bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Intravenous Tramadol for Use in the Prehospital Situation by Ambulance Paramedics
Authors: Ward Michael E. , Radburn John , Morant Steve
Published: July 2016

Introduction:

An evaluation of the opioid analgesic tramadol (Zydol, Searle United Kingdom) was carried-out by ambulance paramedics to assess its efficacy in providing pain relief in the prehospital situation.

Methods:

Type of subjects—Patients suffering severe pain from any cause uncontrolled by other simple methods.

Number of subjects—101 patients received tramadol and 41 patients served as a control. Study design—Random, open study.

Statistical tests—Pain score at scene and on arrival at hospital were compared using Fisher's exact tests (2 sides). Logistic regression analyses also were applied to other factors.

Results:

Pain scores improved for 93.1% of the tramadol treated patients and for 44.0% of the controls. A total of 30.7% of patients treated with tramadol complained of nausea after treatment compared with 17.1% before treatment and with 12.2% of the control patients.

Conclusion:

Pain was significantly decreased by the administration of tramadol. It was safe with only minimal side effects, the major one being nausea. Suggestions are made for areas of further study.
The Utilization of Bicycles in the Delivery of Emergency Medical Services: A Preliminary Report
Authors: Gorham John F. , Kramer Todd S.
Published: July 2016

Introduction:

Bicycles may be useful in the delivery of out-of-hospital emergency medical services. The use of bicycles in providing emergency medical services was investigated by surveying currently existing bicycle-medic systems.

Methods:

Two questionnaires were developed to gain information on service areas, injuries, gear used, missions, and specific data from bicycle-medic response.

Results:

Of 210 surveys mailed to bicyclemedics, 21 (10%) were completed and returned by the pre-established deadline. Of 11 surveys mailed to bicycle-medic supervisors, four (36%) were returned. Preliminary results showed that 76% of respondents are career providers and the remainder serve as volunteers. Mean age for respondents was 33±7.4 years, with 96% being males. Most teams have been in existence for three to four years. Job satisfaction was greater when participating on the bicycle crews than when not performing on the bicycle crew, t = 4.15, p = 0.0002. The teams varied in size (6–100 persons) with a mean value of 31. On the average, team size represented 10% of total number of personnel for the respective organizations.

The majority of bicycle teams operate all year in all conditions. Most bicycle-medic teams were initiated for special events. Nineteen percent reported injuries while on duty or in training. Ninety percent of units that responded use existing agency protocols and have no special protocols related to the bicycle team. Eighty percent of the units are dispatched through the normal agency procedures. Eighty-five percent of respondents coordinate for transport units via dispatch. Reported response times were under two minutes for special event responses. These were within established agency response times. In approximately 25% of the responses, the patients refused transport, and another 65% of the responses were for relatively minor injuries or complaints that did not require transport to a hospital.

Conclusion:

This survey begins to characterize the utilization of bicycles as a tool to gain patient access in specialized situations. The use of bicycle-medics may be cost-effective, may help to improve employee morale, and possibly reduce employee health-care costs. Further study is needed to determine the impact of bicycle-medics on patient outcomes and response times.
Development and Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia: A Retrospective Study
Authors: Thompson Randy H. , Wolford Robert W.
Published: July 2016

Introduction:

A retrospective study of patients transported by paramedics to a community teaching hospital was conducted to: 1) determine the response of hypoglycemic patients to prehospital treatments, 2) develop criteria to identify patients who safely could be released without transport to a hospital, and 3) evaluate the prehospital release criteria.

Methods:

Patients presenting to EMT-paramedics with an altered level of consciousness were identified retrospectively. Pre- and post-treatment blood glucose levels were measured and response to treatment noted (Phase 1). Criteria were established using these data and a second sample was evaluated using these criteria (Phase 2).

