bluuebunny/crossref_metadata_2025 huggingface dataset:
Finnish National Training Centre for Emergency Services
Authors: Kettunen Tapio A. , Mattila Matti A.K. , Hänninen Osmo O.
Published: July 2016

This is a review of the facilities and programmes of the Finnish National Centre for Emergency Services in Kuopio, Finland. It includes the Emergency Services College that provides all of the training for emergency service workers in Finland and provides some services for the international community. There are needs for training by the medical community in Finland that relate both to skills and knowledge. Education and training focus on the demonstration of evidence-based competence. The facility includes a training ground for the provision of immediate emergency medical care, scene safety, extrication, industrial accidents, and water rescue. It is used for the training of paramedic students, nurses, medical students, firefighters, dispatch center staff, and officers. Computer-aided simulations are used to enhance the learning process. Plans are underway for adding tele-education and/or virtual-reality facilities. Close liaison is maintained with the University of Kuopio, Kuopio University Hospital, and with the Pohjois-Savo Polytechnic Institute.
Impact of the 1994 Northridge Earthquake on the Utilization and Difficulties Associated with Prescription Medications and Health Aids
Authors: Sareen Harvinder , Shoaf Kimberley I.
Published: July 2016

Introduction:

The medical impacts of disasters have focused on the injuries, illnesses, and deaths related to the disaster. Little has been written about the impact of disasters on persons who use prescription medications or those medications that require refrigeration, or those who require health aids. The objective of this study was an evaluation of the level of utilization of prescription medications and medications that require refrigeration as well as the use of health aids by the population affected by the disaster.

Methods:

Following the Northridge earthquake of 1994, a survey of Los Angeles County households was conducted to assess the impact of the earthquake. A total of 1247 households completed the 48 minute telephone interview. As part of the interview, 10 questions assessed the utilization of medications and medical aids by household members and the effects that the earthquake had on those medications and devices. Chi-square, analysis of variance (ANOVA), and logistic regression analysis were applied.

Results:

Of the 1,212 completed interviews, 21% of the households had a family member taking a prescription medication or a medication requiring refrigeration. Associated factors included gender, race, age, household income, level of education, presence of children, and the intensity of the earthquake (by the Modified Mercalli Index). Only 3% of those that reported medication usage noted problems associated with the use of these medications.

Thirty-nine percent of the respondents indicated that someone in the household used a health aid (e.g., eyeglasses, hearing aid, etc.). Usage was related to gender, race, age, household income, level of education, presence of children, and the intensity of the shaking associated with the earthquake. Of these, 6.5% reported difficulty with these aids, usually related to loss or breakage.

Conclusions:

Although the proportions of the population requiring prescription or refrigerated medications and/or for those using health aids in Los Angeles seemingly are small, this translates to 630,000 households in which someone requires medications and 1.2 million households with a requirement for health aids. Thus, there are a huge number of persons at risk for serious medical problems related to these medications and devices that could produce profound medical problems during a disaster. However, during and following a moderate earthquake, it does not seem that the consequences will be great.
Lessons Learned in Public Health Emergency Management: Personal Reflections
Authors: Kizer Kenneth W.
Published: July 2016

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs) 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics.

This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated.

The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.
Theme 7. Sharing International Experiences in Disasters: Summary and Action Plan
Authors: Braham Michael , Aghababian Richard , Andrews Richard A. , Austin Cher , Brown Ross , Chen Yao Zhong , Engindeniz Z. , Girouard Roger , Leaman Paul , Masellis Michele , Nakayama Shinichi , Polentsov Y.O. , Suserud Bjōrn Ove
Published: July 2016

Introduction:

The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim.

Methods:

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

Results:

The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives.

Discussion:

The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories.

