Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.8 No.2. January 2025. Page.400-406

400

Pre-Hospital Handling in the Community, a Qualitative

Research

Bambang Wiseno

1* , Mohammad Ikhwan Khosasih

2 , Fajar Rinawati

3 , Didik Susetiyanto

Atmojo 4 , Elfi Quyumi Rahmawati

5 , Dwi Rahayu

6

1,2,4,6 STIKes Pamenang, Indonesia 3,5 Universitas STRADA Indonesia

*Corresponding author: [email protected]

ABSTRACT

Background: Emergency handling before transferring to the hospital (Pre-Hospital

treatment) determines the success of emergency case handling. That’s actions include;

emergency and non-emergency evacuation and first aid escort in the community. Pre-hospital

treatment can be carried out by anyone who is around the location of the emergency at the

time of the incident. This treatment aims to identify clients and to provide immediate action

needed before being sent to health services. Ordinary people who are around the incident

sometimes take actions that worsen the client's condition because of their knowledge and/or

abilities.

Purpose: This study aims to determine the perspective of the ordinary community on Pre-

Hospital treatment for emergency incidents in the community.

Methods: This qualitative study was conducted by interviewing (in-depth-interview) the

ordinary community as Informant with purposive sampling in Pelem Village, Pare District,

Kediri Regency, Indonesia who willing to be informants in this study. Data analysis used

Interpretative Phenomenology Analysis with validity through data triangulation and

conducting peer-debriefing with other qualitative researchers.

Results: From this study, several findings of the theme were obtained, including; lack of

understanding of residents about pre-hospital actions, wrong actions, feeling pre-hospital

knowledge for public, need for the role of the media, hoping for health workers in each

region, helping villagers.

Conclusion: From all the themes, it is possible that there needs to be health education for the

general public, especially about pre-hospital treatment to prevent the severity of wrong

actions. Increasing knowledge about health needs to be done continuously at the community.

Keywords: accident, emergency, handling, patient, transportation

Received November 10, 2024; Revised December 12, 2024; Accepted January 3, 2025

DOI: https://doi.org/10.30994/jnp.v8i2.725

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Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.8 No.2. January 2025. Page.400-406

401

BACKGROUND

Emergencies come unexpectedly and can happen to anyone without prior warning.

Emergency situations must be addressed quickly, and get help immediately, even though it is

not necessarily life-threatening. If an emergency is not handled quickly and appropriately, it

can be life-threatening for the victim. Handling of victims can be divided into two different

situations, namely before the hospital/health services (pre-hospital) and in the hospital (in-

hospital) (Bahrami, M.A., Maleki, A., Ezzatabadi, M.R., Askari, R., dan Tehrani, 2011).

Many incidents often occur in the community such as; high fever, acute pain,

emergency due to diabetes, severe dehydration, asthma, seizures, burns and these incidents

are often found outside the hospital by ordinary people who are around the location of the

incident. Not everyone has the ability to handle emergency cases that can cause conditions to

become more severe, life-threatening and fatal if action is not taken by a competent person.

Emergency situations, also known as emergencies, need to be handled quickly and

appropriately to immediately carry out first aid (pre-hospital) before being sent to a health

service (Ahn, H., Singh, J., Nathens, A., MacDonald, R.D., Travers, A. Tallon, J., Fehlings,

M.G., and Yee, 2011).

The need for ambulances and health workers in emergencies is an important thing to

consider to alleviate the suffering of victims. Accuracy and speed of first aiders will reduce

the risk of death before receiving action at health services. In this case, of course, adequate

transportation facilities are needed to be used to send victims to health services and

coordination between first aiders at the scene with the referral service team so that they can

be informed about the time and place of the incident, the victim's history and what actions

have been taken by the first aiders (BNPB, 2012).

