bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials
Authors: Pepe Paul E. , Bickell William H. , Mattox Kenneth L.
Published: July 2016

There exists strong sentiment, among emergency medical personnel and physicians alike, that the pneumatic anti-shock garment (PASG) “saves lives.” As a result, controlled studies have been criticized as the “withholding of important therapy.” The purpose of this presentation is to confirm the need for controlled clinical trials of the PASG. Despite an early report that the PASG offered no advantage in terms of the presenting emergency center Trauma Score (TS), similar disparagements have continued, particularly because survival data were not discussed. The present report is a pilot analysis of the effect of the PASG on the prehospital survival of patients arriving at an urban trauma center in the United States. In the study, sixty-eight patients were assigned randomly to control and PASG groups in a prospective investigation involving injured patients with systemic hypotension. The 32 control patients, whose mean initial systolic blood pressure (BP) was 59 ± 32 mm Hg, and the 36 PASG-treated patients, whose mean initial BP was 55 ± 31 mm Hg, were found to be well matched for age, sex, type and location of injuries, initial field TS; response, field management, and transport times; and the total amount of intravenous crystalloid infused. The results demonstrated no significant difference between the control and PASG-treated groups in terms of those pronounced dead on arrival at the trauma center (9/32 vs. 10/36). Further studies are therefore justified to determine how the PASG affects the long-term morbidity and mortality of injury victims, particularly those within certain sub-groups such as penetrating abdominal versus those with penetrating thoracic injuries. This report reaffirms the need for early responsible, scientific scrutiny of prehospital interventions.
Ineffective Therapy and Delayed Transport
Authors: Lewis Frank R.
Published: July 2016

The administration of IV fluids to traumatized patients in the field at first seems like a motherhood issue: It can't do any harm and might do some good, so why not use it? This rationale has resulted in its inclusion in prehospital trauma care since the advent of paramedic systems in this country approximately 15 years ago; yet it remains unproven. There are no convincing data in the literature to support the efficacy for the administration of IV fluids in the prehospital setting.
Ten Golden Rules for Urban Multiple Casualty Incident Management
Authors: Pepe Paul E. , Stewart Ronald D. , Copass Michael K.
Published: July 2016

Both civilian and military authorities continually are compelled to develop and revise disaster plans in order to demonstrate that they are prepared to manage any major incident occuring within their jurisdiction. Such plans may have some distinct value in that they often contain lists of key persons and agencies to contact in the event of a major incident, or because they prospectively document local policies of operation when actions taken during the incident are subsequently criticized by second-guessers. However, elaborate plans generally are forgotten or initially disregarded at the scene of an actual emergency situation.
International Military-Civilian Collaboration Potential for Disaster Aid in Latin America
Authors: De Ville de Goyet Claude
Published: July 2016

Latin American and Caribbean countries have been affected by many natural disasters in past decades. Earthquakes caused in Peru (1970) approximately 70,000 deaths, in Nicaragua (1972) 5,000 deaths while destroying the capital, Managua, and in Guatemala (1976) 22,000. Hurricanes also wreak havoc: hurricane Fifi in Honduras (1974) with 10,000 deaths, hurricane David (1979), and hurricane Allen in Saint Lucia, Haiti and Jamaica (1980), have amply demonstrated the high vulnerability of these countries to emergency situations. These catastrophes and many other smaller ones required that all resources of the nation, governmental or private, military or civilian, be mobilized in a coordinated manner to meet the emergency needs of the population.
The Needs of Developing Countries
Authors: Fouad Saad
Published: July 2016

EMS in developing countries must be established as a high priority, since it is one of the key elements in making possible any realistic improvement in health care. In Egypt, the pre-hospital phase of EMS is a highly visible commitment to the welfare of the nation and is a catalyst for other health activities. Satisfying needs identified in rural health care, such as high-risk infants, trauma, and time-related health problems, will be facilitated by an effective EMS system. EMS must be adapted to fit the culture of the people and their specific needs.
Helicopter Rescue for Traffic Accidents in West Germany
Authors: Burghart Hans
Published: July 2016

