bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons Learned and Unsolved Public Health Problems After Large-Scale Disasters
Authors: Koscheyev Victor S. , Leon Gloria R. , Greaves Ian A.
Published: July 2016

Background:

This paper examines the considerable medical and psychological problems that ensue after disasters in which massive populations are affected for extended and sometimes unknown time periods. The organization of disaster response teams after large-scale disasters is based on experiences as a medical specialist at Chernobyl immediately after this catastrophe. Optimal ways of dealing with the immediate medical and logistical demands as well as long-term public health problems are explored with a particular focus on radiation disasters. Other lessons learned from Chernobyl are explained.

Issues:

Current concerns involve the constant threat of a disaster posed by aging nuclear facilities and nuclear and chemical disarmament activities. The strategies that have been used by various groups in responding to a disaster and dealing with medical and psychological health effects at different disaster stages are evaluated. The emergence of specialized centers in the former Soviet Union to study long-term health effects after radiation accidents are described. Worldwide, there has been relatively little attention paid to mid- and long-term health effects, particularly the psychological stress effects. Problems in conducting longitudinal health research are explored.

Recommendations:

The use of a mobile diagnostic and continuously operating prehospital triage system for rapid health screening of large populations at different stages after a large-scale disaster is advisable. The functional systems of the body to be observed at different stages after a radiation disaster are specified. There is a particularly strong need for continued medical and psychosocial evaluation of radiation exposed populations over an extended time and a need for international collaboration among investigators.
Feedback to Emergency Medical Services Providers: The Good, the Bad, and the Ignored
Authors: Mock Elisabeth F. , Wrenn Keith D. , Wright Seth W. , Eustis T. Chadwick , Slovis Corey M.
Published: July 2016

Hypothesis:

To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel.

Methods:

Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale.

Results:

In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (<1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill.

Conclusion:

The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.
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 turn 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±6 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.
Assessment of a Triage Label System during a Major Incident Exercise
Authors: Barton D. , Bodiwala G. G.
Published: July 2016

The Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties—Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards.
Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation
Authors: Valenzuela Terence D. , Spaite Daniel W. , Clark Lani L. , Meislin Harvey W. , Sayre Raymond O.
Published: July 2016

Hypothesis:

Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technician (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VF) in adult patients.

Methods:

A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms.

Results:

Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR, These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US]$2,834 versus $4,881 without ETCPR. The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation.

Conclusion:

The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.
A Model Strategy for Teaching Prehospital Personnel Management of Patients with Alzheimer's Disease
Authors: Cason Debra , Wilson Rosemary Wade , Chafetz Paul K. , McIntire Donald D.
Published: July 2016

Accompanying the graying of America is the increased incidence of Alzheimer's Disease (AD) and the need to teach prehospital personnel how to manage these patients. The purpose of this project was to develop an instructional strategy to teach prehospital personnel about AD and some basic management techniques. This information includes: causes of acute and gradual onset confusion in the elderly; symptoms and course of AD; mental status exam; methods to facilitate communication; techniques to avoid confrontation; and means to identify personal feelings about the elderly and AD.

Teaching methodology includes instructional objectives, videotape presentation of didactic/clinical material, videotape situations demonstrating patient management techniques, role playing exercises, and discussion groups.

The videotape presentation portion of the teaching methodology was shown to be effective as a single instructional strategy. One hundred and thirty-four EMS personnel were given a sixteen item exam before and after the videotape presentation. Pre-test to post-test difference was significant at p=.001. The additional instruction components may further impact the knowledge of AD and positive delivery of care to the elderly.
Vital Signs Records Omissions on Prehospital Patient Encounter Forms
Authors: Moss Robert L.
Published: July 2016

Introduction:

A reported in-field, prospective evaluation of 227 prehospital patient assessments by advanced life support (ALS) emergency medical technicians (EMTs) found a frequent failure to measure vital signs. The objective of this retrospective review was to report the omission frequency of vital signs found in a centralized emergency medical services (EMS) data collection system.

