bluuebunny/crossref_metadata_2025 huggingface dataset:
Privatization and Emergency Medical Services
Authors: Reissman Stephan G.
Published: July 2016

Introduction:

Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, “It is not government's obligation to provide services, but to see that they're provided.” Even in the area of public safety, privatization has found a “market.”

In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. Privately owned ambulance services staff and respond to medical emergencies in a given community as part of the 9–1–1 emergency response system. Regulations for acceptable response times, equipment, and other essential components of EMS systems are specified by contract. This allows the municipality oversight of the service provided, but it does not provide the service directly. As will be discussed, this “contracting-out” model has many benefits.

Privatizing EMS services is a decision based not only on cost-savings, but on accountability. A thorough evaluation must be utilized in the selection process. Issues of efficiency, effectiveness, quality, customer service, responsiveness, and equity must be considered by the government, in addition to cost of service.

The uncertain future of health care in the United States has led those in EMS to look beyond the field's internal market to explore additional opportunities for expanding and redefining its roles beyond emergency care. It is important, however, to consider how emergency medical care, the original role of EMS, can be best delivered. Responding to emergencies is not just one of the functions involved in this field, it is the principal function from which public perception of EMS is formed, and from which support for entering other markets can be fostered.

The purpose of this paper is to present several important concepts and considerations that public officials, medical directors, and the public must be aware of when contemplating the possibility of privatizing their Emergency Medical Services. A review of the general concepts of privatization and issues of accountability will be presented, referencing policy experts, followed by an examination of how advocates of privatization might see these issues as they relate to providing EMS. The conclusion will present prescriptions for both municipal and commercial ambulance providers.
Medical and Surgical Issues in the Persian Gulf War
Authors: Adler Jacov
Published: July 2016

This report includes the preparations for and the medical impact of the missile attacks launched by Iraq on Israel. It includes the authorization language for the preparations, the preparations undertaken, the perceived threat to the civilian population of Israel, the operational plans activated, the attacks and the medical impact of these attacks, the number and types of casualties, the damage to property, and the initial and subsequent protection times. There occurred a total of 18 missile attacks with 40 conventional missiles launched against Israeli civilians. They resulted in an 4.4 times overall increase in the number of ambulance responses, 228 civilians injured; and two deaths. In addition, five persons died of myocardial infarction related to these attacks. Eight persons died of suffocation due to use of the gas masks.
The EMS Response to the Oklahoma City Bombing
Authors: Maningas Peter A. , Robison Mark , Mallonee Sue
Published: July 2016

This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.

There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion.

The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.
The Efficacy of Integrating “Smart Simulated Casualties” in Hospital Disaster Drills
Authors: Gofrit Ofer N. , Leibovici Dan , Shemer Joshua , Henig Avinoam , Shapira Shmuel C.
Published: July 2016

Introduction:

Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill.

Objective:

To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill.

Methods:

A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as “Smart Victims.” The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill.

Results:

The “smart casualties” made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The “smart casualties” were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals.

Conclusion:

Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.
Prehospital Treatment of Patients with IV Heroin Overdose: What Are We Treating?
Authors: Pedersen Carsten Boe , Steentoft Anni , Worm Karen , Sprehn Michael , Mogensen Torben , Sørensen Mogens Bredgaard
Published: July 2016

Objective:

To measure blood levels of morphine and additional drugs in patients suspected of intravenous (IV) heroin abuse and to evaluate the effects of antidote treatment.

Design:

Prehospital blood sampling in 52 patients.

Results:

Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses.

Conclusion:

This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.
Medical Outreach After Hurricane Marilyn
Authors: Leonard Ralph B. , Spangler Harold M. , Stringer Lew W.
Published: July 2016

Introduction:

Many geographical areas are subject to devastating disasters that leave the citizens not only without homes, but also without their local medical systems. Now medical-aid stations consisting of personnel, supplies, and equipment quickly can be deployed when needed to such areas under the aegis of the National Disaster Medical System (NDMS). Such teams can provide emergent medical care as well as daily medical care. However, these aid stations are of no help for the home–bound or nursing home patients too infirm to reach them. Thus, these citizens only can obtain medical care if medical teams make planned outreach excursions to reach them.