Results:

During a 12-month period, 60 patients with an altered level of consciousness (ALOC) were encountered. Of the 60 patients, 27 (45%) were documented to be hypoglycemic (blood glucose [BG] <80 mg/dl, mean 27±13 mg/dl). Of the 27 hypoglycemic patients, 24 (89%) were discharged from the emergency department (ED) and three patients (11%) were admitted. Criteria were developed to identify patients who could be treated and released safely without transport to a hospital: 1) history of insulin (IDDM) or non-insulin (NIDDM) dependent diabetes mellitus; 2) pre-treatment BG <80 mg/dl; 3) post-treatment BG >80 mg/dl; 4) return to normal mental status within 10 minutes of treatment; and 5) absence of complicating factors (renal dialysis, chest pain, arrhythmia, dyspnea, seizures, alcohol intoxication, focal neurological signs/symptoms). The criteria were applied retrospectively to 27 hypoglycemic (mean BG=28±14 mg/dl) patients during a different 10-month period. Of the 27 hypoglycemic patients, 23 (85%) were discharged from the ED, and prehospital release criteria correctly identified 19 of 23 (83%). The prehospital release criteria did not select for release any patient who required an additional, major intervention or who was admitted.

Conclusion:

This study demonstrates that there is a group of hypoglycemic patients who respond favorably to paramedic interventions. Retrospectively, the prehospital release criteria were successful in selecting patients who did not require additional interventions. A larger prospective study must be conducted before prehospital treatment and release can be recommended for general practice.
Non-Traumatic Prehospital Sudden Death in Young Patients: An Urban EMS Experience
Authors: Weiss Larry D. , Janasiewicz Stanley , Perper Joshua A. , Verdile Vincent P. , Yealy Donald M. , Menegazzi James J.
Published: July 2016

Non-traumatic, sudden death in young patients has been described in several studies, but most of these studies have involved highly selected populations. This study examined consecutive cases of non-traumatic, prehospital, sudden death in young patients (age 2–35 years) in a six-year period in an urban EMS system. One-hundred-seven cases were identified; however, seven cases were excluded because of occult trauma or lack of documentation. Of the 100 cases studied, drug and/or toxin exposure was the most common etiology (32%), followed by cardiac (22%) and pulmonary (20%). This is the first study which describes all cases of non-traumatic, prehospital, sudden death in young patients presenting to an EMS system. Implications of these data for EMS personnel are discussed.
A Paramedic Peer-Review Quality Assurance Audit
Authors: Swor Robert A. , Bocka Joseph J. , Maio Ronald F.
Published: July 2016

Introduction:

A daily EMS audit was performed to assess whether a paramedic peer review audit would improve the quality of documentation and radio communications in cases transported to a single receiving facility.

Methods:

Prehospital EMS run sheets and run tapes were reviewed for adherence to standards developed for the county EMS system. Items evaluated were run sheet documentation of care and paramedic radio presentation. Checklists were used and multiple parameters evaluated for each case. Two periods, 1987–88 and 1989 were compared to evaluate the effectiveness of this system. Care rendered by a total of 106 paramedics was evaluated. Confidence intervals of 0.95 were calculated on the differences between groups. Practicing paramedics audited 63% of the days in 1987–88 and 80% in 1989. Data from each case were tabulated and a profile, average deficiencies per run calculated for each paramedic.

Results:

A total of 4175 run sheets and tapes were audited for the period 1987–88 with an average of deficiencies/run of 0.27, and for 1989 a total of 1872 run sheets and tapes were reviewed with a deficiency/run rate of 0.21, indicating a statistically significant improvement (0.95 CI= 0.02, 0.08). Twelve paramedics were not auditors in 1987–88, but audited in 1989. Their deficiencies/run decreased from 0.13 to 0.08

Conclusion:

A peer review audit in this system appears to be effective in improving documentation and radio performance. Performance also improved when paramedics served as auditors.
Evaluation of a New Device for Simultaneous Compressions and Ventilations
Authors: Thomson David P. , Yealy Donald M. , Heller Michael B. , Stoy Walt A.
Published: July 2016

The resuscitator bag has been considered the standard for prehospital, ventilatory managment. Recently, the Berg Resuscitation Apparatus (BRA) was developed as an alternative. Two devices were compared for their ability to deliver adequate tidal volumes and efficacy during simulated, single-rescuer CPR In the first phase, emergency care providers ventilated a test lung using a resuscitator bag, BRA, and demand valve. No significant differences between methods were found. During the second phase of the study, subjects performed single-rescuer CPR on a resuscitation mannikin for two minutes, using the bag-valve-mask and the BRA with a mask. The BRA delivered a volume of 0.81±0.26 liters compared to 0.35±0.19 liters using the resuscitator bag. The BRA allows ventilation to be performed as does the traditional equipment. When used in single rescuer CPR, it appears to provide a substantial increase in the tidal volumes delivered.
Infant Ventilation and Oxygenation by Basic Life Support Providers: Comparison of Methods
Authors: Terndrup Thomas E. , Warner Daniel A.
Published: July 2016

Introduction:

Little information is available in the performance of infant ventilation by basic life support (BLS) personnel.

