bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer Records for Rescue Helicopter Service in West Germany
Authors: Osswald P.M. , Hartung H.J. , Bender H.J. , Spier R.
Published: July 2016

Data from many rescue missions can be made more comprehensible by computer processing. Exact and systematic processing of data is needed to evaluate the effectiveness of treatments. We put into practice a computer assisted recording system for the rescue helicopter Christoph 5 in Ludwigshafen-Oggersheim, dealing specifically with medical performance.
Coordination with Ground Emergency Medical Services in Cardiac and Respiratory Emergencies in Flight (abstract)
Authors: Carveth Stephen W. , Montgomery William H.
Published: July 2016

Emergency Medical Services (EMS) have taken great strides toward the development of city and statewide programs. However, once a person embarks on a plane or on a ship for any extended period of time, the EMS are at times meager and at other times not coordinated well with ground EMS. The American Heart Association has developed a protocol for basic and advanced cardiac life support to exist in all major air terminals, and especially within aircraft of all types. Particularly important are those aircrafts carrying large numbers of people for extended periods of time.
Airborne Field Hospital in Disaster Area: Lessons from Armenia (1988) and Rwanda (1994)
Authors: Heyman Samuel N. , Eldad Arie , Wiener Michael
Published: July 2016

The outcome of survivors within disaster areas largely depends upon the quick reallocation and operation of logistic and medical support systems. Enthusiastic media equipped with advanced communication systems, reveal mass human suffering in real time. But, the response period required for the organization of rescue systems is much slower and is most frustrating. In this article, we present our experience in quick deployment and operation of airborne field hospitals gained following the earthquake disaster in Armenia in 1988 and the civil war in Rwanda in 1994.

Deployment of improvised, volunteer-based, military field hospitals was feasible within 24 hours after the decision was made. A multi-disciplinary structure enabled an effective, flexible mode of operation and reduced the dependency on meticulous, time-consuming assessments of requirements prior to deployment.

These missions are a paradigm for the successful incorporation and integration within the capabilities of military infrastructure of volunteer professionals drafted from civil medical facilities. Such field hospitals could provide backup for primary care medical systems in disaster areas and substitute or take some pressure off of local hospitals, particularly when evacuation systems are insufficient.
Portable, but Suitable: Devices in Prehospital Care Might Be Hazardous to Patient or to Aviation Safety
Authors: Dahlgren Bengt-Einar , Hogberg Raul , Nilsson Hans G
Published: July 2016

Introduction:

Devices used for support of patients requiring air rescue or conveyance are subjected to severe environments that may affect their ability to function when needed or may affect other systems within the transporting vehicle.

Methods:

The ability of four portable ventilators, a suction device, and plastic and rubber tracheal tubes to withstand changes in temperature, vibration, sudden deceleration, and electromagnetic fields was studied in the laboratory setting. In addition, the effects of the operation of these devices on the flight instrumentation was investigated.

Results:

All of the ventilators tested delivered stable minute volumes at temperatures above zero, but in sub-zero temperatures problems were encountered with the driving gas. Vibrations produced alterations in the performance of two of the ventilators, and resonant frequencies were detected that are identical to those produced by the rotors of the helicopter used.

Suctioning became difficult at temperatures below −5° C as the mucus froze in the collecting tubing. The motor produced electromagnetic fields that interfered with the aircraft instrumentation, and resonant frequencies had a deleterious effect on the circuit boards. Plastic tubes were adversely affected by cold, and these chilled tubes were excessively sensitive to vibration and shocks.

Conclusion:

The devices used in various aircraft influence certain vital maneuver systems of the craft. Studies on portable ventilators, a suction device, and tracheal tubes showed that, under specific conditions, the equipment was safe to patients and was not hazardous to the aviation safety. However, under certain conditions commonly encountered during air rescue operations, the equipment became dys-functional or presented safety hazards to the aircraft, and, hence, the crew. The Swedish Air Force has adopted three different criteria constellations: 1) operative; 2) storing; and 3) transport environment.
Emergency Medical Services System in Hong Kong: A Pearl in the South China Sea
Authors: Kalinowski Edward , Burkle Frederick M.
Published: July 2016

