bluuebunny/crossref_metadata_2025 huggingface dataset:
Involuntary Commitment in the Prehospital Setting
Authors: Adams James G. , Gerard Jody , Verdile Vince P. , Paris Paul M.
Published: July 2016

Introduction:

Suicidal patients who refuse prehospital transport pose a difficult problem for emergency medical services. A survey was conducted in an attempt to assess the current strategies for involuntary transport of such patients.

Methods:

The medical directors of 135 of the largest EMS systems in the United States were mailed a questionnaire requesting descriptions of the operating procedures for dealing with suicidal patients who refuse transport.

Results:

Fifty-nine of 130 questionnaires (45%) were returned. Seventeen emergency medical services (EMS) systems (29%) serve populations of less the 250,000, while 41 (69%) serve populations greater than 250,000. Cumulatively, respondents represent an excess of 2.1-million EMS responses per year, of which 0.5%-10.0% involve behavioral emergencies. Eleven of the 59 responding systems (19%) have urritten, explicit policies guiding the management of suicidal patients who refuse to be transported. Involuntary commitment proceedings are initiated in the prehospital setting in 25 of the 59 services (42%). Of these 25, the initiation of commitment proceedings is performed by the following (more than one may apply to a given system): 11 (44%) by base-station physicians, six (24%) by the emergency medical technician (EMT), 23 (92%) by a police officer, and five (20%) by family or friends. Ten of the 59 systems (17%) require a mental health delegate to authorize commitment. Two physicians can mandate involuntary commitment in one of the responding systems. Of the 25 systems that actually perform involuntary commitment in the prehospital setting, seven (28%) have established policies. Of the 34 systems which do not perform involuntary prehospital commitment, four (12%) have policies to guide the care of suicidal patients who refuse care.

Conclusion:

Suicidal patients commonly confront emergency medical services, yet many systems lack explicit policies for dealing with such patients. Widely varied strategies are used to authorize transport of patients who are suicidal and refuse to be transported.
Air Medical Transport Utilization Review in North Carolina
Authors: Benson Nicholas H. , Alson Roy L. , Norton Eve G. , Beauchamp Ann P. , Weber Rita , Carreras Jorge L.
Published: July 2016

Objective:

To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria.

Design:

Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated.

Setting:

All six hospital-based helicopter services in North Carolina.

Type of participants:

All available flight records for November and December 1989.

Interventions:

None.

Measurements and main results:

Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively.

Conclusions:

Review of all flights over a period of two months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.
Physician Integration into Mass Gathering Medical Care: The United States Air Show
Authors: Boyle Michael F. , De Lorenzo Robert A. , Garrison Richard
Published: July 2016

Introduction:

Limited information exists concerning physician staffing at mass gathering events.

Methods:

A retrospective review of the preparation, planning, and provision of medical care for the United States Air Show was performed. Patient encounters from the air show for the years 1981–1991 also were evaluated.

Results:

The frequency rate of overall encounters was 8.45 patients/10,000 spectators and hospital transport rate was 0.6/10,000 spectators. The majority of complaints were related to heat or minor injuries. During this period, emergency physicians played a vital role in both medical planning and on-site staffing. Emergency medicine residents also participated. A small patient population received direct benefit from on-site physician intervention.

Conclusion:

The on-site emergency physician is of benefit in event preplanning and reducing the burden on the EMS system during mass gathering events.
Prehospital Treatment with Dobutamine
Authors: Oberg Bjarne , Sorensen Mogens Bredgaard
Published: July 2016

Purpose:

To assess the effectiveness of the use of dobutamine hydrochloride in out-of hospital emergency situations.

Population:

Patients with severe circulatory insufficiency caused by acute illness or injury encountered by the Mobile Intensive Care Unit of Copenhagen (population 467,000) during a 15-month study period.

Methods:

A newly developed dobutamine solution was administered by infusion pump to patients in whom normal emergency treatment failed to restore an acceptable circulatory state.

Results:

A total of 40 patients were treated with 4–48 μg dobutamine/kg/minute. The treatment was judged to be primary life-saving in 15 patients, the condition was improved in 16 patients, and nine patients died. Systolic blood pressures (in those who survived) rose from a mean value of 45 mmHg (range 0–80 mmHg) to 105 mmHg (range 65–180 mmHg). No tachycardia or arrhythmias were noted.