Handling of emergency victims outside the hospital often results in errors that cause

difficulties in handling at the Hospital Emergency Installation. This is possible due to the

ignorance and/or lack of understanding of the first aiders at the time of the incident before

being taken to the hospital. The general public certainly cannot be blamed for taking such

actions because of the nature and character of the Indonesian nation who help each other with

the intention of lightening the burden on the victim (Bjornstig, 2004). From the description

above, the researcher wants to explore the opinions and views of the general public regarding

pre-hospital actions in Pelem Village, Pare District, Kediri Regency, Indonesia.

OBJECTIVE

This study is a qualitative study that explores, finds, describes and explains the quality

of the views of community members as adult individuals who have or have experienced

emergency events and their handling, which are not clearly described and measured including

their perceptions. This study uses a more detailed interpretative phenomenological approach

in interpreting, interpreting and understanding the phenomenon of emergency events and

their handling before being taken to health services (hospitals). The purpose of this research

approach is to interpret the psychology, mood, desires and views of community members

who have been exposed to emergency events in their lives and seek unity of meaning by

identifying the core phenomena that accurately describe their experiences (Streubert, 2011).

METHODS

This study uses a more detailed interpretative phenomenological approach in

interpreting, giving meaning and understanding the phenomenon of emergency events and

their handling before being taken to health services (hospitals). This qualitative study

provides an opportunity for researchers to emphasize the naturalness of data and all realities

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that are closely related to human life experiences (Stadtländer, 2009), especially the

experience of the general public in dealing with emergency events. The researcher has

received an ethics certificate on June 20, 2024 No 12/EC/KEPK/DH/2024.

Informant retrieval is planned using a purposive sampling technique that meets the

principles of appropriateness and adequacy, namely the general public. The inclusion criteria

for the study are as follows: 1) Adult individuals who are in the village where the research is

located, 2) Informants who are willing to be involved in the research, 3) Informants who are

not health workers, 4) Informants who are willing to be interviewed and recorded during the

research and give consent for publication of the research results. Researchers will not discuss

problems related to diseases or health personnel in the community.

According to (Stadtländer, 2009), an important thing that affects the quality of

research data is the quality of the instrument in data collection, namely the researcher as an

instrument. Instrument validation on the quality of the researcher, namely the researcher is a

nurse who has worked in emergency services, a nursing teacher, a social activist for disaster

humanitarianism who is a member of a humanitarian organization that always interacts with

health needs in the community, making it easier to enter the site being studied. In general, the

data analysis that will be used consists of 5 phases, namely 1) compiling the data that has

been obtained, 2) describing the data by grouping similar data, 3) re-collecting and

compiling, 4) interpretation, and 5) concluding. The data analysis process by organizing and

sorting similar data into patterns to make it easier for researchers to find categories, followed

by finding sub-themes that will produce certain themes. In detail, the researcher will use

Interpretative Phenomenological Analysis (IPA) as the flow conveyed by (Smith, 2009).

Validity and reliability of the research will be carried out as procedures for the validity of

qualitative research. A qualitative study will be trusted if it is able to display the Informant's

experience accurately and through the correct process (Stadtländer, 2009). To prove the

accuracy of this research, the researcher will use; a test of the degree of trust (credibility), the

skills of listening and observing the Informant as a research subject (dependability), the

objectivity of the research will be carried out with the agreement of people who are not

interested in the research (confirmability) and conducting external validation with related

parties so that the research results can describe other people (transferability).

RESULTS

This study was conducted after obtaining approval from the head of Pelem Village,

Pare District, Kediri Regency, Indonesia. Data collection was carried out on 6 informants

randomly from July 21 to August 18, 2024 with the criteria that the informants were residents

of Pelem Village who were willing to become informants in research with appropriate themes

and gave their consent that the research results would be published without mentioning the

informant's identity. Data was collected using in-depth interview techniques and observations

as well as observations according to the needs of the research topic and the themes to be

obtained, namely: experience in handling pre-hospital emergency situations. Data collection

was carried out an average of 2 times on informants for clarification and validation of the

findings and themes that could be revealed by the researcher. During data analysis, the

researcher validated with the health team at the Emergency Room of a hospital, discussions

with other qualitative researchers and several emergency lecturers at the Pamenang Health

College. The findings from informants on pre-hospital handling in emergency cases in

accordance with the objectives of the study obtained 6 major themes, including: lack of

understanding of residents about pre-hospital actions, wrong actions, feeling the need for

public pre-hospital knowledge, need for the role of the media, hoping that there are health

workers in each region, obliged to help neighbors. The six themes will be described

Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.8 No.2. January 2025. Page.400-406

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separately supported by several quotes from interviews, observations and observations from

informants.