Approximately 200,000 emergency patients die annually in the Federal Republic of Germany (FRG) after a sudden illness or a serious accident. According to estimates, more than 20,000 die because effective first aid was not rendered soon enough. We know that two-thirds of all victims of fatal traffic accidents die within 25 minutes after the accident has occurred. In order to improve chances of survival, the therapy-free interval must be as brief as possible.
Resuscitation and Surgery for Soldiers of the American Civil War (1861–1865)
Authors: Watson James R.
Published: July 2016

On June 2, 1862, William A. Hammond, Surgeon General of the United States Army, announced the intention of his office to collect material for the publication of a “Medical and Surgical History of the War of the Rebellion (1861–1865)” (1), usually called the Civil War of the United States of America, or the War Between the Union (the North; the Federal Government) and the Confederacy of the Southern States. Forms for the monthly “Returns of Sick and Wounded” were reviewed, corrected and useful data compiled from these “Returns” and from statistics of the offices of the Adjutant General (payroll) and Quartermaster General (burial of decreased soldiers).
The Psychosocial Aftermath of the Chernobyl Disaster in an Area of Relatively Low Contamination
Authors: Koscheyev Victor S. , Leon Gloria R. , Gourine Andrej V. , Gourine Valerie N.
Published: July 2016

Introduction:

There has been relatively little attention paid to the mid- and long-term effects of large-scale disasters, particularly their effects on children and young people. At the present time, the impact of the Chernobyl catastrophe on the daily lives of the affected population may include one of strong psychological stress due to uncertainty about ultimate health outcomes. Persons in the Chernobyl region in specific areas of low contamination may be affected similarly. This investigation assesses radiation concerns and attitudes about health and government information, nine years after the disaster, in a group of adults and adolescents residing in a relatively uncontaminated village in the Chernobyl area.

Methods:

Questionnaires were administered to 94 adults and 50 adolescents. Items assessed beliefs about extent of radiation exposure, health concerns regarding oneself and family members, past and current pre-occupation about the disaster, and trust in the accuracy of government information about health effects.

Results:

Considerable uncertainty was demonstrated in both adults and adolescents about the extent of their and their families exposure to radiation. Marked distrust of past and current government information about health effects was evident. A large proportion of subjects reported that they still thought frequently about the Chernobyl accident. They worried about health problems related to radiation exposure whenever they or their family members exhibited physical symptoms or complaints, and they urged family members to go to a medical clinic for evaluation to assess these symptoms.

Conclusion:

The extent of long-term concerns about the personal and family health effects of the Chernobyl disaster in this population residing in a relatively uncontaminated village is striking: the psychological impact on adolescents is considerable. The stress generated is maintained by the realistic uncertainty about the ultimate health consequences to the overall population as a result of radiation exposure and distrust in government information about contamination levels in this particular village. The level of stress and its effects on physical and mental health may increase over time if there is a rise in morbidity in the area. The continuing health needs of the extremely large population affected by the Chernobyl disaster need to be addressed.
The Gulf War: The Experience of a Department of Anesthesiology in the Management of Scud Missile Casualties
Authors: Adu-Gyamfi Yaw
Published: July 2016

Background:

The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated.

Objective:

To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management.

Methods:

On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel.

Results:

There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed.

The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately.

Conclusion:

The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.
Prehospital Severity Scoring at Major Rock Concert Events
Authors: Erickson Timothy B. , Koenigsberg Max , Bunney E. Bradshaw , Schurgin Brian , Levy Paul , Willens Jacob , Tanner Logan
Published: July 2016

Introduction:

Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing.

Study objective:

To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events.

Methods:

Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadiums first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a “DRUG-ROCK” Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests.