Conclusions:

Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.
Principles of Disaster Management Lesson 12: Structuring Organizations
Authors: Cuny Fred C.
Published: July 2016

This lesson discusses various structures for organizations that have functional roles in disaster responses, relief, and/or management activities. It distinguishes between pyramidal and matrix structures, and notes the advantages and disadvantages of each in relation to disasters. Span of control issues are dissected including the impact of the “P” factor on the performance of disaster managers and workers including its relationship to the coordination and control function. The development of a Table of Organization and how it relates to departmentalization within an organization also is provided.
The Role of the Physician in a Helicopter Emergency Medical Service
Authors: Schwartz Robert J. , Jacobs Lenworth M. , Lee Margaret
Published: July 2016

The purpose of this study was to measure the contributions of a physician crew member in a helicopter emergency medical service (HEMS) and to develop a method to utilize physician services more efficiently. A two-part study utilizing two independent sets of measurements of physician necessity was conducted. A post-flight questionnaire and the success rate for endotracheal intubation were used as measurement tools.

With the passage of time, the fight nurses perceived the physician crew member' contribution to clinical judgment decreased from 21% to 1% of the flights and that the physician's contribution of technical skills (intubation) declined from 11% to 3%. The contribution to clinical decisions seemed more important on interhospital transports than on scene responses. The technical skills (judged by the tracheal intubation success rates) of a physician seemed more cogent on responses to the scene. When in the capacity of a second crew member with an experienced flight nurse, the endotracheal intubation success rate increased from 71% to 90%. Therefore, it seems that physician services could be restricted primarily to scene response flights. This limited utilization of flight physicians should make these physicians available for other duties.
Prehospital and Emergency Department Verification of Endotracheal Tube Position Using a Portable, Non-Directable, Fiberoptic Bronchoscope
Authors: Hutton Kevin C. , Verdile Vincent P. , Yealy Donald M. , Paris Paul M.
Published: July 2016

Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be “difficult.” FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.
Correlation between Motor Vehicle Mortality Rate and Density of Medical Resources
Authors: Maio Ronald F. , Burney Richard E. , Lazzara Scott , Takla Robert B.
Published: July 2016

An inverse correlation has been reported between motor vehicle crash mortality rate (MVCMR) and population density. The reasons for this are unknown, but variations in prehospital and hospital resources are a possible explanation.

Hypothesis:

Densities of prehospital and hospital resources correlate inversely with motor vehicle crash mortality rates.

Methods:

Data regarding population, area, number of motor vehicle deaths, and number and types of hospital and prehospital care resources for 1987, were obtained from the Michigan State Department of Public Health and transformed to create measures of resource per square mile by county. Correlation coefficients were computed between motor vehicle death rate and medical resource densities.

Results:

Small negative correlations were seen for all variables. Correlation coefficients ranged from -0.224 (EMTs per sq mi) to -0.167 (beds per sq mi). Only the coefficient for EMTs per square mile was statistically significant (p=0.043).

Conclusion:

Small negative correlations exist in Michigan counties between MVCMR and medical resources. We conclude that only a small proportion of MVCMR variation can be accounted for by the density of medical resources.
Quality versus Quantity in Medical Research: Can We Average Cheshire Cat Smiles?
Authors: Magalini Sergio Ivano
Published: July 2016

It is a sunny day in Moscow. I am participating in an excellent meeting on Disaster Medicine. While sitting at the breakfast table eating red caviar and sturgeon, somebody started to talk of the scarce value attributed to qualitative research since it cannot be statistically evaluated. I do not recall the unfortunate statement I made that induced Dr. Birnbaum to say, “You are going to write a paper for our journal on this topic.” I did not know what to reply and thus started the day in a very troubled mood. In a status of “reverie” (almost dozing) during a presentation in the morning session, a title spontaneously presented itself for what I still do not know I am going to write—Can You Average Cheshire Cat Smiles? Perhaps the further development of this free writing will explain the title or will serve to float, as if a koan, for our meditation and interpretation.
Effects of Early Prehospital Life Support to War Injured: The Battle of Jalalabad, Afghanistan
Authors: Husum Hans
Published: July 2016

Objective:

To study the effects of early, advanced prehospital life support on the survival rate of war casualties during the battle of Jalalabad, Afghanistan from 1989–1992.