Each Emergency Medical Services (EMS) system is unique in its development and scope of practice. In many instances, incorporates components of other models, It is important to the intellectual growth of the Emergency Medical Technicians that they visualize EMS design from an international perspective. This article describes the EMS system that exists in Hong Kong. It explores the changes that are occurring, defines the relationship between Hong Kong and China, and considers the influence that this evolving model might have on China after 1997.
Relationship Between Battery Capacity and the Delivery of Shocks in Prehospital Defibrillators
Authors: Cleland Mark J. , Maloney Justin P. , Hay James L. , Rowe Brian H.
Published: July 2016

Study Objective:

Automatic external defibrillators (AED) have enabled the medical act of defibrillation to be performed in the community by a number of non-physician providers. However, these portable, battery-powered units are costly to maintain and service. This study examines the life of AED batteries and provides a battery replacement protocol.

Design:

Prospective diagnostic testing of 191 field batteries to determine their ability to deliver shocks at 360 joule.

Setting:

Ottawa General Hospital Paramedic Program.

Outcomes:

Using a battery analyzer, battery capacity and the number of shocks delivered were determined for each battery (at room temperature and in a controlled, refrigerated setting). In addition, the reliability of the testing method was assessed using the interclass correlation coefficient (ICC).

Results:

High reliability of blinded technical assessment of the batteries was achieved (ICC = 0.85). A strong correlation between the battery's capacity and the number of shocks it can deliver was obtained. For example, a battery with a measured capacity of 75% is capable of delivering more than 30 consecutive 360 joule shocks. This compares to a battery with a capacity of 20%, which is capable of delivering only 12 consecutive 360 joule shocks.

Conclusion:

While manufacturers' recommendations on battery replacement always have been based on an assumed technical threshold, these recommendations are not based on individual battery performance. The system for testing batteries described in this paper, should provide significant cost savings and improve quality assurance within a prehospital AED program.
Computerized Hospital On-Line Resources Allocation Link (CHORAL): A Mechanism to Monitor and Establish Policy for Hospital Ambulance Diversions
Authors: Neely Keith W. , Bennison Alice , Acker Joe , Long David , Norton Robert L. , Schriver John A.
Published: July 2016

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy.

In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base-station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn is transmitted automatically to all other CHORAL computers.

Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours). Using this system, the paramedics know the resource status of destination hospitals immediately, resource information monitored at base-stations and 911 centre is accurate, and data are available for use in establishing policy.
Emergency Medical Services for Collegiate Football Games: A Six and One-Half Year Review
Authors: Rose William D. , Laird Sherry L. , Prescott John E. , Kuhns Gerald B.
Published: July 2016

An emergency medical services (EMS) system involving paramedic and physician coverage at collegiate football games is described. Injury data for six and one-half years were reviewed. During this period, the data indicated that 313 patients sought medical care, either at the first-aid stations on-scene or at a local hospital emergency department. Lacerations and abrasions were the most common presenting complaints, totaling 20%. Bee stings were the second most common injury. One paramedic per 5,000 and one physician per 30,000 spectators appear to be adequate coverage for this type of event, although preplanning for a mass influx of patients is a necessity. Recommendations are provided for some basic personal and health needs of spectators at mass gatherings.
The Role of Pulse Oximetry in the Initial Airway Management of Helicopter Transported, Trauma Victims
Authors: Carol Ross S. , Renzi Francis P.
Published: July 2016

Introduction:

Circumstances surrounding the prehospital management of trauma patients may mask clinical signs of inadequate oxygenation. Pulse oximetry (PO) may influence airway management prior to helicopter transport by helping to identify patients with occult hypoxemia.

Methods:

Patients were enrolled in a prospective study. Initially, the flight physician clinically decided how best to manage the patient's airway prior to helicopter transport. The patient's oxygenation saturation (O2at), was determined by PO. Then, the physician reassessed the initial airway management decision based on clinical assessment and knowledge of the O2Sat. All patients had an arterial blood gas (ABG) measurement taken after completion of transport.

Results:

Sixty patients were enrolled. Knowledge of the O2Sat, as determined by pulse oximetry, did not influence airway management. No patients with occult hypoxemia were identified.

