bluuebunny/crossref_metadata_2025 huggingface dataset:
Ten Economic Lessons from Short-Haul Airline Operations
Authors: Wheatcroft Stephen F.
Published: July 2016

The 1,179th Main Lecture to be given before the Society–and the first Main Lecture to be given in the new Lecture Theatre–“Ten Economic Lessons from Short-Haul Airline Operations,” was given by Mr. S. F. Wheatcroft, B.Sc.(Econ.), A.F.R.Ae.S., on 15th December 1960. Mr. P. G. Masefield, M.A.(Eng.), F.R.Ae.S., Hon.F.I.A.S., Immediate Past President, presided.

Before introducing the Lecturer, Mr. Masefield said ttiat this was an auspicious occasion because this was the first Main Society Lecture to be held in the Lecture Theatre. Although he was sure there was nobody better fitted than Steve Wheatcroft to give this first lecture and no more valuable subject than the economic lessons from short-haul airline operations, Mr. Wheatcroft unfortunately had let the side down by not requiring any of the modern pushbutton equipment which was a feature of the Lecture Theatre.

Steve Wheatcroft was known to everybody in air transport, not only in this country but all over the world, where he spent half his time when he was not advising B.E.A. on what not to do. Mr. Wheatcroft obtained his B.Sc. degree with first class honours in economics at the London School of Economics in 1942. After the war, during which he served as a pilot in the Fleet Air Arm, he returned to the London School of Economics, taking a Leverhulme Post Graduate Studentship and studying, in particular, the economics of air transport. He was appointed Economic Adviser to British European Airways in 1946 and subsequently joined the Commercial Department as Manager in charge of Research and Tariffs. In 1953 he left the Corporation to go to Manchester University as a Simon Research Fellow and wrote a book called “The Economics of European Air Transport”. Wheatcroft on “The Economics of European Air Transport” was still a standard and was rapidly becoming a classic work. Since 1954 he had acted as a Consultant and had been retained as Economic Adviser to British European Airways. In 1958 he was commissioned by the Canadian Government to make a study of the desirability and economic consequences of trans-continental competition and his report, “Air Competition in Canada,” was published in June 1958. In 1959 he was appointed Chairman of a Committee set up by the Government of India to investigate the cost structure of the Indian Airline Corporation. More recently he had been a member of the Tymms Committee to the West Indian Government to advise on civil air policy in the West Indies, and now, he was about to go to Nigeria to tell them how to do it.
Flutter of an Aircraft Controlled by an Automatic Navigation System
Authors: Parks P. C.
Published: July 2016

Automatic navigation systems for aircraft often use gyroscopes to measure the changes in the direction of motion of the aircraft they are controlling. These measurements are fed back to the mechanisms moving the control surfaces of the aircraft.

Such a system is usually designed, in the first instance, assuming the aircraft structure to be rigid and such that the system is then stable.

Now suppose the aircraft structure, considered elastic, is disturbed in flight by, say, a gust. Normal modes of vibration of the structure will be excited, the resulting oscillations will be detected by the gyroscope and fed as error signals to the control surface actuators. If the actuators are capable of following these error signals, the control surfaces will also oscillate, exciting the structure further and so completing the cycle. This cycle may be unstable.
Transactional processes in the development of adult personality disorder symptoms
Authors: Carlson Elizabeth A. , Ruiz Sarah K.
Published: July 2016

The development of adult personality disorder symptoms, including transactional processes of relationship representational and behavioral experience from infancy to early adolescence, was examined using longitudinal data from a risk sample (N= 162). Significant preliminary correlations were found between early caregiving experience and adult personality disorder symptoms and between representational and behavioral indices across time and adult symptomatology. Significant correlations were also found among diverse representational assessments (e.g., interview, drawing, and projective narrative) and between concurrent representational and observational measures of relationship functioning. Path models were analyzed to investigate the combined relations of caregiving experience in infancy; relationship representation and experience in early childhood, middle childhood, and early adolescence; and personality disorder symptoms in adulthood. The hypothesized model representing interactive contributions of representational and behavioral experience represented the data significantly better than competing models representing noninteractive contributions. Representational and behavioral indicators mediated the link between early caregiving quality and personality disorder symptoms. The findings extend previous studies of normative development and support an organizational developmental view that early relationship experiences contribute to socioemotional maladaptation as well as adaptation through the progressive transaction of mutually informing expectations and experience.
Transactional cascades of destructive interparental conflict, children's emotional insecurity, and psychological problems across childhood and adolescence
Authors: Davies Patrick T. , Martin Meredith J. , Coe Jesse L. , Cummings E. Mark
Published: July 2016