Methods:

The EMS database contained information from 90,480 optically scanned, prehospital patient encounter forms. Each record identified EMT skill levels, response times, dispatch type, vital signs, medical and trauma information, treatment, and patient disposition. Records for 1989 and 1990 were collected from 92 rural EMS providers who responded to emergency medical and trauma events.

Results:

Of 90,480 emergency responses, 14,129 (15.6%) were false alarms, deceased, or canceled without vital patient contact. Valid encounters were documented for 76,351 (84.4%) patient contacts. Systolic blood pressure measurements were not recorded for 13,262 (17.4%) patients. Diastolic blood pressure was not recorded for 14,272 (18.7%) patients. A pulse record was not recorded for 12,125 (15.9%) patients. A ventilatory rate was absent in 12,958 (17.0%) patient records.

Conclusion:

This study found a frequent failure by non-metropolitan basic life support (BLS) and advanced life support (ALS) EMTs to record vital signs on prehospital emergency patient encounter forms. It supports a previous report of direct in-field observations of ALS EMTs failing to measure vital signs during patient assessment. The impact of vital sign omissions upon individual patient care can be assessed only by receiving medical control physicians. In the absence of effective emergency physician networking, the statewide magnitude of the problem among BLS and ALS EMTs has not been recognized as a system issue.
ExacTech Blood Glucose Meter Clinical Trial
Authors: Bartkus Edward A. , Daya Mohamud , Hedges Jerris R. , Jui Jonathan
Published: July 2016

Introduction:

Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia.

Objective:

To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly.

Methods:

Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample, was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods.

Results:

A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (<60 mg/dl) and 23 (28.8%) were hyperglycemic (>180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40–450 mg/dl) was 0.8656 (p <.001). If the prehospital “definition” of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population.

Conclusion:

The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals.
Public Perceptions of a Rural Emergency Medical Services System
Authors: Brown Lawrence H. , Prasad N. Heramba , Grimmer Kirk
Published: July 2016

Introduction:

To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system.

Hypothesis:

Citizens and physicians are unaware of the capabilities of the EMS system.

Methods:

Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p <0.01.

Results:

A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p <0.001).

Conclusion:

This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.
The Effect of Prehospital Transport Time on the Mortality from Traumatic Injury
Authors: Petri Roland W. , Dyer Alan , Lumpkin John
Published: July 2016

Objective:

To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.

Design:

Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.

Participants:

A total of 5,215 injured persons with an Injury Severity Score (ISS) >10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.

Measurements:

Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.

Results:

Patient outcomes were significantly different statistically between ISS groups (p <0.001, X2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p <0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p <0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p <0.001, two-way analysis of variance).

Conclusion:

No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time <90 minutes exerted a significant adverse effect upon survival.
EMS Providers Do Not Accurately Note Motor-Vehicle Crash Patients With Positive Serum Alcohol Concentrations
Authors: Maio Ronald F. , Wu Audrey , Blow Frederic C. , Zink Brian
Published: July 2016

Introduction:

Alcohol use is associated with many motor-vehicle crashes and may increase the severity of injury. Because alcohol use also may mask injury, prehospital emergency care providers (PHECPs) may make inaccurate assessments. To assess and triage crash victims accurately, PHECPs must identify recent alcohol use.

Study Objective:

This study examines the accuracy of PHECPs in identifying motor-vehicle crash victims who had positive serum alcohol concentrations.

Design:

Retrospective cohort study.

Population:

Included in the study were motor-vehicle crash victims more than 17 years of age who were conveyed directly to a university medical center emergency department by ground ambulance (n = 372).