Conclusion:

The use of PO in the initial evaluation of trauma patients prior to helicopter transport did not influence the flight physician's initial management of the airway.
Seroconversion by EMS Personnel Vaccinated with HBV Recombinant DNA
Authors: Koenigsberg Max D. , Ward Sharon , Herman Linda , McDonald Cary , Feldman Richard M.
Published: July 2016

Objective:

To evaluate the seroconversion rate of EMS personnel given the hepatitis B virus (HBV) recombinant deoxyribonucleic acid (DNA) vaccine series.

Design:

Retrospective review of paramedics and firefighters consecutively completing the HBV recombinant DNA vaccine program.

Setting:

Urban, non-prof it, private, regional EMS Resource Hospital. The Chicago North EMS System is under contract with the Chicago Fire Department. This contract allows for the voluntary vaccination of EMS personnel with recombinant DNA-HBV vaccine and treatment and follow-up of paramedics and firefighters possibly exposed to HBV.

Population:

Initial 68 EMS personnel completing HBV recombinant DNA vaccine program (48 primary prophylaxis and 20 post-exposure prophylaxis).

Intervention:

HBV recombinant DNA vaccine series was administered voluntarily to Chicago EMS System paramedics and firefighters per manufacturers recommendations. Two weeks after completion of the vaccination series, blood samples for HBV antibody titres were drawn to determine reactivity and the need for further immunization.

Results:

Of the 68 vaccinated individuals, only two had negative titres (3%). These two individuals were given a fourth dose of vaccine with successful seroconversion.

Conclusions:

Prehospital care personnel are known highrisk, health-care workers for acquiring HBV and should be vaccinated prophylactically. There is a high seroconversion rate (97%) utilizing HBV recombinant DNA vaccine. However, post-vaccination antibody titres must be performed to identify those rare individuals that do not seroconvert.
SARA Three Years Later: Emergency Physician's Knowledge, Beliefs, and Actions
Authors: Landesman Linda Y. , Leonard Ralph B.
Published: July 2016

Objective:

Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals.

Methods:

A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods.

Results:

One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials.

Conclusion:

Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts.

Recommendations:

A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.
Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13
Authors: Hsiao Albert K. , Michelson Stuart P. , Hedges Jerris R.
Published: July 2016

Introduction:

Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).

Methods:

A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of ≤13 was performed. A total of 120 patients met the inclusion and exclusion criteria.

Results:

A significant number of patients presenting with a GCS score of ≤9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10–13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.

Conclusion:

Patients with a presenting GCS score of ≤9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10–13 is problematic. Patients with a presenting GCS score of 10–13 must be evaluated individually and closely monitored. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.
Comparison of Two Systems for Quality Assurance of Prehospital Advanced Life Support Services
Authors: Holliman C. James , Swope Gregory , Mauger Lisa , Wuerz Richard C. , Meador Steven A.
Published: July 2016

Introduction:

The need for quality assurance (QA) systems for review of prehospital advanced life support (ALS) care has long been recognized. However, there only have been limited published studies on the operation and cost of QA systems for prehospital care. A number of different systems currently are in use, and the relative effectiveness of different QA systems has not been well determined.

Objective:

The aim of this study was to compare the personnel work-time and costs of two different systems of QA for prehospital ALS services, and thereby determine which type of system was more cost-effective in the generation of QA reports.

Methods:

The quality assurance program (System 1) for three independent ALS services in a rural/suburban area and the QA program (System 2) for a nearby urban ALS service were compared. Data recorded included the training level and number of hours per year devoted exclusively to QA activities by different personnel. The annual costs for other aspects of the QA systems and apportioned salary costs for time spent on QA work were recorded.

Results:

System 1, a computer-based system, utilized 1,116 hours per year of personnel time and required [US]$17,662 in total costs per year (average cost per run reviewed of $4.38). System 2 (a manual system) utilized 569 hours per year of personnel time and had an annual cost of [US]$8,361 (or $2.15 per run reviewed). System 1 generated 852 reports per year (21 % of runs) about non-compliance with protocols or charting deficiencies. System 2 generated 284 reports per year (7.3% of runs) for similar events.

Conclusions:

Either a computer-based or “manual” system for QA of prehospital ALS services can be utilized. A computer-based system requires more personnel time and is more expensive, but generates more reports per year than does the manual system. A computer-based system more readily can retrieve run report data for further review.
Are Race, Age, Gender, and Insurance Status Determinants in Interhospital Helicopter Transport Time and Frequency?
Authors: Furlong Brendan R. , Heller Michael B. , Auble Thomas E.
Published: July 2016

Objective:

To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers.

