bluuebunny/crossref_metadata_2025 huggingface dataset:
Possibilities of Cost Reduction with All-Wing Aircraft
Authors: Lee C. H.
Published: July 2016

The aim of this paper is to show how design improvements may lead to a reduction in direct operating cost, pence per passenger mile. In all the comparisons made it is assumed that equal standards of equipment, accommodation, powerplant efficiency, and so forth, apply and that equal skill and standards apply in manufacturing; differences therefore are due to design features. The paper is in two main sections:

(1) A Satellite's eye-view of the whole design problem of the cheap short-range transport aeroplane.

(2) A more detailed description of two specific examples which illustrate the conclusions drawn from the general survey.

The first part is historically fiction but technically fact; the second part (despite the temptation to interchange the above two nouns and adjectives) is, I claim, fact both historically and technically.

I have departed from the historical sequence of events for the first part because we have now realised that it is possible to present in a comprehensive general argument the rather confused mass of data, ideas, techniques, inspirations and false trails that, in the course of time, led us to an enthusiasm for the all-wing Aerobus.
The Prospects of Lower Airline and Airport Costs
Authors: Stratford Alan H.
Published: July 2016

It is surely of the greatest importance that those engaged on the development of Civil Aircraft should give attention to all aspects of the economic operation of air transport and consider indirect operating costs and revenue, as well as the direct costs. This is no easy field of study and one may be accused of asking questions rather than providing answers. However, no discussion of short-haul transport can be complete without the fullest consideration of all aspects of airline cost.

Although the airframe, engine and accessory manufacturing industries are primarily concerned with the provision of vehicles, systems and equipment for Civil operators, they are also closely concerned with the utilisation of equipment and with the scale and direction of the developments of air transport in the future. We therefore subject to continuous study all areas of potential air transport growth and, of these, the short-haul domain is now of special concern.
A Simple Device for Preventing Turbulent Contamination on Swept Leading Edges
Authors: Gaster M.
Published: July 2016

On unswept wings, or wings with small amounts of sweep, the favourable pressure gradient round the leading edge, where the flow is rapidly accelerated away from the stagnation line, ensures a certain amount of laminar flow, provided the wing surface is sufficiently smooth. On highly swept wings, however, it has been found that turbulent flow can exist on the attachment line itself and there are therefore no naturally occurring regions of laminar flow. This trouble arises from the turbulence at the root of the wing, which sweeps along the attachment line. If the Reynolds number of this turbulent attachment line boundary layer is greater than some critical value, the whole attachment line boundary layer remains turbulent and the complete wing is contaminated. But if the Reynolds number is below the critical value, the turbulence decays along the leading edge and the boundary layer on the attachment line reverts back to the laminar state. This situation arises when the leading edge radius is small and the wing is only slightly swept. The attachment line boundary layer Reynolds number, Rθ, is given by the following equation:
Development Management and Cost Control
Authors: Blackwell B. D. , Reed A. V. N.
Published: July 2016

The object of this paper is to present a study of the problem of development management and cost control in a Defence setting. It does not offer any simple final solution, nor indeed claim some sudden breakthrough. It is, however, felt that progress in this field in the UK has been retarded by the lack of publication of attempts to think about this problem. In these circumstances, the processes of both criticism and cross-fertilisation of ideas, so essential to progress in any field of endeavour, cannot get to work and there is a high probability that the same mistakes will be made over and over again. If the publication of this paper does no more than stimulate others to publish their thoughts on this important problem, a major part of the objective of preparing it will have been achieved.
The Low Volume Technique of Spraying Fungicides for the Control of Potato Blight (Phytophthora Infestans)
Authors: Evans E. , Taylor J. W. H. , Runham R. , Couzens B. J.
Published: July 2016

The history of the application of fungicides is one which shows a tendency to use ever decreasing quantities of spray liquid to the acre; the reason for this is obviously one of economics. The classification of various spray techniques is discussed with particular reference to the term ultra low volume. This may be defined briefly as the spraying of such extremely small volumes of liquid to the acre that it becomes impossible to use a simple aqueous medium as carrier. The reasons for this are given and the advantages of using special formulating agents noted.

The success of the low volume technique of spraying potatoes for the control of blight is illustrated with a series of blight progress curves, showing that 5 lb of copper oxy-chloride applied at 50 gpa gives identical results to a similar rate of copper at 2 gpa. Copper estimations made on leaf samples from the top, middle and bottom leaves of a potato crop sprayed at 100 gpa and 5 gpa respectively show that the mass distribution of copper is much more uniform in the high volume plots than in the low volume plots. However, the largest quantities of copper are found in the top layers of the plots sprayed at low volume.
Practical Noise Control at International Airports with Special Reference to Heathrow
Authors: Petts F. C.
Published: July 2016

The technical and the legal aspects of aircraft noise having been adequately covered by others the present paper does not stray unnecessarily into those specialised fields but confines itself largely to the practical aspects of this very wide subject. It examines under six headings what can be done in practice, and covers in some detail what has been done at Heathrow. It describes several of the more interesting arrangements at other international airports, and with reference to the differences between them, poses some questions which must be answered when planning an automatic noise monitoring system. It concludes with reference to some features which, although desirable, may not be practicable for Heathrow.

