bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Job Satisfaction Among Rural Emergency Medical Technicians
Authors: Whitley Theodore W. , Revicki Dennis A. , Allison E. Jackson , Landis Sandra S.
Published: July 2016

This study investigated the capacity of selected personal and work environment characteristics, in combination with occupational stress, to predict job satisfaction for 495 emergency medical technicians (EMTs) who provided emergency medical services in a rural area in the United States. Using data obtained during a three-year survey, multiple regression analysis identified work group cohesiveness and effective supervisory behavior as the best predictors of job satisfaction. The perceived level of occupational stress and years of experience as an EMT were inversely related to job satisfaction, but EMTs who responded to the survey as they were preparing to enroll in advanced training programs were more satisfied with their jobs than were other subgroups. These results suggest that job satisfaction can be enhanced by reinforcing cooperation and cohesiveness within EMS work groups, by establishing and maintaining effective communication networks between EMS administrators and EMTs, and by providing opportunities for professional growth and development for EMTs.
Rapid Volume Infusion in Prehospital Care
Authors: Rottman Steven J. , Larmon Baxter , Manix Tom
Published: July 2016

The ability to deliver large volumes of intravenous (IV) fluids may be critical to the successful prehospital resuscitation of hypovolemic patients. We compared the time required to deliver one liter of crystalloid solution, using an administration set-up consisting of a 16-guage (g), 1.25 inch, intravenous cannula, a pneumatic pressure bag, and either conventional intravenous tubing (3.2 mm internal diameter [ID]) or large bore (4.4 mm internal diameter [ID]) “shock” tubing. With the fluid bag positioned at 110cm (46 inches) above the level of the cannula, the mean elapsed time to deliver 1,000ml using the conventional tubing set-up was 6.0 minutes, while the same volume could be delivered in only 2.7 minutes with the shock tubing configuration. This time was reduced to 1.8 minutes when the intravenous cannula size was increased to 14g. By attaching a liter of fluid to each arm of the “Y” adapter of the shock tubing, virtually uninterrupted fluid flow may be maintained at this rate. We feel this intravenous configuration could enhance greatly the ability of paramedics to provide fluid resuscitation in the field setting. When such IVs are established en route to a receiving hospital, this technique may prove to be an important adjunct to improving patient outcome from hypovolemic shock.
Endotracheal versus Intravenous Epinephrine in the Prehospital Treatment of Cardiac Arrest
Authors: Schneider Sandra M. , Yealy Donald M. , Michaelson Edward A. , Kearns Thomas R. , Paris Paul M.
Published: July 2016

We performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.
Minimum Data Set for EMS Report Form: Historical Development and Future Implications
Authors: Hedges Jerris R. , Joyce Steven M.
Published: July 2016

Report forms are used by Emergency Medical Services (EMS) systems for documentation of services provided and for self-analysis of EMS functions. Although the EMS Systems Act of 1973 originally intended for the development and implementation of a uniform EMS report form, items recorded on EMS forms vary throughout the United States. We review the governmental sponsored development of a recommended minimum data set (MDS) for EMS forms performed in 1974, and discuss areas of needed investigation regarding data set development and usage. The concepts used to develop the recommended MDS provide a useful resource for review of the purpose and content of one's own EMS report form. However, future data set development and applications should use outcome measure guided data set selection, on-line validation of data item accuracy and recordability, psychometric analysis of the process of form completion, and incorporation of new data entry and storage technology.
15 Years of Experience with Cardiopulmonary Resuscitation in the Kingdom of Saudi Arabia: A Critical Analysis
Authors: Seraj Mohamed A. , Harvey Paul J.
Published: July 2016

The objective of this review is to establish a framework about the educational activities of the Cardiopulmonary Resuscitation (CPR) National Committee of the Saudi Heart Association (SHA) and determine if it has had any effect on the survival rate in daily hospital work. Further, the review puts forward recommendations regarding the key to success for future implementations and improvement in the outcome of heart attacks in the Kingdom of Saudi Arabia (KSA).