Design:

A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites.

Setting/Participants:

A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion.

Results:

The TTT (mean ± SD) was longer (2666 ± 3940 minutes (min.) versus 619 ± 909 min., respectively) for adult than pediatric patients (p <O1), and (2588 ± 4041 min. versus 640 ± 1301 min., respectively) for insured versus uninsured patients (p <.O1). The observed proportion of non-whites transported was less than expected (.41% versus 2.1 %) based on the proportion of non-whites in the region (p <.O5).

Conclusion:

The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted.
A Hospital-Based, Hazardous Materials Decontamination and Treatment Unit: Utilization Patterns Over a Nine-Month Period
Authors: El Sanadi N. , Grove C. , Takacs M. , Daly S. , Ellenberger D.
Published: July 2016

Federal [U.S.] law and the Joint Commission on the Accreditation of Healthcare Organizations mandate plans and mechanisms for response by hospitals to hazardous material incidents/accidents be developed and implemented. This paper describes the response of the University Hospitals of Cleveland to these regulations and to the anticipated needs of the community and local industiy. The physical plant constructed and its relationship to the emergency department personnel for staffing this unit are described. Utilization patterns since implementation of this program are presented.
Action Resolutions
Authors:   The National Association of State EMS Directors
Published: July 2016

The National Association of State EMS Directors (NASEMSD) held its annual meeting in Austin, Texas, in October 1993. The Association expressed its support and concern for several issues at that meeting. In Austin, seven resolutions were approved.
Emergency Medical Services Systems in the United States and China: A Developmental Comparison
Authors: Burkle Frederick M. , Zhang Xiaoping , Patrick Walter , Kalinowski Edward , Li Zonghao
Published: July 2016

International emergency medical services (EMS) consultation requires many sensitivities to cross-cultural issues. Contemporary EMS models in developed countries have, by necessity, a systems framework. This study compares evolving EMS systems in the United States and China. It is concluded, that, no matter what the potential and cultural differences might be, a systems framework inherently will emerge in EMS development. As such, the EMS components recognized often will expose an evolving systems approach with more similarities than differences and can reveal strategies for improvement. Providing a developmental comparison process is a necessary first phase in analysis of a country's systems development or restructuring.
Complex, Humanitarian Emergencies: I. Concept and Participants
Authors: Burkle Frederick M.
Published: July 2016

Complex, humanitarian emergencies, the result of civil strife and armed conflict affecting large populations at the brink of extinction, represent the most compelling of disaster relief challenges. They require the coordination of the United Nations agencies, the International Committee of the Red Cross, international nongovernmental relief organizations, and military forces. An increasing number of civilian and military health-care providers find themselves involved in the planning, coordination, and direct patient-care aspects of these emergencies, often without proper initiation and understanding of the unique nature of these disasters. This article provides a primer on the concept of complex, humanitarian emergencies and the contributions, characteristics, capabilities, and limitations of each major participant.
Emergency Medical Care in the Athletes' Village: World University Games 1993
Authors: Janicke David M. , Jacob Donald J. , LaFountain Richard B. , Pundt Mark R. , Young Gregory E.
Published: July 2016

Objective:

Little information exists concerning special medical needs at the athletes' residence (as distinct from the sport venues) at major international sporting events. During the summer of 1993, Buffalo, New York became the first city in the United States to host the World University Games. Approximately 6,000 athletes and accompanying staff from 118 countries attended. This report seeks to characterize emergency medical care use and the degree of language difficulty encountered at the athletes' village medical center (AVMC) set up at the athletes' residence for this event.

Methods:

Demographic data were collected prospectively for each athlete or staff member housed in the athletes' village who presented to AVMC for medical evaluation rather than being cared for by a team physician or at one of the venues. Difficulty in medical treatment secondary to language differences was assessed, by the treating physician on a scale of 0–3.