Before talking about what can be done about noise in the vicinity of an airport it is important to emphasise that worthwhile control can be achieved only as a result of co-operation between the civil aviation and airport authorities, the airlines and the pilots. Such co-operation exists at Heathrow but continuous effort is required to keep it effective.
Engine Flight, RAE in Wartime
Authors: White J. M. F.
Published: July 2016

These recollections start a long time after those in the memorable Centenary issue of the JOURNAL, but will add a page in the history of the RAE which I joined in 1939—and found myself in the Engine Research Flight.

Life there was very peaceful before the War and aeroplanes were new and exciting. Looking back now, some of the work done there was very primitive with none of the elaborate test and recording equipment available today. I recall flying for hours in a Harrow, looking for icing conditions to test an automatic carburettor de-icing system; endurance flights on new plug types, high octane fuel and tests of an early Merlin in a very odd aeroplane where the observer sat in a box under the pilot's seat. The pilots then in C Flight are now almost legendary figures—“Spinner” White, killed in the prototype Spitfire K 5054, Rex Hayter, “Tiger” Hawkins, Roly Falk, “Bruin” Purvis, Hubert Broad, Clouston and H. J. Wilson, to name but a few.
My First Ten Years in Aviation
Authors: Sopwith Thomas
Published: July 2016

My first illustration Fig. 1 shows how the World's very first powered flight was announced in this Country—and it had no more notice in any other—I cannot help feeling that the first manned space flight will cause a slightly greater fuss.

I suppose it really all began, so far as my urge to fly was concerned, in the summer of 1910. At that time I owned half a 166 ton schooner—the owner of the other half was my old friend Bill Eyre.

Incidentally, the engineer in charge of the auxiliary engine was Fred Sigrist. We were to remain in partnership through many varied experiences in aviation for the following 30 years.

We had left Le Havre and as we were becalmed in the Channel we put into Dover Harbour. There we heard that an American architect of Spanish descent, Johnny Moisant, was flying a Bleriot monoplane (Fig. 2) in a field nearby so we thought we would go and have a look.
Delta Wings of Shapes Amenable to Exact Shock-wave Theory
Authors: Nonweiler T.
Published: July 2016

A class of delta wings is considered, whose under-surface has an inverted-V, or inverted-W, cross section of such a form that, at the “design” Mach number and incidence, the shock waves formed are plane. The geometry of the shock-wave system and surface is described briefly, and comments made about the utility of the concept in relation to hypersonic flow studies.
Rotating Aerofoils and Flaps
Authors: Neumark S.
Published: July 2016

Some aerodynamic properties of auto-rotating or forcibly rotated cylinders and aerofoils were investigated even prior to the beginning of aviation and, somewhat surprisingly, it was Maxwell who wrote the earliest (1853) known paper on the subject. That entirely non-mathematical paper tried to explain the curious behaviour of an oblong card which, left to fall freely in the air, started immediately to rotate about its longitudinal axis while deviating from the vertical in the horizontal direction perpendicular to the axis of rotation. Steady “terminal” conditions are soon reached in which speed, rate of rotation, and path angle, are all constant. This simple experiment revealed at once two important properties of an “aerofoil of large aspect ratio“: (1) ability to autorotate, and (2) ability, when rotating in an air stream, to create an asymmetrical pressure distribution resulting in a force normal to both axis of rotation and mainstream velocity. About the same time, the famous “Magnus effect” on rotating circular cylinders was discovered, but it was not before the Kutta-Joukowski theory of aerodynamic lift appeared some 50 years later that a more general understanding of the “lift through circulation” principle became possible. Magnus effect found important applications in ballistics, and one serious (although not economically successful) attempt was made to apply it in maritime navigation (Flettner's rotorship). As to the use of aerofoils rotating about a horizontal transverse axis for generating lift in aircraft, very little indeed has been done apart from some early publications. The concept of a wing with rotating flap as a lift-augmenting or control device arose from suggestions by Riabouchinsky and Chappedelaine, and there were some early French and German patents based on this concept. However, the matter was soon abandoned. It was taken up again during the last war in Germany, where some interesting experimental and theoretical research was done on a small scale. The subject has apparently never attracted any attention in Britain until 1957 when a short review of the existing information was given by Crabtree. This was followed by the lecturer's own effort which concentrated on the relevant mathematical theory.
The Development of the Boeing 727
Authors: Steiner J. E.
Published: July 2016

The development of a new commercial aircraft is a complex process spanning several years and requiring the energies of a large number of persons, both within and outside the originating organisation. Conditions for successful growth must be just right for the design to proceed to the first major accomplishment stage—that of flyable “hardware.” Conditions have to continue to be extremely favourable to reach the second stage—that of widespread airline operation. History indicates that they must be favourable to an unfortunately remote extent to reach the third stage—that of financial success for the manufacturer.