Cardiopulmonary resuscitation (CPR) was introduced into the Kingdom of Saudi Arabia in the 1980s. The birth of CPR in the Kingdom was conducted by the American Heart Association (AHA) provision of the first instructor course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) in the spring of 1984. This educational activity was initiated by the Postgraduate Center of the College of Medicine and currently is a function of the Saudi Heart Association (SHA). The National Heart Center (NHC) continually expands its activities. The number of courses organized, conducted, and reported herein totaled 459 for providers and instructors in BCLS and advanced cardiac life support. This resulted in certification of 916 and 204 instructors in basic and advanced CPR respectively. There were 80 centers established in the Kingdom over the span of 15 years. They all provide BCLS courses; only 13 provide advanced cardiac life support courses. The SHA issued a total of 84,659 certificates.
Quantifiable Effects of Nuclear War on Health
Authors: Gunn S. William A.
Published: July 2016

Superpower military competition has abated, but the specter of nuclear weapons still adds a completely new dimension to warfare. The destructive capacity of so-called conventional bombs was made cruelly evident in the Second World War. Yet, today, a single, thermonuclear bomb has the explosive power of a million times the largest conventional device, with not only devastatingly immediate consequences but also extremely harmful long-term effects, both at the site of the attack and far away, in time and space (Figure 1).

In Figure 2, the small central circle with a radius of 1.4mm represents the combined area which would have been affected by the total of all the explosives used in the Second World War. The larger circle, with a radius of 100mm, represents the relative destructive power of the nuclear arsenals stockpiled today. This is a terrible and, hopefully, a sobering image.
Disaster Reanimatology Potentials: A Structured Interview Study in Armenia
Authors: Ricci Edmund M. , Pretto Ernesto A. , Safar Peter , Klain Miroslav , Angus Derek , Tisherman Samuel A. , Abrams Joel , Crippen David , Comfort Louise , Semenov Victor ,   other members of the Disaster Reanimatology Study Group
Published: July 2016

The study of a disaster which has occurred cannot be researched using the traditional techniques as it is not possible to conceive or conduct controlled, randomized experiments for such an event. Paper I of this series described non-experimental, scientific methodologies which were applied to study the detection-extrication-resuscitation activities which occurred following the devastating 1988 earthquake in the Republic of Armenia, USSR. This paper critically evaluates the methodologies used for the Armenia study and proposes modifications in these methods for application to the study of future disasters.

Approaches which could be applied to the study of future disasters are defined and critically evaluated from the view of reliability, validity, costs, and practicability. The revised set of protocols is discussed in terms of: 1) the structured interview process; 2) training of personnel to conduct, synthesize, and evaluate the interviews; 3) the time required to complete the interview process; 4) sampling techniques; 5) mechanisms for cross-checking the data; and 6) the addition of preliminary data collection immediately following or during the event. Use of this revised approach should assist in the collection and analysis of data associated with future disasters so that it is possible to: 1) further enhance life-saving and reduce mortality; 2) improve relief efforts; 3) reduce damage to communities; 4) evaluate the long-term effects of such events; and 5) assist in better preparation for future events.
Critical Incident Stress Intervention After Loss of an Air Ambulance: Two-year Follow Up
Authors: Macnab Andrew J. , Russell James A. , Lowe John P. , Gagnon Faith
Published: July 2016

Objective:

Following an air ambulance crash with five fatalities, critical incident stress debriefing (CISD) was provided for involved paramedics, physicians, and nurses. A study was conducted to evaluate the long-term effects of a critical incident with critical incident stress debriefing according to the Mitchell model.

Methods:

Six months following the incident, empirically designed questionnaires were mailed to all transport paramedics and directly involved medical staff, and a random sample of both nurses from the dispatch/receiving institution and paramedics from around the province. Twenty-four months post-incident, all members of the transport paramedics completed the Impact of Events Scale and the General Health Questionnaires.

Results:

There were no differences between groups on any scores, except for disturbed sleep patterns, bad dreams, and the need for personal counseling being greater among transport paramedics at one day. There was no correlation between how well the deceased individuals were known, amount of debriefing, and symptom severity. A trend was seen for those with pre-existing stress management routines to have less severe symptoms at six months (p = 0.07). At two years, 16% of transport paramedics still had significant abnormal behavior.