Results:

Over the 14 days that the AVMC was in operation, for 24 hours a day, a total of 362 athletes (mean age: 22.9 ±2.9 years, 257 males, 105 females) and 149 accompanying staff (mean age: 39.8 ±11.6 years, 110 males, 39 females) were treated. More than 90 % of the patients were seen between the hours of 0800 and 2400. A broad spectrum of minor medical problems occurred, with musculoskeletal injuries accounting for most of the visits for both athletes (54 %) and staff (27%). Nonsteroidal anti-inflammatory agents and oral antibiotics were the most commonly prescribed medications. On-site radiographic facilities were used for 22% of the athletes and 11% of the staff treated. The majority of patients (92% of athletes, 91% of staff) were discharged from the AVMC. Four of the 12 patients that were transferred to a hospital-based emergency department were admitted to the hospital. Language problems, as assessed by the treating physician, were mostly minor; 25% of the patients had accompanying interpreters. One volunteer Physician, and two to three nurses adequately staffed each shift.

Conclusion:

The AVMC provided medical care for a large variety of medical problems that could, be treated on-site without transfer to a higher-level facility, thereby providing directed medical care for this special population in a secure environment. Language differences were perceived as a minor problem. This report should be valuable in the planning of medical care at the athletes' residences for similarly large sporting events.
Comparison of Prehospital Cervical Immobilization Devices Using Video and Electromyography
Authors: Manix Thomas , Gunderson Michael R. , Garth Geoffrey C.
Published: July 2016

Introduction:

Previous evaluations of prehospital devices intended for spinal immobilization have focused on the device's ability to restrict motion only. This study defines six relevant criteria for evaluation of cervical immobilization device (CID) performance.

Objectives:

To suggest relevant criteria for evaluation and use available technology to improve measurements for performance testing of prehospital-care devices.

Methods:

Six parameters (motion restriction, access, ease of application, environmental performance, radiolucency, and storage size) were used to evaluate three types of CIDs: Device A—a single-use corrugated board; Device B—a reusable foam-block CID; and Device C—hospital towels and adhesive tape. To test motion restriction, the most frequently compared parameters for immobilization devices, 20 volunteers were asked to move their heads and necks through a series of motions (flexion, extension, lateral bending and rotation). Their movements were videotaped, still images of each movement were generated, and the degrees of deflection recorded from these still images. To ensure a consistent level of force, electromyography (EMG) of the sternodydomastoid and extensor muscles was employed.

Results:

Data were produced for each parameter and presented for comparison. The use of video to determine deflection proved to be a useful and highly accurate (±1°) method for measurement. The use of EMG technology enabled force to be controlled indirectly when the subjects used moderate levels of exertion. Overall, Devices A and C restricted motion better than Device B. Although Device C required the shortest time for application, it took the longest to prepare for application. The total time required for preparation and application of A and B essentially were equivalent, with A requiring no preparation time but taking the longest for application, and B having an intermediate interval for application. Device A allowed for the best examination of the head and neck. No differences were detected in performance in extreme environmental conditions or in radiolucency for cervical spine X-ray examinations. Device A consumed the smallest storage volume, B the greatest storage volume, and C an intermediate volume substantially greater than that required for A.

Conclusion:

Device evaluation should include examination of all relevant performance parameters using the most accurate and meaningful methods possible.
Hand Injuries From Snow Blowers: A Report of an Epidemic
Authors: Tetz David J. , Aghababian Richard
Published: July 2016

During a record snowfall in Worcester, Massachusetts, 11–13 December 1992, 37 male patients with hand injuries suffered during snow blower operation were seen at three area hospitals. Two previous reports describe 13 patients seen over a 3-year period and 28 patients over a 12-year period. This report describes the largest number of hand injuries from snow blowers that have occurred over a 48-hour period. The snow was unusual because of the high water density in the initial 9 inches (23 cm) that fell at an average temperature of 33° F (0.6° C) with the final depth of 30 inches (76 cm), causing the machines to become clogged. Patients admitted to reaching into a running machine in 35/37 (95%) cases, 11/37 (30%) claimed the auger and impeller blades were disengaged, and 2/37 (5%) patients claimed their injuries occurred with the engines turned off. All injuries occurred when the patients placed their hands down the chute, contacting the impeller blades. Injuries involved 32 long, 15 ring, 13 index, and five small fingers and ranged from simple lacerations to partial phalangeal amputations. The majority, 27/37 (73%), were managed in emergency departments without interventions in the operating suites. Infection occurred in one patient who had the lesion repaired in the operating suite. As in previous studies, no differences were found for the variables of snow blower age, type, or horsepower, or on experience level or age of the operators. Despite the safety defaults provided on newer machines, warnings posted on equipment and in owner's manuals, or public-service announcements provided by the media during the storm, injuries continued to occur. Operator error was the common denominator, suggesting that a change in snow-blower design that prevents hand access or impeller rotation is necessary to prevent these devastating injuries.
Physicians' Experiences with Prehospital Do-Not-Resuscitate Orders in North Carolina
Authors: Travers Debbie A. , Mears Greg
Published: July 2016