Conclusion:

This newly developed dobutamine solution is very useful in prehospital treatment of patients with circulatory failure and is recommend for use by mobile intensive care unit teams.
The 1989 Loma Prieta Earthquake: Issues in Medical Control
Authors: Palafox Jorge , Pointer James E. , Martchenke Julie , Kleinrock Marie , Michaelis Janet
Published: July 2016

Introduction:

The role of the base-hospital and on-line medical control in a disaster has not been investigated previously. This study assesses the roles of base-hospitals and the value and feasibility of on-line medical control during the 1989 Loma Prieta earthquake.

Methods:

The researchers studied five Bay Area counties most affected by the earthquake: San Francisco, Alameda, San Mateo, Santa Clara, and Santa Cruz. Researchers sent questionnaires to all 1,498 registered EMTs and paramedics in these counties; 620 were returned (41.4%). Respondents answered questions about activities performed, contacts with base-hospitals and other agencies, and problems encountered the night of the earthquake. Researchers selected 63 paramedics for in-depth interviews based on their performance of significant advanced life support (ALS) activities performed during the disaster. The coordinators of the 13 base-hospitals (BHCs) in the region also received and returned questionnaires about medical control, base-hospital roles during the disaster, and problems encountered. Researchers interviewed all five county emergency medical services (EMS) agency directors.

Results:

The surveys of EMS directors, base-hospital coordinators, and paramedics indicate that confusion existed over the status of medical control after the earthquake. There was general agreement among base-hospital coordinators (BHCs) that suspension of medical control is appropriate in a major disaster.

Three bases had appropriate equipment to function as back-up dispatch centers. Eight bases had adequate personnel, but only one BHC felt his personnel had adequate training to function in a dispatch capacity. Nine paramedics did not start or continue resuscitation on patients whom they ordinarily would have begun resuscitation.

Conclusion:

Emergency medical services should suspend medical control immediately following a major disaster and ensure that all prehospital and base personnel are notified. Disrupted communications protocols for prehospital personnel should reflect the skill and knowledge level of paramedics and the need for rapid, advanced practice in a disaster. Disaster planners should consider other roles for base hospitals in major disasters.
Adverse Events during Interfacility Transfers by Ground Advanced Life Support Services
Authors: Wuerz Richard , Meador Steve
Published: July 2016

Objective:

To identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS).

Design:

A four-year, retrospective, case series.

Setting:

Three ALS units in a rural/suburban emergency medical services (EMS) system.

Participants:

351 transports to or from twelve acute care facilities; two patients records could not be located.

Interventions:

Patients were classified by illness/injury, transporting staff, and ongoing therapy; these were correlated with frequency of ALS intervention and patient deterioration.

Results:

During the study period, the number of transfers as a percentage of total calls (1.1%–5.2%) rose consistently. There were 11 illness/injury categories; the largest was cardiac (44%, 154 patients). Hospital staff accompanied the patient in 15% (52). Advanced life support (ALS) therapy was required in 4.9% (17): one monitored cardiac arrest was defibrillated successfully, 13 patients required unanticipated medication therapy, and three were noted to have clinical deterioration en route. The upper 95% confidence limit for cardiac arrest is 12.9/1,000 transfers or 20.8/1,000 hours. Patient deterioration and the need for ALS intervention were associated with the presence of medication infusions (p <.O5), but not with hospital staff (p >.40).

Conclusions:

Interfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.
Prototype Curriculum for a Fellowship in Emergency Medical Services
Authors: Krohmer Jon R. , Swor Robert A. , Benson Nicholas , Meador Steven A. , Davidson Steven J.
Published: July 2016

The developments of emergency medicine and emergency medical services (EMS) have occurred simultaneously although at times on parallel paths. The recognition of EMS providers as physician surrogates and emergency care resources as an extension of emergency department care has mandated close physician involvement. This intimate physician involvement in EMS activities is now well accepted. It has, however, pointed out the need for in-depth training of physicians in the subspecialty of EMS.
National Guidelines for Statewide Implementation of EMS “Do Not Resuscitate” (DNR) Programs
Authors:   National Association of State Emergency Medical Services Directors (NASEMSD),   the National Association of Emergency Medical Services Physicians (NAEMSP)
Published: July 2016