Objective:

To describe a planned outreach program that was implemented for such patients on St. Thomas Island after it was devastated by Hurricane Marilyn in 1995.

Results:

Over a five-day period, the out-reach team provided medical care for 67 patients ranging in age from 11 days to 90 years. Play and art therapy was provided for non-injured children. The most common needs in the elderly were anti-hypertensive medications and insulin-loaded syringes.

Conclusion:

For outreach efforts of this nature, membership of the team should include a registered nurse, a paramedic, a respiratory therapist, a public health specialist, and a local authority familiar both with the area and its inhabitants. A physician does not need to be assigned to the team, but should be available by radio.
Identifying Victims of Elder Abuse and Neglect: A Training Video for Prehospital Personnel
Authors: Seamon Jason P. , Jones Jeffrey S. , Chun Eric , Krohmer Jon R.
Published: July 2016

Introduction:

The majority of prehospital emergency medical services (EMS) personnel lack specific training relating to elder abuse and neglect.

Objectives:

To develop and test an audio visual training program that focuses on the identification and reporting of domestic violence in the elderly.

Methods:

A videotape was designed to be used as a 45-minute training course for prehospital personnel using one-half inch, super-VHS recording. A convenience sample of 60 EMS personnel working in Kent County then were asked to evaluate the videotape program. Each volunteer completed a pre-test on elder abuse and neglect, watched the 45-minute videotape, and then answered 12 questions on a post-test.

Results:

Participants had an average of 12.4 years (range: 1–30 years) prehospita emergency-care experience. Only four (7%) could recall any previous training relating to elder abuse or neglect during their career. Although the prevalence of elder abuse in their community was described as “rather rare” by most (60%) of the subjects, 85% (51/60) had seen a suspected case of elder abuse or neglect during their careers; 47% (28/60) had seen a case during the past six months. Only 29% of these suspected cases were reported to county authorities. Approximately 40% of the questions on the pre-test were answered correctly (mean score, 4.8 ± 3.0). In comparison, 83% of the questions on the post-test were answered correctly (10.0 ± 3.0). Although participants had a number of suggestions to improve the video program, 78% (47/60) expected this material to change the way they will evaluate elderly patients in the future.

Conclusion:

Prehospital personnel do not feel confident identifying or reporting victims of elder abuse or neglect. A videotape training program may be an effective way of presenting this information as a means of continuing education.
Automatic External Defibrillation and Its Effects on Neurologic Outcome in Cardiac Arrest Patients in an Urban, Two-Tiered EMS System
Authors: Ho Jeffrey , Held Timothy , Heegaard William , Crimmins Timothy
Published: July 2016

Objective:

To describe the use of the Automatic External Defibrillation (AED) device in an urban, two-tiered Emergency Medical Service (EMS) response setting with regard to its potential effects on cardiac arrest patient survival and neurologic outcome.

Methods:

A retrospective and descriptive design was utilized to study all cardiac arrest patients that had resuscitations attempted in the prehospital environment over a 30-month period. The study took place in a two-tiered EMS system serving an urban population of 368,383 persons. The first tier of EMS response is provided by the City Fire Department, which is equipped with a standard AED device. All first-tier personnel are trained to the level of Emergency Medical Technician-Basic. The second tier of EMS response is provided by personnel from one of two ambulance services. All second-tier personnel are trained to the level of Emergency Medical Technician-Paramedic.

Results:

271 cardiac arrest patients were identified for inclusion. One-hundred nine of these patients (40.2%) had an initial rhythm of either ventricular fibrillation or pulseless ventricular tachycardia and were shocked using the AED upon the arrival of first-tier personnel. Forty-two patients (38.5%) in this group had a return of spontaneous circulation in the field and 22 (20.2%) survived to hospital discharge. Of the survivors, 17 (77.3%) had moderate to good neurologic function at discharge base on the Glasgow-Pittsburgh Cerebral Performance Categories. Faster response times by the first-tier personnel appeared to correlate with better neurologic outcomes.