Hypothesis:

There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers.

Methods:

Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO2) were recorded. The percent of breaths with excessive PAP (i.e., >30 mmHg), percent of acceptable breaths using loose (i.e., 25−125ml) and strict (i.e., 50−100ml) criteria, and FiO2at at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA.

Results:

For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths between the respective ventilation methods using loose or strict criteria. The proportion of excessive breaths produced by PBM (56±6) (mean±SEM; all subjects) and ABM (41±6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO2delivered with each ventilation method was significantly better in the patent airway group.

Conclusion:

For BLS providers, M-Ma ventilation with supplemental O2provided the best method of initial infant ventilation based upon the percent of acceptable breaths, oxygen delivery, and fewest excessive pressure breaths.
Prehospital Thrombolysis in Acute Myocardial Infarction
Authors: Varshavsky Sergey Yu
Published: July 2016

Introduction:

The effectiveness and safety of thrombolytic treatment (TT) for acute myocardial infarction (AMI) in the prehospital setting have not been defined. Therefore, its use on a mobile coronary care unit (MCCU) was studied.

Methods:

A MCCU was provided with the equipment and supplies necessary for the administration TT and its personnel were trained in the indications for TT and in its administration. When an emergency medical team physician suspected the diagnosis from the presence of chest pain typical of an AMI, the patient's ECG was transmitted to the Cardiological Consulting Center. If the S-T segments were elevated and the patient met all of the screening criteria, the cardiologist ordered the MCCU personnel to carry out TT. Streptokinase (Avelyzin, Germed, GDR) was administered intravenously at a dose of 500,000 UE.

Results:

Sixty-seven patients with AMI were included in the trial. The mean interval between the onset of the symptoms and the beginning of the TT was 156±77 minutes; it was less than 3 hours for 54 patients. Thirty-four patients (50.7%) had non-invasive markers of successful reperfusion, while 33 (49.3%) did not. Three patients had non-fatal ventricular fibrillation (VF), ventricular tachycardia (VT) and/or ventricular premature beats of high grades (Lown classes 3–5) developed in six and 22 patients respectively. Five patients had conduction disturbances, and 40 had symptomatic hypotension. None of the patients died before arrival at the hospital. Four suffered reinfarction, and one died of VF during the in-hospital phase of care. Post-discharge follow-up (17.5±5.0 months) demonstrated a positive exercise test in 23 (43%), and a left ventricular ejection fraction >80% in 29 (85.2%) and <40% in five (14.8%) of the patients. The in-hospital and post-discharge mortalities were 1.5 and 4.8% respectively. There was not a single case of bleeding sufficient to require a transfusion.

Conclusions:

The study indicates that the administration of TT for AMI in the prehospital setting is both safe and effective.
Teaching Endotracheal Intubation Using Animals and Cadavers
Authors: Trooskin Stanley Z. , Rabinowitz Sidney , Eldridge Christopher , McGowan Dennis E. , Flancbaum Louis
Published: July 2016

Introduction:

The effectiveness of using supplemental teaching sessions with animals and cadavers on the acquisition of technical skills of endotracheal intubation was studied.

Methods:

Paramedic students were evaluated for early endotracheal skill acquisition in the operating room and by questionnaire.

Results:

Supplemental practice skills using either sheep or cadavers did not produce a statistically significant improvement in the percentage of successful clinical operating room intubations as compared to a group trained solely using intubation mannequins. More paramedics, certified and in practice, reported a statistically significant psychological benefit to supplemental cadaver training compared to supplemental animal (p<.05) and mannequin (p<.05) training.

Conclusion:

Adjunctive teaching sessions using animals or cadavers do not improve the acquisition of initial technical success in clinical intubation over the use of the mannequin alone.
Compliance with Closest Hospital Transport Protocol
Authors: Norton Robert L. , Bartkus Edward A. , Neely Keith W. , Schriver John A. , Hedges Jerris R.
Published: July 2016

Hypothesis:

Paramedics accurately estimate the closest trauma hospital for ground transport.

Population:

Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded.

Methods:

A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “closest” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 = 0.924). Chisquare analysis was used to analyze hospital bypasses to specific hospitals.