With the growth of hospice and home health care, more patients with terminal illness are electing to avoid hospitalization until the final stages of illness. Many of these patients, as well as others with advanced chronic illnesses, have decided with the help and support of their attending physicians, that they do not wish to be resuscitated in the event of cardiac or respiratory arrest. However, as death draws near, well-meaning family or friends, or perhaps the patient, may call emergency medical services (EMS) personnel to transport the dying patient to the hospital; the prehospital providers who respond to these calls may be the last medical persons to attend terminally ill patients at home or in nursing homes. In many cases, these calls to EMS personnel are intended only to obtain transportation or comfort measures for the loved one. However, unless the state provides statutory authority for EMS personnel to honor a “do not resuscitate” (DNR) order, there may be a requirement for such personnel to attempt resuscitation, regardless of the patient's wishes and the physician's directive.
Humanitarian, Noncombat Role for the Military
Authors: Gunn S. William A.
Published: July 2016

This paper is being composed on Olympic Day 1994, exactly 10 years after its historic flame illuminated the skies of Sarajevo for a festival of peace and friendship. Today, the flames sadly come from incendiary bombs, shell streaks, and fratricide hatred. Against this tragic degradation, the role of the military and the international community has been changing from that of aggressive interference to one of humanitarian assistance and negotiated settlement. In this new setting, disaster and emergency medicine have a special opportunity to prove a noble calling and obligation.

Conflict, unfortunately, and help, fortunately, are as old as humanity. The thoughts expressed herein concern the latter aspect with special reference to the military. As long as man has had a heart, some adrenaline, and the physiological reflex for protection, he has had compassion and an urge to bring succor to those who suffer. The sufferer may be a friend or he may be an enemy, but in humanitarian medical actions, there is no foe.
Review of Accidents/Injuries Among Emergency Medical Services Workers in Baltimore, Maryland
Authors: Gershon Robyn R.M. , Vlahov David , Kelen Gabor , Conrad Bruce , Murphy Larry
Published: July 2016

Objectives:

To characterize the types of occupational exposures and injuries reported by emergency medical service (EMS) workers.

Methods:

A blinded review of accidents/exposures among EMS workers employed by a Baltimore County fire department was conducted. Medical records for 1992 were reviewed.

Results:

Two hundred and twenty-six reports were filed by EMS workers (n = 197) employed by a large, urban fire department in 1992. The most commonly reported injuries were sprains (23%), strains (20%), and exposure to blood and body fluids (15%). The body site most commonly injured was the back (20%) followed by the respiratory system (10%). Most incidents were treated at the employee health clinic, and 13% of the incidents resulted in a hospital visit. Fifteen percent of the injuries resulted in more than seven lost work days. Most incidents were caused by stretcher mishaps, especially during transport of heavy patients. Walkway impediments (e.g., icy steps, wet leaves, broken and uneven pathways) also played an important role in creating slipping and tripping hazards.

Conclusion:

These results suggest a variety of prevention strategies aimed at reducing accidents and exposures among EMS workers.
Can Correct Closed-Chest Compressions Be Performed During Prehospital Transport?
Authors: Stone C. Keith , Thomas Stephen H.
Published: July 2016

Introduction:

The resuscitation rate from out-of-hospital cardiac arrest is low. There are many factors to be considered as contributing to this phenomenon. One factor not previously considered is the impact of a moving ambulance environment on the ability to perform closed-chest compressions.

Hypothesis:

Proper closed-chest compressions can be performed in a moving ambulance.

Methods:

A cardiopulmonary resuscitation (CPR) training mannequin with an attached skill meter (Skillmeter ResusciAnnie®, Laerdal, Armonk, N. Y., USA) that measures each chest compression for proper depth and hand placement was used. Ten emergency medical technician-basic (EMT-B) certified prehospital providers were assigned into one of five teams. Each team performed a total of four sessions of five minutes of continuous closed-chest compressions on the mannequin. Two sessions were done by each team: one in the control environment with the mannequin placed on the floor, and the other in the experimental environment with the mannequin placed in the back of a moving ambulance. The ambulance was operated without warning lights and siren, and all traffic rules were obeyed. The percentage of correct closed-chest compressions was recorded for each session, and the mean values were compared using Student's t-test with alpha set at 0.01 for statistical significance.