Conclusion:

First responder-based AED usage on patients in ventricular fibrillation or pulseless ventricular tachycardia can be applied successfully in an urban setting utilizing a two-tiered EMS response. In this study, a 20.2% survival to hospital discharge rate was obtained. Seventy-seven percent of these survivors had a moderate to good neurologic outcome based on the Glasgow-Pittsburgh Cerebral Performance Categories.
Medical Disaster Preparedness of Rotterdam Europort: An Application of Methodology for Assessing Disaster Preparedness
Authors: de Boer Jan
Published: July 2016

Medical disaster preparedness (MDP) of Rotterdam-Europort has been estimated by grading personnel, materials, and methods utilized in the chain of medical care, from the disaster site to the hospital. On a scale from 1 to 5, this MDP was set at 2.8: the disaster site is the weakest link, which determines the strength of the whole chain. This, in turn, was the result mainly of the methods utilized for which the personnel were not properly educated and trained.

By applying the methodology as described in an earlier paper, the MDP of cities, airports, harbors, industrial plants, etc. can be determined in a standardized way. This methodology should facilitate epidemiologic research in the public health aspects of disaster preparedness.
Nitroglycerine Lingual Aerosol in Prehospital Emergency Care,
Authors: Rottman Steven J. , Larmon Baxter
Published: July 2016

Nitroglycerine (NTG) commonly is used in the prehospital emergency care setting for the treatment of chest pain suggestive of myocardial ischemia or infarction or for cardiac unloading in patients with presumed pulmonary edema. The usual form of this drug is as a 400 mcg tablet administered sublingually. Recently, NTG has become available as an aerosolized form (NTGA) in a multiple dose, pressurized canister containing 200 metered doses of 400 meg of NTG each. In this form, the drug is purported to be absorbed rapidly from the surface of the tongue.

In the field, we have noted that the sublingual tablet form of NTG occasionally remains undissolved following administration to patients complaining of chest pain. In each of these cases, clinically, the patients were unchanged on arrival at the receiving hospital and an intact tablet was discovered properly placed under the tongue. In an attempt to evaluate the ease of administration and clinical responses of patients with chest pain to the aerosolized form of the drug, we replaced NTG sublingual tablets on paramedic units in the Burbank system with the NTGA form.
Analgesia in the Field
Authors: Stewart Ronald D.
Published: July 2016

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.

Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).
Medical Anti-Shock Trousers: Blind Faith, Poor Judgment and Patient Jeopardy
Authors: Mattox Kenneth
Published: July 2016

The oft-repeated historic development of the pneumatic lower body compression suit (MAST, PASG) for the presumed treatment of hypotension has been well-documented by McSwain(l). While the experimental and anecdotal clinical observations of Crile, Gardner, Wangenstein and Kaplan are interesting, they are not prospective, controlled, randomized clinical trials in humans(2,3,4,5). In the early 1970s, the EMS community was ripe for the bandwagon reflex to grasp at any and all gimmicks and gadgets which became available, regardless of a lack of evidence regarding their safety or danger to patients. Inventions such as the esophageal obturator airway, various darts, MAST, external cardiac bumpers, percutaneous trachea obturators, and many others simultaneously were thrust upon the unsuspecting and unprotected patient community. Some of these innovations may have been beneficial but others were dangerous. Contending that some intervention in a “life threatening, good Samaritan situation” was better than no interventional treatment or “stabilization” at all, the paramedics' blind faith in these modalities persisted. The Medical Device Amendment of 1976 (6), which requires safety and efficacy for devices, similar to that long in effect for new drugs, had not yet been enacted into law to require premarketing clearance of new medical devices. Building on blind faith and premature recommendations regarding in the unproven concept of MAST, the EMS community exercised poor judgment in recommending to state legislators that this unproven device be “required equipment” on board ambulances. Furthermore, this small cadre of “special interest groups” lobbied to have the MAST mandated as essential equipment in trauma centers(7,8). Although the minutes of the trauma planning meetings do not reflect the debate at the American College of Surgeons Committee on Trauma, numerous voices of advised constraint, said “go slow” on including the MAST as part of the ATLS course and the ACS optimal resources document.
Prehospital Use of Pulse Oximetry in Rotary-Wing Aircraft
Authors: Valko Peter C. , Campbell Jack P. , McCarty David L. , Martin Dennis , Turnbull Joe
Published: July 2016

A prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of critically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of the 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft.
Medical Planning for Mass Gatherings: A Retrospective Review of the San Antonio Papal Mass
Authors: Hnatow David A. , Gordon Donald J.
Published: July 2016

There are limited data available and no recognized standards or guidelines for providing emergency medical care at large public event The organizational planning of emergency medical care for the 1987 San Antonio Papal Mass was reviewed. Medical care was provided using a multi-tiered system. The San Antonio EMS system played a leading role in the design, administration, and implementation of this medical care.