Introduction:

Many states are implementing prehospital do-not-resuscitate (DNR) programs through legislation or by state or local protocol. There are no outcome studies in the literature regarding the utilization of, access to, or barriers to prehospital DNR programs, nor are there studies that evaluated whether they meet the patients' needs.

Study Objective:

To explore physicians' perceptions of the utilization of, access to, and barriers to a southeastern state's prehospital DNR program, and to identify key professional groups needing information about prehospital DNR issues.

Methods:

A convenience sample survey and a descriptive review using retrospective, self-report questionnaires sent to all physicians who requested and obtained a supply of the state's out-of-facility DNR forms in 1993.

Results:

Respondents reported that the most common terminal conditions for patients with prehospital DNR orders are cancer and multiple chronic diseases in elderly patients. More than half of the physicians recalled that enrolled patients had engaged the services of emergency medical services (EMS), most often because the patients' conditions worsened, and the families were uncertain about what to do. Most of the enrolled patients have at least one other DNR order in another health-care setting, and are at home with hospice care or home-health care at the time of the prehospital DNR order implementation. The most frequent barrier to honoring dying patients' wishes in the prehospital environment is a lack of knowledge of prehospital issues by patients, families, primary care physicians, and nursing home staff. Ninety-eight percent of the respondents support a single, universal DNR order that would apply across all health-care settings.

Conclusions:

Patients, families, and key health-care professional groups need to be targeted with educational programs regarding prehospital DNR issues. Primary care physicians, using the current prehospital DNR program, support more comprehensive approaches to DNR orders across health-care settings.
Does the Level of Prehospital Care Influence the Outcome of Patients with Altered Levels of Consciousness?
Authors: Adams James , Aldag Gene , Wolford Robert
Published: July 2016

Hypothesis:

Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers.

Methods:

Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included: trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records.

Results:

Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the “alert, verbal, painful, unresponsive” scale (ALS vs BLS) were: “verbal” (40% vs 51%), “painful” (23% vs 23%), and “unresponsive” (37% vs 25%). The mean value for scene time was 15±6 minutes for ALS versus 10±4 minutes for BLS (p <0.001). On arrival in the emergency department, the LOC of 72 (64 %) ALS patients and 58 (64%) BLS patients had improved to “alert.” The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS provider had significantly shorter emergency department treatment times than did those transported by BLS providers (160±62 minutes ALS vs 229±67 minutes BLS [p <0.005]).

Conclusion:

Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.
The Relevance of the Occult Cervical Spine Controversy and Mechanism of Injury to Prehospital Protocols: A Review of the Issues and Literature
Authors: Butman Alexander M. , Schelble Daniel T. , Vomacka Richard W.
Published: July 2016

Prehospital guidelines that define the clinical indications for spine trauma also serve as the criteria for selective spinal immobilization in the field. Therefore, these criteria are important for avoiding further spinal cord damage. Because some spine injuries may occur without neurological deficits or other clinical signs, the recommended field guidelines extend beyond the signs and symptoms and include mechanisms of injury or other injuries commonly associated with a high risk of spine injury.
In Memoriam, Asmund S. Laerdal
Authors: Safar Peter
Published: July 2016

Asmund Laerdal, a patron, catalyst and leader for resuscitation developments worldwide, died from cancer at his home in Stavanger, Norway on November 19, 1981. At the funeral services on America's Thanksgiving Day, we said thanks for what he has given the world. He was a great man, whose quiet, but determined, manners and eagerness to help whenever he perceived a need, earned him much respect and love.