Method:

The outcomes of simple trauma care administered from 1989–1990 were compared to the outcomes of advanced trauma care administered from 1991–1992 in the combat zone. The outcomes were measured by the number of deaths at admission to the referral surgical hospitals in Pakistan.

Results:

A total of 3,890 war casualties were treated in the combat zone by paramedics, and were evacuated through light, forward, field clinics to surgical hospitals in Pakistan. Advanced trauma care that was administered in the combat zone reduced the prehospital mortality rate from 26.1% to 13.6% (95% confidence interval for difference = 9.7–15.4%).

Conclusion:

In scenarios with protracted evacuation, early and advanced trauma care should be included in the chain of survival. Local paramedics can provide such trauma care with a minimum of resources.
Adenosine Conversion of Supraventricular Tachycardia Associated with High-Dose Epinephrine Therapy for Cardiac Arrest
Authors: Gerhardt Robert T. , Furlong Richard , Schrank Kathleen , Ress Bradford D.
Published: July 2016

Adenosine has received wide acceptance as the drug of choice for initial treatment of supraventricular tachycardias (supraventricular tachycardia), and as a diagnostic adjunct in hemodynamically stable, wide-complex tachycardias. This report describes the successful use of adenosine for the treatment of supraventricular tachycardia occurring after successful initial resuscitation from ventricular fibrillation, in which a high dose of the epinephrine protocol was used.
Recommendations for Uniform Reporting of Data following Major Trauma — The Utstein Style: An Initiative
Authors:   International Trauma Anaesthesia and Critical Care Society (ITACCS)
Published: July 2016

The document is published in collaboration with the following organisations: the European Society of Emergency Medicine (Leuven); the European Resuscitation Council (Antwerpen); the Air Medical Physician Association (Salt Lake City, US); the German Interdisciplinary Association of Critical Care Medicine; and the German Society of Anaesthesiology and Intensive Care. The document is to be published jointly in the following journals: 1) Trauma Care (ITACCS); 2) Resuscitation; 3) Prehospital and Disaster Medicine; 4) European Journal of Emergency Medicine; 5) Trauma and Emergency Medicine Journal (SA); 6) Emergency Medicine(Norway); 7) JEUR; and 8) Notfall und Rettungsmedizin (Germany).
Predictors of Demand for Emergency Prehospital Care: An Australian Study
Authors: Clark Michele J. , Purdie Jennifer , FitzGerald Gerry J. , Bischoff Noelene G. , O'Rourke Peter K.
Published: July 2016

Introduction:

Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities.

Hypothesis:

Demand for prehospital care can be explained by demographic, health status, and economic determinants.

Methods:

The study used a cross-sectional design to investigate the association of demographic, health status, and insurance factors with the use of prehospital, ambulance care. Core data items including age, gender, marital status, country of origin, triage score, diagnosis, time of presentation, method of arrival, and patient disposition were collected for every patient who pre-sented at the Emergency Department of the study hospital over a four-month period. Ambulance usage was analysed using Poisson regression.

Results:

For the 10,229 patients surveyed, only a small number were triaged as having the highest level of urgent medical need (0.8%), but the majority of these used prehospital emergency medical care (90.2%). Predictors of ambulance use included age >65years (Prevalence Ratio [Prevalence Ratio] = 2.92; 95% confidence interval [ Confidence Interval]: 2.35–3.63), being married or in a defacto relationship (Prevalence Ratio = 0.69; 95% Confidence Interval: 0.60–0.79) or divorced, separated, or widowed (Prevalence Ratio = 0.83; 95% Confidence Interval: 0.70–0.98), triage score level 1 or 2 (Prevalence Ratio = 1.95; 95% Confidence Interval: 1.68–2.28), or triage score level 3 (Prevalence Ratio = 1.54; 95% Confidence Interval: 1.38–1.72), diagnosis involving either mental (Prevalence Ratio = 4.29; 95% Confidence Interval: 1.84–10.01), nervous (Prevalence Ratio = 2.74; 95% Confidence Interval: 1.19–6.31) or trauma (Prevalence Ratio = 2.33; 95% Confidence Interval: 1.03–5.27) conditions, and insurance status (Prevalence Ratio =1.54; 95% Confidence Interval: 1.40–1.71). Ethnicity, gender, and time of day were not associated with usage.