Results:

Ten sessions of compressions were done in both environments. The mean percentage of correct compressions was 77.6 ±15.6 for the control group and 45.6 ±18.3 for the ambulance group (p = 0.0005).

Conclusion:

A moving ambulance environment appears to impair the ability to perform closed-chest compressions.
Spirituality of EMTs: A Study of the Spiritual Nature of EMS Workers and Its Effects on Perceived Happiness and Prayers for Patients
Authors: Backus Candace J. , Backus William , Page David I.
Published: July 2016

Introduction:

There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients.

Purpose:

This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness.

Methods:

Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies.

Results:

Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62 % pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p <0.025>0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182,p<0.025>0.005).

Conclusion:

Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.
Prehospital Transport Time and Mode of Transportation in Zenica, Bosnia
Authors: Tom Prentice A. , Music Lejla
Published: July 2016

Study Objectives:

To provide a descriptive analysis of the prehospital emergency medical transportation system operating in and around a major Bosnian city, and to discuss the effect of the war on that transportation system.

Design:

A prospective, consecutive sample study.

Setting:

The largest tertiary-care referral hospital currently operating in central Bosnia.

Participants:

158 consecutive patients who sought care in the trauma and medical receiving rooms at Zenica Hospital.

Method and Measurements:

Patients were surveyed as to time of transportation to the site of first medical care and to Zenica Hospital, and modes of transportation used.

Results:

Time to transport to first care within the city of Zenica is 30±21 minutes. Time to transport to Zenica Hospital from within Zenica is 51±39 minutes. Time to transport to first care outside of Zenica is 77±56 minutes. Time to transport to Zenica Hospital from outside the city of Zenica is 178±94 minutes. The prehospital emergency medical service was used in 11.7% of cases reviewed.

Conclusion:

The majority of patients with major injury and illness are unable to obtain prehospital transportation and medical care through informal modes of transportation. The existing prehospital emergency medical services system is inadequate for the numbers of patients requiring such services, and transportation time from outside the city of study is especially prolonged.
Patient Care and Daily Stress Among Emergency Medical Technicians
Authors: Boudreaux Edwin , Jones Glenn N. , Mandry Cris , Brantley Phillip J.
Published: July 2016

Introduction:

There is conflicting research regarding the extent to which patient care is a source of stress for emergency medical technicians (EMTs). Some research indicates that it is important, whereas other studies suggest that it takes a “back seat” to administrative and organizational problems. This study sought to explore this issue further by investigating the relationship between caring for patients, daily workday stress, and daily nonworkday stress among EMTs.

Methods:

All EMTs employed by East Baton Rouge Parish Emergency Medical Services were eligible for participation. After the study was described, subjects completed a demographic information sheet and informed consent was obtained. Participants then completed 30 days of monitoring with a standardized measure of daily stress (the Daily Stress Inventory) and a measure of patient-care stress designed for use in this study (Emergency Call Questionnaire).

Results:

A very large portion of the variance in the EMTs' overall daily workday stress was associated with patient care (r = 0.677, p <0.001). Additionally, patient care stress on workdays significantly predicted overall daily stress on the following nonworkday (i.e., post-workday) (r = 0.633, p <0.001). Finally, EMTs who had stressful pre-workdays rated their patient care as more stressful on the following workday (r = 0.512, p <0.01).

Conclusions:

Results suggest that patient care is a critical factor in daily stress among EMTs, both on workdays and post-workdays, providing preliminary evidence for a carryover effect. Evidence also suggests that stress on the day before work may influence EMTs' perceptions of their patients on workdays.
Complex Emergencies: Expected and Unexpected Consequences
Authors: Schull Michael J. , Shanks Leslie
Published: July 2016

