Rajiv Gandhi University of Health Sciences, Karnataka s13

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address AJITH P SALIM FIRST YEAR M.SC. NURSING, ROYAL COLLEGE OF NURSING, 7TH MAIN ROAD, 1ST BLOCK, UTTARAHALLI, BANGALORE 560 061

2. Name of the Institution Royal College of Nursing, Bangalore 3. Course of study and subject I Year M.Sc. Nursing Medical Surgical Nursing

4. Date of admission to course 01-06-2010 5. Title of the topic: “A Quasi-Experimental Study to Assess the Effectiveness of Self Instructional Module Regarding Emergency Trauma Care Among Emergency Medical Technicians Working in 108 Ambulance Service in Bangalore city”.

6. Brief resume of the intended work: 6.1 Need for the study Enclosed 6.2 Review of literature Enclosed 6.3 Objectives of the study Enclosed 6.4 Operational definitions Enclosed 6.5Hypothesis of the study Enclosed 6.6 Assumptions Enclosed 6.7 Delimitations of the study Enclosed 6.8 Pilot study Enclosed 6.9 Variables Enclosed 7. Material and methods: 7.1 Source of data will be collected from 108 ambulance service in Bangalore city 7.2 Method of collection of data- Structured questionnaire 7.3 Does the study require any investigations or intervention to the patients or other human being or animals? Yes 7.4Has ethical clearance been obtained from your institution? Yes, it’s enclosed here with 8. List of references Enclosed

1 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address AJITH P SALIM FIRST YEAR M.SC. NURSING, ROYAL COLLEGE OF NURSING, 7TH MAIN ROAD, 1ST BLOCK, UTTARAHALLI, BANGALORE 560 061

2. Name of the Institution Royal College of Nursing, Bangalore-560 061.

3. Course of Study and subject IYear M. Sc Nursing, Medical Surgical Nursing

4. Date of admission to course 01-06-2010

5 Title of the topic . “A Quasi-Experimental Study to Assess the Effectiveness of Self Instructional Module Regarding Emergency Trauma Care Among Emergency Medical Technicians Working in 108 Ambulance Service in Bangalore city”.

2 6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

‘"Safety First" is "Safety Always." ~Charles M. Hayes1

Accidents, tragically, are not often due to ignorance, but are due to carelessness, thoughtlessness and over confidence. Human, vehicle and environmental factors play roles before, during and after a trauma event. Accidents, therefore, can be studied in terms of agent, host and environmental factors and epidemiologically classified into time, place and person distribution.2

Since the early 1970s, trauma has been reorganized as the leading cause of death for those between the ages of 14 and 40 and id the third leading cause of death for all age groups, after cardio- vascular disease and cancer.3

Emergency or a disaster may occur at any time of the day or night, weekend or holiday, with little or no prior warning. Emergency service providers ensure public safety by addressing different emergencies. With any trauma patient, determining the possible extent of injury is critical to make good priority decisions regarding on-scene assessment and care vs. rapid transport with assessment and care continuing in the route. To make these judgments, the EMT-Basis must not only recognize obvious injuries but also must maintain a high index of suspicion for hidden injuries. An understanding of the mechanism of injury is the chief component of this critical assessment skill.

Emergency medical technicians working in the emergency vehicle often relate the efficient emergency management to quick access to the victim's location, shorter time at the location, good support to the paramedics, and faster transport to definite care unit. The role of the emergency rescuers in emergency management is crucial, as reaching the victim quickly is more important than providing the pre-hospital care. The role of the trauma care givers is multifaceted: coordinator, facilitator and educator. It requires an expert knowledge of trauma care and the consequences of injury to the human body. The care giver’s knowledge and activation of resources, ongoing evaluation, and ability to reset priorities allowed the patient, his family, and the healthcare team to achieve the highest level of function and personal satisfaction.