Conclusion:

CISD did not appear to affect the severity of stress symptoms, whereas having pre-existing stress management strategies may. These findings give justification for proceeding to a randomized, controlled trial of different levels of critical incident stress intervention.
Intraoperative Autotransfusion
Authors: Lapin Ron , Erdman Wilhelm , Faithful Simon
Published: July 2016

In spite of the current interest in intraoperative reinfusion and the acknowledged benefits of the autologous versus homologous transfusions, this approach towards blood conservation and minimizing the risks inherent to blood transfusions (Table I) has not received the recognition which it properly deserves. Reluctance by surgeons to use this technique is undoubtedly due to the confusion which still exists in the literature regarding the possibility of complications in using this procedure. Widely divergent hematological abnormalities in the form of various coagulopathies and hypofibrinogenemia still appear in medical communications.
Casualty Patterns in Disasters
Authors: Sklar David P.
Published: July 2016

This brief examination of casualty patterns suggests that differences may exist in the numbers of immediately dead and critical patients, depending on the nature of the disaster. More data must be collected from future disasters to more accurately define relationships between critical patients and total numbers injured. Such characterization is essential for hospital disaster planning because critical patients require great resources and optimal hospital functioning.

Knowledge of casualty patterns can make disaster planning more practical, disaster drills more realistic, and disasters less disastrous.
Emergency Medical Service System (EMSS) in Tokyo: Special Reference to the Disaster Program
Authors: Tsuzuki Masakazu , Tsutsumi Haruhiko , Aruga Tohru , Mii Kohji
Published: July 2016

The Emergency Medical Service System in Tokyo has been developed through the cooperative efforts and achievements of many. EMS in Tokyo consists of three parts: 1) the network system of emergency hospitals; 2) the transportation system of emergency patients (Ambulance System); and 3) the communications system (Emergency Medical Information System). Emergency services are controlled by the Japanese Ministry of Home Affairs and the Ministry of Health and Welfare. The former is in charge of ambulance and rescue services located in the fire department, the latter has to do with medical affairs.
The American Red Cross Training System for Preparing Disaster Health Services Personnel
Authors: Kauffman Carole K.
Published: July 2016

Disaster relief and the spirit of volunteerism have been inextricably interwoven with the design and development of Red Cross societies around the world. The American Red Cross is one of 131 members of an international federation of national Red Cross and Red Crescent societies, the League of Red Cross Societies. Societies are chartered by their own governments and conduct programs in the fields of health, welfare, and safety in accordance with each nation's needs.
Anecdotes on Resuscitation Potentials Following the Earthquake of 1970 in Peru
Authors: Safar P. , Ramos V. , Mosquera J. , Ames A.
Published: July 2016

Data on resuscitation potentials immediately following major earthquakes are lacking. Published reports have been unrevealing. Retrospective interviews of surviving eyewit esses might be more revealing. The epicenter of the last major Peruvian earthquake of May 30, 1970, was off the coast, but the damage included most of central Peru including the Andean Range. A total of 80,000 people were killed, including the entire population of Yungay (25,000), buried alive by several m of an ice-mud-rock avalanche which broke off Mt. Huascaran (22,000ft.). There, resuscitation potential was zero. In nearby Huaras (pop. 30,000, alt. 12,000 ft.), 15,000 died, 90% of houses were destroyed. Interviews with lay survivors gave unclear reports.
A Study of the Clinical Effects of Airway Warming in the Treatment of Accidental Hypothermia
Authors: Loyd Evan Ll
Published: July 2016

Nineteen clinical cases of accidental hypothermia were treated with airway warming (AW) and the results compared with 18 cases which were allowed to rewarm spontaneously. AW accelerated the rate of rewarming and had beneficial effects on cardiac and cerebral function. In patients with chronic hypothermia, i.e. the elderly and those suffering from malnutrition, the accelerated rewarming increased the risk of developing pulmonary and/or cerebral edema which could prove fatal. The patients with acute hypothermia all rewarmed successfully but the mortality for the chronic hypothermic patients was higher in the AW group.
The International Veterinary Academy on Disaster Medicine
Authors: Shomer Robert R.
Published: July 2016