Conclusion:

Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.
Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study
Authors: Richards John R. , Ferrall Stephen J.
Published: July 2016

Study objective:

To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.

Methods:

A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.

Results:

A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).

Conclusion:

Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.
Fred C. Cuny Memorial Continuing Education Series: Principles of Disaster Management Lesson 6: Personnel and Personnel Management
Authors: Cuny Fred C.
Published: July 2016

Relief operations require capable resposible staff. This lesson discusses the types of staff and workers required. It stress the importance of employing locals an refugees infilling many of these positions and examines the role of volunteers, paid personnel, and expatriates and the issues involved.
Age-related Utilization of Advanced Life Support Services
Authors: Meador Steven A.
Published: July 2016

Purpose:

To investigate the relationship between age and Advanced Life Support (ALS) utilization.

Population:

All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.

Methods:

All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.

Results:

There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.

Conclusion:

Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.
Improving Reliability of Abstracted Prehospital Care Data: Use of Decision Rules
Authors: Maio Ronald F. , Burney Richard E.
Published: July 2016

Our experience suggests that even with standard definitions, information on ambulance report forms may be abstracted inconsistently.

Hypothesis:

The use of written decision rules will improve agreement between paramedics abstracting data from records of prehospital cardiac arrest.

Methods:

Sixty-three ambulance reports were selected by a random sample of all out-of-hospital cardiac arrests. Four paramedic abstractors each were given a set of definitions for use in abstracting data and one pair, randomly assigned, also was given a set of decision rules. Abstractors recorded whether there was: (1) underlying cardiovascular disease; (2) a witnessed arrest; (3) bystander CPR; and (4) the presenting rhythm. Agreement between pairs of abstractors was determined by computing kappa values.

Results:

Kappa values for each variable, for abstractors without and with decision rules were: (1) 0.23, 0.33; (2) 0.39, 0.41; (3) 0.43, 0.66; and (4) 0.65, 0.80. Kappa values consistently were higher for the pair of abstractors using decision rules. The degree of improvement varied with the difficulty of the decision required.

Conclusion:

The addition of decision rules to variable definitions is worthwhile but does not ensure good or excellent levels of agreement in data abstracted from records by paramedics.
Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest
Authors: Spaite Daniel W. , Criss Elizabeth A. , Valenzuela Terence D. , Meislin Harvey W. , Ross John
Published: July 2016

The purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p<0.05 considered significant. Two hundred ninety-eight cases were recorded of which 293 patients (98.3%) had documented ST (study group). Seventy-nine patients (27.0%) had ST <12 minutes, while 214 (73.0%) had ST≥12 minutes. Patients with ST <12 minutes were more likely to have return of spontaneous circulation in the field (26.6% vs. 15.9%, p<0.05) and also were more likely to survive than were patients with ST ≥12 minutes (13.9% vs. 6.5%, p<0.05). Mean ST for survivors was significantly less than for non-survivors (12.8 vs. 15.3 min., p<0.05).

We conclude that, in our system, adult victims of CA with ST <12 minutes are more likely to survive than are patients with longer ST. In addition, the mean ST for survivors is shorter than for non-survivors. It remains unclear whether shorter ST actually has an impact on survival or is merely a reflection of a sub-group with rapid resuscitation and consequently a higher likelihood of survival. Future investigations are needed to determine whether shorter ST actually impacts the likelihood of survival from CA.
Diagnosis of Premature Ventricular Complexes: Common and Often Forgotten Rules
Authors: Jansen Diana J. , Robinson Nancy E. , Birnbaum Marvin L.
Published: July 2016

Prehospital and hospital emergency medical care providers frequently rely on the electrocardiogram (ECG) to assist them in the differential diagnosis of complex patient problems and as such, the ECG often constitutes a major determinant of the definitive treatment selected. The purpose of this exercise is to review a small portion of the vast area of ECG interpretation: specifically, those rules that guide the practitioner in the diagnosis of Premature Ventricular Complexes (PVCs).