3 6.1 NEED FOR STUDY

“Better a thousand times careful than once dead”-proverb4

Worldwide it was estimated in 2004 that 1.2 million people were killed (2.2% of all deaths) and 50 million more were injured in motor vehicle collisions. This makes motor vehicle collisions the leading cause of death among children worldwide 10 – 19 years old (260,000 children die a year, 10 million are injured). RTIs are often preventable, and the technology and knowledge to achieve success in this area exist. In spite of this, it is projected that given the current trend and without adequate intervention, RTIs will rank third of all major causes of morbidity and mortality globally by 2020. . Injuries in Road traffic injuries (RTIs) are a leading cause of morbidity, disability and mortality in less developed countries Although > 85% of the global deaths and injuries from road traffic crashes occur in less developed countries, traffic safety attracts little public health attention in these nations. Unfortunately, the public health and economic impact of traffic-related injuries and disabilities can be incalculable in these countries, owing to their poorly developed trauma care systems and nonexistent social welfare infrastructures to accommodate the needs of the injured and the disabled.5

In India the total road accidents increased since 2001 so much so that the severity of accidents in terms of persons killed per 100 accidents increased from 19.9 per cent in 2001 to 24.7 per cent in 2008 given that 1.18 lakh people were killed in 4.15 lakh accidents. According to the latest available figures, the number of road accidents has more than quadrupled between 1970 and 2008 from 114,100 to 4, 15,855. Worse, fatalities shot up eight-fold to 118,239 from 14,500, while injuries shot up seven-fold to 4, 69,156 from 70,100.The number of injuries in 2008 exceeded the number of accidents. The 2008 statistics showed that there were a total of 4, 15,855 cases of road traffic accidents reported all over India in which 4, 69,156 peoples injured and 1,18,239 were killed. The major shareholders were 14.5% by Tamil-nadu, 11.9% by Maharashtra, 11.9% by Karnataka 10.1% by Andhra Pradesh and 9% by Kerala. Another significant factor is that four of the topper five states are south-Indian states6

In 2008 Karnataka state reported 46,252 cases of accidents with 63,281 injured and 8,814 death Karnataka has earned the distinction of the being the state with the third highest accident rate in India behind, Tamil Nadu and Maharashtra. Statistics further reveal that in the year there were 43,280

4 accidents in 2006 and in the year 2007, the figure rose to 45,284. In 2007, there were 8,686 deaths in the state while in Bangalore alone there were 1,663 deaths7

Statistics with the National Crime Records Bureau indicate that at least 23 people die every day in Karnataka out of which five are in Bangalore. Bangalore city holds the highest number of accident cases of 7,773 (13%) followed by 7,426 (12.4%) by Delhi and 6,133(10.3%) cases by Chennai. Currently Bangalore is holding the position as accident capital of India8

A trauma care center is a place challenged to provide optimal trauma care to patients in the region it serves. It is critical to increase the knowledge and clinical skills of all trauma care providers, especially those who work outside urban areas for a better trauma care to the victims. Continuous assessment of the knowledge status of the care givers and in service education can ensure maintaining the standards.

The researcher had an experience while working as a staff nurse at a major trauma care centre in Bangalore. The researcher met with a 28yrs old male patient, admitted in Neuro-Surgery ICU .On admission, the patient was fully conscious and oriented but the patient’s body was fully paralyzed with a muscle strength of grade zero, diaphragmatic breathing, bradypnea and bradycardia . Patient was sent for CT- scan, and was diagnosed as cervical spine fracture of C4, C5 and C6 with severe acute inflammation and injury, of the spinal cord in the same region. History collection revealed that the patient met with a bike accident and was thrown out to a drainage system. The victim got completely stucked in the drainage system, but later after collecting data from bystanders and patient, it was revealed that patient was forcefully taken out from the drainage tube by a group of emergency rescuers and as the rescuers were not using any cervical collar, any other protective measures or proper transporting techniques which might have worsen the cervical spine injury. Mishandling or lack of awareness regarding proper handling of traumatized patient might have led to the bad luck of that young man. This incident encouraged the researchers’ thoughts about the need of an awareness programme regarding trauma care among emergency rescuers. So the researcher is using this opportunity to fulfill the thoughts by conducting a study on knowledge of emergency rescuers regarding trauma care and educating them. The researchers’ ultimate aim is to improve the quality of trauma care among the emergency rescuers.