The International Veterinary Academy on Disaster Medicine had its genesis in Perth, Australia, when at the World Veterinary Congress in August 1983, Dr. Ole Stalheim extended an invitation to attend a meeting of a group under the label “World Veterinarians Against Nuclear War”. It had an auspicious beginning—we attracted some attention in the media, more indeed, than we had received during our early attempts at formation in the United States. It became apparent, however, that we were in effect replicating activities of other well-established and more financially secure groups—Physicians for Social Responsibility, the Society Against Nuclear Energy (SANE), etc. We needed greater participation to cope with “peace time” problems already confronting us as well, and it was evident that a larger veterinary audience would be reached and our services to the community enhanced if we broadened the commitment.
Prehospital Fluid Administration in Trauma
Authors: Rottman Steven J.
Published: July 2016

Emergency Medicine has become an accepted specialty in the medical community, and with the recognition has come the responsibility for those of us who teach and practice it to study our clinical practices. We must be satisfied that our clinical judgments are well- founded, not only in emergency departments, but also in our special role as providers of prehospital medical care. With the advent of trauma centers and Advanced Trauma Life Support (ATLS) training, the pivotal issues of the prehospital care of the trauma victim, and the timeliness of transporting these patients to appropriate receiving hospitals have resulted in a pair of recurring criticisms in the medical literature.
The Role of Veterinary Sciences In Chemical Disasters and Emergencies
Authors: Mantovani A.
Published: July 2016

The roles of the veterinary sciences in disasters and emergencies related to exposures of the environment to harmful chemicals are reviewed. Characteristics of chemical emergencies which require the use of the veterinary sciences are discussed. Veterinary services are important in the: 1) definition of the kind and severity of the pollution through biological monitoring; 2) use of animals as monitors of the environment; 3) use of changes in the health status of animals for identification of pathophysiologic changes to man and other animals (sentinels); 4) maintenance of the hygiene of elements of the food chain; 5) evacuation and management of animal populations; 6) disposal of carcasses; and 7) treatment and follow-up of involved animal populations. Veterinary services are important components of responses to incidents marked by chemical pollution and must be included in the development of contingency plans to meet the demands created by chemical pollution.
Cellular Telecommunications at Amtrak's Worst Crash
Authors: Wiles Charles E. , Ramzy Ameen I. , Belzberg Howard
Published: July 2016

Medical communications associated with a collision between a passenger train and three locomotives which resulted in the death of 16 and injury to at least 177 persons quickly overwhelmed the relatively sophisticated EMS communications center (SYSCOM) serving the state of Maryland, U.S.A. Other than traditional talk-by and ambulance-hospital communications, the system was saturated by: 1) communications between seven prehospital sectors; 2) persons moved into the field from their usual in-hospital environment who were not familiar or experienced with the use of radio communications; 3) traffic generated through the operations of 11 helicopters; and 4) the usual confusion that accompanies such events. The use of cellular telephones during this incident, substantially enhanced all levels of communications. Many of the participants expressed preference for this form of communications compared to the use of radios.

Problems associated with the use of cellular telephone communications included an insufficient number of channels made available by the telephonecommunications provider causing competition with non-essential personnel for use, and relatively short battery life. These problems can be solved by the provider opening more channels and by the use of larger power sources such as automobile storage batteries. It is concluded that portable and vehicle-mounted cellular telephones can serve as useful communications tools in mass casualty and disaster situations.
The League of Red Cross and Red Crescent Societies (LRCS)
Authors: Kisselev Andrei K.
Published: July 2016

The “International Red Cross” is composed of: (1) The International Committee of the Red Cross (ICRC) which focuses on war victims; (2) the LRCS; and (3) the 130 National Red Cross and Red Crescent Societies worldwide which are federated by the LRCS. The LRCS was founded to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world. The LRCS considers health as one of the keys to a better world for everyone. Red Cross programs include the training of nursing personnel, the provision of health care in rural areas, the organization of assistance to the sick, aged, and handicapped, and teaching first aid skills to lay people.
Resolutions Concerning Disaster Medicine and Nuclear War
Authors:   World Association for Emergency and Disaster Medicine (WAEDM)
Published: July 2016

The members of the World Association for Emergency and Disaster Medicine (WAEDM) (The Club of Mainz) have considered the medical consequences of a major nuclear war and would like to make the following recommendations to all relevant governments and powers, and their medical professions:

1. That disaster medical preparedness should be continued and developed for conventional wars, nuclear accidents and the single small nuclear bomb explosion (e.g., by accident or terrorism).
Military-Civilian Collaboration for Disaster Medicine in Israel (Discussion Comment)
Authors: Adler Yakov
Published: July 2016

