The analytic process resulted in five categories and twelve subcategories of facilitators or hindrances to using first aid skills at work (See Table 2). Examples of quotes extracted from the responses of police officers are provided in the text for each category and subcategory.
Table 2. Overview of categories and subcategories
Categories
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Subcategories
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Training exposure
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Training methods
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Course content
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Work situation
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Decision making authority
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Overwhelming responsibilities
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Physical and social environment
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Accessibility of the crash location
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Safety at the crash scene
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Support from people around crash scene
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Resources for first aid
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Emergency call system
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Equipment and materials for first aid
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Transport to and from the crash scene
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Hospital atmosphere
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Referral and admission processes
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Healthcare provider attitude
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Training exposure
Police officers felt that the training facilitated their ability to apply their first aid skills. This category involves two subcategories: training methods and course content.
Training methods
Police officers explained that before the first aid training they used to care for victims merely through guessing because their knowledge and skills were limited. They felt that hands-on practice significantly contributed to their ability to apply their skills more appropriately. They said that by reflecting on their training in first aid procedures during the course, they were easily able to apply their skills in real situations.
‘So now if something happens you remember what we did in the training and you do it properly. In that training we were told how to do things practically (through manikin and role plays), so you apply it in the real situation.’ (Participant in FGD 1)
Course content
Police officers mentioned that trauma conditions taught during the first aid training nearly matched with what they commonly encountered at work. They explained that this boosted their confidence in using the skills they learned in class. However, they confessed that at times care of real crash injury victims could be more overwhelming and challenging than those in a simulated environment.
‘We were called to an accident that happened. When we got there, I found that they had placed the victim on the back. After doing assessment the way you trained us, I realised she had lost consciousness. So, I placed her on her side.’ (Participant in FG 1)
Work situation
This category refers to the time and space available for using first aid skills at the crash scene. Two subcategories were identified as barriers to using their first aid skills: decision-making authority and overwhelming responsibilities.
Decision-making authority
Police officers work under a chain of command. Working with a senior officer who had no first aid education was felt to be a barrier, because senior offices tended not to listen to junior officers’ opinions about the proper management of victims. In some situations, their decision to help was interrupted by a senior officer’s priorities; they had to follow orders and so were hindered in assessing the scene and the safety of the victim.
‘The boss tells you “Pick him/her up and let’s go”, so there is no time. And I have seen that as a challenge that we face when we attempt to care for the victim in our work.’ (Participant in FG 2)
Overwhelming responsibilities
Police officers explained that using their skills was often hindered by their other responsibilities. Apart from ensuring the safety of the scene and smooth flow of traffic, they also have to attend to legalities associated with the crash. They further said that their work can become overwhelming when there is shortage of officers.
‘In our area a lot of accidents happen during the night. At that time only one officer manages the area, so when an accident happens, you don’t have time to attend to the victim, and even help from other people may not be available.’ (Participant in FG 3)
Physical and social environment
This category refers to the physical and social environment where the crash occurred. Three subcategories are described as either facilitating or hindering application of first aid skills: accessibility of the crash location, safety at the crash scene, and support from people around crash scene.
Accessibility of the crash location
Police officers reported that when vehicle crashes occur, their ability to reach the crash location in time and provide meaningful interventions to victim was often limited by mobility issues related mainly to inadequate police vehicles. When the crash was far away, even getting a lift to those areas became a challenge, which meant they were routinely late in reaching the crash scene.
‘Because sometimes accidents happen far away from our position, for me to get there, the victim will already be in a very poor situation for me to do something.’ (Participant in FG 4)
Safety at the crash scene
Police officers reported that some situations, such as crowds of people at the scene and busy roads, posed safety issues to both officers and victims. People at the crash scene could become anxious, blaming police for almost everything. At times they would interfere with the caring process by taking action through their own judgement or being uncooperative with the police, and therefore making the area unsafe for providing care.