Time Period:

15 July 1990 to 15 July 1991.

Methods:

Data sources included ambulance report forms and hospital records. Variables that were abstracted included the Revised Trauma Score (RTS), the PHECPs' impression of alcohol use, and serum alcohol concentrations. Sensitivity, specificity, predictive-value positive, predictive-value negative, and 0.95 confidence intervals (0.95 CI) were calculated for the PHECPs' ability to identify patients with a serum alcohol concentration >0. The relationship between the RTS and the impressions of alcohol use was analyzed with chi-square testing: a p-value of <0.05 was considered statistically significant.

Conclusion:

This study suggests that tims with positive serum alcohol concentrations. Selection bias and retrospective design are significant limitations of this study. Future studies should develop and evaluate methods to improve PHECPs' accuracy in assessing alcohol use in motor-vehicle crash victims.
Using Interactive Videodisc to Test Advanced Airway Management Skills
Authors: Rubens Arthur J. , Stoy Walt , Piane Gina
Published: July 2016

Purpose:

To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration.

Methods:

The study was a nonrandomized, nonequivalent comparison group design of a convenience sample of 86 American Heart Association (AHA), advanced cardiac life support (ACLS) students, who obtained instruction in airway management by the interactive videodisc (IVD) learning system (n = 41), or by the traditional method of demonstration/return demonstration (n = 45). The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal (ET) intubation and esophageal obturator airway (EOA) insertion.

Results:

No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated. However, initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect (p = 0.004) compared to ACLS students learning by the traditional method. This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification. In a post-test satisfaction questionnaire, 34 IVD students reported satisfaction with learning airway management using this instructional method, but also expressed a preference to have an ACLS instructor available.

Conclusion:

This study highlights the role of IVD in teaching the complex skills of advanced airway management.
Medical Care at Mass Gatherings: Considerations for Physician Involvement
Authors: Parrillo Steven J.
Published: July 2016

Although many authorities define a “mass gathering” as a group exceeding 1,000 persons, several times that number likely are to be present. The event for which the group will gather may be anything from a rock concert to an Olympic competition. Preparations for the event can be minor or major. This article reviews the issues that a physician should consider if he or she chooses to become involved in the delivery of medical care to such populations, as well as the evidence suggesting that a physician should be involved in most such gatherings.

Emergency medical care at public gatherings is haphazard at best and dangerous at worst.

There are surprisingly few data from which to plan the emergency medical needs for public events and no recognized standards or guidelines for providing emergency medical services at mass public gatherings.
The Consequence of Land Mines on Public Health
Authors: Kakar Faiz , Bassani Fabrizio , Romer C.J. , Gunn S.W.A.
Published: July 2016

An estimated 110 million land mines scattered in 64 countries continue to terrorize people and destroy human lives long after wars and fighting have ceased. Despite efforts to clear these devices, their numbers continue to increase and their presence, constitutes a substantial threat to public health in the affected countries. Direct consequences include both the physical and emotional injuries from the impact, flying debris, and structural collapse associated with their detonation. Indirect consequences include increases in the incidence of waterborne diseases, diarrhea, malnutrition, infectious diseases, and spread of the human immunodeficiency virus associated with the increased use of blood. Those at highest risk of these latter consequences are mostly the disadvantaged poor, especially children. Psychiatric disorders, such as post-traumatic stress disorder, occur in those not directly injured as well as those physically wounded by the explosion.

Besides efforts to ban production, stockpiling and export of land mines, a comprehensive and integrated health program aimed at the prevention, treatment, and rehabilitation of those injured directly or indirectly by land mines is needed urgently. Strategies should include mine-awareness programs, enhanced transport of those directly injured, training the villagers in first aid, augmenting the capacity and quality of treatment facilities, improving the psychological support and treatment capabilities, development of rehabilitation programs, and the institution and enhancement of public-health programs directed at the indirect consequences associated with the presence of land mines.