The only organization presently capable of responding immediately to a mass casualty situation in peacetime in Israel would be the Israeli Defense Forces. They have available the necessary means, organization, trained manpower and equipment. If a state of emergency would be proclaimed in the state of Israel in case of a major earthquake or similar disaster, in any part of the country, the chief military commander would be in charge. His army would take command over that area. All the other civilian institutions concerned with the care of casualties, including fire fighting forces, police and hospitals, would come under his command. With the military in charge, the response would be much shorter. The chief military commander would proclaim a state of emergency if he feels that it is warranted.
Military-Civilian Collaboration for Disaster Medicine in the Federal Republic of Germany (FRG)
Authors: Wedel Karl-Wilhelm
Published: July 2016

The subject of disaster medicine may seem suspect to those who say that it means to prepare for war. Others maintain that in the FRG we need not concern ourselves with disaster medicine because “disasters in this country seem unlikely.” I consider those claims absurd. I will try to point out possibilities for medical support by the West German Bundeswehr (Federal Armed Forces) in the event of natural disasters (e.g., earthquakes, floods, forest fires) or in severe accidents (e.g., traffic, aircraft, railway) where suitable civilian helpers or equipment are unavailable or are available only in insufficient numbers or too late. The Federal Armed Forces' Medical Service, according to legislation, is part of the Armed Forces, organized for defense. The medical service has to provide free medical care for military personnel, and protect, maintain or restore as far as possible the health of military personnel. Moreover, it is a matter of course in our country to employ the medical service of the Bundeswehr for aid in natural disasters or major accidents. For this purpose, the Surgeon General, Federal Armed Forces, in March 1982, issued guidelines on which I will primarily base my remarks.
Hospital Disaster Management Simulation System
Authors: Levi Lion , Bregman David , Geva Hana , Revach Moshe
Published: July 2016

Introduction:

Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals.

Methods:

The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casalty incident (MCI) were developed in the pilot phase. It contains detailed description of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committe decided the crucial model issues and estaalished the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD).

Results:

During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms.

Conclusion:

Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.
The Role of EMS Systems in Public Health Emergencies
Authors: McIntosh Barbara A. , Hinds Patricia , Giordano Lorraine M.
Published: July 2016

Introduction:

Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers.

Methods:

Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDCJ/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9–1–1 system.

Results:

In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the “surveillance net” further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9–1–1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified.

Conclusion:

The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrival at a definitive treatment facility.
The Dynamic Nature of ST-Segment and T-Wave Changes During Acute MI
Authors: Harvey Richard A. , Fuller Frederick P.
Published: July 2016

Obtaining aprehospital 12-lead electrocardiogram (ECG) diagnostic of acute myocardial injury has been demonstrated to hasten the administration of thrombolytic agents in the emergency department. This case demonstrates that aprehospital electrocardiogram diagnostic of acute anterior wall infarction can become non-diagnostic following routine administration of oxygen, nitroglycerin, and morphine by paramedics. Although this phenomenon has been observed in the in-hospital setting, it has not been reported in patients with a prehospital ECG.
Patient Selection for Advanced Prehospital Care in a Two-Level Emergency Medical System
Authors: Applebaum David
Published: July 2016

In Jerusalem, the Emergency Medical Service is the sole prehospital provider for a population of 450,000 residents. Ambulances are dispatched from a centrally located first-aid center. Separate basic and advanced life support (MICU) ambulances are provided. Basic life support units are staffed by Emergency Medical Technicians (EMTs) trained to provide first aid and cardiopulmonary resuscitation (CPR). These units are dispatched to service persons in whom advanced life support (ALS) services are not likely to be required. The MICU is staffed by paramedical personnel plus a qualified physician. In order to maximize the efficiency of the service an attempt was made to use the MICU only for patients who may benefit from ALS interventions.

Selection of patients for whom the ALS unit may be required is accomplished by switchboard operators. These personnel routinely dispatch the MICU for definite emergencies such as unconsciousness or absence of breathing. All other cases have been reported first to an on-call physician who ultimately decides whether or not to dispatch the MICU. This method of determining priority for dispatch is called the Consultation-Dispatch System (CDS). This method of determining priority seemed inefficient, so an alternative system was implemented that did not require prior physician consultation. This brief report details the impact of this change on system operation and MICU activity.
A Survey of Advanced Life Support Practices in the United States
Authors: Lavery Robert F. , Doran James , Tortella Bartholomew J. , Cody Ronald P.
Published: July 2016

Study Objective:

A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.