Asmund Laerdal was born in Norway on October 11, 1913. He went to business school, traveled throughout Europe by bicycle during his youth, married Margit in 1939, and started a small printing business in 1940. Nazi occupation between 1941 and 1945 threatened his life, but did not wreck his little company. Throughout the 1940s and 1950s he printed childrens' books and calendars and made inexpensive wooden and plastic toys. The latter included “Anne Doll,” the “toy of the year,” made of soft plastic, with sleeping eyes and natural hair.
Emergency Medical Services Delivery Research In Japan
Authors: Honda Kenji
Published: July 2016

The EMS delivery system in Japan is divided into three levels of medical care. One can request the first aid ambulance by dialing the emergency number 119. The ambulance service takes the patient to the first aid clinic (hospital), i.e., emergency department. Physicians and nurses of a city, town or village are being rotated for the first aid clinic once every month or two. A physician has to decide whether or not a certain patient needs further evaluation. When the physician of the first aid clinic (hospital) decides the patient needs hospital admission, he sends the patient to the second aid hospital. When a physician of the second aid hospital judges the patient needs special examinations or surgical treatment which requires the patient's admission to a more advanced facility, he sends the patient to the third aid hospital. At the present time, the third aid hospitals are medical school hospitals and national hospitals.
Ethical and Legal Problems in Resuscitation Research
Authors: Abramson Norman , Meisel Alan , Safar Peter
Published: July 2016

Medicine has made great advances in the past decade, and is now opening the frontiers of brain resuscitation. Coinciding with the advances in medicine, society has witnessed great changes. There is an increasing awareness of patients' rights, an increasing desire for self determination, a rejection of the once-accepted paternal role of the physician, and an increasing willingness to challenge physicians in the courts. At the same time, government regulation of biomedical research has been expanding rapidly. The origin of this regulation dates back to the post-World War II Nuremburg trials. In 1974, the National Research Act established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The evolving concern about human experimentation has led to the current Department of Health and Human Services (DHHS) and the Federal Drug Administration (FDA) regulations which became effective July 27,1981. All biomedical research supported by federal funds must conform to these legal requirements. One aspect of these regulations is that all research protocols be approved by an institutional review board (IRB) established at the institution where the research is conducted.
Development of a Mathematical Constant for the Prediction of Casualties at Mass Gatherings
Authors: Franaszek Jacek , Jayne Harold , Morkovin Vera , Krome Ronald , Baker Frank
Published: July 2016

In preparation for the visit of Pope John Paul II on Oct. 5, 1979 to Chicago, Illinois, a multi-departmental committee met for a number of months prior to the Pope's visit to prepare for possible mass casualties at the outdoor papal mass held in Grant Park. Data taken into consideration in preparation for this mass gathering included predictions of the number of people to attend the event, calculations by the National Safety Council of the possible number of victims and type of casualties, a review of the literature and the experience of others at outdoor events of the same scale.

On this basis, it was predicted that aproximately 3,000 to 3,500 casualties would occur simply as a result of a mass gathering of one million individuals. The actual total number of casualties was 400, with twenty being transported to the hospital and no deaths. On the basis of this experience a formula was described to predict the number of casualties based on total attendance figures.
Adapting First Aid to Actual Needs
Authors: Laerdal Asmund S.
Published: July 2016

The purpose of first aid remains the same through the ages: to prevent pain, disease and death. But the need is different in different places and at different times.

It should not be forgotten that in large parts of the world the most immediate threat to human life is starvation and malnutrition, together with lack of hygiene and basic medical care. The kind of first aid most needed under such circumstances is food and medicine. The key to a long-term solution is education in self-help. The prosperity and experience of the Western world must, in the future, be used more systematically to booster development towards self-sufficiency in the less developed countries. These are most important aspects that should be dealt with more often. The time frame of this article forces me to concentrate on conditions in the industrial world.
Medical Student Education in Advanced Cardiac Life Support
Authors: Jastremski Michael S. , Grogono Alan W.
Published: July 2016

A standardized approach to advanced cardiac life support (ACLS) improves the morbidity and mortality from cardiac arrest. Physicians should receive formal training, certification, and periodic recertification in ACLS. This paper describes the system we have developed to provide all the medical graduates of our university with training and American Heart Association (AHA) certification in ACLS.