Many of the conditions involved go far beyond those under the control of the manufacturer and may even be wholly unpredictable in nature. This is why the third stage is so seldom achieved, at least in a free enterprise system.
A Note on the Bending of Beams Made of Non-Linear Material
Authors: Calladine C. R.
Published: July 2016

Patel And Venkatraman have studied the general behaviour in bending of a thin-walled channel section (Fig. 1) made of non-linear elastic material which deforms in simple tension according to the law

where ε represents strain, σ direct stress and λ, n the relevant material properties. (It is understood that a negative sign is inserted in where this is necessary to make σ and ε have the same sign.) As Patel and Venkatraman explain, the results are, by a trivial substitution, applicable to steady creep behaviour of the channel section.
The interplay among socioeconomic status, household chaos, and parenting in the prediction of child conduct problems and callous–unemotional behaviors
Authors: Mills-Koonce W. Roger , Willoughby Michael T. , Garrett-Peters Patricia , Wagner Nicholas , Vernon-Feagans Lynne ,   The Family Life Project Key Investigators
Published: July 2016

Child conduct problems (CP) reflect a heterogeneous collection of oppositional, aggressive, norm-violating, and sometimes violent behaviors, whereas child callous–unemotional (CU) behaviors reflect interpersonal styles of interactions reflecting a lack of guilt and empathy as well as uncaring and shallow emotional responses to others. Taken together, high levels of child CP and CU behaviors are thought to identify a relatively homogenous group of children at elevated risk for persistent and more severe problem behaviors across childhood and into adulthood. Although a large body of research has examined the developmental etiology of CP behaviors, only recently has a developmental psychopathology approach been applied to early CU behaviors. The current study examines multiple levels of contextual influences during the first years of life, including family socioeconomic status, household chaos, and parenting behaviors, on CP and CU behaviors assessed during the first-grade year. Whereas previous studies found associations between parenting behaviors and child problem behaviors moderated by household chaos, the current study found no evidence of moderation. However, path analyses suggest that the associations between child CP and CU behaviors and the contextual variables of socioeconomic status (family income and parental education) and household chaos (disorganization and instability) were mediated by maternal sensitive and harsh–intrusive parenting behavior. Analyses are presented, interpreted, and discussed with respect to both bioecological and family stress models of development.
Parenting and the development of effortful control from early childhood to early adolescence: A transactional developmental model
Authors: Tiberio Stacey S. , Capaldi Deborah M. , Kerr David C. R. , Bertrand Maria , Pears Katherine C. , Owen Lee
Published: July 2016

Poor effortful control is a key temperamental factor underlying behavioral problems. The bidirectional association of child effortful control with both positive parenting and negative discipline was examined from ages approximately 3 to 13–14 years, involving five time points, and using data from parents and children in the Oregon Youth Study—Three Generational Study (N= 318 children from 150 families). Based on a dynamic developmental systems approach, it was hypothesized that there would be concurrent associations between parenting and child effortful control and bidirectional effects across time from each aspect of parenting to effortful control and from effortful control to each aspect of parenting. It was also hypothesized that associations would be more robust in early childhood, from ages 3 to 7 years, and would diminish as indicated by significantly weaker effects at the older ages, 11–12 to 13–14 years. Longitudinal feedback or mediated effects were also tested. The findings supported (a) stability in each construct over multiple developmental periods; (b) concurrent associations, which were significantly weaker at the older ages; (c) bidirectional effects, consistent with the interpretation that at younger ages children's effortful control influenced parenting, whereas at older child ages, parenting influenced effortful control; and (d) a transactional effect, such that maternal parenting in late childhood was a mechanism explaining children's development of effortful control from middle childhood to early adolescence.
Developmental cascade models of a parenting-focused program for divorced families on mental health problems and substance use in emerging adulthood
Authors: Wolchik Sharlene A. , Tein Jenn-Yun , Sandler Irwin N. , Kim Han-Joe
Published: July 2016