5 6.2 REVIEW OF LITERATURE

Introduction

Review of literature is a broad comprehensive in depth, systematic and critical review of scholarly publication, unpublished scholarly print materials, audiovisual materials and personal communications.9

Researchers almost never conducted a study in an intellectual vacuum; their studies are usually undertaken within the context of an existing knowledge base. A literature review helps to lay the foundation for the study and can also inspire a new research idea.

A study was conducted regarding knowledge base of Healthcare professionals to function effectively during a hospital's response to a mass-casualty incident in, Hadera, Israel. A survey of 128 physicians, nurses, and emergency medical technicians involved in trauma care was conducted to assess their knowledge base and how it affected their decision-making in response to a MCI following a terrorist bombing. Three-quarters of the study group responded that =/>20% of the surviving victims were critically injured. Only half of the responders indicated that the main objective of medical management is identifying and treating patients with critical injuries. Forty percent of responders indicated that they would not triage a critically injured victim to immediate care. This survey indicates that further education in the principles of MCI management should be based on critical evaluation of the literature.10

A study was conducted regarding trauma care training among Nurses working in Colombia. The Colombian National Pre-hospital Care Association developed a Combat Tactical Medicine Course (MEDTAC course), in response to a requirement for advanced trauma care nurses to provide combat tactical medical support. The study was to evaluate the effectiveness of this course in imparting knowledge and skills to the students. They trained 374 combat nurses using the MEDTAC course. They evaluated students using pre- and post-course performance with a 45-question examination. Field simulations and live tissue exercises were evaluated by instructors using a Likert scale with possible choices of 1 to 4. Interval estimation of proportions was calculated with a 95% confidence interval. The difference between examination scores before and after the didactic part of

6 the course was statistically significant. After the practical session of the course, all participants demonstrated competency on final evaluation. The study came in to the conclusion that the MEDTAC course is an effective option improving the knowledge and skills of combat nurses serving in the Colombian National Police.11

A study was conducted regarding the effectiveness of a newly developed basic trauma care course in Ecuador, Africa. The basic trauma care course was designed based on local resources and location of injury, including rudimentary health posts in the jungle, rural hospitals, and definitive referral centers. Course effectiveness was evaluated by a comparison of test scores before and after the course. A multiple choice questionnaire was given. Comparison to previous test scores was also performed. Paired Student's t test was used for statistical analysis. Twenty-six rural physicians participated in the course. Mean test scores significantly improved from pretest to post-test. Knowledge deficiencies in pre-hospital care, extremity injury care, and patient evaluation adjuncts significantly improved from 23% to 87%, 23% to 100%, and 31% to 100%, respectively. Test results after the course showed improvements in all major categories tested. Twelve of the 26 participants were repeat test takers from a course provided 2 years earlier. These participants showed improved pretest scores compared with their highest previous test score. Compared with first-time test takers, these participants showed improved pretest as well as post-test scores. The study came in to a conclusion that where there is no advanced trauma life support, a tailored trauma course and evaluation can be effective in educating local providers. The course design and evaluation methods may serve as a model for continuing trauma care education in developing countries.12

A study was conducted in Pennsylvania, USA to study was to study the factors that promote or deter trauma care nurses' participation in continuing professional education. A multi-site analysis was conducted with professional trauma nurses employed in a total of 27 accredited Pennsylvania trauma centers. Two RN directors employed at the Pennsylvania Trauma Systems Foundation, a regulatory accrediting agency, also participated in the study. Data were both qualitative and quantitative. Qualitative data were collected through semi-structured one-on-one telephone interviews with 26 trauma program RN managers and two PTSF directors and three semi-structured focus group interviews with 18 trauma care staff nurses. Quantitative data were collected through questionnaires completed anonymously by 1,675 trauma care staff nurses employed in 25 of Pennsylvania's 27 accredited trauma centers. The quantitative data complemented the qualitative data

7 and broadened the number of eligible participants able to take part in the study. Five specific categories of information arose from the data: beliefs about CPE and its role in professional nursing development and competency maintenance, perceived benefits of participation in CPE, perceived obstacles to participation in CPE, factors considered when choosing CPE, and parallels and differences between trauma program managers and trauma care staff nurses regarding participation in CPE.. The study's results show that Pennsylvania's trauma care nurses perceived that much of the CPE they participated in enhanced their clinical knowledge, skills, and abilities and, in addition, benefited their clients, customers, and employers. These findings validate much of the existing literature on nursing CPE.13