An analysis of the types and frequencies of emergency medical problems encountered by health care providers is detailed. The total attendance was approximately 100,000, 1.5% (1553) required medical attention, and 241 were evaluated on-site by physicians. The majority of medical problems encountered were managed by non-physician, health care providers.

Severe environmental conditions with a heat index exceeding 102°F were responsible for 174 cases (72%) of heat-related illness. A total of 55 patients required transport to local emergency department. There were no cardiopulmonary arrests, major injuries, or deaths.
The Integration of a Helicopter Emergency Medical Service in a Mass Casualty Response System
Authors: Jacobs Lenworth M. , Gabram Sheryl G. A. , Stohler Sherry A.
Published: July 2016

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level I, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital.

This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and the three hospital-based emergency medical helicopter programs that operate in the New England states.

This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.
Analysis of Hospital Ability to Provide Trauma Services: A Comparison between Teaching and Community Hospitals
Authors: Neely Keith W. , Norton Robert L. , Bartkus Ed , Schiver John A.
Published: July 2016

Hypothesis:

Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).

Methods:

A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiogaphy (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.

Results:

With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p<.01).

Conclusions:

In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability analysis can be performed in other communities to help guide trauma center designation.
Emergency Evacuations in Disasters
Authors: Leonard Ralph B.
Published: July 2016

Some disasters produce circumstances that require the emergency removal of some or all of the citizens from a geographic area. Emergency or mass evacuation can be divided into immediate evacuation, in which the citizens are given no warning of their need to evacuate, and potential evacuation, in which citizens are given time (usually a day or two) to evacuate. The mass evacuation aspect of disaster planning frequently is neglected, but must be planned in detail. An essential ingredient of a plan is the designation of a person who has the authority to order an evacuation and that that person or an authorized alternate, is available instantly 24 hours a day. The plans should identify likely scenarios which could require emergency evacuation for a given community requiring, means of communicating with the citizens, evacuation routes, evacuation mechanisms, and shelter arrangements. All plans need to take into account human behavior during such a stressful situation.
Advanced EMS Anatomical Workshop
Authors: Griffin Stephanie , Gough John E. , Allison E. Jackson
Published: July 2016

Due to time constraints, most Emergency Medical Services (EMS) certification and continuing education programs offer no more than an overview of the principles of anatomy, physiology, and pathology. In an effort to strengthen the EMS professionals' knowledge of these concepts, an EMS Anatomical Workshop was developed. This workshop is a day-long program consisting of lectures and laboratory sessions covering anatomy, physiology, and pathology of major body systems. The workshop has been successful, and its fourth offering has been completed. This program could serve as a model for areas that desire to enhance the education of their EMS providers.
Stress in the Prehospital EMS and Disaster Setting
Authors: McHenry Susan D.
Published: July 2016

While formal efforts have been made during the past quarter century in the United States to develop and coordinate emergency medical services (EMS) as a “system” of care, it was not until the past decade that we began to recognize and acknowledge the impact of stress on the lives of EMS and other public safety personnel, in both normal day-to-day response to emergencies as well as response to mass casualty incidents or disasters. The first significant writing on this complex issue, Emergency Response to Crisis, by Jeffrey T. Mitchell, PhD and H. L. P. Resnik, MD, provided a crisis intervention guidebook for emergency service personnel and early insight on crisis-worker stress and burnout. The most recent comprehensive discussion of this important area of concern can be found in Emergency Services Stress, by Mitchell and Grady Bray, PhD.
A New Model for Evaluating the Impact of Major System Changes on Emergency Air Medical Scene Responses in a Regional EMS System
Authors: Spaite Daniel W. , Brophy Toni , Valenzuela Terence D. , Meislin Harvey W. , Criss Elizabeth A. , Hinsberg Paul
Published: July 2016

Hypothesis:

Centralized dispatch data can provide useful information regarding the impact of major air medical system changes in a regional emergency medical services (EMS) system.