Methods:

A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.

Results:

One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.

Conclusion:

The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.
Hazardous Materials Incidents: A One-Year Retrospective Review in Central California
Authors: Walter Frank G. , Dedolph Richard , Kallsen Gene W. , Knopp Robert K.
Published: July 2016

Objective:

This study describes the epidemiology of hazardous materials (hazmat) incidents in Fresno County, California, and analyzes the emergency medical services (EMS) response to these incidents.

Setting:

The study area has a population of 635,000 people living in an area of 6,004 square miles.

Design:

All Hazmat Emergency Response Team (HERT) reports and related prehospital, emergency department, and inpatient records from ljuly 1988 through 30 June 1989 were reviewed retrospectively.

Results:

There were 107 hazmat incidents involving 156 materials consisting of pesticides (24.4%), miscellaneous chemicals (17.3%), corrosives (16.7%), petroleum products (13.5%), airborne toxins (10.2%), organic solvents (7.7%), unidentified chemicals (5.1%), infectious medical waste (1.9%), empty containers with radioactive warning symbols but without detectable radiation (1.3%), heavy metals (1.3%), and alkali metals (0.6%). In ten (9%) of the 107 incidents, 68 patients required on-scene evaluation and 26 patients were transported to emergency departments. Four of these patients required admission, three because of injuries due to vehicular accidents, and one because of a coincidental cere-brovascular accident. Five incidents produced multiple victims from exposures to airborne toxins, accounting for 63 (93%) of 68 patients. Spills of solid or liquid pesticides occurred in four incidents involving patients. Ambulance personnel and/or equipment became contaminated in three of these four incidents.

Conclusions:

1) Ambulances should be dispatched selectively to hazmat incidents because only 9% of incidents involved patients. 2) training should emphasize personnel protection and proper patient decontamination to help prevent contamination of EMS personnel and equipment. 3) Preparation of EMS personnel should emphasize exposure to airborne toxins because these produced 93% of patients.
Multi-Casualty Incident EMS Response at a Very Remote Location
Authors: Lewis Craig R. , Johnson Mark S.
Published: July 2016

When a multiple patient incident occurs in a remote location, significant challenges are presented to the Emergency Medical Services (EMS) system. Emergency medical services systems need to have the capability to respond effectively to major incidents anywhere within the service area.

On 2 September, 1988, some time after 1400H, a Gray Line of Alaska tour bus overturned at milepost 132 on the Taylor Highway in the interior region of Alaska. The bus rolled from a soft shoulder down a hill as it attempted to pass a large truck going the opposite direction. The accident location was 220 air miles east of Fairbanks, a city of about 60,000 population.
Disaster Reanimatology Potentials: A Structured Interview Study in Armenia. III. Results, Conclusions, and Recommendations
Authors: Pretto Ernesto A. , Ricci Edmund , Klain Miroslav , Safar Peter , Semenov Victor , Abrams Joel , Tisherman Samuel , Crippen David , Comfort Louise ,   other members of the Disaster Reanimatology Study Group
Published: July 2016

National medical responses to catastrophic disasters have failed to incorporate a resuscitation component.

Purpose:

This study sought to determine the lifesaving potentials of modern resuscitation medicine as applied to a catastrophic disaster situation. Previous articles reported the preliminary results (I), and methodology (II) of a structured, retrospective interview study of the 1988 earthquake in Armenia. The present article (III) reports and discusses the definitive findings, formulates conclusions, and puts forth recommendations for future responses to catastrophic disasters anywhere in the world.

Results:

Observations include: 1) The lack of adequate construction materials and procedures in the Armenian region contributed significantly to injury and loss of life; 2) The uninjured, lay population together with medical teams including physicians in Armenia were capable of rapid response (within two hours); 3) Due to a lack of Advanced Trauma Life Support (ATLS) training for medical teams and of basic first-aid training of the lay public, and scarcity of supplies and equipment for extrication of casualties, they were unable to do much at the scene. As a result, an undetermined number of severely injured earthquake victims in Armenia died slowly without the benefit of appropriate and feasible resuscitation attempts.