A study was conducted regarding trauma care training in Iowa, USA. A Bystander Trauma Care programme was developed to train citizens to provide initial care at the scene of a motor vehicle crash. Emergency medical technicians (EMTs) were trained to be instructors in a two-hour course offered at each of four community colleges. The EMTs, in turn, provided instructions to the general populace. Five hundred participants were given a questionnaire before the one-hour Bystander Trauma Care training session, immediately after the training and six months later. The questionnaire obtained background data and assessed attitudes regarding willingness to stop and assist, and knowledge obtained. One hundred twenty EMT instructors trained more than 2,000 citizen bystanders in a 17-county area in central Iowa. Immediately after the training program, participants were more likely to provide assistance, and understand the sequence of actions to be performed at the scene of a crash and how to prioritize the information provided to 911. There was also evidence of retention of the knowledge six months after training. Results of the questionnaire suggest citizens can be successfully trained to recognize the needs of, and provide initial care for, acutely injured persons, and the positive effects of such training are maintained over time.14

A study was conducted regarding the effect of a half – day trauma care course based on Advanced Trauma Life Support in osham Portsmouth, UK This study was designed to measure the change in knowledge of Accident and Emergency (A & E) nurses in three key areas of trauma care and to detect any correlation between the length of experience of nurses in A & E with their theoretical knowledge of the management of severe injuries. A questionnaire was completed by 27 A & E nurses before and after attending the course on trauma management based on the ATLS system. The questions related to triage, initial management and practical procedures in trauma victims. A

8 statistically significant improvement was observed in the overall result after the course. An unexpected finding was the low score on triage related questions. Abbreviated ATLS based teaching provides improved theoretical knowledge for A & E nurses waiting to attend a full trauma course.15

A study was conducted in Nepal to evaluate the efficacy of training programmes for the village health practitioners aimed at improving primary orthopedic and trauma care in our rural setting. A Six year prospective study of training workshops in local health institutions was carried out using locally available manpower and materials. After 6 years the evaluation of this programme shows a significantly improved knowledge base and working skills after completion of training workshop. The study was to avoid unnecessary complications; effective primary health care provided by an appropriately trained person should be available at the peripheral level. This training programme seems successful in achieving this goal and hence needs adoption for wider use in Nepal.16

A study was conducted regarding pre-hospital trauma management among paramedics in Edinburgh, UK. A six year prospective study was conducted of adult trauma patients attended to by the Scottish Ambulance Service and subsequently admitted to hospital. Pre-hospital times, interventions, triage, and outcomes were compared between patients treated by paramedics and those treated by technicians. The results showed that the paramedics attended more severely injured patients; they attended a higher proportion of patients with penetrating trauma and had longer prehospital times. Patients managed by paramedics were more likely to be taken to the intensive care unit, operating theatre or mortuary, and had higher crude mortality rates. However, no difference in mortality between the two groups was noted when corrected for age, Glasgow coma score and injury severity score. The study came in to the conclusion that paramedics show good triage skills and clinical judgment when managing trauma patients. However, the value of the individual interventions they perform could not be ascertained. Further controlled trials are necessary to determine the true benefits of advanced pre-hospital trauma life support.17

A study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and

9 circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54+/- 2.36 years (range, 4-89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment. A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). The study concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.18

A comparative study was conducted regarding challenges faced by ambulance faced by ambulance drivers in two metropolitan cities in India. The current research study attempts to understand the major challenges faced by the ambulance drivers in handling emergencies in cities. The study undertook a survey among the ambulance drivers of GVK Emergency Management and Research Institute, in the cities of Hyderabad and Ahmedabad in India. Data were collected from 27 pilots in Ahmedabad and 52 pilots in Hyderabad through a self-administered questionnaire. Congested street and non-availability of lift facility were cited as the major problem in handling the emergencies in cities where the survey was conducted. A strong correlation was observed between floor numbers of the buildings and mean call to scene departure time to hospital, indicating difficulty in managing time during emergency in case of emergencies happening for residents residing at higher floor in a multistoried building. As floor number increases mean call to scene departure time also increases. It was found that in Ahmedabad the cooperation from traffic police and public was not satisfactory as compared to Hyderabad. In Ahmedabad, pilots cited that locating the proper address at night time was a problem. The researcher strongly recommended to introduce trained volunteers or first responders to overcome barriers by opening locked outer doors, securing elevators, and providing directions to the patient's location. 19