Complex emergencies emerged as a new type of disaster following the end of the Cold War, and have become increasingly common in recent years. Human activity including civil strife, war, and political repression often coexist with and contribute to natural phenomena such as famine. They frequently result in high mortality, population displacement, and the disruption of civil society and its infrastructure. This article reviews the context of recent complex emergencies, and their expected health consequences, such as diarrhea, measles, malnutrition and outbreaks of infectious disease, and the disruption of mechanisms of disease control and surveillance. However, the complex nature of these emergencies also may have unexpected consequences, such as hindering understanding of their causes or limiting the attention paid to them by the public. This paper discusses the context and consequences of complex emergencies from the health standpoint, and explores some of their unexpected effects.
Military Assistance in Complex Emergencies: What Have We Learned Since the Kurdish Relief Effort?
Authors: Sharp Trueman W. , Wightman John M. , Davis Michael J. , Sherman Sterling S. , Burkle Frederick M.
Published: July 2016

After the success of relief efforts to the displaced Kurdish population in northern Iraq following the Gulf War, many in the US military and the international relief community saw military forces as critical partners in the response to future complex emergencies (CEs). However, successes in subsequent military involvement in Somalia, Rwanda, the former Yugoslavia, and other CEs proved more elusive and raised many difficult issues. A review of these operations reinforces some basic lessons that must be heeded if the use of military forces in humanitarian relief is to be successful. Each CE is unique, thus, each military mission must be clearly defined and articulated. Armed forces struggle to provide both security and humanitarian relief, particularly when aggressive peace enforcement is required. Significant political and public support is necessary for military involvement and success. Military forces cannot execute humanitarian assistance missions on an ad hoc basis, but must continue to develop doctrine, policy and procedures in this area and adequately train, supply, and equip the units that will be involved in humanitarian relief. Militaries not only must cooperate and coordinate extensively with each other, but also with the governmental and non-governmental humanitarian relief organizations that will be engaged for the long term.
Rehabilitating Public Health Infrastructure in the Post-Conflict Setting: Epidemic Prevention and Preparedness in Kosovo
Authors: Brennan Richard J. , Valderrama Camilo , MacKenzie William R. , Raj Kamal , Nandy Robin
Published: July 2016

The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes. On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovo's public health infrastructure, which had sustained enormous damage as a result of the fighting. Of particular importance was the need to develop a system of epidemic prevention and preparedness. But no single agency had the resources or capacity to implement such a program. Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, nongovernmental organization. Important components of the program included a major Kosovo-wide baseline health survey, the development of a provincewide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response. While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project. This program represents a model that potentially could be replicated in other post-conflict or development settings.
In Memoriam, Michael Pozen
Authors: Ricci Edmund M.
Published: July 2016

The relatively young scientific field of health services research, whose practitioners are still struggling to establish legitimacy within the vast domain of health care, owes much to Michael Pozen. Indeed, Michael must be counted as one of the founders of this new speciality in that his brief but incredibly productive career began as the field of health services research took form and emerged as a distinct career specialty. His very significant contributions to health care can be assessed from two perspectives.

The most visible perspective upon Michael Pozen's professional work can be obtained from a review of his research as reported in his published articles and presented papers. Michael clearly established himself as a creative and resourceful scholar and researcher who had a particular interest in improving the design and delivery of emergency medical services as well as the clinical aspects of emergency medical care.
Impact Evaluation Of A Community Wide Resuscitation Training Program
Authors: Ricci Edmund M. , Malloy Catherine L. , Safar Peter
Published: July 2016

This study focused upon one critical condition, acute respiratory insufficiency (ARI), and the treatment patterns used before and after a training program designed to teach hospital personnel the most current methods of treating acute respiratory insufficiency. The study was a methodological investigation in which a means for collecting and analyzing data concerning the treatment of an acute health problem was developed, implemented, and assessed. It was also an attempt to evaluate the quality of treatment of ARI in a set of hospitals and to assess the extent to which a training program was able to affect the quality of treatment. Thirdly, the study was an epidemiological investigation of the extent to which ARI exists in hospital critical care units.
Limitations of Abdominal Binding during CPR
Authors: Alifimoff James K. , Safar Peter , Bircher Nicholas
Published: July 2016

Sudden cardiac death is the number one killer in the western world. In the USA alone, CPR attempts are justified in 200,000 cases per year. Recovery of brain function requires immediate initiation and uninterrupted maintenance of artificial ventilation and circulation by basic life support (BLS) until restoration of spontaneous circulation (ROSC) is possible with advanced life support (ALS). Presently recommended standard CPR (SCPR) produces only 6–30% of normal common carotid blood flow. For this reason, a more effective method of prolonged CPR-BLS is necessary in the absence of ALS ambulance services, which is common in rural areas.

