The analytic process resulted in five categories and eleven 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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Staff shortage
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Physical and social environment
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Accessibility of the crash location
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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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Attitude of healthcare providers
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Training exposure
This category involves two subcategories: training methods and course content. It describes how the the training facilitated the use of first aid skills on site.
Training methods
Hands-on practice significantly contributed to the ability of police officers to apply first aid skills more appropriately. They explained that before the first aid training they used to care for victims merely through guessing because their knowledge and skills were limited. 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
Teaching trauma conditions similar to what police officers commonly encountered while on site was considered to boost police officers’ confidence in applying their skills they learned in class as they could easily familiarize with them. 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 staff shortage.
Decision-making authority
Working with a senior officer who had no first aid education was treated as a barrier, because senior officers tended not to follow junior officers’ suggestion about the 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)
Staff shortage
Opportunity to apply first aid skills was hindered by shortage of police officers. In addition they have to attend to other responsibilities such as to ensure smooth flow of traffic and legalities associated with the crash.
‘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 and support from people around crash scene.
Accessibility of the crash location
Ability of police officers to reach the crash location in time and provide meaningful interventions to victims was often limited by mobility issues. When the crash was far away from the police station, getting to the scene 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)
Support from people around the crash scene
Presence of people around the crash scene was considered to facilitate provision of first aid by police officers. They described getting support from people in forms of manpower, materials, and moral support.
‘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. This was described as a hindrance in the care process.
‘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 facilitated police officers to reach the scene and provide help. 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
Admission to and referral procedures at hospitals were reported by police officers as lengthy and bureaucratic, this hindered their morale and ability to give good care to victims. 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 as they thought that their efforts were wasted. Furthermore, 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
Slow action of healthcare providers at hospitals in taking responsibilities of patient care from police officers was viewed by police officers to hinder their morale to further engage in the care of victims. They described that 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 or a nurse 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)