A developmental cascade model from functioning in adolescence to emerging adulthood was tested using data from a 15-year longitudinal follow-up of 240 emerging adults whose families participated in a randomized, experimental trial of a preventive program for divorced families. Families participated in the program or literature control condition when the offspring were ages 9–12. Short-term follow-ups were conducted 3 months and 6 months following completion of the program when the offspring were in late childhood/early adolescence. Long-term follow-ups were conducted 6 years and 15 years after program completion when the offspring were in middle to late adolescence and emerging adulthood, respectively. It was hypothesized that the impact of the program on mental health and substance use outcomes in emerging adulthood would be explained by developmental cascade effects of program effects in adolescence. The results provided support for a cascade effects model. Specifically, academic competence in adolescence had cross-domain effects on internalizing problems and externalizing problems in emerging adulthood. In addition, adaptive coping in adolescence was significantly, negatively related to binge drinking. It was unexpected that internalizing symptoms in adolescence were significantly negatively related to marijuana use and alcohol use. Gender differences occurred in the links between mental health problems and substance use in adolescence and mental health problems and substance use in emerging adulthood.
Joint developmental trajectories of internalizing and externalizing disorders between childhood and adolescence
Authors: Nivard Michel G. , Lubke Gitta H. , Dolan Conor V. , Evans David M. , St. Pourcain Beate , Munafò Marcus R. , Middeldorp Christel M.
Published: July 2016

This study sought to identify trajectories of DSM-IV based internalizing (INT) and externalizing (EXT) problem scores across childhood and adolescence and to provide insight into the comorbidity by modeling the co-occurrence of INT and EXT trajectories. INT and EXT were measured repeatedly between age 7 and age 15 years in over 7,000 children and analyzed using growth mixture models. Five trajectories were identified for both INT and EXT, including very low, low, decreasing, and increasing trajectories. In addition, an adolescent onset trajectory was identified for INT and a stable high trajectory was identified for EXT. Multinomial regression showed that similar EXT and INT trajectories were associated. However, the adolescent onset INT trajectory was independent of high EXT trajectories, and persisting EXT was mainly associated with decreasing INT. Sex and early life environmental risk factors predicted EXT and, to a lesser extent, INT trajectories. The association between trajectories indicates the need to consider comorbidity when a child presents with INT or EXT disorders, particularly when symptoms start early. This is less necessary when INT symptoms start at adolescence. Future studies should investigate the etiology of co-occurring INT and EXT and the specific treatment needs of these severely affected children.
Prior Planning to Avoid Responders Becoming “Victims” During Disasters
Authors: Nocera Antony
Published: July 2016

Prior planning to meet the physical and mental needs of medical and emergency services responder, is a practical measure to reduce staff stress. This has the potential to improve both the operational efficiency of a disaster response and reduce the incidence of post-traumatic stress disorders in responders. Research is needed to define which interventions provide the greatest benefits to local responders.
Pneumothorax During CPR Training: Case Report and Review of the CPR Literature
Authors: Sullivan Francis , Avstreih Daniel
Published: July 2016

Cardiopulmonary resuscitation is taught widely to both lay persons and health care oworkers. It is a challenging psychomotor skill. Concerns about its safety to the rescuer have centered around the risk of infectious disease exposure. A young nursing assistant developed a minimally symptomatic pneumothorax during CPR training. This case is the first reported example of this complication for a CPR trainee or provider. The literature is reviewed for complications for CPR provider and recipient and the relevant issues regarding the current status and future direction of this intervention.
Controversy and Consensus in Disaster Mental Health Research
Authors: Tierney Kathleen J.
Published: July 2016

Controversies regarding the mental health consequences of disasters are rooted both in disciplinary orientations and in the widely varied research strategies that have been employed in disaster mental health studies. However, despite a history of dissensus, there are also key issues on which researchers agree. Disasters constitute stressful and traumatic experiences. However, vulnerability to such experiences, as well as to more chronic Stressors, is socially structured, reflecting the influence of socio-economic status and other axes of stratification, including gender, race, and ethnicity. Disaster events differ in the extent to which they generate stress for victims. A holistic perspective on disaster mental health would take into account not only disaster event characteristics, but also social-systemic sources of both acute and chronic stress, secondary and cumulative Stressors, and victims internal and external coping capacities.
How to Talk To the Media: Televised Coverage of Public Health Issues in a Disaster
Authors: Anzur Terry
Published: July 2016

Public health officials often are critical of the way television news covers disasters, while broadcast journalists complain of a lack of cooperation from the public health sector during disaster coverage. This article summarizes the issues discussed in a session on Televised Coverage of Disasters, presented in April 1999 at the UCLA Conference on Public Health and Disasters in Los Angeles. Public health officials were asked to “talk back to their television sets” in a dialog with television journalists. Concerns included: 1) the lack of balance in television coverage that is dominated by sensational images that may frighten rather than inform the public; 2) the potential for psychological damage to viewers when frightening images are shown repeatedly in the days and weeks of the disaster; and 3) the perception that TV reporters place too much emphasis on crime, property damage, and loss of life, giving relatively low priority to disaster preparedness and to public health issues in the aftermath of a disaster. Options for improving communication between television journalists and public health professionals also are discussed.
Effects Of The Video Case Study in Preparing Paramedic Preceptors For The Role Of Evaluator
Authors: Janing Judy , Sime Wesley
Published: July 2016

Introduction:

Accurate field evaluations are critical in determining paramedic students' competency to provide patient care. The [U.S.] National Paramedic Curriculum does not address the skills needed by evaluators, and requirements to be a preceptor/evaluator vary from state to state. Therefore, it is imperative that educational programs develop an evaluation process that reflects valid performance criteria and assure a high degree of rating consistency among the evaluators. This study sought to determine the effects of using a video case based teaching approach in preparing paramedic preceptors for the role of evaluator.