Results:

Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5±22.5 minutes (± standard deviation; range: 5–150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (±2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1–4), with 27% rated as moderate (score = 5–9), and 6% severe (score >10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p <0.005).

Conclusion:

The DRISS was useful in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.
Quality Management Tool for Mass Casualty Emergency Responses and Disasters
Authors: Villarreal Marcus S.
Published: July 2016

Introduction and background:

Quality management (QM) principles generally have not been applied to multi-casualty and disaster situations. Quality management incorporates quality assurance (QA) and quality improvement (QI) supported by a management information system (MIS). Since responders to disasters and multi-casualty incidents generally operate on standing orders and/or protocols, the character of the responses lends itself to quality management methods. Standards and indicators of performance readily can be developed for these situations.

Objectives:

1) to format disaster medical records as data collection instruments; 2) to develop appropriate tools that are easy to use for rapid assessments; 3) to develop a mechanism for determination of causes of injuries; and 4) to develop methods to: a) track patients; b) document response and recovery; andc) document the circumstances associated with the event.

Methods:

Model tools using checklists and short, fill-in answers are provided. These tools are designed to be incorporated into the trauma or EMS registries. Emergency medical technicians, nurses, physicians, and medical students scored the same disaster scenario for the functional areas of calling the state of the disaster, triage, and field stabilization.

Results:

Testing indicated that the checklists are completed in less than one minute, and produce objective data per patient in each functional area evaluated. In one instance, data were compiled for 38 patients from one bus accident in less than 10 minutes. The same data were reproduced, without variation, in the same amount of time, by three different providers of varied professional backgrounds.
Survey of Iowa Emergency Medical Services on the Effects of the 1993 Floods
Authors: Chartoff Stanley E. , Gren Joann M.
Published: July 2016

Introduction:

From June through August 1993, extensive flooding in the Mississippi and Missouri River basins resulted in 50 deaths and 12 billion dollars [U.S.] in damages in nine Midwestern states. In Iowa (1990 population 2,777,000), the government declared all 99 counties Federal Disaster Areas. This study examines how this event impacted local emergency medical services (EMS).

Methods:

All 797 registered prehospital ambulance, rescue, and first-response companies in Iowa received survey questionnaires. Two follow-up mailings were provided for non-responders.

Results:

A total of 468 EMS companies (59%) returned completed questionnaires. The geographic distribution ofresponders and non-responders was similar. Of the companies responding, 132 (28%) reported an impact on their operations from the flood disaster. The most frequently reported operational changes included the use of non-traditional vehicles, providing aid to regions outside usual service areas, and involvement in non-medical rescue operations.

Conclusion:

A major flood provides unique challenges for emergency medical services. Cross-sectional surveys can identify areas of improvement for prehospital systems located in flood-prone areas. Results from this study provide a basis for constructing a more refined instrument to study future flood disasters.
Adenosine for the Treatment of PSVT in the Prehospital Arena: Efficacy of an Initial 6 mg Dosing Regimen
Authors: Wittwer Lynn K. , Muhr Marc D.
Published: July 2016

Objective:

To confirm the efficacy of pre-hospital administration of adenosine, using a 6 milligram (mg) initial dosing regimen, for the treatment of paroxysmal supraventricular tachycardia (PSVT).

Methods:

Urban, suburban, rural emergency medical services (EMS) system in Clark County, Washington with advanced life support (ALS) patient transports. Concurrent, paramedic Medical Incident Report (MIR) review was conducted for 102 patients receiving prehospital adenosine during a 42-month period. Patients were administered 6 mg of adenosine using an intravenous (IV) bolus followed by 10 ml of balanced salt solution flush. If the patient's rhythm remained unchanged, the dosing regimen was increased to 12 mg followed by a 10 ml flush. This was repeated once more if the rhythm remained unchanged, to a total maximum dose of 30 mg. Medical direction for administration of adenosine was in the form of standing orders rather than direct (on-line) medical control.

