Participant Observation, Observant Participation, and Hybrid Ethnography

How much should ethnographers involve themselves with the people, places, and processes they study? One answer has become increasingly popular: invert the standard method of participant observation into observant participation. This article draws on an ethnography of ambulance work to consider the trade-offs between these approaches. My fieldwork included “ride-alongs” with labor and management at a private ambulance firm in California (participant observation) and short-term employment as a novice emergency medical technician at the same company (observant participation). Beyond a simplistic distinction in “empirical depth,” I identify three issues at stake between participant observation and observant participation: field positioning, analytic gaze, and data assembly. Where participant observation presents more opportunities for mobile positioning, outward gazing, and inscription, observant participation presents more opportunities for fixed positioning, inward gazing, and incarnation. In addition to justifying such contrasts, I consider the advantages of mixing these styles into a hybrid approach when feasible.

Tinjauan Kritis Kewenangan Terapis Gigi Mulut dalam Memberikan Pelayanan Tindakan Medik Berdasarkan Peraturan Menteri Kesehatan Nomor 20 Tahun 2016

ABSTRACTThere are thirteen kinds of health workers in Health Facility, and one of them is Dental Therapist which categorized as medical technician. The Law Number 39/2014 has changed the allocation of Dental Therapist from nursing group to medical technician group. But, their authority is the same with Dental Nurse. In the Minister of Health regulation Number 20/2016 about Licence and Practice of Dental Therapist, there is an authority to give limited medical service to the patient. The research’s approach was normative juridic by evaluating the laws with applicable laws and regulations. The result was there were three sources of Dental Therapist’s authorities which were Attribution, Delegation, and Mandate. These authorities should carry out in Health Facility and not in Independent PracticeKeyword: Dental Therapist, Authority, Medical Service ABSTRAKTenaga kesehatan yang memberikan pelayanan di Fasilitas Kesehatan saat ini dikategorikan dalam 13 jenis dan salah satunya adalan tenaga Terapis Gigi dan Mulut yang termasuk dalam rumpun Keteknisian Medis. Undang Undang Nomor 39 Tahun 2014 telah mengubah mengubah penempatan Terapis Gigi Mulut (dulu bernama Perawat Gigi) dari rumpun keperawatan menjadi rumpun keteknisian medis. Dalam hal ini terlihat bahwa kewenangan seorang terapis gigi dan mulut tidak berbeda seperti halnya kewenangan perawat gigi walaupun bukan lagi dapat dikategorikan sebagai seorang perawat. Dalam Peraturan Menteri Kesehatan Nomor 20 Tahun 2016 tentang Izin dan Penyelenggaraan Praktik Terapis Gigi dan Mulut terdapat kewenangan dalam pemberian pelayanan tindakan medik terbatas kepada pasien. Pendekatan penelitian ini dengan menggunakan pendekatan yuridis normatif dengan melakukan kajian hukum melalui berbagai sistem peraturan perundang-undangan yang ada. Hasil dari penelitian ini menunjukkan ada 3 sumber kewenangan yang dimiliki terapis gigi dan mulut yaitu kewenangan atribusi, kewenangan delegasi dan kewenangan mandat yang dapat dilakukan di Fasilitas Pelayanan Kesehatan dan bukan di Fasilitas Praktik Mandiri. Kata Kunci: Terapis Gigi dan Mulut, Kewenangan, Pelayanan Medik

Disaster Preparedness among Emergency Medical Service Providers: A Systematic Review Protocol

Background. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. Methods/Design. This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: “Medical Technician,” “Paramedic,” “Emergency Paramedic,” “Emergency Medicine Technician,” “Emergency Medical Technician,” “Emergency Prehospital Provider,” “Emergency Preparedness,” “Disaster Preparedness,” “Hospital Preparedness,” “Disaster management,” “Disaster Competencies,” “Disaster Readiness,” “Disaster,” “Disaster Role,” “Readiness, Preparedness, Terrorist,” “Mass Casualty Incident,” “Major incidents,” “Mass Casualty,” “Mass Gathering,” “CBRNE,” “Weapons of Mass Destruction,” and “Chemical, Biological, Radiological, Nuclear, and Explosive Event.” Discussion. To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider’s disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).

Telemedicine communication using instant messaging technology improves pre-hospital triage in high mountain train disasters

Background: Differences between pre-hospital triage by an emergency medical technician and Simple Triage and Rapid Treatment triage (START) by emergency staffs often affect manpower management and aggravate the chaos condition of emergency room. Objectives: Under the assistance of instant messaging, the authors aimed to identify ways of improving triage differences between emergency medical technician triage grading and Simple Triage and Rapid Treatment triage grading by emergency staffs. Methods: Recorded photographs of all patients were reviewed by a smartphone. We categorized patients according to three triage conditions: group 1, accident scene on-site or instantaneous Simple Triage and Rapid Treatment triage by the emergency medical technician; group 2, triage under Simple Triage and Rapid Treatment grading by emergency staffs; group 3, re-triage with START grading using recorded photographs, Glasgow Coma Scale, and vital signs when these patients were arrived in emergency room. The Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test are employed to test differences among the groups. We used risk estimates with odds ratios and the chi-square test to statistically analyze the differences in triage grading. Results: Statistical analysis found conflicting results among Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test. The difference in triage grading between groups 2 and 1 was greater than that between groups 2 and 3 (odds ratio, 6.473; 95% confidence interval, 1.693–24.470; p-value < 0.05). Conclusion: Transferred photographs combined with Glasgow Coma Scale and vital signs can help us to understand the real situations of patients. With instant messaging applications, it is possible to make more precise pre-hospital or instantaneous triage.

Emergency Medical Technician-Facilitated Telehealth Visits: A New Model to Expand Home-Based Primary Care for Homebound Seniors

Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program. Design: A descriptive framework outlining the deployment of an innovative telehealth model. Setting: An HBPC program serving homebound seniors in downstate New York. Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half >90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions. Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician. Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results. Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience). Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.