Land mines constitute a major public-health problem in the world that must be addressed.
Evaluation of the Pediatric Trauma Triage Checklist as a Prehospital Pediatric Trauma Triage Tool for the State of Florida
Authors: Johnson William P.
Published: July 2016

Introduction:

Triage of injured children poses a significant challenge for prehospital-care providers because there is no single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not “user friendly” for field personnel. As such, the PTS has been modified to generate the more user-friendly ”pediatric trauma triage checklist (PTTC).”

Methods:

This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center.

Results:

The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0%. The PTTC demonstrate an overtriage rate of 58.3% and an under-triage rate of 13.8%. When compared with a previous study, the PTTC demonstrated a 74 % increase in overtriage. However, the 59% reduction in undertriage is more important.

Conclusions:

Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.
Does Ambulance Crew Size Affect On-Scene Time or Number of Prehospital Interventions?
Authors: Brown Lawrence H. , Owens Charles F. , March Juan A. , Archino Elizabeth A.
Published: July 2016

Introduction:

While large cities typically staff ambulances with two emergency medical services (EMS) professionals, some EMS agencies use three people for ambulance crews. The Greenville, North Carolina, EMS agency converted from three-person to two-person EMS crews in July 1993. There are no published reports investigating the best crew size for out-of-hospital emergency care.

Hypothesis:

Two-person EMS crews perform the same number and types of interventions as three-person EMS crews. Two-person EMS crews do not have longer on-scene times than do three-person EMS crews.

Methods:

Data for the two most common advanced life support calls in this system—seizures and chest pains—were collected for the months of June and August 1993. Three-person EMS crews responded to both types of calls in June. In August, two-person EMS crews responded to seizure calls; two-person EMS crews accompanied by a fire department engine (pumper) with additional manpower responded to chest pain calk. The frequency of specific interventions, number of total interventions, and scene times for the August calls were compared to their historical control groups, the June calls.

Results:

One hundred twenty-six patient contacts were included in the study. There were no significant differences in total number or types of procedures performed for the two patient groups. Mean on-scene time for patients with seizures was 11.0±4.2 minutes for three-person crews and 19.4±8.3 minutes for two-person crews (p <0.001). Mean on-scene time for patients with chest pain was 13.6±4.9 minutes for three-person crews, and 15.4±3.2 minutes for two-person crews assisted by fire department personnel (p >0.05).

Conclusion:

Two-person EMS crews perform the same number of procedures as do three-person EMS crews. However, without the assistance of additional responders, two-person EMS crews may have statistically significantly longer onscene times than three-person EMS crews.
Sources of Stress Among Emergency Medical Technicians (Part I): What Does the Research Say?
Authors: Boudreaux Edwin , Mandry Cris
Published: July 2016

Research repeatedly has demonstrated that organisms exhibit adaptive physiological, emotional, and behavioral responses when exposed to noxious or threatening environmental stimuli. However, when the noxious stimuli are excessive or prolonged, efforts to cope may become overwhelmed, and the adaptive responses can turn into maladaptive reactions (e.g., illness, depression, and impaired performance). According to this model of stress, people who work in occupations that continually place them in danger or repeatedly force them to encounter psychologically demanding or distressing situations would appear to be at greater risk for developing adverse stress reactions.

Both anecdotal evidence and empirical research suggest that prehospital emergency medical services (EMS) may be a particularly high-stress field, placing emergency medical technicians (EMTs) at risk for developing such maladaptive stress reactions. This article reviews and synthesizes the empirical literature investigating the sources of stress among EMTs, and concludes with critical comments and guidelines for future research. The authors intend this review to be a resource for investigators conducting research in this area, as well as a convenient summary for anyone interested in learning more about the stressors EMTs experience, particularly mental health professionals and EMS administrators coordinating stress-management programs for EMTs.
Emergency Medical Services (EMS) Lessons for Worldwide Health Care
Authors: Caroline Nancy L.
Published: July 2016

I should like in these remarks to try to place the discussions of this Congress in a larger perspective and perhaps to broaden somewhat our concept of what constitutes a medical emergency, and what should be labelled as a disaster. I should also like to ask whether emergency care and disaster planning as we usually think of these activities are either affordable or useful when viewed in a global context. What are the day-to-day emergencies and major disasters of this planet, and are we addressing them properly with the emergency medical services systems as now constituted?
Emergency Medicine in the United Kingdom—How It Is Taught
Authors: Marsden Andrew K.
Published: July 2016

The staff of accident and emergency departments in the United Kingdom are realizing their increasing role in teaching the elements of emergency care. This paper highlights some recent developments which have influenced the way in which emergency medicine is taught.