Results:

Of the 1193 eligible patients entered into the trauma system, 160 (13%; 95% CI = 11–15%) transports bypassed the closest available hospital for a receiving hospital ≥1 mile more distant. There were 11 (1%; 0–2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS) <12, 15 (11%; 6–18%) were taken to a hospital one mile or further beyond the closest hospital. None (0%; 0–2%) were transported more than five miles past the closest hospital. Of the six hospitals, three were bypassed more than one mile significantly more often then they received bypass patients. One hospital received such patients four times more than it was bypassed (p <.001).

Conclusion:

While paramedics generally can identify the closest hospital for trauma patient transport, some systematic hospital bypass errors occur. If a community wants assurance of an equitable patient distribution among participating trauma hospitals and assignment of the closest geographic hospital for injured patients, then map vector distance determination to identify the closest available hospital should supplement paramedic dispatching.
Standing Orders for Field Intravenous Lines Do Not Shorten Prehospital Time in Trauma Patients
Authors: Tortella Bartholomew J. , Lavery Robert F. , Cody Ronald P. , Salant Mindi
Published: July 2016

Study Objective:

No randomized, prospective studies have been conducted that examine how standing orders for establishing intravenous (IV) lines in trauma patients affect prehospital time. The purpose of this randomized, prospective study was to determine if standing orders for IV lines in the field shorten prehospital time.

Design:

A prospective, randomized study was conducted.

Setting:

Trauma patients (n = 521) were randomized prospectively on an even-/odd-day basis over a one-year period from 1 April 1988 to 1 April 1989. Patients were sorted into an IV Standing Orders (SO) arm (n = 258) and a No Standing Orders (NO) arm (n = 263) in which On-Line [Direct] Medical Command (OLMC) was required before IV initiation.

Participants:

Trauma patients, paramedics in a high-volume, urban, EMS system, and medical-command physicians on the trauma team at a Level 1 trauma center.

Results:

No significant differences were found in demographics, prehospital vital signs, mechanism of injury, or trauma severity scores between the two treatment arms. Scene times were similar for the two groups (IV SO = 11.4 minutes, and NO = 10.6 minutes, p = .1675) as was IV success rate (92% vs. 88%, p = .1729).

Conclusion:

When compared to OLMC in this EMS system, IV standing orders did not affect scene time. This supports the concept that only spinal stabilization and airway management be performed at the scene and other ALS maneuvers (e.g., IVs) be performed in the ambulance, preferably en route to a Trauma Center. Since IV standing orders had no documented, adverse effects and led to focused, concise radio telemetry reports, this EMS system adopted their use on a permanent basis.
Lessons from the Israel Defense Forces Medical Corps' Experience in the Organization of International Medical Disaster Relief Forces
Authors: Shemer Joshua , Heller Ori , Adler Jakov
Published: July 2016

Natural and man-made disasters continue to be a major cause of morbidity and mortality. Natural disasters include earthquakes, storms such as hurricanes, floods, fires, drought. Man-made disasters include fires, explosions, chemical and radioactive releases, major transportation accidents, terrorism, and war. The effects of disaster include injury, death, damage to infrastructure, environmental exposure, population movement, and increased incidence of communicable diseases.
The Prehospital Use of Nitroglycerin According to Standing Medical Orders in an Urban EMS System
Authors: Herman Linda L. , Koenigsberg Max , Ward Sharon , Sloan Edward P.
Published: July 2016

Purpose:

The purposes of this study are to quantify the use of nitroglycerin (NTG) in prehospital care, to detect deviations from the Standing Medical Orders (SMO), to determin the effectiveness of its administration, and the incidence of clinically significant adverse reactions (hypotension, bradycardia).

Method:

Retrospective review of 7683 Advanced Life Support (ALS) telemetry, base-station contacts over a three month period (June, July, Auguest 1990) to identify all prehospital patient contacts in which NTG was utilized.

Setting:

The Resource Hospital/Telemetry Base-Station a two community hospitals/Telemetry Base-Stations for the Chicago North EMS System.