Hypothesis:

Paramedic preceptors receiving the case-based teaching approach to prepare them for the role of evaluator would demonstrate significantly higher scores on a video posttest than paramedic preceptors who were not prepared for the role of evaluator using the case-based approach.

Methods:

Thirty-four paramedic preceptors from a Midwestern fire-based Emergency Medical Services system were enrolled in this study. Two scripted video student/patient encounters were used to measure evaluation scores in a pretest-posttest comparison of control versus experimental group. The experimental group was given structured rating guidelines and practice applying those guidelines to a case study. Pretest and posttest scores were weighted and analyzed using Analysis of Variance.

Results:

Analysis of the pretest–posttest differences revealed significantly higher scores for the experimental group in the categories containing complex behaviors: communication F(1,16) = 13.21,p<.01, assessment F (1,16) = 8.81,p<.01, and knowledge F (1,16) = 29.64,p<.001. There was no significant difference between groups in the categories containing simple, easily observed behaviors: reliability F (1,16) = .55,p>.05 and cooperativeness F (1,16) = 3.02,p>.05.

Conclusions:

Using the case study method and written guidelines that provide concrete examples of complex behaviors appears to increase reliability of evaluations among preceptors.
Emergency Health Surveillance After Severe Flooding in Louisiana, 1995
Authors: Ogden Cynthia L. , Gibbs-Scharf Lynn I. , Kohn Melvin A. , Malilay Josephine
Published: July 2016

Introduction:

In disaster situations, timely surveillance systems that provide illness, injury, and mortality information to public health officials and hospitals are essential for planning and evaluating interventions.

Objectives:

To describe flood surveillance methodology, the impact of the event on hospitals, and the number of daily patient visits due to selected illnesses and injuries before, during, and after severe flooding in southeastern Louisiana in May 1995.

Methods:

Survey of disaster-area hospitals regarding flood impact. Emergency department surveillance of injuries and illnesses for the week before, the two days during, and the week after the flood.

Results:

There occurred an increase in the number of persons who drowned or were injured that presented to the moderately affected hospitals during the storm, but there was no increase in visits for gastroenteritis to any group of hospitals. Services were disrupted in more than half of hospitals. The severely affected hospitals had the least variation in the average number of daily visits. None of the drownings were reported by those hospitals that reported severe service disruption.

Conclusions:

Data should be collected from all hospitals in or near disaster areas, even if they were not directly affected by the disaster. Public education about the danger of drowning during flash flooding must be improved. The Louisiana experience emphasizes the need for a disaster-preparedness plan for rapid surveillance of illnesses and injuries.
The Effects of Hurricane Mitch on a Community in Northern Honduras
Authors: Guill C.K. , Shandera W.X.
Published: July 2016

Introduction:

Hurricane Mitch was an event described as one of the most damaging recent natural disasters in our hemisphere. This study examined its effects on a community of 5,000 residents in northern Honduras.

Methods:

Survey responses of 110 attendants at an ambulatory clinic 4 months after the event were analyzed. Correlates were established between demographic and housing characteristics and morbidity and mortality.

Results:

The availability of food, water, and medical care decreased significantly immediately after the hurricane, but by four months afterward returned to baseline values. Residents reported emotional distress correlated with the loss of a house or intrafamilial illness or mortality. Diarrheal illnesses more commonly were found in households with poor, chronic access to medical care. The use of cement block housing correlated with availability of food or running water, with access to medical care and vaccinations, and with a reduced frequency of diarrhea or headaches in the immediate post-hurricane phase.

Conclusions:

Improvements in housing construction appear to be the most effective preventive measure for withstanding the effects of future hurricanes in tropical regions similar to northern Honduras.
Topical Mafenide Hydrochloride Aqueous Spray in Initial Management of Massive Contaminated Wounds with Devitalized Tissue
Authors: Mendelson Janice A.
Published: July 2016

Since at least WWII, some open, contaminated wounds involving massive soft tissue injury and vascular damage have resulted in “irreversible shock,” despite prompt rescue, hemorrhage control, and blood and fluid replacement, without signs of clinical infection.

In animal studies, survival time was related statistically to the dosage of Clostridium perfringens in multicontaminated explosive wounds. Survival time was lengthened by the application of some topical antibacterial agents, but actual recovery was achieved only with topical mafenide hydrochloride solution aqueous spray, which resulted in negative clostridium. perfringens cultures. Although not related statistically to survival time, the mafenide hydrochloride spray also controlled the Pseudomonas aeruginosa in these wounds.