First Aid instruction aims to impart the universally agreed and accepted principles to a wide ranging audience. Traditionally these principles have been embodied in the combined manual of the St. John Ambulance Service, St.
The SAMU System of France
Authors: Cara M. , Lareng L. , Gaston J.T.
Published: July 2016

Our emergency medical services (EMS) system is called SAMU (“Service d'Aide Medicale d'Urgence”). It was initiated in Paris in 1956. Since that date, it has developed a new concept of emergency transportation, which excludes speed as the best way for saving life threatened by danger. Indeed, this EMS System is based upon the same principles that are used everywhere, but there are some practical differences which are characteristic of the service in France. One example is the medicalization (physician-staffing), which permits excluding speed in transportation.

Everywhere, the fundamental EMS principle is to struggle against time to give efficient care as soon as possible. In emergency situations, all things are simpler and all treatment is more efficient if you can do it within the limit of time available for resuscitation. If this limit is surpassed, success is dubious. The means to reach it are more sophisticated and cost increases tremendously; however, the mortality goes up inexorably to death in all severe cases.
Hyperthermia with Cardiac Arrest, CPR and Irreversible Shock in Monkeys
Authors: Sassano John , Eshel Gideon , Safar Peter
Published: July 2016

Each year 4,000–9,000 people die in the USA from hyperthermia-related crises, such as heat stroke and febrile convulsions. In most of these cases, variable combinations of hot environment, physical exercise, dehydration, and infection can be identified. Heat stroke is a complex clinical picture with poorly understood pathophysiology and unexplored resuscitation potentials. Protection of vital organs against hyperthermia is also important for cancer therapy.

This study (1978–1980) was aimed exclusively at the effects of controlled hyperthermia. In pilot experiments on lightly anesthetized dogs and rhesus monkeys, brain temperature was raised to 42°C for 1/2–1 hour by immersion heating. This was followed by cooling to normothermia. Partial recovery with a lucid period of 1 hour or longer was followed by diffuse gastrointestinal bleeding and irreversible shock in spite of standard life support measures.
Disaster Planning in the Stockholm Region of Sweden: Medical Teams for Qualified First Aid
Authors: Brismar Bo , Norberg Karl-Axel
Published: July 2016

Although in Sweden the risk of natural catastrophes is small, several have occurred in recent years. Two examples are a storm disaster in 1970 and a landslide in 1978—both causing extensive personal and material damage.

Other disasters can be caused by human activity in different forms, for instance, fires, explosions and accidents involving public transport, and also—a subject of much concern today—accidents at nuclear power plants. Terrorist actions have also led to serious disaster situations in recent years.

Common to the different types of disasters from the viewpoint of medical care is the fact that locally available resources are often inadequate. Even with very good access to ambulances and other forms of medical transport the waiting time at the scene of the accident can be so long that many patients suffer from acute respiratory distress, major hemorrhages and shock. Under such circumstances qualified first aid can be expected to reduce the morbidity and mortality considerably.
Refugee Camp Medical Care During Cambodian Disaster Relief
Authors: Feldstein Bruce , Weiss Robert
Published: July 2016

The Khao I Dang Holding Center for Kampucheans opened November 21, 1979 as part of an effort to bring relief to the thousands of Cambodian on the eastern frontier of Thailand. The camp population increased from 4800 that first day to 50,000 by December 1, 1979 and 110,000 by mid-January, 1980. Sixty-one percent (61%) of the population were 15 years of age and older; 12% of these over 44. Thirty-nine percent (39%) were children under 15.