Methods:

Prospective evaluation of helicopter dispatch data from a centralized EMS dispatch agency. During the study period, four alterations in the total number of helicopters available to the system occurred (1,2,3,2,3). Statistical analysis consisted of Chi-Square with Yates' correction and comparison of sample proportions with p<.05 considered significant.

Results:

A total of 667 helicopter dispatches occurred during the 20-month study period from April 1989 through November 1990.

Conclusion:

Changes in dispatch patterns could result either from increased availability or alterations in the dispatchers' “threshold” for use based upon a perceived lessening of the need to save a “scarce” resource. Had the second possibility played a significant role, the rate of cancellation by ground personnel after arrival at the scene would be expected to have increased. Since this did not occur, it is likely that the increased use actually was a result of increased availability. In systems that dispatch helicopters prior to arrival of ground personnel, this method of evaluation may provide a useful model for analyzing the impact of major system alterations.
The Extracorporeal Joining of Donor (Pig) Spleen (EJDS) for the Treatment of Patients with the Complications of Shockogenic Trauma
Authors: Grinev Michael V. , Tarelkina M. N. , Frolov G. M. , Tsibin Yu. N.
Published: July 2016

Introduction:

A principal cause of death following presumed recovery from an episode of shock is the development of shockogenic trauma [post-resuscitation syndrome]. The causes of this complication remain unclear and its various treatments continue to be controversial.

Hypothesis:

The use of perfusion of the blood of patients suffering shockogenic trauma through a donor pig spleen mill decrease the mortality from the complications of this process.

Methods:

Freshly harvested pig spleens were adjoined to the venous circulation of patients suffering severe shockogenic trauma and the patient's blood perfused through them for periods of 30-60 minutes. The mortality rates of similar patients treated in this manner were compared with those not treated. Blood analyses included measures of the functions of the renal, immune, and coagulation systems.

Results:

The experience with 212 Extracorporeal Joinings of Donor (pig) Spleens (EJDS) by means of a veno-venous shunt for the treatment of 86 patients with severe shock trauma and its complications is reported. The clinical effects consisted of decreasing signs of intoxication, namely reduction in fever and in the severity of associated encephalopathy. Extracoporeal joinings on donor (pig) spleens (EJDS) was followed by a decline in the concentration of “middle molecules,” fibrinogen levels, leucocyte intoxication index, and the number of circulating immune complexes at different times following complexion of the procedure. The number of blood cells remained constant. On the following day, there occurred an increase in the number of thrombocytes. In addition, there was a decline in the quantity of circulating particles in the plasma. The level of plasma creatinine remained constant.

Conclusions:

Extracoporeal circulation through donor (pig) spleens (EJDS) has an important influence on that part of the immune system that performs the functions of phagocytosis, and also increases the levels of chemokinetic and chemotaxc reactions.
A Prospective Evaluation of the Impact of Initial Glasgow Coma Score on Prehospital Treatment and Transport of Seizure Patients
Authors: Spaite Daniel W. , Valenzuela Terence D. , Meislin Harvey W. , Criss Elizabeth A. , Ross John
Published: July 2016

Hypothesis:

The initial Glasgow Coma Score (GCS) obtained by prehospital personnel on seizure victims is associated with the likelihood of treatment and transport.

Methods:

Prehospital data were collected prospectively for all patients presenting with seizures to a mid-sized emergency medical services system during a five-month period. A total of 419 cases occurred (62.8% male, 37.2% female). Seizure frequency was highest in infants under the age of three years and in adults in their late 20s. A GCS was recorded in 378 cases (90.2%, study group). The GCS was >10 in 304 patients (80.4%) and ≤10 in 74 (19.6%). Patients with GCS≤10 were more likely to receive: oxygen (50.0% vs. 20.1%, p<.0001); IV (35.1% vs. 8.9%, p<.0001); intravenous (IV) medications (16.2% vs. 1.0%, p<.0001); and transport (97.3% vs. 76.3%, p<.0001).