Results:

There were 445 runs in which NTG was indicated as per SMO. Two hundred eighty-eight patients (64.7%) received NTG for appropriate indications as per SMO, 203 for ischemic chest pain (45.6%), 79 for pulmonary edema (17.7%), and six for both (1.3%). There were 157 (35.5%) runs in which NTG was indicated, but not administered. There were 22 patients who received NTG for indications that deviated from the SMO. Reassessment data concerning the subjective symptom was completed on 118 patients (40.9%), 92 (45.3%) patients with chest pain and 26 with dyspnea (32.9%). Following the administration of NTG, 21 patients (10.1%) with chest pain were unchanged, while 13 with dyspnea (15.3%) improved, 13 patients (15.3%) were unchanged, and none worsened. In 121 patients, the systolic blood pressure (SBP) decreased, while 24 were unchanged (5.4%), and 28 had an increase (6.3%). The mean initial value SBP was 176±44 mmHg and the repeat mean SBP was 164±41 mmHg with a mean decrease of 12±22 mmHg. The diastolic blood pressure (DBP) decreased in 87 patients, was unchanged in 53 (11.9%), and increased in 33 (7.4%). The initial mean DBP was 97±24 mmHg, the repeat mean DBP was 92±23 mmHg, a mean decrease of 5±15 mmHg. Only one patient became hypotensive with the administration of NTG and was successfully resusticated with a fluid bolus of 300 ml normal saline.

Conclusions:

In this EMS system, NTG is under-utilized based on the indications delineated by this system's SMOs. Reassessment is documented infrequently, but when completed, clinically significant adverse reactions are rare. Since the incidence of hypotension and bradycardia are rare, the inability to establish an IV line should not preclude the administration of NTG.
Reporting of Child Abuse by Prehospital Personnel
Authors: King Brent R. , Baker M. Douglas , Ludwig Stephen
Published: July 2016

Introduction:

Prehospital (EMS) personnel routinely enter patient's homes and often are the first trained persons to evaluate an ill or injured child. Therefore, it is vital for these individuals to recognize child abuse (CA), and to understand the proper procedures for reporting suspected cases.

Methods:

A questionnaire was administered to prehospital care-givers participating in a seminar on pediatric emergencies. Questions were designed to test factual knowledge of CA and the correct reporting procedures, as well as to evaluate attitudes toward CA.

Results:

There were 48 responses to the questionnaire; 34 (71%) were paramedics, the remainder were emergency medical technicians (EMTs) and/or registered nurses (RNs). Thirty-three (69%) practiced either in a rural or suburban setting. Subjects had an average of 10.8 years of prehospital emergency-care experience. Twenty-eight (58%) reported no previous training in CA. All participants understood the nature of CA, were able to identify the various forms of CA, and believed CA to be a significant problem. However, 33 (69%) did not understand the legislation that mandates reporter status, and while 27 (56%) claimed to have reported CA, only 16 (33%) had made a report either to police or to children's services workers. Of the 21 who never had reported a case of CA, 14 (67%) believed that they never had encountered an abused child. The remainder were not certain, and therefore, did not report, or thought that the hospital staff would report.

Conclusions:

While this subject deserves further study, it seems that many EMTs and paramedics lack a complete understanding of their role in the identification and reporting of CA. This information should be emphasized further in EMT and paramedic education, and should be reinforced through continuing education.
Devices for Expired Air Resuscitation
Authors: Rossi Rolando , Lindner Karl Heinz , Ahnefeld Friedrich Wilhelm
Published: July 2016

Objectives:

Expired air resuscitation is an essential part of first-aid and cannot be replaced by other measures. Because of the risk of transmitting infectious diseases, the use of devices is recommended. Three types are available—masks, tubes, and foils.

Participants:

Six masks (Air-Vita Bi-Protect, Laerdal Pocket-mask, Dräger Hivita Mask E, Rescue-Med De-vice, Resuscitator, SealEasy Resuscitation Kit), five tube instruments (Dr. Brook Airway, Dual-Aid, Goettinger Tubus, Lifeway, Sussex Valve Airway), and two foils (Ambu Life-Key, Laerdal ResusdFace Shield) were studied.

Measurements:

Inspiratory and expiratory resistance, valve leakage, ability to protect against infection transmission, and practicability (e.g., possibility of training on standard mannequins, seal) were measured and tested in the laboratory.

Results:

Only a few of the mask and tube devices had low inspiratory and expiratory resistances. Some of the one-way valves failed. There were definite risks of provoking complications (vomiting, lacerations) when using tube instruments.

Conclusions:

Devices consisting of a foil have definite advantages, and seem to be more appropriate for the use by first-aiders [first responders].
The Utilization of Quality Assurance Methods in Emergency Medical Services
Authors: Davis Eric A. , Billitier Anthony J.
Published: July 2016

Objective:

The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.