A study was conducted regarding the trauma care cases attended by the Australia emergency medical service in Victoria; Australian The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS. A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these,

10 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459). This is a unique analysis of pre-hospital trauma. It provides a baseline dataset that may be utilized in future studies of pre-hospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the pre-hospital and the hospital assessments.20

A study was conducted on the effect of the pre-hospital trauma life support program (PHTLS) on pre-hospital trauma care in Toronto, Canada. The study was aimed at identifying pre-hospital care factors that may explain this improvement. All patients transferred by ambulance to the major trauma referral hospital had assessment of airway control, oxygen use, cervical (C)-spine control, and hemorrhage control, as well as splinting of extremities during pre-PHTLS and post-PHTLS periods Pre-PHTLS data were compared with post-PHTLS data by chi 2 analysis with a p value < or = 0.05 being considered statistically significant. The frequency (%) increased in the post-PHTLS period for airway control (10 vs. 99.7%), C-spine control (2.1 vs. 89.4%), splinting of extremities (22 vs. 60.6%), hemorrhage control (16 vs. 96.9%), and oxygen use (6.6 vs. 89.5%) when no specific problem was identified. When a specific problem was identified in these areas, the post-PHTLS percentage also increased for airway control (16.2 vs. 100%), C-spine control (25 vs. 100%), splinting of extremities (33.9 vs. 100%), hemorrhage control (18 vs. 100%), and oxygen use (43.2 vs. 98.9%). The study concluded that pre-hospital trauma care has changed after the introduction of the PHTLS program as indicated by more frequent airway control, use of oxygen, control of cervical (C)- spine and hemorrhage, as well as splinting of fractures. This change in pre-hospital care could be responsible for the improved trauma patient outcome after PHTLS.21

A study was conducted regarding potential areas of development in prehospital trauma care in Tehran; Iran. They conducted a cross-sectional study in which all trauma-related dispatches of Tehran's emergency medical services (EMS) system were evaluated-during 18 randomly selected days from September 22, 1997, to March 17, 1998. Emergency medical technicians completed a checklist for all trauma cases, and the criteria for this performance evaluation were different partial time intervals in each dispatch and different procedures that had been done for the patients. The means of the "dispatch-beginning-to-scene-arrival interval" and "scene-arrival-to-scene-leaving interval" were 10 and 18 minutes, respectively. The mean of the "dispatch-beginning-to-hospital-

11 arrival interval" was 45 minutes. Among advanced life support (ALS) procedures that include cardiac monitoring, intratracheal intubation, intravenous fluid therapy, nasogastric tube insertion, defibrillation, and tracheostomy, only intravenous fluid therapy had been administered for the patients. The patients, however, had received different kinds of basic life support (BLS) that include initial evaluation, bleeding control, oxygen administration, splinting, suction use, and cardiopulmonary resuscitation. They came in to the conclusion that prolonged response, scene, and dispatch-beginning-to-hospital-arrival intervals compared with those for a developed EMS system indicate one potential area for improvement. Furthermore, significant differences in the field of prehospital care showed that ambulance equipment and training of EMS personnel are two other potential sites for improvement.22

An article was published regarding management of traumatic injuries by Gallaspy JG, in AAOHN Journal. According to the author, Traumatic injuries in the workplace occur from a variety of mechanisms and may produce a wide range of injuries. Critical to the management of these injuries is the knowledge that lifesaving interventions for airway, breathing, and circulation must take priority. Controlling external bleeding and managing circulation is imperative in the traumatically injured worker. Inadequate control of hemorrhage leads to cellular shock from which the client may never recover. Extremities should be managed appropriate to the specific injury. Careful monitoring of neurovascular status is significant in limb preservation. Amputated parts must be meticulously cared for, with the vision of replantation in mind. Electrical burns are unique burn injuries, as the complete area of damage is not visible. Monitoring cardiac and respiratory function is essential to detect any life threatening abnormalities in all injuries, but is especially important in the electrically injured client. The occupational health nurse can make a significant difference in the outcome of a traumatically injured client in the workplace. Adequate knowledge of treatment modalities, as well as transfer to the most appropriate trauma care facility, can make the difference in obtaining the best possible outcome.23