Augmentation of blood flow during CPR can be accomplished by intravenous fluid load and epinephrine, which are unavailable to BLS personnel. Sustained abdominal compression in dogs during CPR increases blood flow but produces a high incidence of hepatic trauma. The use of military anti-shock trousers (MAST) during short-term SCPR has been shown to increase common carotid blood flow (CCABF); this, however, has not been evaluated with a long-term model.
The United Nations Disaster Relief Coordinator (UNDRO)
Authors: Lütem Ilhan
Published: July 2016

In the late 1960's and early 1970's, several major disasters occurred in rapid succession. The most devastating of them was no doubt the earthquake in Peru in 1970, which claimed some 50,000 lives and caused untold damage and destruction in that country.

Experience in these, and indeed in other disasters, made it clear that much of the generous aid provided by the international community in the wake of these disasters was, in the absence of co-ordination, often wasted or did not correspond to the real needs of victims. Enormous quantities of goods, some of them quite unsuitable, would pour in, together with countless well-meaning individuals wishing to help. Unfortunately, many of them were more hindrance than help. Obviously, some order had to be created to rectify this haphazard approach, and to ensure that relief supplies of the right kind and in appropriate quantities would reach the survivors rapidly to cover their basic and most urgent requirements during the emergency period.
World Federation of Societies of Anesthesiologists (WFSA)
Authors: Zorab John
Published: July 2016

The World Federation of Societies of Anesthesioologists (WFSA) is a federation of some 76 anesthesia societies throughout the world. Our role in the management of disasters is very minimal; in fact, we have no specific service role. It does have a role to play in education and research aspects of acute medicine. The World Federation's aims are those of education of anesthesiologists of our member societies. This educational role is fulfilled by the staging of meetings, by the foundation of training centers in anesthesiology, by the production of special manuals and by meeting some of the expenses of visiting educational teams that travel to various parts of the world as visiting professors. These are all educational functions. Included in this function, of course, would be education in emergency medicine and disaster medicine.
Hypothesis on Loss from Natural Catastrophe (Seismic) and on the Organization of an Emergency Medical Services (EMS) System
Authors: Ruggieri G. , Bruzzese E. , Manni C.
Published: July 2016

The problem of forecasting the number of injured in need of treatment as a consequence of earthquake damage, and the percentage of those in need of diversified forms of therapy, still remains unresolved. Past experience provides us with partial and variable figures. It may thus be useful to propose as a working hypothesis some degree of comparability between the effects caused by the energy released by earthquakes and those resulting from nuclear explosions, especially as regards some of their predominant aspects (collapse of buildings).
Engineering Challenges for Minimizing Casualties from Earthquakes
Authors: Williams M. L. , Hammond Paul Y.
Published: July 2016

Once an earthquake or similar disaster has occurred, and the salvage operation begins, it must be viewed as something that can do further damage to the victims as well as help them. The more ambitious the rescue and salvage effort—the effort to minimize the human casualties—the more serious the problem becomes of preventing the salvage operation from doing more harm than good after the obvious and easy cases have been located and treated. The key engineering elements can be reviewed from the position of the rescuer or of the victim and his ability to participate actively or passively in his own rescue and treatment. In either case, the main improvement would appear to result from, first, improved sensors and receptors; second, improved methods for timely debris removal; third, improved aids to active self-indicated survival efforts, including rescue and treatment; and fourth, improved methods of restoring vital services (water, sewage, heat, light, food, transportation and communication).
84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements
Authors: Michelson Edward A. , Pearlman Kenneth S.
Published: July 2016

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.

Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.

Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.
Diagnostic accuracy of refractometer and Brix refractometer to assess failure of passive transfer in calves: protocol for a systematic review and meta-analysis
Authors: Buczinski S. , Fecteau G. , Chigerwe M. , Vandeweerd J. M.
Published: July 2016

Calves are highly dependent of colostrum (and antibody) intake because they are born agammaglobulinemic. The transfer of passive immunity in calves can be assessed directly by dosing immunoglobulin G (IgG) or by refractometry or Brix refractometry. The latter are easier to perform routinely in the field. This paper presents a protocol for a systematic review meta-analysis to assess the diagnostic accuracy of refractometry or Brix refractometry versus dosage of IgG as a reference standard test. With this review protocol we aim to be able to report refractometer and Brix refractometer accuracy in terms of sensitivity and specificity as well as to quantify the impact of any study characteristic on test accuracy.
The Affective Economy of the Business Case for Mature Aged Workers
Authors: Riach Kathleen , Jack Gavin
Published: July 2016

This article draws on Ahmed's (2004) concept of affective economies as a means of critically exploring the nature and consequences of the ‘business case for mature aged workers’: a framework that underpins recent government and corporate policy focusing on extending working lives. Contra to the claims of the business case as wholly rationalistic ‘common sense’ and logical, the article argues that the business case operates discursively by drawing on latent but potent circuits of emotionality. Drawing on a range of government ‘best practice’ resources for employers, we show how the ‘rippling effects’ of emotionality result in particular systems of valuation pertaining to mature aged workers and later life working. In situating these dynamics as important to a broader affective political economy, we argue this may inadvertently undermine current initiatives seeking to promote the retention and recruitment of mature aged workers.
Can living mulches in intercropping systems reduce the potential nitrate leaching? Studies of organic cauliflower (Brassica oleraceaL. var.botrytis) and leek (Allium porrumL.) production across European conditions
Authors: Xie Yue , Tittarelli Fabio , von Fragstein Peter , Bavec Martina , Canali Stefano , Kristensen Hanne Lakkenborg
Published: July 2016

The effect of introduction strategy for living mulches (LMs) to reduce the potential nitrate leaching was investigated when grown with vegetables with high nitrogen (N) demand and low use efficiency in four European countries: Italy, Slovenia, Germany and Denmark over 2 yr. The plant N uptake and soil nitrate N content at harvest, in the autumn, and in the following spring were measured below open-pollinated and hybrid cultivars of cauliflower and leek crops. The cultivars performed differently over the 2 yr. In Italy and Slovenia, when LM of burr medic or white clover was broad sown (addition design ADD) at the same time as crop transplanting, the N uptake of crops was hampered without increasing the total aboveground N accumulation. Delaying LM sowing by 2.5–4 weeks maintained the N uptake of crops. In Germany, delaying white clover sowing for a month in cauliflower reduced soil nitrate at the start of leaching by 17–33 kg N ha−1in the ADD design and 25 kg N ha−1in the substitution design (SUB), where rows of cash crops were replaced by rows of LM. An overwintering LM of grass–clover incorporated in strips and root pruned decreased soil nitrate at the start of the leaching period by 35 kg N ha−1in cauliflower, and in leek, an LM of dyer's woad decreased the soil nitrate by 55 kg N ha−1at harvest and 30 kg N ha−1at the start of leaching. The effect of delayed LM sowing depended on the LM species and system design. Overall, the SUB and ADD designs showed potential to reduce nitrate leaching, whereas the ADD design had stronger competition against either cash crop or LM. The key to reduce soil nitrate N without jeopardizing crop yields may be to identify suitable growing periods, sometimes combined with root pruning, for each LM species and system design. The LM introduction strategy can be used to control competition and reduce the potential leaching, but the performance depends on the intensity of the interspecific competition and the local conditions.
THE LOGIC OF LEIBNIZ’SGENERALES INQUISITIONES DE ANALYSI NOTIONUM ET VERITATUM
Authors: MALINK MARKO , VASUDEVAN ANUBAV
Published: July 2016

TheGenerales Inquisitiones de Analysi Notionum et Veritatumis Leibniz’s most substantive work in the area of logic. Leibniz’s central aim in this treatise is to develop a symbolic calculus of terms that is capable of underwriting all valid modes of syllogistic and propositional reasoning. The present paper provides a systematic reconstruction of the calculus developed by Leibniz in theGenerales Inquisitiones. We investigate the most significant logical features of this calculus and prove that it is both sound and complete with respect to a simple class of enriched Boolean algebras which we call auto-Boolean algebras. Moreover, we show that Leibniz’s calculus can reproduce all the laws of classical propositional logic, thus allowing Leibniz to achieve his goal of reducing propositional reasoning to algebraic reasoning about terms.
Clozapine users in Australia: their characteristics and experiences of care based on data from the 2010 National Survey of High Impact Psychosis
Authors: Siskind D. J. , Harris M. , Phillipou A. , Morgan V. A. , Waterreus A. , Galletly C. , Carr V. J. , Harvey C. , Castle D.
Published: July 2016

Aims.

Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.

Methods.

Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n= 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.

Results.

One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.

Conclusions.

Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.
Determinants of decreasing major amputation rates in Germany
Authors: Pütter Carolin , Stausberg Jürgen , von Beckerath Olga , Reinecke Holger , Schäfer Erika , Kröger Knut
Published: July 2016

Abstract. Background: We analysed a potential association between the decrease in major amputations in Germany and the number of doctors, prescribed podologic foot care (PFC) and antidiabetic drugs, and performed percutaneous endoluminal angioplasties (PTA). Patients and methods: Data of all lower limb major amputations between 2007 and 2011, the cases hospitalised with an additional diagnosis of diabetes mellitus, and the numbers of PTAs, and the number of doctors in private practices and in hospitals were obtained from the Federal Statistical Office. Furthermore, the number of PFC treatments and prescribed antidiabetics for each of the five years were derived from the federal report of the statutory health insurance. Results: Within the 5 year time period, major amputations decreased by 19.0%, from 17,846 in 2007 to 14,463 in 2011. There is an inverse relation between the number of major amputations and the increasing number of prescribed PFC, of doctors working in hospital and of below-the-knee PTA in the multiple Poisson regression analysis. The number of prescribed antidiabetics and that of all PTA showed a positive relation. In the multiple linear regression analysis with the dependent variable ratio of amputations and the cases hospitalised with an additional diagnosis of diabetes mellitus, only numbers of prescribed PFC and below-the-knee PTA still showed an inverse relation that reached a level of significance. Conclusions: While substantial improvements in patients care by doctors, endovascular interventions, prescriptions of PFC and antidiabetic drugs are under discussion to reduce major amputation rates, in this approach including comprehensive data from Germany, only prescriptions of PFC and the number of below-the-knee PTA had an independent and significant impact on the reduction of major amputations. It has to be pointed out that such a statistical association does not prove any causality.
Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease
Authors: Buschmann* Eva-Elina , Brix* Michele , Li Lulu , Doreen Janke , Zietzer Andreas , Li Meijing , Buschmann Ivo , Hillmeister Philipp
Published: July 2016

Abstract. Background: External counterpulsation therapy enhances blood flow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT). Patients and methods: In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks. For ISRT, individual treatment pressures that do not exceed 160 mmHg were assessed by Doppler flow parameters during counterpulsation (individual shear rate diagnosis) in order to enhance and maximise peripheral perfusion. The study aimed to enhance peripheral perfusion and evaluate the primary clinical endpoint endothelial function, as well as to perform preliminary analysis of the ankle brachial index (ABI) and walking distance. Results: Doppler flow measurements in the lower limb (ankle) validated that maximum blood flow velocity during systole and acceleration doubled during ISRT. Study results demonstrated that long-term ISRT significantly increased flow-mediated dilation (FMD) in the brachial artery (0.13+/- 0.09 mm to 0.38+/- 0.05 mm; p < 0.05), while nitromediated dilation (0.36+/- 0.10 mm to 0.45+/- 0.08 mm) remained and common femoral artery FMD did not reach statistical significance (0.38+/- 0.08 mm to 0.67+/- 0.19 mm; p<0.05). Initial claudication distance considerably improved for all patients after 30 hours of ISRT (92.6 +/- 8.2 metres to 280+/- 101.3 metres, p<0.05), just like the absolute claudication distance, which showed a more than 2.5-fold increase (167.8+/- 18.1 metres to 446.7+/- 133.3 metres; p<0.05). The ABI did not improve (0.58+/- 0.03 to 0.65+/- 0.04). Conclusions: Our data demonstrate that long-term ISRT is a potential novel non-invasive treatment to improve endothelial function and absolute pain-free walking distance for PAD patients.