Although each disaster is unique, the medical problems for a type of disaster in a stated area are considered predictable. This was not the case at Khao I Dang for hospital pysicians in providing patient care. It has been shown that relief efforts are amenable to study, yet such studies have been handicapped by a lack of data. Since major disasters involving international aid are reported several times a year, the problem is considerable.
The Three Mile Island (TMI) Nuclear Accident: Revisited
Authors: Reid Donald
Published: July 2016

At 0400 hours on Wednesday, March 28, 1979, an extremely small and initially thought unimportant malfunction occurred at the nuclear power plant at Three Mile Island (TMI). Within a short period of time, that malfunction would turn into an event of momentous impact with repercussions felt over most of the world. The events of that malfunction would cause TMI to be labelled as the worst commercial nuclear incident in history and transform it into the nuclear test tube of the universe. What really happened at Three Mile Island? Thirty-six seconds after 0400 hours, several water pumps stopped functioning in the unit 2 nuclear power plant. In the minutes, hours and days that followed, a series of events—compounded by equipment failure, inappropriate procedures and human errors—escalated into the worst crisis yet experienced by the nation's nuclear power industry. This resulted in the loss of reactor coolant, overheating of the core, damage to the fuel (but probably no melting) and release outside the plant of radioactive gases. Hydrogen has was formed, primarily by the reaction between the zirconium casing that holds the radioactive fuel and steam. There, however, was no danger of the bubble inside the reactor vessel exploding, because of the absence of oxygen within the reactor.
43. Prehospital Determination of Eligibility for Thrombolytic Therapy
Authors: Delozier T , White LJ , Dougherty JM ,   the Summit County Prehospital Research Group
Published: July 2016

Purpose: To determine the degree of concordance between thrombolytic checklists completed by emergency medical technicians (EMTs) in the field and corresponding checklists completed by emergency physicians in the emergency department (ED).

Methods: This was a comparative analysis of matched pairs of thrombolytic checklists. Subjects included patients 35 years or older with clinical signs or symptoms of cardiac origin who were transported to the ED by ambulance. The checklist contained 12 items and was completed by EMTs during transport of eligible patients. An identical checklist was completed in the ED by an emergency physician upon arrival of the patient. The main outcome measurement was concordance between the matched pairs.
48. Age, Sex, Ethanol Levels, and Helmet Use Among Injured Motorcyclists
Authors: Lober William B. , Judkins Daniel G.
Published: July 2016

Introduction: Previous studies of motorcycle injuries show that helmet use is associated with a decrease in head trauma. Understanding patterns of helmet use is important in selecting and assessing injury prevention strategies.

Methods: All 470 motorcyclists presenting to either of two regional Level I trauma centers from 7/93 through 12/95 comprise this case series. Thirty-three patients were excluded due to unknown helmet use or outcome, and 50 due to age under 18 years (for whom helmet use was required by state law).

Results: Of 386 patients, 42% wore helmets, and 58% did not, with no difference in the mean ages of the groups. 13% of patients were women (n = 50), and 10% were passengers (n = 38). Women were 25 times more likely than men to be passengers (95% CI: 11 to 50), and passengers were 5 times more likely than drivers to not wear a helmet (95% CI: 2 to 16). Helmet use was not related to sex, even when the data were controlled for driver vs. passenger. Of 265 patients assayed for ethanol, 30% had >100 mg/dL, 7% had <100 mg/dL, and 63% had none. Non-helmeted patients were 3.6 more likely than helmeted ones to have detectable ethanol (95% CI: 2.0 to 6.5), but there was no association with sex or age. The mean ethanol level was 80 mg/dL in non-helmet users, and 24 mg/dL in helmet users (p <0.001). 39% of non-helmeted patients were legally intoxicated (ethanol > 100 mg/dL), compared to 11% of helmeted ones.
25. A Prospective Time-Motion Study of The EMS Turnaround Interval
Authors: Cone David C. , Nguyen Que , Davidson Steven J.
Published: July 2016

Purpose: Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval consists of the delivery and recovery intervals as defined in Spaite's EMS time-interval model.