Results:

Seventy-four of 102 patients had PSVT as determined by physician analysis of the initial six-second electrocardiographic rhythm strip (ECG) recording. Sixty-six of these patients converted their cardiac rhythm from PSVT using adenosine; 46 (70%) converted with the initial 6 mg bolus. Fifteen patients converted after receiving the second dose (12 mg); and five patients required 30 mg.

Conclusion:

These results show that for paramedics, adenosine is an effective treatment for PSVT. An initial bolus of 6 mg converts the majority of cases. Eighty-nine percent of cases of confirmed PSVT converted with adenosine administration.
A Self-Assessment of Wisconsin Prehospital Provider Needs
Authors: Stueland Dean , Patzner Mary Jean , Rauch Robert , Birnbaum Marvin L.
Published: July 2016

Introduction:

The pressures facing emergency medical services (EMS) in Wisconsin and their effects on the delivery of prehospital emergency medical care were not known by the Wisconsin EMS Board. In an effort to assess these pressures and the needs of the emergency medical services in the State as perceived by the services, the Board undertook a survey of the EMS providers in Wisconsin.

Methods:

A survey instrument was developed and approved by the EMS Board and distributed to all of the licensed emergency medical services in Wisconsin.

Results:

Of the 453 survey instruments distributed, 323 (71.3%) were completed and returned. Intermediate- and paramedic-level services were more likely to respond than were the basic services, but 235 (72.8%) of the respondents identified their service levels as basic. In addition to providing information about the service characteristics, each responding service also rated the importance of their perceived needs. Lack of medical direction was perceived as the greatest need by all levels of service. However, the second greatest area of need for basic and intermediate services related to difficulty in recruiting new staff. For paramedic services, the second greastest need was associated with dispatching. When comparing services by rural versus urban, difficulty in recruiting new staff and collecting ambulance fees were seen as second and third to lack of a medical director by rural services, whereas urban services noted local training to be in the top three. In the assessment of educational needs, patient-care issues dominated. A review of written comments also demonstrated a difference between rural and urban services, but both noted Medicare and Medicaid reimbursement issues more commonly than any other problem.

Conclusion:

In the restructuring of health care, it will be important to consider the various needs of prehospital providers and recognize that such needs may be unique to the providers' location and level of service.
Patients Who Refuse Transportation by Ambulance: A Case Series
Authors: Hipskind John E. , Gren JM , Barr DJ
Published: July 2016

Introduction:

Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.

Methods:

This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.

Results:

Overall, 30% (683 of2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11–40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.

Conclusion:

There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.
Medical Anti-Shock Trousers: Pneumatic Anti-Shock Garment: Does it Work?
Authors: McSwain Norman E.
Published: July 2016

The use of the Pneumatic Anti-Shock Garment (PASG) has created much controversy in prehospital care. It is interesting that such an inexpensive device and technique has created so much controversy regarding effectiveness when expensive devices and techniques, such as coronary artery bypass, carotid endarteroectomy, and laser angioplasty have been questioned as to effectiveness, but have not created as much controversy.

Where do we stand on the PASG today? One well-done, randomized, prospective study has been reported as several different papers. In reality, these reports originate from only one study (1-5). This is compared to more than 200 other studies, many of which have been randomized, prospective studies in animals using the same quality as the randomized, prospective study done on humans. Such studies have the advantage of having better isolation of the specific condition being studied. It does not seem appropriate to base the clinical use or non-use on just one study. All studies should be reviewed and placed in context when attempting to identify the role the PASG has in patient care.
The Prehospital Use of Albuterol Inhalation Treatments
Authors: Vonderohe Eric A. , Jones James H. , McGrath Roland B. , Bell Leon H.
Published: July 2016

The use of bronch odilators in the prehospital EMS setting is common. This study examined the safety of the administration of 2.5 mg albuterol using a hand-held nebulizer for the treatment of such patients.