‘When you get to the accident scene, you find a lot of people thronging the scene, you hardly have air circulation, you tell them please move back, but they never listen.’ (Participant in FG 1)
Support from people around the crash scene
Support from people around the crash scene can be both facilitative and a hindrance. Support can come in many forms including manpower, materials, and moral support. Most of the police officers described being able to use their first aid skills when bystanders were there to help.
‘I would say that the thing that helped us to use our skills was the readiness of people around to work with me to help the victim, for example, helping me to lift a victim into a vehicle.’ (Participant in FG 3)
On the other hand, people’s ignorance and misconceptions about the care of victims creates mistrust and interference with care at the scene.
‘People think differently. While you have knelt down trying to assess the victim, others around think that you are wasting time, because they don’t know… so they start shouting. If it happens that the relatives of the victim are around, they may just decide to take matters into their own hands’. (Participant in FG 1)
Resources for first aid
Care of injured victims requires the use of resources at the scene and on the way to the hospital. In this category, three subcategories were identified as facilitating or hindering the use of first aid skills: emergency call system, equipment and materials for first aid, and transport to and from the crash scene.
Emergency call system
Having an emergency telephone number available for people to call police about crashes was felt by officers to facilitate them reaching the scene and helping. They reported that people sometimes called them directly through their own mobile numbers or the public emergency call numbers.
‘For example, when an accident happens somewhere at Geza, I may not know until someone calls the police. So, when we get such information, we rush to the scene to provide any needed help.’ (Participant in FG 3)
Equipment and materials for first aid
Lack of equipment for first aid was reported by all police officers as a barrier to using their first aid skills. Police officers mentioned the lack of gloves for self-protection and boards for lifting and carrying injured victims as big challenges. They explained that they often found themselves in difficult situations, especially with victims who are bleeding.
‘You may go to the scene and find the victim is bleeding profusely and you don’t have gloves, bandages, or any piece of cloth. So, it is difficult to proceed with care.’ (Participant FG 3)
Transport to and from the crash scene
Inadequate transport in the police department was described as a challenge to officers’ ability to reach the crash scene on time and provide first aid. Not all police officers have vehicles; they often have to rely on getting a lift from other people or paying for motorcycle taxis to get them to the crash location. Lack of appropriate vehicles to transport victims to hospital was also a challenge to their ability to apply first aid during transport because of the confined space.
‘Even if you succeed in getting a vehicle, they are not suitable to transport victims because we use private cars and find it difficult to accommodate serious victims.’ (Participant in FG 3)
Hospital atmosphere
This last category refers to the interaction between healthcare providers and police officers and the disposition of the victim at the hospital. Two subcategories were identified as discouraging police officers’ efforts to provide first aid care: processes of referral and admission and attitude of healthcare providers.
Processes of referral and admission
Police officers reported that their ambitions and moral obligations towards victims were diminished by hospitals’ bureaucratic routines, which hindered their morale and ability to give good care. For example, the police officers described that they could see that the condition of victim is deteriorating, but the victim had to stay at the hospital for hours just waiting for transfer to another hospital capable of providing needed treatment. This discouraged their putting more effort in care process describing that they felt their efforts were wasted. Regarding admission processes, it could happen that they were asked to pay some amount for admission bills for the victim to cover for initial costs while processes for identifying relatives of the victim are taken.
‘This is very bad because they saw I’m a police officer and that this was an emergency.’ (Participant in FG 3)
Attitude of healthcare providers
Police officers expressed frustration in working with healthcare providers, who they often felt hindered their morale and ability to apply their first aid skills. They reported that nurses were not supportive and considerate of their efforts in assisting injured victims. Police officers described having done their job of transportation as well as they could, but then being in the emergency department for almost an hour waiting for a doctor to attend the victim.
‘When we bring victims, we find that nurses are not helpful. They just watch you. They should be quick in taking care of the victim.’ (Participant in FG 4)