Premature ventricular complexes (PVCs) occur in multiple individuals in multiple settings. Due to these differences, the causes, implications, and treatment of PVCs must be individualized. Thus, the scope possible for this discussion is huge. Consequently, this exercise will focus only on helping the practitioner correctly identify PVCs.
A Comparison of Field Techniques Used to Pressure-Infuse Intravenous Fluids
Authors: White Steven J. , Hamilton William A. , Veronesi James F.
Published: July 2016

Application of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in two trials using a 1-liter bag of saline though a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80cm served as the control.

Pressure infusers generated flow rates of 257±54 ml/min and 296±53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2–2.5 times that of gravity flow (123±2 ml/min) and significantly greater than those rates obtained by any other method (p<.0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184±46 ml/min and 173±40 ml/min achieved by each of two different squeezing methods (p<.01). Neither blood pressure (BP) cuff application and inflation (135±28 ml/min) nor kneeling on the bag (125±36 ml/min) was better than gravity alone.

These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field.
Measures for Increased Nutrition and Utilization of Non-Conventional Food Resources during Disasters in Africa
Authors: Nur Idris M.
Published: July 2016

The basic causes of the poor performance of the food and agricultural sector in the different parts of Africa are external, internal, and natural. The general recession in the Continent limits the capacity of the respective countries to import food to supplement inadequate domestic production and supplies.

There are a number of nutritious food resources, both cultivated and gathered in the different ecological zones of Africa, whose production and consumption can be increased to ensure adequate food security and a nutritious diet, especially during disasters. These food resources could include: cereals, legumes, fruits, vegetables, fish, and insects. These food resources already are available over wide geographical areas in Africa and are utilized or utilized to a limited extent.

Therefore, strategies to increase food supply, eradicate hunger and malnutrition, and keep people alive in times of disasters should have as a priority, the cultivation and consumption of non-conventional food resources in the respective communities and countries.
DC Defibrillators: The Difference Between Selected and Delivered Energy
Authors: Shiner Stephen L. , Gold Martin I.
Published: July 2016

There is controversy over the “ideal” electrical energy needed for defibrillation. Furthermore, too massive an electrical shock decreases the possibility of survival by direct damage to an already ailing myocardium and too little energy results in further deterioration of myocardial physiology and metabolism. Therefore, delivery of an erroneous amount of electrical energy decreases the likelihood of successful defibrillation and survival. All 190 defibrillators within 3 medical school hospitals were investigated. Each defibrillator was analyzed at four selected settings ranging from 100-400 Joules (J). Only 29 of 190 defibrillators delivered 100% of the energy selected, while 161 of the 190 (85%) delivered an average of 74% of the energy selected. This discrepancy between selected and delivered energy should be corrected by regulations and standards for manufacturers.
The Group Process: A Regional Disaster Planning Methodology for Multidisciplinary Consensus
Authors: Brown Frank L. , Connelly Sharon L.
Published: July 2016

In accordance with the 1973 Emergency Medical Services Systems Act in the United States, one of the 15 functions to be performed by every EMS (Emergency Medical Services) system is disaster planning. The predicate of success in remediating such a macrosystem challenge as regional disaster planning requires the consensus of multidisciplinary health care and public safety human resources prior to the effective cataloging of physical resources. As the emergency physician is the medical leader of EMS system design and implementation, it is important that he explore newly developing disaster planning methodologies to facilitate consensus disaster planning.
New Ambulance Design for the Third World
Authors: Lane John C. , White Roger D. , Toledo Luis C. , Tincani Alfio J. , Katayama Massami , Takaoka Kentaro , Gessner Harald U. , Stasiukynas Alberto J. , Frigeri Nicola , Bertazzi Marcos A. , von Reininghaus Ruediger , Grudzinski Georg
Published: July 2016