Conclusion:

Seizure patients with a GCS of ≤10 were more likely to receive a variety of prehospital treatments and to be transported than were patients with GCS >10. However, the clinical indicators that were used to make the decision that it was “safe” not to transport nearly one-third of the patients are unclear. Essentially no data exist regarding the parameters impacting treatment and transport of seizure patients. Future investigations with outcome data, are needed to determine whether low risk criteria can be developed to identify those patients (if any) that do not require treatment or transport. A GCS may provide an objective, reproducible parameter upon which to begin formulating such criteria.
Integrated Information Management System
Authors: Wiederhold Richard
Published: July 2016

This article presents the concepts of a computerized information system and its potential applications to Emergency Medical Services (EMS). It is an informational article intended to provide administrators clear concepts of how computers may be best used to provide information in integrated networked systems for EMS needs. It addresses the function of a system, processes of computerizing a department, planning, and provides an overview of computer hardware.
Implementation of a Regional Medical Control Audit System
Authors: McCarthy Paul
Published: July 2016

The growth and development of emergency medical services (EMS) has been both impressive and extensive since the late 1960s. Since that time, there has been much discussion and debate regarding the level and quality of care that patients receive from the EMS system. In the United States, this has resulted in a wide variety of emergency medical technician (EMT) certification levels that determine which personnel administer an extensive range of medications, procedures, and medical protocols. Because of these differences, the care a patient receives varies not only from state to state but from community to community. Even though there are many different EMS system configurations, EMS professionals generally believe die level of care they provide in their local community is effective. It is unfortunate that very often, opinions about EMS system effectiveness are not based on studies of EMS system performance or patient outcome data, but upon subjective assessments of ongoing activities by those individuals providing the services.
International Children's Center for Disaster Medicine: A Proposal
Authors:   World Association of Emergency and Disaster Medicine: Task Force on Pediatric Disaster Medicine
Published: July 2016

The International Children's Center for Disaster Medicine is conceived as a non-governmental, non-profit institution. Its goal is to provide medical help to children during environmental and military disasters and their resulting circumstances, vnthout regard for their nationality, religion, or the political views of their parents.

The idea for an international children's center for disaster medicine grew out of the experiences of pediatricians active in disaster medicine, who were able to see at first-hand, the potential for assistance in such situations, but who also saw either overlapping services provided by well-intentioned organizations, or severe deficiencies in services because of a lack of communication and coordination between these organizations. Among the goals of this international children's center will be to provide volunteer medical help to children by the best specialists in pediatric care, including surgeons, pediatricians, traumatologists, orthopedists, neurosurgeons, intensive care and critical care specialists, experts in rehabilitation, and psychologists. A special training program will create a system of regional and inter-regional specialists, who can offer qualified help to children in catastrophic situations. This educational program will stress the preparation of local medical assets and simultaneously provide international support. The center will conduct scientific research devoted to the specific problems of assistance to children during catastrophic circumstances. A special surgical hospital will be built to care for children after catastrophes. Branches of this international center will be created to serve large regions of the world, allowing a reduction in mortality and morbidity of children, and leading to an improvement in the results of medical care.
The Effects of Intravenous Glucose Boluses on Serum Potassium Levels
Authors: Trueba Dan , Wolford Robert W.
Published: July 2016

Purpose:

To determine if intravenous (IV) glucose boluses cause significant alterations of serum potassium ([K+]) levels.

Methods:

A prospective, descriptive study of patients ≥18 years of age presenting with altered levels of consciousness (ALOC) to paramedics in the prehospital setting or to the emergency department (ED) of a community teaching hospital and who received 50% Dextrose (D50) intravenously (IV). At presentation, a blood sample (PRE) was obtained prior to D50 therapy. For patients treated by paramedics, a second blood sample (POST) was obtained upon arrival at the ED. For patients who initially were seen in the ED, the POST sample was obtained one hour after D50 therapy. Both samples were analyzed to determine [K+] and glucose levels.