Methods: An on-site observer, while monitoring EMS radio traffic, recorded the delivery and recovery activities of personnel from a large urban EMS system at a university hospital ED. System policy permits a maximum 30 minute turnaround interval. Prospectively defined subintervals were analyzed.

Results: A convenience sample of 122 patient deliveries was collected. Observed and radio-reported arrival at the hospital differed by -1′24″; to +11′8″. Time from arrival to removal of the patient from the ambulance averaged 59″ (range 13″-2′53″), and time from patient removal to ED entry averaged 42″ (10″ - 5′22″). While the mean time for the verbal report to ED staff was 33″ (2″-5′20″), it was 0 = 15″ in 36% of cases. Time from ED entry to placement of the patient on an ED bed averaged 2′11″ (33″-9′35″). Writing the report averaged 17′12″ (5′20″-52′11″). The mean time off radio was 29′51″ (ll′43″-53′37″) and the mean time the ambulance was at the ED was 30′01″ (11′25″-1°17′53″). Observed and radio-reported ambulance departures differed by -4′31″ to +23′32″. In 22% of cases, departure was reported on radio more than 5′after actual departure.
History Made: The Rise of Republican Tim Scott
Authors: Huffmon Scott H. , Knotts H. Gibbs , McKee Seth C.
Published: July 2016

In a time of unprecedented racial polarization in partisan voting, and in a staunchly Republican Deep South state, one black Republican managed to reach the pinnacle of public office. This article examines Tim Scott’s rise by analyzing precinct-level data to better understand his 2010 election to the US House and data from the Winthrop Poll to explore his more recent US Senate victory. To better understand support for Scott, we also report results from an embedded-survey experiment to assess respondents’ favorability toward Scott when he is characterized by two different frames: (1) “Tea Party favorite,” and (2) “first African American Senator from South Carolina since Reconstruction.” We found that conservatives, evangelicals, and less-educated individuals respond more positively to Scott when he is described as a “Tea Party favorite.” More than an intriguing case study, Scott’s rise tells a broader story of the complicated relationships among race, ideology, and partisanship in the contemporary American South.
Never saw one – first-person null subjects in spoken English1
Authors: WAGNER SUSANNE
Published: July 2016

While null subjects are a well-researched phenomenon in pro-drop languages like Italian or Spanish, they have not received much attention in non-pro-drop languages such as English, where they are traditionally associated with particular (written) genres such as diaries or are discussed under a broader umbrella term such as situational ellipsis. However, examples such as the one in the title – while certainly not frequent – are commonly encountered in colloquial speech, with first-person singular tokens outnumbering any other person.

This article investigates the linguistic and non-linguistic factors influencing the (non-) realisation of first-person singular subjects in a corpus of colloquial English. The variables found to contribute to the observed variation are drawn from a variety of linguistic domains and follow up on research conducted in such different fields as first language acquisition (FLA), cognitive linguistics, discourse analysis, sociolinguistics and language variation and change. Of particular interest is the finding regarding the link between null subjects and complexity of the verb phrase, which patterns in a clearly linear fashion: the more complex the verb phrase, the more likely is a null realisation. Not discussed in this form before, this finding, given its high significance and its robustness in light of alternative coding, may prove to be an important candidate for inclusion in future studies on (English) null subjects.
A systematic review and meta-analysis of the antibiotic treatment for infectious bovine keratoconjunctivitis: an update
Authors: Cullen J. N. , Yuan C. , Totton S. , Dzikamunhenga R. , Coetzee J. F. , da Silva N. , Wang C. , O'Connor A. M.
Published: July 2016