Recommendations:

1) Widespread adoption of seismic-resistant building codes for regions of high seismic risk; 2) The lay public living in these regions should be trained in life-supporting first-aid (LSFA) and basic rescue techniques; 3) Community-wide emergency medical services (EMS) systems should be developed world-wide (tai-lored to the emergency needs of each region) with ATLS capability for field resuscitation; 4) Such systems be prepared to extend coverage to mass casualties; 5) National disaster medical system (NDMS) plans should provide integration of existing trauma-EMS systems into regional systems linked with advanced (heavy) rescue (public works, fire, police); and 6) New techniques and devices for victim extrication should be developed to enable rapid extrication of earthquake casualties within 24 hours.
The Prevalence of Occupational Injuries in EMTs in New England
Authors: Schwartz Robert J. , Benson Lionel , Jacobs Lenworth M.
Published: July 2016

Objective:

To characterize the prevalence and morbidity of injuries to emergency medical technicians EMTs) in New England [United States].

Design:

A survey was mailed to a 2% random sample of all registered EMTs in the six New England States. The identity of the EMTs remained anonymous, and a second mailing was used to improve return rate. The EMTs were requested to recall events that occurred during the previous six months.

Results:

A total of 439 of the 786 (56%) surveys were returned representing 13,875 hours of duty time in the six-month period. Seventy one percent of the EMTs were male with a mean age of 35 years. Sixty-six percent were basic-EMTs. Injury attack rates (number of injuries/100 EMTs/6 months) were: stress, 11.2; back, 10.5; extremity, 9.8; assault, 8.4; ambulance collision, 4.1; hearing loss, 2.5; and eye injury, 1.4. Twelve percent of the EMTs were injured more than once in the six-month period. The paramedics more frequently were involved in ambulance collisions, suffered from stress, and were less likely to injure their back. There were minor interstate differences. Disability due to back injury affected 2.5% of those surveyed, four EMTs lost duty time secondary to an assault, and 0.5% of the EMTs were out of work due to stress.

Conclusions:

This survey begins to characterize the occupational risks of EMTs. The prevalence of back injuries, assault, stress, and extremity injuries seems to be too high. Educational programs and preventive interventions should be designed to minimize back injuries, stress, and assault. There is a need for more research nationwide in order to better characterize these injuries.
Do-Not-Resuscitate Orders: Where Are They in the Prehospital Setting?
Authors: Koenig Kristi L. , Tamkin Gary W.
Published: July 2016

Without a well-functioning, prehospital, do-not-resuscitate (DNR) system in place, emergency medical service (EMS) providers must resuscitate all patients who access the system, regardless of the patients' wishes and regardless of what makes ethical or economic sense. In lieu of valid documentation, it is not appropriate to withhold resuscitative measures in this critical, time-dependent situation. In order to help EMS systems implement functional prehospital DNR protocols, this paper reviews the state-of-the-art of prehospital DNR including the issues to consider when designing such a system and a discussion of the features of some of the existing systems. This review includes: 1) the basis and requirements of a DNR system; 2) legal and physical forms for DNR orders; 3) eligibility for DNR status; 4) reversal of DNR orders; and 5) inappropriate use of EMS systems for DNR patients. Finally, a more general discussion of overall resource utilization in prehospital resuscitations is presented to emphasize that implementing prehospital DNR systems is only one piece of a larger issue.
Pregraduate Training in Emergency Medicine
Authors: Binder Louis , Colohan Desmond , Dick Wolfgang , Nemitz Bernard , Donchin Yoel , Ohashi Noriyoshi
Published: July 2016

A panel session on undergraduate education in Emergency Medicine from a worldwide perspective was conducted at the Seventh World Congress of Emergency and Disaster Medicine in Montreal, in May, 1991. Desmond Colohan MD, of the University of Toronto (Canada) was the panel moderator. Panel speakers were: Louis Binder MD, Texas Tech University Health Services Center (USA); Wolfgang Dick MD, University of Mainz (Germany); Bernard Nemitz MD, Faculty de Medicine d'Ameins (France); Yoel Donchin MD, Hadassa Medical Organization (Israel); and Noriyoshi Ohashi MD, Tsukuba Medical Center (Japan).
Therapeutic Agents Utilized in Urban/Rural Prehospital Care
Authors: Moss Robert L. , Kolaric David , Watts Andre
Published: July 2016

Introduction:

Objectives of this study were to determine the number of prehospital emergency patients who were given advanced life support (ALS) drugs and to compare utilization rates for ALS drugs in urban and rural environments. Certified ALS emergency medical technicians (Arizona) have 29 therapeutic agents authorized for prehospital administration. These agents may be administered only under direction of a medical control authority or by following standing orders.