Method

The course takes place during the third year of medical school in four afternoons during the students' medical clerkship. The students are required to take this course and are freed from all other commitments during these afternoons. Several weeks before the course, the students are given a brief introductory lecture, registered, and strongly encouraged to read the AHA manual for providers of advanced cardiac life support.
The Integration of Emergency Care in a Total Critical Care Medicine (CCM) System
Authors: Delooz Herman H.
Published: July 2016

The goal of critical care medicine is to provide specific care to the patient in whom one or more vital systems are threatened or deficient. The methods of critical care medicine are monitoring, support or temporary substitution of vital systems, and the application of titrated therapy. The specific objective of each link in the chain of medical facilities involved with the critical patient deserves to provide the same expertise and should act according to the same protocol.

The different links of the chain are these: (l)recognition of the critical condition; (2) emergency call; (3) care on the spot of the emergency; (4) care during transport; (5) further diagnostic and therapeutic work in the emergency department; and finally (6) if indicated, continued intensive care.
A Guide for Planning Alaska's Emergency Medical Services (EMS) System
Authors: Way Gloria Houston , Johnson Mark S.
Published: July 2016

Planning for emergency medical services (EMS) in a large state with a sparse population like Alaska poses unique challenges that EMS planners in urbanized areas never have to consider. Alaska is the largest state in the USA in land area, covering 586,000 square miles, or an area more than twice the size of the state of Texas. Alaska also has more miles of coastline than the rest of the USA. Despite its large size, Alaska continues to have the smallest year-round population of any state in the nation (400,481–1980 census). Many of Alaska's villages and towns are not accessible by road, including Juneau, the state capital, which can only be accessed by air or water. This means that, with Alaska's often harsh climate, many communities have no available ingress or egress for several hours, or even several days at a time. In these conditions, response times can not be measured in minutes, as they often are in some urbanized areas in other states. For example, Unalaska in the Aleutian Islands, one of Alaska's major fishing ports, is over 900 miles from the nearest hospital in Anchorage.
The Pediatric Emergency Transport System: Momentum toward Regionalization
Authors: Dobrin Robert S. , Cunningham Janet , Dexter Mary , Gifford Chelle , Ivancie Liz , Mayer Kathy , McCabe Mary Kay , Massaro Thomas A.
Published: July 2016

Tertiary care for critically ill children requires a safe, efficient transport modality designed for the pediatric patient. This system should be capable of delivering mobile intensive care en route after resuscitation and stabilization at the sending hospital.

In July 1979, a Pediatric Emergency Transport Service (PETS) was organized at The Children's Hospital, Denver, to provide physicians of the Rocky Mountain-Plains Region with the capability of triaging pediatric nonneonatal patients to three Denver Pediatric Intensive Care Units (PICU's). The components of the system included: (1) a transport team comprising of a medical attending-director, twelve transport physicians including nine pediatricians, two anesthesiologists and one surgeon, six pediatric transport nurses, six pediatric transport respiratory therapists, and four emergency medical technicians; (2) a communication dispatch system; (3) an answering service with Wide Area Telecommunications Service capability; (4) an equipment depot within the PICU at The Children's Hospital; (5) a complete dispatch log; (6) a continuing education and information system for the team, providers, consumers and health planners; (7) a cost and administrative center with established billing procedures and support services; (8| management, drug and equipment protocols, and (9) specifically designed air and ground ambulances which are owned and/or leased by The Children's Hospital.
Superiority of Colloid over Electrolyte Solution for Severe Normovolemic Hemodilution (NVHD) in Concurrent Treatment of Hemorrhage
Authors: Brinkmeyer Scott , Safar Peter , Motoyama Etsuro
Published: July 2016

Treatment of severe hemorrhage with adequate concurrent administration of plasma substitutes leads to acute normovolemic hemodilution (NVHD). Advantages of hemodilution include: l) reduced risk of infection; 2) decreased thromboembolic phenomena; 3) improved microcirculation; and 4) less use of banked blood resulting in reduced patient cost.

In the 1960's, Takaori and Safar described the types of response to various degrees of hemodilution (HD) and demonstrated that dogs survived when hemodiluted with dextrans to a hematocrit (hct) of 10%. In contrast, HD with Lactated Ringers (LR) was unable to support survival.