A total of 55 patients were included. Following treatment, peak expiratory flow rates (PEFR) increased a mean of 27 L/min, ventilatory rate decreased four breaths/min, heart rate decreased slightly, and systolic blood pressure increased 10 mmHg. Five of the 53 patients in whom cardiac rhythm was monitored, had premature ventricular complexes prior to treatment; only one did following therapy. Breath sounds improved in 61% and were unchanged in 39%. Breathing was reported by the patient as improved in 51 of the 53 (93%) and only one felt worse. Adverse reactions were reported in 15%, but none were severe. This study shows that albuterol (2.5 mg) administration by hand-held nebulizer is both safe and efficacious in the prehospital setting.
High Risk Pediatric Emergency Air Transport
Authors: Goldstein Brahm , Fugate John H. , Conn Alasdair K. , Todres I. David
Published: July 2016

Introduction:

Pediatric Emergency Air Transports (PEATs) at Massachusetts General Hospital, Boston, Massachusetts, were reviewed between November 1986 and December 1987. Severity of illness, complications, and outcome of PEATs were compared with ground transports. Factors associated with PEAT survival were identified.

Methods:

Severity of illness was measured using a modified Denver Patient Status Category (DPSC) method and the Therapeutic Intervention Scoring System (TISS). There were 35 PEATs (30 helicopter, five fixed-wing) and 96 ground transports.

Results:

Mean severity of illness for patients was greater in PEAT than for the ground transport (PEAT DPSC score=4.23±1.06 versus ground DPSC=3.57±0.89 [SD], p=.0005). The PEAT mortality was associated with a greater mean severity of illness (TISS survivors=19.1±11.4 versus non-survivors=44.3±9.5, p=.0001), but not with: the presence of an in-flight physician; transport delay; transport duration; age; sex; history of chronic illness; or intra-transport medical complication.

Conclusions:

Compared to ground transports, PEATs were used for higher risk patients.
Gas-Powered and Portable Ventilators: An Evaluation of Six Models
Authors: Nolan Jerry P. , Baskett Peter J.F.
Published: July 2016

Introduction:

Gas-powered resuscitators (ventilators) designed to be used primarily for resuscitation should be basic and simple to use. They offer many advantages over manual methods of ventilation during in-hospital cardiopulmonary resuscitation. Portable ventilators intended for critical care transport require additional, more sophisticated features such as: adjustable pressure limiting valves, air-mixing, airway pressure gauge, independent tidal volume and rate controls, and a Positive End-Expiratory Pressure (PEEP) valve. The performance of six gas-powered resuscitators/portable ventilators (TransPAC, Oxylog, Ambu Matic, ERA 2000, Uni-Vent, and MARS) was evaluated.

Methods:

The accuracy of volumes delivered to a test lung at three different compliance and resistance settings, was assessed for each ventilator prior to clinical evaluation during cardio-pulmonary resuscitation (CPR) and patient transport.

Results:

In each circumstance, measured tidal volumes and levels of minute ventilation decreased as resistance was increased and compliance reduced. Much of this loss of measured tidal volume occurred through inspiratory pressure relief valves that tended to start leaking at pressures below the preset level. Increasing levels of back-pressure resulted in further reductions in tidal volume when the ventilators were tested using the air-mix mode (available on three of the devices). In general, each resuscitator functioned well when used during CPR within the hospital.