Important modifications in ambulance design were suggested and introduced by Safar in 1965 and in 1971. However, most of these modifications have not reached the developing countries. The present “ambulance” in these countries are low ceiling and carry no equipment or trained personnel. They could be better defined as “taxis for horizontal transportation.” Recently, we have been able to introduce onto the market of these countries, a new ambulance that is competitive in price and adapted to the availability of materials, equipment, and personnel.
The Mega Code for Advanced Cardiac Life Support (ACLS): Training and Performance Evaluation
Authors: Kaye William , Sladen Arnold , Stewart Ronald
Published: July 2016

ACLS for cardiac arrest consists of basic life support, which includes mouth-to-mouth breathing and external chest compression; management of the airway with adjunctive equipment including intubation and ventilator support with supplemental oxygen; recognition of specific cardiac dysrhythmias and appropriate emergency therapy; electrical defibrillation and cardioversion; techniques for placement of intravenous lines; diagnosis of and therapy for acidbase abnormalities with particular emphasis on respiratory and metabolic acidosis; drug therapy during the pre-arrest phase, the cardiac arrest itself, and the period following resuscitation; and stabilization, to prevent cardio-respiratory arrest, and during the post-resuscitation period. In 1975, the American Heart Association developed an ACLS Training Program in which cognitive knowledge is presented at lectures and practical skills are taught and tested at several performance stations.
Training Course in First Aid Under Disaster Conditions
Authors: Korver Adriaan J.H.
Published: July 2016

Under the auspices of the Organization for Civil Defence, the Netherlands Red Cross and the National Union for Lifesaving and First Aid “The Orange Cross”, a training course in First Aid under Disaster Conditions was started in 1979.

This training course is meant for laymen, who, after having obtained their First Aid certificate, will participate in the medical care of disaster victims. The contents of the training course are discussed. In order to obtain a clear insight into the training course, attention is also paid to the Medical Disaster Relief Organization.
The Health Environmental Effects of the Mt. St. Helens Volcanic Eruption of 1980
Authors: Heller Jacob L.
Published: July 2016

St. Helens is one of a group of high volcanic peaks that dominate the Cascade Range between northern California and southern British Columbia, Canada. The distribution is in a band that roughly parallels the coastline of the so-called “Ring of Fire,” a near circular array of volcanoes located on islands, peninsulas and the margins of continents that rim the Pacific Ocean.
1980 Earthquake in Basilicata
Authors: Molfese Antonio
Published: July 2016

On November 23rd, 1980 at 7:34 p.m. a violent earthquake, 6 on the Richter scale, hit the South of Italy, at precisely the Regions of Campania and Basilicata. The shock lasted 80 seconds, causing death and destruction.

Basilicata, one of Italy's Southern Regions, has already been hit by several other earthquakes in the past, which seriously damaged its population and territory. It is a most mountainous region, with the only exception being a very small plain stretching towards the sea.
Pre-Earthquake Vulnerability Assessment
Authors: Eldar Reuben , Adler Jakov
Published: July 2016

Health planning for disasters builds on an awareness of ways in which the disaster affects health and on anticipation of tasks to be performed by the health sector.

In view of the possibility of an earthquake of significant magnitude in Israel, and in the absence of previous earthquake experience, published data of earthquake health effects were studied, such as causes of death and injury, casualty rates and factors influencing these, distribution of injuries and their severity, effect on health care facilities and on physical, social and psychological environments. Implications of the studied data were applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, and space and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel.