Methods:

A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.

Results:

Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.

Conclusion:

This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.
Prehospital Care of Agricultural Injuries
Authors: Stueland Dean , McCarty John , Stamas Peter
Published: July 2016

In the United States, farming has become one of the most dangerous occupations. There are unique challenges for the providers of prehospital care to victims of agricultural trauma. The machinery and the work environment associated with agricultural trauma are different from those encountered in other occupations. The unique features of the machinery and risks are discussed. In addition, solutions unique to the problems of agricultural prehospital care are discussed. Effective care of the victims of agricultural trauma has a potential to reduce morbidity.
Pediatric Casualties during the Civil Conflict in the Republic of Georgia 22 November–5 December 1991
Authors: Metreveli Irakli T. , Vosk Arno
Published: July 2016

The Civil War in Georgia

On 9 April 1991, the Republic of Georgia proclaimed its independence from the Soviet Union. Sviat Gamsakhurdia, an anti-communist leader of the Georgian Nationalist movement, was elected President by an overwhelming majority. Soon after the election, however, Gamsakhurdia's popularity began to plummet. He was accused of suppressing any opposition, and he and his supporters accused the opposition of being in league with Moscow and seeking to sabotage Georgian independence. Demonstrators in Tbilisi, the capital city, demanded the resignation of the new government, and the government relied increasingly upon armed forces to maintain power.
Criteria for Prehospital Air Medical Transport: Non-trauma and Pediatric Considerations
Authors:   Air Medical Services Committee of the National Association of EMS Physicians
Published: July 2016

The proliferation of air medical transport in the 1980s and 1990s has been accompanied by minimal investigation into the appropriateness of transport. A strong foundation has been developed regarding adult trauma. However, important issues in pediatric and general medical patients have not been addressed. The health care crisis in America mandates air medical transport systems to provide appropriate access to medical technology and resources in a cost-effective manner while maintaining quality of care. We must identify the patients whose outcomes will benefit from air medical transport.
Epidemic of Surgical Wound Infections in Wartime Sarajevo
Authors: Ler Zeljko , Vujovic Branko , Jazic Sead
Published: July 2016

Background:

An epidemic of surgical wound infections observed at the State Hospital of Sarajevo during June-September 1992 is reported.

Methods:

A cross-sectional survey of 138 surgical patients with wound infection treated by the Department of Surgery of the State Hospital of Sarajevo was performed in mid-September and again in mid-November 1992. A preliminary evaluation of the bactericidal effectiveness of a new antiseptic preparation called DI-ASEPT also was done.

Results:

The frequency of wound infection was 24.4% in September and 19.2% in November. Pseudomonas species was the primary etiologic agent in this epidemic. DI-ASEPT was as effective as povidone-iodine in producing wound asepsis.

Conclusions:

Because of limited resources large numbers of casualties, and an extremely adverse environment as a result of war that has affected hygienic conditions at the State Hospital of Sarajevo, a high frequency of contaminated or dirty operations were performed. This was the primary reason for the observed increase in wound infections. After hygienic conditions were restored, the epidemic of wound infections was terminated.
Hospital Preparedness for Chemical Accidents: The Effect of Environmental Legislation on Health Care Services
Authors: Landesman Linda Y. , Markowitz Steven B. , Rosenberg Stephen N.
Published: July 2016

Background:

Chemical accidents occur often across the United States, endangering the health and safety of many people. The Super fund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents.

Methods:

A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Timel), and in 1989 after its implementation (Time2).

Results:

Ninety-four percent of the directors responded at Timel and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk.

Conclusion:

Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.
Critical Thinking: Incorporation into the Paramedic Curriculum
Authors: Janing Judy
Published: July 2016

The purpose of this paper is to present approaches to foster critical thinking skills within the context of the current paramedic curriculum. It reviews some of the definitions and concepts of critical thinking from selected adult education and nursing literature in an attempt to formulate a workable definition as it applies to paramedics. From that definition, elements are identified and incorporated to form a teaching model for use in presenting the curriculum content. Some sample teaching strategies based on revised objectives of the airway/ventilation section also are included.
Complex, Humanitarian Emergencies: II. Medical Liaison and Training
Authors: Burkle Frederick M.
Published: July 2016