Infectious bovine keratoconjunctivitis (IBK) is a common and important disease of calves. Without effective vaccines, antibiotic therapy is often implemented to minimize the impact of IBK. This review updates a previously published systematic review regarding comparative efficacy for antibiotic treatments of IBK. Available years of Centre for Biosciences and Agriculture International and MEDLINE databases were searched, including non-English results. Also searched were the American Association of Bovine Practitioners and World Buiatrics Congress conference proceedings from 1996 to 2016, reviews since 2013, reference lists from relevant trials, and U.S. Food and Drug Administration New Animal Drug Application summaries. Eligible studies assessed antibiotic treatment of naturally-occurring IBK in calves randomly allocated to group at the individual level. Outcomes of interest were clinical score, healing time, unhealed ulcer risk, and ulcer surface area. A mixed-effects model comparing active drug with placebo was employed for all outcomes. Heterogeneity was assessed visually and using Cochran's Q-test. Thirteen trials assessing nine treatments were included. Compared with placebo, most antibiotic treatments were effective. There was evidence that the treatment effect differed by day of outcome measurement. Visually, the largest differences were observed 7–14 days post-treatment. These results indicate improved IBK healing with many antibiotics and suggest the need for randomized trials comparing different antibiotic treatments.
Comparison of access to services in rural emergency departments in Quebec and British Columbia
Authors: Fleet Richard , Audette Louis-David , Marcoux Jérémie , Villa Julie , Archambault Patrick , Poitras Julien
Published: July 2016

Introduction:

Although emergency departments (EDs) in Canada’s rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged.

Objective:

The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec.

Methods:

Rural EDs were identified through the Canadian Healthcare Association’s Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services.

Results:

British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec.

Conclusions:

The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.
Tetanus: lest we forget
Authors: Dittrich Kenneth C. , Keilany Bashar
Published: July 2016

Tetanus is a life threatening infection that is rarely encountered in clinical practice. Knowledge of the condition is necessary to ensure optimal management. A 30-year-old male presented with classic signs and symptoms of the disease, including trismus, risus sardonicus, paroxysmal muscle spasms and autonomic instability. The pathophysiology and modern management of this condition are reviewed.
Thrombolytic Therapy for Acute Ischemic Stroke: The CAEP Position Statement: another perspective
Authors: Hill Michael D. , Gubitz Gordon J. , Phillips Stephen J. , Buchan Alastair M.
Published: July 2016

The cautiously-worded Position Statement recently issued by the Canadian Association of Emergency Physicians (see Appendix 1) regarding the use of intravenous recombinant tissue-plasminogen activator (tPA, alteplase) for acute ischemic stroke underscores the reality that many physicians in Canada have been reluctant to embrace this therapy. Much of the caution expressed in the CAEP document is related to 2 major areas of concern: evidence of efficacy (i.e., did tPA really “prove” itself in randomized trials?) and effectiveness (i.e., are the trial results generalizable to everyday practice?). While we support the development of documents that help to clarify controversial treatments, and agree with much of what is presented in the CAEP Position Statement, we offer the following comments.
The problem of consent in emergency medicine research
Authors: Gray Jonathan D.
Published: July 2016

This paper outlines some of the ethical and practical dilemmas of securing true informed consent in resuscitation research in the prehospital or emergency department setting. Possible substitutes to such consent are discussed and evaluated. TheCanadian Tri-Council Policy Statementguidelines for emergency medicine research are compared to the US Food and Drug Administration rules, and the former are assessed and critiqued. Modifications to the current Tri-Council guidelines are suggested.
Shiftwork and emergency medical practice
Authors: Frank Jason R. , Ovens Howard
Published: July 2016

Shiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. We conducted a systematic literature review to characterize the effects of shiftwork on physician health, well-being and practice, and to describe rational strategies to mitigate its impact on Canadian emergency physicians.