On the basis of this assessment some recommendations for the preparation and preparedness of the health sector for such an occurrence are submitted.
Improvements in the Transport of the War Wounded: Circa 1792
Authors: McLaren C.A.B.
Published: July 2016

The Falkland Islands conflict in the South Atlantic once again drew attention to the paramount importance of making adequate plans for the treatment of the sick and wounded, and their subsequent removal from the battle area. The pages of history are littered with accounts of battles, and in some cases wars, being lost because of the inadequate or non-existent plans made to give logistic medical support to the fighting units
Disaster Triage by Advanced Emergency Medical Technicians
Authors: Doyle Constance J. , Birney Richard E.
Published: July 2016

Many disaster plans are based on the presence of a physician at the scene to perform triage. This requirement originated when there were no trained paramedical personnel in the field and may actually delay care in rural areas where a physician may not be readily available or may be the only physician at the hospital.

It is our hypothesis that properly trained Advanced Emergency Medical Technicians (AEMT's) may serve as triage officers for rural disasters with little difference, and perhaps improvement, in the outcomes of medical care. AEMT's are among the first responders to arrive at scenes of accidents and often triage from three to five trauma patients in multiple victim accidents on the highway. They are on duty, available and strategically located both day and night. The AEMT's are familiar with working under field conditions, i.e. at night by headlight, in rain, snow, and darkness, and know extrication procedures. They are aware of environmental hazards. They have radio and telemetry communication with a physician when needed.
Prehospital Care for Patients with Head Injury and its Relevance to Post Traumatic Prognosis
Authors: Singbartl G.
Published: July 2016

Head injury has been demonstrated to be one of the most important lesions in polytrauma patients and of very decisive relevance to the posttraumatic prognosis. Moreover, other lesions and their sequelae (e.g. shock, thorax trauma) are known to worsen the primary cerebral injury by causing secondary brain damage due to hypotension and hypoxemia. This study considers the influence of prehospital emergency care to the posttraumatic prognosis in severe head injuries.
Controversial Aspects of PEEP Ventilation in Emergency Medicine
Authors: Dick W. , Schutz I.
Published: July 2016

Controlled mechanical ventilation using positive and expiratory pressure (PEEP) is a well-established therapeutic measure in intensive care. Its early application has been shown to markedly decrease morbidity and mortality, especially in polytraumatized patients with an acute respiratory distresss syndrome. It therefore seems reasonable to use positive end expiratory pressure as early as possible in the clinical treatment of emergency patients before extensive pulmonary changes have had time to develop completely.
A Review of Pulmonary Barotrauma in Scuba Diving Accidents
Authors: Mathew B.G.
Published: July 2016

The increasing popularity of scuba diving as a sport necessitates that emergency personnel become familiar with medical diving problems. It is important to understand that pulmonary barotrauma can be sustained with an uncontrolled ascent of little more than 1 meter. This can occur under any circumstance in which compressed air is breathed under water. The most common is scuba diving or submarine escape training, but it may also be encountered when a person escapes from a submerged car or a child surfaces after breathing from an inverted bucket in a swimming pool. Two cases of pulmonary barotrauma are reported and the spectrum of presentation of this condition is discussed.

Knowledge of this condition increases clinical awareness resulting in early diagnosis and effective treatment. It will be shown that it is better to over treat this condition, as the side effects of treatment are minimal and the results of failure to treat can be disastrous.
The Civil Defense System of Switzerland
Authors:   Civil Defense Office, Bern
Published: July 2016

The Swiss Civil Defense system forms part of the national defense, has no combat tasks, and aims at the protection, rescue of, and care for the entire population of Switzerland. Horizontal evacuation is considered impractical and unrealistic. Vertical evacuation into special shelters in homes, public buildings, factories, etc., is the focus of CD. planning efforts. Shelters have increased air pressure, are artificially ventilated, are equipped with gas filters and are strong enough to give a relative protection against outside pressure, irradiation, chemical contamination and missile fragments of conventional weapons. The Swiss CD. system is to ameliorate the direct or indirect effects on the population of conventional, chemical, or nuclear war.
Controversies about Disaster Medicine and Nuclear War
Authors: Rebentisch Ernst
Published: July 2016