A journal article was published regarding a cases study on structured communication for patient safety in emergency medical service in, Grand Rapids. According to the author providers of emergency medical services (EMS) must communicate vital information during critical phases of operations. Errors in communications, for example, the failure to hear a directive, will compromise safe and effective patient care. The article presents a case that resulted in litigation because of

12 communication failures during the interfacility transfer of a trauma patient who subsequently died in the ambulance. The communication failure involved members of a ground ambulance crew, their dispatcher, and a supervisor. The failure of the emergency medical technician (EMT) who was driving to hear from the treating EMT and her dispatcher vital information pertaining to changes in their destination and of plans to intercept another ambulance, or alternatively, the driver's ignoring this information, led to a delay in care and may have contributed to the patient's death. Factors contributing to the cause of this communication failure may have been related to the nature of the EMS setting: the physical separation between crew members; the noise of the ground ambulance transport environment, most notably, the siren; and the stress of treating a patient in critical condition. The case highlights the importance of using structured forms of communication, specifically the read-back tool and the critical assertion strategy, to limit failures in communication during EMS operations and in operations in other high-risk medical settings.24

6.3 OBJECTIVES OF THE STUDY

 To assess the knowledge of emergency medical technicians regarding emergency trauma care

 To prepare and administer self-instructional module regarding emergency trauma care on emergency medical technicians.

 To assess the effectiveness of self-instructional module regarding emergency trauma care among emergency medical technicians.

 To find out the relation between knowledge and selected demographic variable

6.4 OPERATIONAL DEFINITIONS

 Assess: Statistical measurement of knowledge scores of emergency medical technicians regarding emergency trauma care as observed from the scores obtained based on the closed ended questionnaire

13  Effectiveness: Effectiveness is determined the desired changes in the knowledge of emergency medical technician brought by the self-instructional module by using structured closed ended questionnaire and its measured in terms of significant gain in post-test.

 Self-instructional module: Itrefers to Module prepared for emergency medical technicians working in emergency trauma care service that contains assessment, management and evaluation of a victim, during emergency trauma care services, which is self-explanatory.

 Trauma: It refers to anybody wound or shock produced by sudden physical injury, as from accident, injury, or impact

 Emergency trauma care: It refers to the emergency medical services provided by an emergency medical technician to the victim of Trauma

 Emergency medical technician: It refers to the qualified person, who works in an emergency medical ambulance service.

6.5 HYPOTHESIS OF THE STUDY

 H1.There will be statistically significant difference between pre and post-test knowledge source of Emergency medical technicians regarding emergency trauma care.

 H2.There will be statically significant association between knowledge regarding emergency trauma care and years of work experience.

6.6 ASSUMPTIONS

 The emergency medical technicians possess some knowledge regarding emergency trauma care.

 Self-Instructional Module increases knowledge of care emergency medical technicians on emergency trauma care

14  Emergency medical technicians’ knowledge can be assessed by using a knowledge questionnaire

6.7 DELIMITATIONS OF THE STUDY

This study is limited to

 Emergency medical technicians who are working in emergency ambulance service

 Emergency medical technicians working in Bangalore city.

 Emergency medical technicians between the age of 21-50 years

6.8 PILOT STUDY

The study will be conducted with six samples. The purpose of the pilot study is to find out the feasibility for conducting the study and design on plan on statistical analysis

6.9 VARIABLES UNDER STUDY

A variable is any phenomenon or characteristic or attribute that changes. Variables are measurable characteristics of a concept and consist of a logical group of attributes.

Dependent variable:

Knowledge of care providers those who are working in 108 ambulance service in Bangalore

Independent variable:

Self-Instructional Module on emergency trauma care

Extraneous Variable:

Gender

Educational qualification

15 Years of experience

Exposure to in-service education training

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

The source of data will be emergency medical techniciansworking in 108 ambulance service in Bangalore.