Conclusions:

Each resuscitator tested failed to deliver the preset volumes and this must be considered during their use. Inspiratory pressure relief valves for all but one of the ventilators tested would not permit the delivery of adequate levels of ventilation in patients with low pulmonary compliance and/or high airway resistance.
Emergency Medical Services Systems Issues: A Delphi Study
Authors: Chin Jonathan , Schario Mark E.
Published: July 2016

A Delphi survey was conducted to determine the current and future issues facing emergency medical services systems. The information provided by this study can be used by individuals involved in emergency medical services systems for strategic planning and evaluation. The issues identified are categorized and listed by priority. A tiered priority model is utilized to represent the interrelations between these issues. Economics, leadership, research, and human resources are the foremost issues identified in this study. Further detailed analysis and refinement of these issues is recommended for local application. Emergency medical services systems need information to drive the decision-making process.
An Analysis of Invasive Airway Management in a Suburban Emergency Medical Services System
Authors: Krisanda Thomas J. , Eitel David R. , Hess Dean , Ormanoski Robert , Bernini Robert , Sabulsky Nancy
Published: July 2016

Introduction:

Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated.

Methods:

A retrospective review was undertaken of the records of all such patients requiring endotracheal intubation over a three-year period (1987–1989). The study population included 278 patients enrolled by five advanced life support (ALS) units serving a suburban population of 425,000. Field trip sheets were reviewed for diagnosis, intubation method and success, number of intubation attempts, provider experience, reasons for unsuccessful intubations, and complications.

Results:

A total of 394 invasive airway management attempts were performed on 278 patients. The overall successful intubation rate was 75% (41 % orotracheal, 52% nasotracheal, 7% other or unknown). The most common diagnoses were COPD and pulmonary edema (30%) and trauma (24%). Experienced providers were successful on the first attempt in 57% of cases compared to 50% by inexperienced providers (p=.24). Multiple intubation attempts were required in 33% of the patients. There was no statistically significant difference in success rates between the orotracheal and nasotracheal methods (p=.51). The most common reason for unsuccessful intubation was altered level of consciousness. Complications occurred with 7% of successful attempts and in 18% of unsuccessful attempts (p<.001). Forty-six percent of the patients who were not intubated successfully in the field and required intubation in the emergency department (ED) received a neuromuscular blocking agent prior to successful intubation.

Conclusion:

Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.
The Outcome of Patients Refusing Prehospital Transportation
Authors: Sucov Andrew , Verdile Vincent P. , Garettson Doug , Paris Paul M.
Published: July 2016

Objective:

To study the natural outcome of patients refusing prehospital transportation (PT).

Methods:

A total of 188 consecutive patients who refused PT in an urban, advanced life support (ALS), emergency medical services (EMS) system were studied. Of these, 77 (41 %) were male, and the average age was 51 years. Patients were entered into the study group only once.

Results:

Only 94 (50%) patients could be reached by telephone follow-up. Seven (7%) of these 94 patients had abnormal vital signs, 33 (35%) had cardiopulmonary complaints, 16 (17%) had an altered level of consciousness, nine (10%) were involved in accidents, and eight (8%) had abdominal pain. Six (6%) patients were admitted to the hospital, two (2 %) received ALS-level treatment by the paramedics and then refused conveyance, and 31 (33 %) either saw or contacted a physician. Consultation with an EMS physician was initiated for nine (5%) refusals. Of all the patients contacted, six (6%) needed PT for hospitalization.

Conclusion:

As only 50% of the patients refusing prehospital transportation could be reached using follow-up telephone calls, the 6% figure probably underestimates the true number of patients requiring PT. Telephone follow-up is an inadequate means of determining the natural outcome for this patient population. The ALS nature of many of the complaints combined with the lack of consistent physician consultation, exposes the EMS system to an undefined medico-legal liability risk.
After Hurricane Andrew: An EMS Perspective
Authors: Johnson William P. , Lanza Charles V.
Published: July 2016

This manuscript serves as a brief overview of the prehospital and emergency medical care delivery system in the area devastated by Hurricane Andrew. There is unlimited information available from the hundreds of workers, both paid and volunteer, as well as, the residents and victims of the hurricane.
Accuracy of the Prehospital Index in Identifying Major Hemorrhage in Trauma Victims
Authors: Jones Jeffrey , Newman Carol , Krohmer Jon , Mattice Connie
Published: July 2016

Purpose:

To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.