In complex, humanitarian emergencies, professional liaison roles are just one of many that evolve from the coordination of United Nations agencies, the International Committee of the Red Cross, international and national non-governmental relief organizations, and coalition military forces. Liaison is crucial to the humanitarian relief process. Decision makers benefit from liaisons' professional experience, their knowledge of the characteristics, missions, and capabilities of each major participant in the relief process, and in their ability to coordinate and clarify professional issues in meeting the goals of a mission. Medical liaison roles develop from the awareness that complex emergencies primarily are catastrophic public-health emergencies. Unfortunately, education and training of the medical liaison currently are ill-defined. However, limited experience suggests that skills should be broadly based in principles of disaster epidemiology, assessment and management, knowledge of contributing relief resources, agencies and the military, and international humanitarian law and the Geneva Conventions.
Post-Disaster Malaria in Costa Rica
Authors: Sáenz Rocio , Bissell Richard A. , Paniagua Francisco
Published: July 2016

Introduction:

In recent years, controversy has surrounded the issue of whether infectious disease should be considered a serious potential consequence of natural disasters. This article contributes to this debate with evidence of a significant outbreak of malaria in Costa Rica's Atlantic region after the 1991 earthquake and subsequent floods.

Methods:

This study is an epidemiologic investigation of the incidence of malaria for the periods of 22 months before the April 1991 Limon earthquake and for 13 months afterward. Data were obtained from the Costa Rican Ministry of Health's malaria control program.

Results:

Some of the cantons in the region experienced increases in the incidence of malaria as high as 1,600% and 4,700% above the average monthly rate for the pre-earthquake period (p ≤0.01). Causal mechanisms are postulated as relating to changes in human behavior (increased exposure to mosquitoes while sleeping outside, and a temporary pause in malaria control activities), changes in the habitat that were beneficial to mosquito breeding (landslide deforestation, river damming, and rerouting), and the floods of August 1991.

Conclusions:

It is recommended that there be enhanced awareness of the potential consequences of disaster-wrought environmental changes.

Date of Event: 22 April 1991; Type: Earthquake, 7.4 Richter scale; Location: Costa Rica; Number of deaths and casualties: 54 deaths and 505 moderate to severe injuries.
Incorporating Drugs and Devices into Emergency Medical Services Systems
Authors: Wolfberg Douglas M. , Verdile Vincent P. , Flinn Richard D.
Published: July 2016

The proliferation of new medical technology and pharmacology forces the medical community to ensure the efficacy and safety of new drugs and devices before their use in patient care. Although traditional medical practices have a fairly consistent means to achieve this end, prehospital medical practice often does not. In addition, it often appears that the emergency medical services marketplace does not always follow conventional supply/demand and cost/quality paradigms. This article describes a process implemented in Pennsylvania to standardize the mechanism by which new drugs and devices are introduced into prehospital medical practice.
Factors Influencing Successful Intubation in the Prehospital Setting
Authors: Doran James V. , Tortella Bartholomew J. , Drivet Walter J. , Lavery Robert F.
Published: July 2016

Objective:

To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.

Design, Setting, and Participants:

Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.

Results:

Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).

Conclusions:

Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.
Low-Level Carbon-Monoxide Poisoning: Inability of Neuropsychological Testing to Identify Patients Who Benefit from Hyperbaric Oxygen Therapy
Authors: Rottman Steven J. , Kaser-Boyd Nancy , Cannis Timothy , Alexander John
Published: July 2016

Introduction:

Although major sequelae of carbon-monoxide (CO) poisoning and its treatment with hyperbaric oxygen (HBO) are well-documented, a syndrome of low-level CO poisoning has received relatively little attention. Subtle symptoms of poor concentration, language difficulty, problems with calculations, and memory loss were noted after an acute exposure of 131 dormitory residents to low levels of CO. The CO Neuropsychological Screening Battery (CONSB), a series of tests reported by others as useful to identify victims of CO poisoning, was performed on a subset of 46 victims. It was hypothesized that their test scores would improve after treatment with HBO.

Methods:

Testing was performed both before and after HBO on 35 CO-exposed victims. A control group of 20 students residing on the same college campus, but not involved with the CO incident, also were tested on two separate occasions to assess the ability of the test to identify selectively victims of low-level CO poisoning, as well as to evaluate its validity when administered serially.