Mafenide hydrochloride had the American trade name of Sulfamylon from about 1942 until 1998, when another pharmaceutical company patented Sulfamylon as the trade name for mafenide acetate, a weaker antibacterial agent. However, mafenide hydrochloride still is available from chemical companies.

Mafenide hydrochloride solution spray has been used successfully in treatment of patients with severe by contaminated wounds and deep burns, and its use in initial care should be revisited.
Retention of Basic Trauma Life Support Skills
Authors: Werman Howard A. , Keseg David R. , Glimcher Mayer , Schumacher Carol , Shaner Steven , Brown Charles G.
Published: July 2016

The Basic Trauma Life Support (BTLS) course was developed to teach prehospital providers a rapid, prioritized approach to assess and manage the trauma victim. Little data currently are available relative to the retention of the cognitive and psychomotor skilk taught in the course. To examine this question, thirteen paramedics were retested on identically moulaged trauma scenarios and written examinations 14–16 months after initial training in BTLS. No advanced notification of the re-test was given. Written test scores decreased from an initial mean of 93.0±6.6 to a mean of 64.9±11.8 (p<0.001) 14–16 months later. Similarly, the trauma scenario test scores declined from 71.6±10.4 to 61.3±16.2 (p<0.05). The results suggest that there is significant loss of both didactic information and practical skills from the BTLS course 14–16 months after training. Frequent BTLS refresher training in the form of supplemental readings, lectures, and repeated exposures to trauma simulations is needed.
The Feasibility of Prehospital Medical Response Teams for Foreign Disaster Assistance
Authors: Abrams Terry
Published: July 2016

Disasters are defined as events caused either by natural or technological occurrences, that overwhelm the resources that are immediately available to manage or mitigate the impact of the event. Disasters, by their very nature, are newsmakers. With the improvement in telecommunications, the barriers of distance are reduced to the extent that the people of the world all are members of what Marshall MacLuhan called the “global village.” It now is a common practice to watch the effects of a disaster on the other side of the world, from the safety and comfort of the living room, live on television. The capacity to empathize with the victims, and to feel almost a part of the incident, results in tremendous public attention and an urging of governments, not directly affected by the event, to get involved and “do something!”
The Physician's Role In Canada's Disaster Response System
Authors: Sookram Sunil , Cummings Garnet
Published: July 2016

The most recent tragedy in Manitoba illustrates that disasters can strike any community. Within Canada, a tiered disaster response system exists. Even though physicians often play an integral role in the disaster plan, few participate in the planning process or even appreciate their potential role in the event a disaster should occur. Physician involvement would guarantee health matters be appropriately addressed resulting in reduced mortality and decreased morbidity. There are ample opportunities to become involved in disaster planning and response at all levels government. The objective of this paper to inform physicians about the disaste planning infrastructure that exists in Canada, show them where they may get involved, and urge them to do so.
Care Provided by VA Mobile Clinic Staff During Northridge Earthquake Relief
Authors: Weiss Thomas , Weiss Linda , Teeter David , Geraci Jane
Published: July 2016

Introduction:

From 25 January 1994 to 02 February 1994, staff aboard four Veterans Affairs Mobile Clinics treated Northridge Earthquake victims. This study examined the types of conditions treated by Clinic staff during the disaster.

Methods:

A descriptive case series using 1,123 ambulatory encounter forms was undertaken. Case-mix was assessed by classifying diagnoses into 120 possible diagnostic clusters.

Results:

Forty-five percent of patients were infants or children and 60% were female. The primary diagnoses were characterize by acute conditions: 1) upper respiratory infection (34.6%); 2) stress reactions (11.9%); 3) otitis media (10.1%); and injuries (8%). Two-thirds of the infants and children either had an upper respiratory infection (46.4%) or otitis media (20.1%). Increasing age indicated an increased likelihood of stress and anxiety reactions.

Conclusion:

The results provide additional information for agencies involved in planning for and responding to disasters. Based on the types of conditions diagnosed at the United States Veterans' Administration mobile clinics (i.e., a high prevalence of acute conditions, including stress and anxiety reactions, and the large numbers of children), staff trained in primary care, mental health, and pediatrics should be considered for relief missions that begin several days after an event resulting in a disaster.
Disaster-Site Medical Support Organization in a Small Country
Authors: Anantharaman V.
Published: July 2016

Optimal, initial medical care given at the disaster site to victims of civil disasters requires an organized, pre-planned, disaster-site medical support system. Such a system has been developed in Singapore.

On notification of a serious civil disaster, the Coordinating Health Agency (CHA) initially dispatches up to three medical teams. Each team consists of two doctors, four nurses, and an allotment of pre-packaged medical supplies. A Disaster-site Medical Command (DSMC) head-quarters (HQ) is established, consisting of a Medical Commander (MC), a Deputy Medical Commander (Dy MC), three hospital staff, and a clerk. The MC conducts an initial assessment of the disaster site and then deploys medical teams and establishes the headquarters. The MC also informs the CHA (via cellular telephone) of the situation at the disaster site and when deemed necessary requests further medical assistance.