Methods:

The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requiremets for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severityscore.

Results:

Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI >3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI ≤3; 86% (102/119) of these patients did not require transfusion.

Conclusion:

The data suggest that patients with PHI scores >3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.
Urban Search and Rescue Medical Teams: FEMA Task Force System
Authors: Barbera Joseph A. , Lozano Michael
Published: July 2016

Recent national and international disasters involving collapsed structures and trapped casualties (Mexico City; Armenia; Iran; Philippines; Charleston, South Carolina; Loma Prieta, California; and others) have provoked a heightened national concern for the development of an adequate capability to respond quickly and effectively to this type of calamity. The Federal Emergency Management Agency (FEMA) has responded to this need by developing an Urban Search and Rescue (US&R) Response System, a national system of multi-disciplinary task forces for rapid deployment to the site of a collapsed structure incident. Each 56person task force includes a medical team capable of providing advanced emergency medical care both for task force members and for victims located and reached by the sophisticated search, rescue, and technical components of the task force. This paper reviews the background and development of urban search and rescue, and describes the make-up and function of the Federal Emergency Management Agency (FEMA) Task Force medical teams.
Comparison of Delivered Volumes and Airway Pressures when Ventilating Through an Endotracheal Tube with Bag-Valve Versus Demand-Valve
Authors: Mosesso Vincent N. , Lukitsch Karen , Menegazzi James , Mosesso Janet
Published: July 2016

Introduction:

Use of an oxygen-powered demand-valve to ventilate through an endotracheal tube is considered inappropriate due to concern regarding excessive airway pressure.

Hypothesis:

It was hypothesized that ventilation through an endotracheal tube using a bag-valve (BV) device and the recently modified demand-valve (DV) would produce similar tidal volumes (Vt), minute ventilation (MV), and peak airway pressures (PAP).

Methods:

This is a prospective, randomized vitro experimental model. Subjects were blinded to volume and pressure gauges. Thirty-nine EMTs (mean age 27 years with mean experience five years) volunteered to ventilate a mechanical test lung through an endotracheal tube for 10 minutes. Each subject was randomized to BV or DV and to either normal (0.1 L/cm H2O) or poor (0.04 L/cm H2O) lung compliance. This DV delivers set flow of 40 L/min at maximum 50±5 cm H2O. Subjects were instructed to use their “usual” technique for an average size adult in respiratory arrest with normal heart rate and blood pressure. The Vt and PAP were recorded for each breat; the MV and maximum PAP (PAP-max) for each minute was noted. Data were analyzed using repeated measures ANOVA and Tuke multiple comparisons with alpha set at 0.05.

Results:

Overall average tidal volumes and minute ventilations were acceptable with both ventilalory devices at both normal and poor compliance for the first, fifth, and 10th minute of continuous ventilation. Average airway pressures and peak airway pressures during the first, fifth, and 10th minute of ventilation all were significantly higher with those of the bag-valve than with the use of the demandvalve at both normal and poor compliance.

Conclusion:

In this model, ventilation with bag-valve and demand-valve both provided more than adequate Vt and MV; values wer similar except for higher Vt with BV at normal compliance. However, DV yielded significantly lower PAP and PAPmax at both poor and normal compliance. These findings need corrobration in an in vivo model, but suggest that with proper training, demand-valve ventilation through an endotracheal tube may be preferable.
Use of Warning Lights and Siren in Emergency Medical Vehicle Response and Patient Transport
Authors:   National Association of Emergency Medical Services Physicians (NAEMSP),   the National Association of State EMS Directors (NASEMSD)
Published: July 2016