Methods:

A retrospective review was made of prehospital emergency encounter records. They were acquired by the Arizona Office of Emergency Medical Services (OEMS) from rural EMS providers who used optically scannable forms and from a metropolitan fire department's medical emergency response records.

Results:

In 1989 and 1990, 273,611 emergency patient encounter records were entered into the EMS database; 197,260 were urban responses and 76,351 were rural responses. Drugs (ALS) were administered to 16,730 (8.5%) urban emergency patients and to 5,359 (7%) rural emergency patients at the incident site or during transport to a medical care facility. Nitrostat, 0.4 mg sublingual tablet, was the drug most frequently administered to emergency patients in the prehospital setting. Utilization rates found in the urban and the rural data sets were consistent for the indivdual agents. Variations in use frequency between urban and rural setting were noted for some drugs. Of the 29 approved ALS drugs, seven (24%) were administered to 10% or more urban patients who received drugs. In the rural areas, eight (27.6%) were administered to 10% or more patients who received drugs. There were nine (31%) agents administered to less than 1% of all patients who received drugs. A majority of the approved drugs, 17 (59%) were administered at a rate below 5% of all patients receiving medications.

Conclusion:

Severity of illness or injury prompted administration of ALS drugs to 8.1% of patients receiving prehospital emergency care. The most frequently utilized medication in the urban/rural areas was for treatment of cardiac symptoms. Variations between urban/rural drug utilization reflected the drugs of choice which are compatible with long transport times to a medical facility.
Medical Control of Mass Gatherings: Can Paramedics Perform Without Physicians On-site?
Authors: McDonald Cary C. , Koenigsberg Max D. , Ward Sharon
Published: July 2016

Objective:

Evaluate the experience of paramedic personnel at mass gatherings in the absence of on-site physicians.

Design:

Retrospective review of patients evaluated by paramedics with emergency medical services (EMS) medical control.

Setting:

First-aid facility operated by paramedics at an outdoor amphitheater involving 32 (predominantly rock music) concerts in accordance with the Chicago EMS System, June through September 1990.

Participants:

A total of 438 patients (≤0.1% on-site population) were evaluated.

Interventions:

Presentations to the first-aid facility were viewed as if the patient was presenting to an ambulance. Transportation to an emergency department was strongly recommended for all encounters. Time from presentation to the first-aid facility until disposition was limited to 30 minutes in the absence of on-line [direct] medical control. Refusal of care was accepted. On-line [direct] medical control with the EMS resource hospital was initiated as needed. Off-line [indirect] medical control consisted of weekly reviews of all patient records and periodic site visits.

Results:

Of the 438 patients, 366 (84%) refused further care, including 31 patients (7%) who refused advanced life support (ALS) level care. Seventy-two patients (16%) were transported; 37 by ALS and 35 by basic life support (BLS) units. On-line [direct] medical control was initiated in all ALS patients that were transported as well as for those who refused care. No known deaths or adverse outcomes occurred, based on lack of inquiries or complaints from the local EMS system, emergency departments receiving transported patients, law enforcement agencies, 9-1-1 emergency response providers, venue management, or security. No request for medical records from law firms have occurred. Problems noted initially were poor documentation and a tendency not to document all encounters (e.g., dispensing band-aids, tampons, earplugs, etc.). Concerns noted included: initial and subsequent vital signs, times of arrival, interventions, dispositions, and patient conditions of refusal. Specific problems with documentation of refusals at disposition included: appropriate mental status, speech, and gait; release with an accompanying family member or friend; and parental notification and approval of care for minors. There also was an initial tendency not to establish on-line [direct] medical control for ALS refusal or BLS medicolegal issues.

Conclusions:

The medical system configuration modeled after practices of prehospital care, demonstrates physicians did not need to be onsite when adequate EMS medical control existed with less than 30 minutes on-scene time.