The MC has two-way radio contact with all medical teams. The medical teams relay information regarding the casualty situation, requirements for ambulances, stretchers, and medical supplies. Direct channel communication with the CHA enables the MC to direct ambulance transport of patients from the disaster site. The MC also has operational control over other paramedical teams from the Fire Service, the Singapore Red Cross, and the Singapore Armed Forces. Prior to transportation to the hospital, the medical teams only carry out trauma resuscitative procedures such as maintenance of airway, ventilation, and circulation.

This system is expected to provide a coordinated and rapid medical response to a civil disaster situation.
KAMEDO — A Swedish Disaster Medicine Study Organization
Authors: Kulling Per E. J. , Lorin Henry
Published: July 2016

Kamedo is a Swedish Disaster Medicine study organization that sends observers to disaster areas anywhere in the world to study recent events, collect useful information, and identify problems relative to the practice of Disaster Medicine. The results of these investigations are published in the KAMEDO Reports, and the English versions will be published in Prehospital and Disaster Medicine.

Three of the recent reports follow: 1) KAMEDO Report 69: Ebolus Virus Epidemic in Zaire, 1995; 2) KAMEDO Report 70: The German Rescue and Emergency Organizations: a) Industrial Chemical Fire, Memmingen, Germany 23 January 1997; b) Fire at the Düsseldorf Airport, 01 April 1996; and c) Bus Accident on the Autobahn in Rosenheim, Germany; and 3) Terrorist Attack with Sarin, 20 March 1995. In addition, a catalog listing all of the KAMEDO Reports available in English is provided.
Compact Ventilators in Emergency Medicine
Authors: Dahlgren B. E. , Nilsson H. G.
Published: July 2016

An increasing amount of medical equipment is brought to the scene of a medical emergency. Most of these apparatus seem to be only slightly modified versions of equipment originally designed to be used inside the hospital. This equipment has to function in various extreme environmental conditions.
A New Model of Mobile Intensive Care Unit
Authors: Boncinelli Sergio , Lorenzi Paola , Marsili Massimo , Bozzi Antonio , Giunti Patrizia , Lowe Vivien
Published: July 2016

For some time emergency ambulances have been in operation in Italy. In spite of their modern equipment, these ambulances often turn out to be unsuitable for a comfortable journey and do not have satisfactory working conditions. This is due to the lack of up-to-date standards for vehicles and equipment.
Trauma Triage
Authors: Champion Howard F.
Published: July 2016

Triage is the process of classifying injured patients according to a predetermined hierarchy. Triage typically involves the urgency prioritization of trauma patients in mass casualty circumstances. The triage process is also used daily in Emergency Medical Systems that incorporate trauma care systems to identify how severely a patient is injured and to channel the patient into the appropriate treatment echelon, i.e., to determine a threshold level of severity that merits a specific level of care.
Microcirculatory Support by Fluorocarbons
Authors: Faithfull N.S. , Erdmann W. , Fennema M. , Smith A. , van Alphen W. , Kok A.
Published: July 2016

Fluorocarbons, or more strictly perfluorochemical (PFC) containing plasma substitutes have a high solubility for the respiratory gases, a desirable feature for a plasma substitute. This was dramatically demonstrated by their ability to sustain life for many hours in rats almost completely devoid of red cells. The ability of PFCs to carry oxygen exceeds that of other hemodilutents and they have been shown to produce better oxygenation under conditions of hemodilution than hydroxyethyl starch, dextran solutions or stroma-free hemoglobin solutions.
Trauma: Renal Function and Hydroelectrolyte Balance Assessment in Real Time
Authors: Magalini S.I. , Proietti
Published: July 2016

The kidney plays a fundamental role in the maintenance of the homeostasis of all body fluids; it operates as an efficient buffer system in the prevention of dehydration, hyperhydration, acid base and electrolyte imbalance and it removes toxic metabolites. It is not surprising, therefore, that post traumatic acute tubular necrosis (ATN) is characterized by a mortality that exceeds 80% in spite of the progress offered by dialysis and clinical nutrition. The mechanisms of this critical pathological condition are summarized in Figure 1.
A Model for a Statewide Critical Incident Stress (CIS) Debriefing Program for Emergency Services Personnel
Authors: Neely Keith W. , Spitzer William J.
Published: July 2016

Purpose:

Emergency services personnel are highly vulnerable to acute and cumulative critical incident stress (CIS) that can manifest as anger, guilt, depression, and impaired decision-making, and, in certain instances, job loss. Interventions designed to identify such distress and restore psychological functioning becomes imperative.