This study examined the transactional interplay among dimensions of destructive interparental conflict (i.e., hostility and dysphoria), children's emotional insecurity, and their psychological problems from middle childhood and adolescence. Participants were 232 families, with the first of five measurement occasions occurring when children were in first grade (M age = 7 years). Cross-lagged, autoregressive models were conducted with a multiple-method, multiple-informant measurement approach to identify developmental cascades of interparental and child cascades. Results indicated that emotional insecurity was a particularly powerful mediator of prospective associations between interparental conflict (i.e., dysphoria and hostility) and child adjustment during adolescence rather than childhood. In reflecting bidirectionality in relationships between interparental and child functioning, children's psychological problems predicted increases in interparental dysphoria during childhood and adolescence. Although emotional insecurity was not identified as a proximal predictor of interparental difficulties, an indirect cascade was identified whereby insecurity in early adolescence was associated with increases in teen psychological problems, which in turn predicted greater interparental dysphoria over time. Results are interpreted in the context of how they advance transactional formulation of emotional security theory and its resulting translational implications for clinical initiatives.
Transactional relations between caregiving stress, executive functioning, and problem behavior from early childhood to early adolescence
Authors: Lagasse Linda L. , Conradt Elisabeth , Karalunas Sarah L. , Dansereau Lynne M. , Butner Jonathan E. , Shankaran Seetha , Bada Henrietta , Bauer Charles R. , Whitaker Toni M. , Lester Barry M.
Published: July 2016

Developmental psychopathologists face the difficult task of identifying the environmental conditions that may contribute to early childhood behavior problems. Highly stressed caregivers can exacerbate behavior problems, while children with behavior problems may make parenting more difficult and increase caregiver stress. Unknown is: (a) how these transactions originate, (b) whether they persist over time to contribute to the development of problem behavior and (c) what role resilience factors, such as child executive functioning, may play in mitigating the development of problem behavior. In the present study, transactional relations between caregiving stress, executive functioning, and behavior problems were examined in a sample of 1,388 children with prenatal drug exposures at three developmental time points: early childhood (birth to age 5), middle childhood (ages 6 to 9), and early adolescence (ages 10 to 13). Transactional relations differed between caregiving stress and internalizing versus externalizing behavior. Targeting executive functioning in evidence-based interventions for children with prenatal substance exposure who present with internalizing problems and treating caregiving psychopathology, depression, and parenting stress in early childhood may be particularly important for children presenting with internalizing behavior.
Long-term effects of the Family Bereavement Program on spousally bereaved parents: Grief, mental health problems, alcohol problems, and coping efficacy
Authors: Sandler Irwin , Tein Jenn-Yun , Cham Heining , Wolchik Sharlene , Ayers Tim
Published: July 2016

This study reports on the findings from a 6-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on the outcomes for spousally bereaved parents. Spousally bereaved parents (N= 131) participated in the trial in which they were randomly assigned to receive the FBP (N= 72) or literature control (N= 59). Parents were assessed at four time points: pretest, posttest, and 11-month and 6-year follow-up. They reported on mental health problems, grief, and parenting at all four time periods. At the 6-year follow-up, parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Bereaved parents in the FBP as compared to those in the literature control had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, and alcohol problems, and higher coping efficacy (for mothers) at the 6-year follow-up. Multiple characteristics of the parent (e.g., gender, age, and baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome, but only 3 of 45 tests of moderation were significant. Latent growth modeling found that the effects of the FBP on depression, psychiatric distress, and grief occurred immediately following program participation and were maintained over 6 years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the 6-year follow-up. Mediation analysis also found that improved parenting at the 6-year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the 6-year follow-up was partially mediated through reduced depression and grief and improved parenting. FBP reduced mental health problems, prolonged grief, and alcohol abuse, and increased coping efficacy of spousally bereaved parents 6 years later. Mediation pathways for program effects differed across outcomes at the 6-year follow-up.
The bidirectional pathways between internalizing and externalizing problems and academic performance from 6 to 18 years
Authors: Van der Ende Jan , Verhulst Frank C. , Tiemeier Henning
Published: July 2016

