CONTEXT; INJURY;

D O I：

10.1136/bmjqs-2017-006517

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Introduction On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare. Methods We performed focus group interviews using the critical incident technique with 30 healthcare professionals involved in the care of the attack victims to establish determinants of the EMS' success. Two independent teams of professional experts classified and validated the identified determinants. Results Our findings suggest a combination of four elements essential for the success of the EMS: (1) major emergency preparedness and competence based on continuous planning, training and learning; (2) crisis management based on knowledge, trust and data collection; (3) empowerment through multiprofessional networks; and (4) the ability to improvise based on acquired structure and competence. The informants reported the successful response was specifically based on multiprofessional trauma education, team training, and prehospital and in-hospital networking including mental healthcare. The powerful combination of preparedness, competence and crisis management built on empowerment enabled the healthcare workers to trust themselves and each other to make professional decisions and creative improvisations in an unpredictable situation. Conclusion The determinants for success derived from this qualitative study (preparedness, management, networking, ability to improvise) may be universally applicable to understanding the conditions for resilient and safe healthcare services, and of general interest for quality improvement in healthcare.

引用

页码：806 / 816

页数：11

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