Description of each theme as below:

Lack of understanding of residents about pre-hospital actions

Informants said that when helping accident victims or helping neighbors who need

treatment at health facilities, it is done immediately even though they do not know whether

their actions are right or wrong. This is evidenced by the quotes obtained in accordance with

the theme above;

… … sorry sir, I think he'll be taken to the hospital soon, that's what I think) … … (I-1), … … I

think he'll be taken to the hospital soon, … the hospital will have a weighing officer who will

take care of him … … (for us, there's no need to wait long, the main thing is to handle him

immediately and finish him (the matter at the location), there must be many officers at the

hospital who still don't know what to do) , … … (I-3, I-1) I don't understand, it's wrong, the

important thing is to take him to the hospital soon … … (don't know what's right or wrong,

the important thing is to send him to the hospital soon) (I-4).

Wrong action

Treatment in cases of health problems must of course be carried out correctly by

competent people or people who understand how to deal with these health problems.

Emergency incidents often come suddenly and anywhere without being expected so that

when an emergency occurs there are only people around the location who do not necessarily

have experience in the correct actions regarding emergencies. Mistakes in handling often

occur and are carried out by the community, such as the following interview excerpts with

Informants:

… … still on the road no longer there (dead), but .. continued to the hospital)… … (I-4), … …

when about a motorcycle accident victim who was immediately transported to be taken to the

hospital) (when being handled, he was still breathing when he was lifted onto a motorbike,

suddenly became unconscious with his neck bent forward without any strength to hold him

up) … … (1-5), … … when he was in the bathroom he was unconscious, when his wife was

forced to go to the hospital, but when he arrived at the hospital, he went home because he

had died … … (1-2).

Feeling the need for knowledge pre-hospital handling

Health knowledge is not only for health workers but is also needed by the general

public, including in understanding and skills in handling emergencies. The community feels

the need to know and understand the correct actions in emergency cases in the community

before being taken to the hospital, such as the opinions and hopes of the following

informants:

… … hopefully … so as not to be excessive (can't do anything) when seeing something like

that (emergency) … … (I-2), … … actually want to understand, but will I be able to, at that

time the school often ran away from class) (I-6), … … a little bit understand (the correct

action in an emergency … … yeah it's okay to understand event rare abaut emergensy at

least it can help… … (I-5).

The role of the media is needed

Today's technological advances are all digital and there are many social media which

certainly greatly facilitates and accelerates the dissemination of information in the

community including many social media that provide information about health. The findings

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404

in the community represented by informants in this study are that they understand the actions

that can be taken at home in emergency cases from social media still do not feel sufficient so

that the community has high hopes for a special program on social media that discusses

emergencies. Here is a summary of information from informants in this study about the need

for a special social media role for emergency issues:

I know from television.. but I don't really understand … … but for example there is a special

program about emergency handling, I wonder if it's good …, hehehe watch it on YouTube) (I-

2), But I don't really understand …, … … on the radio what is usually discussed is about

illness, it doesn't discuss what to do in the event of an accident, what should be done? … …

(I-1, I -5).

Hoping for health workers in each region

Information about the presence of nurses in every village which is a government

program has reached the public. So that when the research was conducted, several informants

were happy and hoped that it could be realized. assisting the community's need for health

workers in their area. Expectations from the community are as follows:

… … I heard there will be a nurse in every village, that's good … … but, is it can will solve

the problem??… … (I-5, I-6), … … There is a nurse, but they not open a service practice at

home, They are work in a hospital, … for example, if some of them willing to stand by at

home for patients. It’s the good thing… but who will pay? (I-3, I-2).