Internalizing and externalizing problems are associated with poor academic performance, both concurrently and longitudinally. Important questions are whether problems precede academic performance or vice versa, whether both internalizing and externalizing are associated with academic problems when simultaneously tested, and whether associations and their direction depend on the informant providing information. These questions were addressed in a sample of 816 children who were assessed four times. The children were 6–10 years at baseline and 14–18 years at the last assessment. Parent-reported internalizing and externalizing problems and teacher-reported academic performance were tested in cross-lagged models to examine bidirectional paths between these constructs. These models were compared with cross-lagged models testing paths between teacher-reported internalizing and externalizing problems and parent-reported academic performance. Both final models revealed similar pathways from mostly externalizing problems to academic performance. No paths emerged from internalizing problems to academic performance. Moreover, paths from academic performance to internalizing and externalizing problems were only found when teachers reported on children's problems and not for parent-reported problems. Additional model tests revealed that paths were observed in both childhood and adolescence. Externalizing problems place children at increased risk of poor academic performance and should therefore be the target for interventions.
Volume Kinetics of Intravenous Fluid Therapy in the Prehospital Setting
Authors: Svensén Christer , Sjöstrand Fredrik , Hahn Robert G.
Published: July 2016

Introduction:

To study the volume effect of isotonic and hypertonic crystalloid fluid during ambulance transports after mild trauma, a prospective case-control study was initiated, using the ambulance and helicopter transport system in Stockholm.

Methods:

The hemodilution resulting from intravenous infusion of 1.0 L of Ringer's acetate solution (n = 7) or 250 ml of 7.5% sodium chloride (n = 3) over 30 minutes (min) was measured every 10 min during 1 hour when fluid therapy was instituted at the scene of an accident, or on arrival at the hospital. The dilution was studied by volume kinetic analysis and compared to that of matched, healthy controls who received the same fluid in hospital.

Result:

The hemodilution at the end of the infusions averaged 7.7% in the trauma patients and 9.1% in the controls, but the dilution was better maintained after trauma. The kinetic analysis showed that the size of the body fluid space expanded by Ringer's solution was 4.6 L and 3.8 L for the trauma and the control patients, respectively, while hypertonic saline expanded a slightly larger space. For both fluids, trauma reduced the elimination rate constant by approximately 30%.

Conclusion:

Mild trauma prolonged the intravascular persistence of isotonic and hypertonic crystalloid fluid as compared to a control group.
Theme 4. Effective Models for Medical and Health Response Coordination: Summary and Action Plan
Authors: Noji Eric K. , Gunn SWA , Aziz A. Abdul , Chi Huan-Teng , Dauphinee Wayne , Davenport Deborah , Gonzales Roberto , Jaeger Hilary , Kipor G.V. , Mares Carlos A. , Shrestha R. P. , Yoshinaga Kazumasa
Published: July 2016

Introduction:

To effectively respond to this relatively new, complex mandate it is essential to find effective models of coordination to ensure that medical and health services can meet the standards now expected in a disaster situation. This theme explored various models, noting both the strengths that can be built on and the weaknesses that still need to be overcome.

Methods:

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 1 and Theme 4 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.

Results:

The main points developed during the presentations and discussion included: (1) preplanning (predisaster goals), (2) information collection (assessment), (3) communication (materials and methods); and (4) response centres and personnel. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.

Discussion:

Action plans presented include: (1) creation of an information and data clearinghouse on disaster management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) action on lessons learned from evidence-based research and practical experience.

Conclusions:

There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.
Theme 6. Multidisciplinary Team Interaction: Summary and Action Plan
Authors: Cruz-Vega Felipe , Sun Charles , Brink Bruce , Bugslag Robert (Bob) , Del Castillo Beatriz González , Hastings Patricia , Kipor G.V. , Lee Sung Woo , Lo Chi-Biu , Poles Lion , Robinson Peter , Ronquillo Eleanor L. , Staña Jirí , Sydor Jody , Thani Haresh
Published: July 2016

Introduction:

Multidisciplinary team interaction has become a commonplace phrase in the discussion of disaster response. Theme 6 explored multidisciplinary team interactions and attempted to identify some of the key issues and possible solutions to the seemingly intractable problems inherent in this endeavour.

Methods:

Details of the methods used are provided in the introductory paper. The Cochairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The Cochairs then presided over a workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.

Results:

Main points developed during the presentations and discussion included: (1) promotion of multidisciplinary collaboration, (2) standardization, (3) the Incident Command System, (4) professionalism, (5) regional disparities, and (6) psychosocial impact.