Results:

Both CO-exposed and control subjects demonstrated significant performance improvement when completing the testing for the second time. In addition, the baseline test scores were not significantly different for either the CO-exposed or the control groups. Nonetheless, all CO-exposed victims reported immediate subjective improvement of their symptoms after HBO therapy.

Conclusion:

These observations and a review of the literature suggest that there might exist a syndrome of subtle neurological disturbances in victims of low-level CO poisoning. Whether this is permanent or might regress spontaneously over time is unknown. As a diagnostic adjunct, the CONSB does not appear to be as useful in low-level CO poisoning.
Human Health Concerns from Pet Ownership After a Tornado
Authors: Heath Sebastian E. , Champion Max
Published: July 2016

Introduction:

Although 50% to 60% of North American households own pets and many of these pets are considered family members, there is little information on the impact pet ownership on pet-owning families affected by disasters.

Methods:

This case report describes some of the effects of a tornado on 17 families whose dwellings were destroyed. The setting was a typical urban trailer park.

Results:

After a tornado at the Sagamore Village Trailer Park in north central Indiana, 104 families were evacuated. Seventeen (16.3%) of these families owned pets. For 14 families (13.5%), pet ownership had an important impact on the families' recovery from the tornado. Public- and mental-health concerns that arose from pet ownership included failure to evacuate a dangerous site, attempts to re-enter a dangerous site, separation anxiety leading to psychosomatic disturbances, and the need for additional animal care.

Conclusions:

In urban disasters, the behaviors of families with a human-animal bond are likely to pose a significant risk to their own and others' health and safety in urban disasters. In this small study of families affected by a tornado, the most prominent public-health concerns were failure to evacuate because of a pet and attempts of re-entry to save a pet; the most common mental-health concerns resulted from separation anxiety from a pet and refusal to accept medical treatment until a pet's well-being can be assured. These are thought to be typical issues that will arise out of the human-animal bond in urban disaster situations and differ considerably from traditional public-health concerns over dog bites, spread of zoonotic diseases, and human food contamination. Medical disaster preparedness planning should consider the substantial effects that the human-animal bond is likely to have on human recovery from large-scale urban disasters.
Introduction
Authors: Koscheyev Victor S. , Leon Gloria R. , Greaves Ian A.
Published: July 2016

The fall of the Berlin wall was a symbol of the failure of two systems to exist totally independent of each other. It also rendered obsolete the grand scenarios necessitated by the Cold War for dealing with a nuclear bombing attack. We hope and expect that these particular scenarios based on the premise of hostility between the world powers of the East and West never will need to be considered again. However, both sides gained a tremendous amount of experience in how nuclear and other weapons and industries operate, their health and environmental effects, and the extreme danger of these weapons. In the present time of peace among the world powers, it is important to develop disaster response scenarios that will be useful world-wide. We must contribute our collective wisdom and experience through working together as a world community. The recent cooperation between the United States and Russia in joint space program efforts is an example of the progress that can be made through close collaboration between countries that formerly were adversaries.
The 1994 Northridge Earthquake Disaster Response: The Local Emergency Medical Services Agency Experience
Authors: Stratton Samuel J. , Hastings Virginia Price , Isbell Darlene , Celentano John , Ascarrunz Miguel , Gunter Carol S. , Betance Joe
Published: July 2016

Introduction:

This paper describes the 1994 Northridge earthquake experience of the local emergency medical services (EMS) agency. Discussed are means that should improve future local agency disaster responses.

Methods:

Data reported are descriptive and were collected from multiple independent sources, and can be reviewed publicly and confirmed. Validated data collected during the disaster by the Local EMS Agency also are reported.

Results:

The experience of the Los Angeles County EMS Agency was similar to that of earthquake disasters previously reported. Communication systems, water, food, shelter, sanitation means, power sources, and medical supplies were resources needed early in the disaster. Urban Search and Rescue Teams and Disaster Medical Assistance Teams were important elements in the response to the Northridge earthquake. The acute phase of the disaster ended within 48 to 72 hours and public health then became the predominant health-care issue. Locating community food and water supplies near shelters, providing transportation to medical care, and public-health visits to shelter locations helped prevent the development of long-term park encampments. An incident command system for the field, hospitals, and government responders was necessary for an organized response to the disaster.

Conclusion:

Disaster preparedness, multiple forms of reliable communication, rapid mobilization of resources, and knowledge of available state and federal resources are necessary for a disaster response by a local EMS agency.