Feeling obliged to help

Informants feel that they have an obligation to help neighbors who need help,

including with health matters, even though sometimes they come to the location not knowing

what to do, as quoted from several of the informants' statements below:

… … the neighbors are so closer, sir, when someone asks for help, everyone come quickly to

find out what to do to help, event sometimes it's made more terrible … because they don’t

know what to do, … … like yesterday Aunt X's son fainted, all of them are coming together…

… (I-2), … … I'm the one who will help those who complain are hunted directly, Even though

I don't know how to help, but who knows what I can to do… … (I-6).

DISCUSSION

The informant conveyed his/her opinion, feelings and desires from the emergency

situation before being taken to the hospital so that several themes of the research results were

found(Cooke, 2003). From these findings, the possibility of why this could happen to the

informant can be explained. The description of each theme is as follows. 1). Lack of

understanding of residents about pre-hospital actions. The informant said that when

helping accident victims or helping neighbors who need treatment at health facilities, it is

done immediately even though they do not know whether their actions are right or wrong.

Emergency assistance actions before being taken to the hospital or health facility must be

carried out correctly by the helper (Elmqvist, C., Brunt, D., Fridlund, B., and Ekebergh,

2010). 2) Wrong action. Treatment in cases of health problems must of course be carried out

correctly by competent people or people who understand how to deal with these health

problems. Emergency incidents often come suddenly and anywhere without being expected

so that when an emergency occurs there are only people around the location who do not

necessarily have experience in the correct actions regarding emergencies (Geduld, H. and

Wallis, 2011). Mistakes in handling often occur and are made by the community. 3) Feeling

the need for general pre-hospital knowledge. Health knowledge is not only for health

workers but is also needed by the general public including in understanding and skills in

Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.8 No.2. January 2025. Page.400-406

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handling emergencies. The public feels the need to know and understand the correct actions

in emergency cases in the community before being taken to the hospital (Jayaraman, S.,

Mabweijano, J.R., Lipnick, M.S., Caldwell, N., Miyamoto, J., Wangoda, 2009). 4) Media

role is needed. The advancement of technology today which is all digital and many social

media that exist certainly greatly facilitate and accelerate the dissemination of information in

the community, including many social media that provide information about health. The

findings in the community represented by informants in this study are that they understand

the actions that can be taken at home in emergency cases from social media still do not feel

sufficient so that the community has high hopes for a special program on social media that

discusses emergencies (Smith, 2009). The following is a summary of information from

Informants in this study about the need for a special social media role for emergency

problems. 5) Hope there are health workers in each region. Information about the

existence of nurses in every village which is a government program has been heard by the

community. So that when the research was conducted, several Informants were happy and

hoped that it would be realized this could help the community’s need for health workers in

their area. Informants realized that emergency handling before being taken to the hospital was

very important to be carried out by people who understand and understand, namely medical

personnel who have special knowledge about emergencies (VanRooyen, 2002). 6) Feeling

obliged to help. Informants feel that it is an obligation to help neighbors who need help,

including in health matters, even though sometimes they come to the location not knowing

what to do. Such are Indonesians who hold fast to the culture of mutual cooperation (WHO,

2019).

CONCLUSION

Emergency cases often occur in the community and receive immediate treatment from

the community around the location. The emergency measures taken before being taken to the

hospital (pre-hospital) by the community turned out to have a deep meaning for the

community. The general public is aware that they do not understand the correct pre-hospital

actions. Residents still do that because they feel that they are part of the community that is

responsible when there is an emergency so that they sincerely help and help other residents

who are in need. The hope of citizens, even if they are not / not as health workers, to get the

right information in an emergency so that they can provide the best and the right when they

find a case. In addition, the community hopes for a realization from the government regarding

treatment personnel in each region (village) to help the community if there is a health case to

be quickly dealt with by competent people before being taken to the hospital.

REFERENCES

Ahn, H., Singh, J., Nathens, A., MacDonald, R.D., Travers, A. Tallon, J., Fehlings, M.G., and

Yee, A. (2011). Pre-hospita

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