Methods:

A statewide debriefing team was formed in 1988 through a collaborative effort between an academic department of emergency medicine and a social work department of a teaching hospital, and a metropolitan area fire department and ambulance service. Using an existing CIS debriefing model, 84 pre-screened, mental health professionals and emergency services personnel were provided with 16 hours of training and were grouped into regional teams.

Debriefing requests are received through a central number answered by a communicator in a 24-hour communications center located within the emergency department. Debriefings are conducted 48–72 hours after the event for specific types of incidents. Follow-up telephone calls are made by the debriefing team leader two to three weeks following a debriefing. The teams rely on donations to pay for travel and meals.

Results:

One hundred sixty-eight debriefings were conducted during the first four years. Rural agencies accounted for 116 (69%) requests. During this period, 1,514 individuals were debriefed: 744 (49%) firefighters, 460 (30%) EMTs, and 310 (21%) police officers, dispatchers, and other responders. Deaths of children, extraordinary events, and incidents involving victims known to the responders (35%, 14%, and 14% respectively) were the most common reasons for requesting debriefings. Feedback was received from 48 (28%) of the agencies that requested the debriefing. All of those who responded felt that the debriefing had a beneficial effect on its personnel. Specific individuals identified by agency representatives as having the greatest difficulty were observed to be returned to their pre-incident state.

Conclusion:

CIS debriefings are judged as beneficial. A statewide response team is an effective way to provide these services at no cost to agencies.
Interactive Computer-Aided Training of Emergency Care Tactics: An Experimental Study with Medical Students
Authors: Mattila Matti A. K. , Jama Timo
Published: July 2016

Introduction:

It is important to know which level of tactical preparedness is reached after completing lectures and training included in a medical curriculum. A computer-based interactive programme aimed for tactical training of emergency care tactics at the scene (Matimed,™ Matimed Ltd, Kuopio, Finland) was used in testing the skills of 20 medical students.

Methods:

In this standardised test, every student first received guided introduction on the technical use of the programme. The test included four severely injured victims. The traumas used were hepatic rupture, flail chest, haemothorax, and femoral fracture. The students were tested in making decisions on the priority of care and transportation and in keeping the patients alive with appropriate emergency care until they were transported to a trauma centre.

Results:

Only five of20 (25%) succeeded in this task, 50% lost one victim and 25% lost two. The results show that the tactical preparedness of medical students is far from what is presumed. A more detailed analysis shows serious deficiencies in decision-making, priority order of actions, and in the use of available resources.

Conclusion:

This type of interactive computer-aided training of tactics appropriately supplements theoretical lectures, and partially fills the need for practical training.
A Comparative Study of Five Transcutaneous Pacing Devices in Unanesthetized Human Volunteers
Authors: Heller Michael B. , Peterson Joseph , Ilkahpamipour Keveh , Kaplan Richard , Paris Paul M.
Published: July 2016

Transcutaneous Pacing (TCP) is a rapidly applied “non-invasive” technique that can be used successfully in the hospital, emergency department or field setting (1–9). Although the technique has been studied for three decades (7), it is only in the last few years that commercial units have been widely available. Improvements in pad design (particularly the development of non-metallic electrodes) and pulse characteristics (a pulse width of greater than 20 msec.) have allowed the development of units which may provide high capture rates with a level of discomfort which is tolerable in the conscious patient. Transcutaneous pacing may obviate the need for emergency transvenous pacing; further, it is easily adaptable to the field setting although early application appears to be needed for success (1,2).

No study has compared the relative effectiveness of different TCP units, and there are no published data on some of the devices. The purpose of this investigation was to compare the functions of five different external pacemaker units on ten volunteers, in order to determine: 1) what percent of subjects could be captured within the limits of tolerability (the capture rate); 2) how much current was required by each unit to capture (the capture threshold); and 3) the degree of discomfort produced by each pacemaker at the capture threshold.
Paramedic On Scene Time for Patients Initially Refusing Treatment or Transport
Authors: Heiser John M. , Norton Robert L. , Neely Keith W. , Acker Joe , Hedges Jerris R.
Published: July 2016

Introduction:

Patients initially refusing care (PIRC) place their health in jeopardy and consume paramedic and base-station physician time. This study quantifies the time spent on-scene related to PIRC cases.

Methods:

A retrospective analysis of 128 PIRC cases was performed in the Multomah County EMS system.

Results:

The PIRC cases had a significantly longer mean on-scene time than did non-refusal cases (30.3 vs 14.6 min; p<.001). Medication administration by paramedics (14% of patients) significantly increased the on-scene time. Overall, the mean time on-scene was not affected by age, gender, vital signs (pulse, blood pressure, respiratory rate), police involvement, and whether the patient was transported. The type of call had limited influence on on-scene time, although mean on-scene time was significantly longer for altered mental status cases than for trauma related cases (35.6 vs 22.4 min; p<.03).

Conclusions:

PIRC cases create a burden on the EMS system by consuming paramedic and base-station physician time and by preventing these personnel from responding to other calls.