7.1.1 RESERCH DESIGN:

Quasi experimental design will be used for the proposed study, where one group pre and post-test design.

7.1.2 RESEARCH APPROACH:

Evaluative Research Approach

7.1.3 SETTING OF THE STUDY

The study will be conducted at 108 ambulance service in Bangalore city

7.1.4 POPULATION

All emergency medical technicians working in the 108 ambulance service in Bangalore city

7.2 METHODS OF COLLECTION OF DATA

The data collection procedure will be carried out for a period of one month. The study will be conducted after obtaining permission from the concerned authorities .Data will be collected by the

16 investigator himself by using structured closed ended questionnaire to assess the emergency medical technicians’ knowledge regarding emergency trauma care.

Data collection instrument consists of the following Sections

Section A: Demographic data

Section B: Knowledge questionnaire related to emergency trauma care

7.2.1SAMPLING TECHNIQUE

Sampling Technique adopted for the selection of sample is Non-probability convenience sampling.

7.2.2 SAMPLE SIZE

The sample size will be 60 emergency medical technicians working in 108 ambulance service

SAMPLING CRITERIA

7.2.3 INCLUSION CRITERIA:

Emergency medical technicians

 Working in emergency medical ambulance service only

 Who give consent for the study

 Who come under the selected ambulance service for the study.

 Who have minimum one year experience

7.2.4 EXCLUSION CRITERIA:

Emergency medical technicians

17  Who selected for the pilot study

 On leave vacancy or absence for duty.

 Who have not given consent for the study

7.2.5 TOOL FOR DATA COLLECTION

A structured closed ended questionnaire will be used to collect data.

7.2.6 DATA ANALYSIS METHOD

The data collected will be analysed using descriptive and inferential statistics

 Descriptive Statistics: Frequency and percentage will be used for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge

 Inferential statistics: inferential statistics will be done by using chi square test will be used to find out the association between knowledge and demographic variables. Paired ‘t’ test for the effectiveness of the self-instructional module.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS OR INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Since the study is quasi in nature, investigations are not required but interventions are required

7.4 ETHICAL CLEARANCE

Yes, ethical committee’s report is here with enclosed. The main study will be conducted after the approval of research committee of the college permission will obtained from the head of the

18 institution. The purpose and the details of the study will be explained to the study subjects and assurance will be given regarding confidentiality of the data collected

8. LIST OF REFERENCES :( VANCOUVER STYLE FOLLOWED)

1. Charles M. Hayes. Safety first is Safety Always. Available from: URL: http://www.quotegarden.com/

19 2. Brent Q Hafen B, Keith J Karren .Prehospital Emergency Care. : Brady Prentice Hall ; 1996. p.487-488

3. Wikipedia. Article related to trauma. Available from: URL: http://en.wikipedia.org/wiki/Trauma

4. Better a thousand times careful than once dead. Available from: URL:http://www.quotegarden.com/

5. GURURAJ G. Injuries in India: A national perspective. Available from: URL: http://whoindia.org/LinkFiles/Commision_on Macroeconomic_and_Health.pdf

6. Revealing India statistically. Available from: URL:http://www.indiastat.com/crimeandlaw/6/accidents/35/roadaccidents/17897/stats.aspx

7. Revealing India statistically. Available from: URL:http://www.indiastat.com/crimeandlaw/6/accidents/35/roadaccidents/17897/stats.aspx

8. Vicky Nanjappa.The case of rising deaths on Karnataka roads. Available from: URL:http://www.rediff.com/news/2008/feb/21road.htm

9. Nancy Burns, Susan K Groove. Understanding Nursing Research. New Delhi: Saunders; 2007. p.135-136

20 10. Ashkenazi I, Olsha O, Schecter W, Kessel B, Khashan T, Alfici R. Inadequate mass-casualty knowledge base adversely affects treatment decisions by trauma care providers: survey on hospital response following a terrorist bombing. Prehospital& Disaster Medicine [serial on the Internet]. (2009, July), [cited September 11, 2010]; 24(4): 342-347.

