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Updated: Aug 26, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Complex systems design based on actual system functioning: Coping with variability in a national water ambulances
Hugo Cesar Bellas1, Rodrigo Arcuri1,2, Denise de Souza Ferreira3
1Oswaldo Cruz Foundation - FIOCRUZ, Rio de Janeiro, Brazil.
Guidelines were developed to enhance the resilient performance of Brazil's Mobile Emergency Medical Service (SAMU) water ambulance operations. These address team composition, equipment, communication, and protocols for safer emergency care in riverine and coastal areas.
Area of Science:
- Emergency Medical Services
- Resilience Engineering
- Healthcare Systems Design
Background:
- The Mobile Emergency Medical Service (SAMU) in Brazil provides standardized emergency care nationwide.
- Water ambulance services within SAMU operate in challenging riverside and coastal environments.
- These unique conditions complicate the delivery of high-quality, safe emergency care.
Purpose of the Study:
- To create organizational design guidelines for improving the resilient performance of complex emergency care systems.
- Specifically applied to riverine and coastal mobile emergency care services in Brazil.
Main Methods:
- An ethnographic approach was used, including participatory fieldwork.
- Data collection involved technical descriptions, interviews with managers and professionals, and work observation.
- Content analysis of coded data focused on system capacity, demand, and agent adaptations.
Main Results:
- Developed design guidelines cover team composition and training, uniforms, and personal protective equipment (PPE).
- Guidelines also address decentralized water bases, communication systems, intervention protocols, biosafety, and inter-sectoral actions.
- Identified gaps and adaptations informed the proposed solutions for organizational design.
Conclusions:
- The study successfully framed and assessed design elements using resilience engineering principles.
- The findings offer pathways to enhance emergency medical services and align idealized system functioning with actual operations.
- The developed guidelines aim to improve the safety and quality of care in complex aquatic environments.
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