The German Association for Disaster Medicine published the following declaration for physicians, citizens and governments (J. German Physicians, June 24, 1983, pg. 39): “Disaster medicine defines as the limit of its applicability situations in which violence and the dimension of destruction will make every systematic and organized aid impossible; this would be the case in a nuclear war.” This explanation would show the right way to act for those who reject disaster medicine, as they consider it an alleged preparation for nuclear war — i.e., some members of the peace movement. This declaration also addresses authorities, so that they will not cherish false expectations. Some of these allegations culminate in the statement that the physicians supporting disaster medicine would suggest to the political and military leaders that nuclear warfare could be risked. This is obvious nonsense.
Civilian Emergency Hospital Plans for Conventional War in Sweden
Authors: Norberg Karl-Axel , Brismar Bo
Published: July 2016

In war a large number of military and civilian wounded and injured patients, and patients with disease, will increase the strain on the system of medical care. The expected distribution of injured in a conventional war can be estimated on the basis of previous war experiences, especially from World War II (1), the Korean war (5), the Vietnam war (7, 8), and the Arab-Israel wars (3). Corresponding figures for the civilian population are less readily accessible. Statistical data from previous wars as well as expected weapon development can be compared with data from various peacetime accidents and disasters. Thus, the expected distribution of injuries can be estimated (Table 1) (7).
Military-Civilian Collaboration for Disaster Medicine in Canada (Discussion Comment)
Authors: Armstrong Barry
Published: July 2016

Besides defense, a military organization can protect a country in two ways: (1) Ensure the integrity of a country despite internal disasters and disturbances; military aid can have a humanitarian role. (2) International responsibilities.

The Canadian Forces participate in peacekeeping and disaster relief all over the globe. This international military job results in increased prestige for Canada and security for Canadians.
Health Care for South Lebanon's Civilian Population Following the June 1982 War
Authors: Tulchinsky T.H. , Adler Yakov
Published: July 2016

Following the June 1982 war in South Lebanon, the Israel Ministry of Health sent a medical team to assess health conditions in the area, to assist in the restoration of local health services, and to provide additional medical assistance as needed in public health and specialized medical services. For the approximately 600,000 population of the area, public health sanitary conditions were restored by local authorities, with some external assistance. Sanitation and housing for the refugee camp populations were difficult to solve because of extensive damage in the camps; but United Nations activities, supported by international and Israeli sources, were effective. Epidemic conditions did not occur. Monitoring for specific infectious diseases showed increases not exceeding usual summer conditions. Child nutrition status was satisfactory. Medical needs for specialty services, not available in South Lebanon, were arranged through screening and referral to Israeli hospitals. Renal dialysis needs were met by establishing a dialysis unit using local personnel in a damaged and non-functioning government hospital. Private medical and hospital services, the bulk of health care in the area, functioned except for minor dislocations throughout the war and post-war period. Israeli medical aid, managed by a small multidisciplinary team, was designed to assist and, where necessary, augment rather than replace local health services.
Lung Function During Hoist Rescue Operations
Authors: Haagensen Rolf E. , Sjöborg Karl-Ake , Mjelstad Stig , man Rescue , Steen Petter A.
Published: July 2016

Introduction: A case is presented in which a 43-year-old man suffering from a severe asthma attack, had ventilatory arrest during a hoisting procedure. Based on this experience, the influence of three hoisting techniques on lung function was tested.

Methods: The ventilatory capacity of 12 healthy volunteers was tested during three commonly used hoisting techniques: 1) single sling; 2) double sling; or 3) strapped to a stretcher.

Results: The vital capacity (VC) and the one-second, forced expiratory volume (FEV1) were reduced significantly during all hoisting techniques compared to the standing position. The reduction was significantly more pronounced on a stretcher than in either sling position. There were no differences in the FEV1 to VC ratio between the positions.

Conclusion: The small reduction in ventilatory capacity during hoisting procedures is tolerated easily by healthy individuals, but should be taken into account when planning such procedures on patients with severe pulmonary disease.