Available from:

http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010442629&site=ehost- live

11. Rubiano A, Sánchez Á, Guyette F, Puyana J. Trauma care training for National Police nurses in Colombia. Prehospital Emergency Care [serial on the Internet]. (2010, 2010 Jan-Mar), [cited September 11, 2010]; 14(1): 124-130.

Available from: http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=2010499649&site=ehost-live

12. Aboutanos M, Rodas E, Aboutanos S, Mora F, Wolfe L, Duane T, et al. Trauma education and care in the jungle of Equador, where there is no advance trauma life support. Journal of Trauma [serial on the Internet]. (2007, Mar), [cited September 11, 2010]; 62(3): 714-719.

13. Apgar C. Factors that promote or deter trauma care nurses' participation in continuing professional education [dissertation]. Pennsylvania State University; 200

14. Peterson T, Noland S, Russell D, Paradise N. Bystander trauma care training in Iowa. Prehospital Emergency Care [serial on the Internet]. (1999, July), [cited September 11, 2010]; 3(3): 225-230. Available from: http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=2000012851&site=ehost-live

15. Gautam V, Heyworth J. The value of the abbreviated ATLS course for accident and emergency nurses... Advanced Trauma Life Support. Accident & Emergency Nursing [serial on the Internet]. (1994, Apr), [cited September 11, 2010]; 2(2): 100-102.

21 Available from: http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=1994196587&site=ehost-live

16. Shah R, Thapa V, Jones D, Owen R. Improving primary orthopaedic and trauma care in Nepal. Education for Health (Taylor & Francis Ltd) [serial on the Internet]. (2003, Nov), [cited September 11, 2010]; 16(3): 348.

17. Sukamaran S, Henry J, Beard D, Lawrenson R, Gordon M, O'Donnell J, et al. Prehospital trauma management: a national study of paramedic activities. Emergency Medicine Journal [serial on the Internet]. (2005), [cited September 12, 2010]; 22(1): 60-63.

18. Soysal S, Karcioglu O, Topacoglu H, Yenal S, Koparan H, Yaman O. Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital. Advances in Therapy [serial on the Internet]. (2005, 2005 Jan-Feb), [cited September 12, 2010]; 22(1): 44-48. Available from: http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=2005096329&site=ehost-live

19. Jena M, Dubey A, Dhal M. Challenges in handling medical emergencies by ambulance drivers: a comparative study in two metropolitan cities in India. Journal of Emergency Management [serial on the Internet]. (2010, 2010 Jan-Feb), [cited September 12, 2010]; 8(1): 67-75.

20. Boyle M, Smith E, Archer F. Trauma incidents attended by emergency medical services in Victoria, Australia. Prehospital& Disaster Medicine [serial on the Internet]. (2008, 2008 Jan- Feb), [cited September 12, 2010]; 23(1): 20-28.

22 Available from: http://search.ebscohost.com/login.aspx? direct=true&db=rzh&AN=2009903231&site=ehost-live

21. Ali J, Adam R, Gana T, Bedaysie H, Williams J. Effect of the prehospital trauma life support program (PHTLS) on prehospital trauma care. Journal of Trauma [serial on the Internet]. (1997, May), [cited October 8, 2010]; 42(5): 786-790.

22. Modaghegh M, Roudsari B, Sajadehchi A. Prehospital trauma care in Tehran: potential areas for improvement. Prehospital Emergency Care [serial on the Internet]. (2002, Apr), [cited October 28, 2010]; 6(2): 218-223.

23. Gallaspy J. Management of traumatic injuries in the workplace. AAOHN Journal [serial on the Internet]. (1994), [cited September 11, 2010]; 42(1): 33-41.

24. Greenwood M, Heninger J. Structured communication for patient safety in emergency medical services: a legal case report. Prehospital Emergency Care [serial on the Internet]. (2010, July), [cited September 12, 2010]; 14(3): 345-348.

23 9. Signature of the Candidate.

10. Remarks of the Guide.

11. Name and Designation of

11.1 Guide

11.2 Signature

11.3 Co- Guide

11.4 Signature

11.5 Head of the Department

11.6 Signature

24 12. 12.1 Remarks of the Chairman &

Principal.

12.2 Signature.