Results:

Over a seven-month period, 40 patients met study criteria. The average age was 46±20 years. Sixty percent of patients (24/40) had PRE blood sugars (BS) <80 mg/dl (mean PRE BS = 37±12 mg/dl; mean POST BS = 140±45 mg/dl) and 40% (16/40) had a PRE BS >80 mg/dl, (mean PRE BS = 241±255 mg/dl; mean POST BS = 274±237 mg/dl). The mean PRE [K+] was 4.1±0.8 mEq/L and the mean POST [K+] was 4.2±0.7 mEq/L. Forty-two percent of patients (17/40) had a <5% change in [K+], 33% (13/40) had a >5% increase in [K+], and 25% (10/40) had a >5% decrease in [K+]. Ten percent of patients (4/40) had a >20% increase in [K+], and 3% (1/40) had a ≥20% decrease in [K+]. No patient was treated for symptoms of either hyperkalemia or hypokalemia.

Conclusion:

Boluses of IV glucose produce unpredictable changes in [K+]. The majority of these changes probably are insignificant clinically.
Demographics of Prehospital Helicopter EMS Responses in Rural Florida
Authors: Savitsky Eric , Rodenberg Howard
Published: July 2016

Introduction:

Helicopter emergency medical service (HEMS) systems typically are described in terms of their role in the care and transport of trauma victims, while their function(s) in the care of patients with medical illness goes unrecognized.

Methods:

Review of 575 prehospital HEMS missions by a flight program located in rural, north-central Florida over a five-year period, was performed to define demographics regarding the nature of the call.

Results:

Scene responses for trauma victims comprised 63% of these missions, while patients with medical illnesses comprised 37%. The incidence of medical scene responses is significantly higher in this review than has been noted in previous reports.

Conclusion:

1) In rural settings, patients with medical illnesses comprise a major share of prehospital HEMS responses; 2) HEMS flight crews should be competent in treatment of prehospital medical patients, and their protocols reflect the needs of these patients; and 3) EMS providers must be aware of the role of HEMS in the transport of the medical patient.
Financial Triage: Strain, Stress, and Adaptation Within Today's Medical System
Authors: Palmer C. Eddie , Gonsoulin Sheryl M. , Bias Ray , Eaves Wanda
Published: July 2016

Introduction:

This paper explores the interactional nexus surrounding the delivery of non-paying and/or uninsured patients by paramedics to hospital emergency departments (EDs).

Methods:

Interviews, direct observation, and participant observation were used as data-gathering techniques.

Results:

Twenty-four of 25 paramedics and 17 of 25 nurses in the sample responded affirmatively to a question which asked, “Does trouble ever arise regarding the ‘kind’ of patients …” brought to the emergency department. The majority of the respondents who said that trouble was produced by the kind of patient brought to the emergency department specifically mentioned that the poor financial or non-insured status of the patient produced trouble between paramedics and ED personnel.

Conclusion:

These circumstances present problematic situations in the United States especially within the context of recent COBRA and OBRA legislation.
The Non-Use of 9-1-1: Private Transport of Trauma Patients to a Trauma Center
Authors: Hammond Jeffrey , Gomez Gerardo A. , Fine Ellen , Eckes Jeanne , Castro Monica
Published: July 2016

Hypothesis:

Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use.

Methods:

Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry.

Results:

In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult.

Conclusion:

Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for nonemergencies, the causes of underutilization should not be ignored.
Trauma System Development and Future Directions
Authors: Braslow Judith B. , Snyder Joan A.
Published: July 2016

Traumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems.
Complication Rates for the Esophageal Obturator Airway and Endotracheal Tube in the Prehospital Setting
Authors: Hankins Daniel G. , Carruthers Nancy , Frascone R. J. , Long Linda Ann , Campion Brian C.
Published: July 2016

Purpose:

The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) a the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGT during the treatment of patients with prehospital cardiac arrest.

Methods:

A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments.

Results:

The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gas lube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopha ryngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively).

Conclusions:

The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use. Serious questions also arise concerning the complication rates associated with the use of the ET: is the complication rate of 2.5% acceptable or should other airway alternative be considered for use in prehospital care?