The use of warning lights and siren (L&S) by prehospital emergency medical services (EMS) vehicles is a basic component of emergency response and patient transport. This public-safety practice predates modern EMS by 50 years. Despite the long-term reliance on L&S, it is not a risk-free practice. There are many reports of emergency medical vehicle (EMV) collisions during L&S responses and transports. These collisions often result in tragic consequences for the EMV occupants and those in other vehicles, and may cause significant delays to medical care for the patient the EMV was responding to or transporting. While there is no systematic collection of EMV collision data, some authors have suggested that the available information underestimates the extent of the problem. In addition, to date there have been few published analyses regarding the effectiveness of L&S as a modality that improves response times or, more important, patient outcome.
Improvised Purification Methods for Obtaining Individual Drinking Water Supply Under War and Extreme Shortage Conditions
Authors: Kozlicic Abdulah , Hadzic Abdulfetah , Bevanda Hrvoje
Published: July 2016

Background:

Supplying an adequate amount of drinking water to a population is a complex problem that becomes an extremely difficult task in war conditions. In this paper, several simple methods for obtaining individual supplies of drinking water by filtration of atmospheric water with common household items are reported.

Methods:

Samples of atmospheric water (rain and snow) were collected, filtered, and analyzed for bacteriological and chemical content. The ability of commonly available household materials (newspaper, filter paper, gauze, cotton, and white cotton cloth) to filter water from the environmental sources was compared.

Results:

According to chemical and biological analysis, the best results were obtained by filtering melted snow from the ground through white cotton cloth.

Conclusions:

Atmospheric water collected during war or in extreme shortage conditions can be purified with simple improvised filtering techniques and, if chlorinated, used as an emergency potable water source.
Effectiveness of Interactive Videodisc Instruction for the Continuing Education of Paramedics
Authors: Heller Michael , Stoy Walt A. , Shuman Larry J. , Wolfe Harvey , Zavada Chalice A.
Published: July 2016

Objectives:

To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets.

Design/Setting:

Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS).

Interventions:

All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using “Student's“ t-test and Chi-square with alpha set at 0.05.

Exclusions:

Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15).

Results:

Overall the mean compliance score of the pre-IVD group was 0.65 ±0.19 (±SD). The post-IVD group score was 0.65 ±0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030.

Conclusion:

Eight hours of IVD instruction did not result in improved paramedic performance as judged by computer analysis of trip sheets.
Evolution of Rescue Systems: A Comparison between Cologne and Cleveland
Authors: Lechleuthner Alex , Emerman Charles , Dauber Andreas , Bouillon Bertil , Kubincanek John A.
Published: July 2016

Introduction:

Comparisons of different emergency medical services (EMS) systems often are reduced to simple comparisons between distinct facilities or strategies (e.g., prehospital physician versus paramedic, “scoop and run” versus “stay and play”).

Methods:

The EMS systems of similar cities (Cologne and Cleveland) in two different countries (Germany and the United States) are compared. The comparison is seen from the perspective of an evolutionary standpoint that reflects the development of the EMS system in connection with the special environments. Data on rescue times, facilities, and (trauma) outcomes are compared.

Results:

No statistically significant differences in outcome between the systems were detected.

Conclusion:

Both systems are developed in special environments and are optimized over decades, which explains the similarities in outcome.
System Implications of the Ambulance Arrival-to-Patient Contact Interval on Response Interval Compliance
Authors: Campbell Jack P. , Gratton Matthew C. , Salomone Joseph A. , Lindholm Daniel J. , Watson William A.
Published: July 2016

Background:

Background: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.

Purpose:

To determine the effect of the VSPA interval on the mandated code 1 (<9 min) and code 2 (<13 min) response time interval compliance in an urban, public-utility model system.

Methods:

A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the man dated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.

Results:

Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p<0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).

Conclusion:

The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.
Sources of Disagreement Among Public and Private Agency Paramedics
Authors: Federiuk Carol S. , O'Brien Kerth
Published: July 2016

Introduction:

The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system.

Methods:

This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics.

Results:

On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment.

Conclusion:

A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.