Discussion:

Action plans recommended: (1) a standardized template for Needs Assessment be developed, implemented, and applied using collaboration with international organizations, focusing on needs and criteria appropriate to each type of event, and (2) team needs assessments be recognized for local responses and for determination of when international assistance may be required, for planning a command system, and for evaluating the psychosocial impact.

Conclusions:

There is a clear need for the development of standardized methods for the assessment of needs, development and implementation of a command structure, and for appreciation of regional differences and the psychosocial impact of all interventions.
Study Design and Pre-Trial, Peer Review in EMS Research
Authors: Yealy Donald M. , Scruggs Kevin H.
Published: July 2016

In order to identify the study designs andthe type of pre-trial peer review in published EMS research, we reviewed three refereed emergency medicine journals during the period from 1985 through 1988. All original scientific manuscripts utilizing human subjects in prehospital care were analyzed. Ninety-six issues were examined, and 79 manuscripts met the criteria for analysis. The research design was cross-sectional in 7.5%, retrospective in 51%, and prospective in 41.5%. Pre-trial peer review had been sought in nine (11%). Each was performed by a hospital or university-based Institutional Review Board (IRB). Only four (5%) manuscripts contained statements about pre-trial peer review. All reviewed trials were prospective in design (9/33, 27%). A follow-up telephone survey of the authors of the non-reviewed prospective trials indicated that 96% were unaware of the potential need for pre-trial review, 16% anticipated difficulty obtaining approval from traditional IRB committees, and 11% feared that the protocol would be interfered with by the review committee.

We conclude that 92.5% of the current published EMS research is retrospective or prospective in design, and that pre-trial peer review is not obtained in the majority of prehospital EMS research. Guidelines should be developed to educate EMS researchers about the need for and the value of pre-trial peer review. Journal editors should clearly state and enforce policies about manuscripts lacking information about pre-trial peer review when human subjects are involved.
Education about Prehospital Care during Emergency Education Residency Training: The Results of a Survey
Authors: Paris Paul M. , Benson Nicholas H.
Published: July 2016

The Society of Teachers of Emergency Medicine's, EMS Educators Committee performed a mail survey of emergency medicine residency training directors regarding their curricula for EMS. The Committee was interested in determining the quality and quantity of EMS training in emergency medicine residencies. Out of 66 programs, 48 responded (73%). The programs reported that they provide medical control for a mean of 4837 calls per year (range 0–20,000) and interact with a mean of eight EMS agencies. Ten programs (21%) do not offer any formal EMS administrative experience, while 42 (87%) programs require residents to participate in paramedic training, and 31 (65%) require participation in EMT training. Both the type and the amount of “in-field” experience reported by programs varied considerably, with some programs offering it only as an elective. Similarly, there was great diversity in the type and amount of experience with helicopter ambulances. In conclusion, there is wide disparity among the offerings from all residency programs. Each training program must evaluate its own EMS curricula and expand it to fill existing gaps. Specific topics to be covered are suggested.
Federal Trauma Legislation: The 101st United States Congress
Authors: Jordan Larry
Published: July 2016

The United States Congress presently is considering comprehensive legislation regarding emergency medical services (EMS) and trauma systems planning. This legislation amends the Public Health Service Act and, if enacted, would represent the federal government's first significant statutory mandate to exercise a leadership role in EMS since the federal EMS program was abolished in the early 1980s. On 14 November 1989, the House passed House Resolution (H.R.) 1602, Trauma Care Systems Planning and Development Act of 1989, authored by Representative Jim Bates. The Senate is considering similar legislation (S. 15) by Senator Alan Cranston, titled the Emergency Medical Services and Trauma Care Improvement Act of 1989. The Senate Bill is awaiting final action by the full Senate. If the Senate approves S. 15, a joint House and Senate conference committee will meet to present its own conference report to each of those bodies for consideration and passage.
The Protection and Sheltering Policy in Hospitals
Authors: Adler Jakov
Published: July 2016

The problem of protection and sheltering of hospitalized patients in wars and other national emergencies has been reviewed by many countries in recent years. Presently, there are wide differences in policies that range from full underground sheltering of hospitals as adopted by the Swiss, partially protected to almost fully protected facilities in hospitals as adopted by the Israelis, to no protection at all as in most other countries.
Utilization of Military Support in the Response to Hurricane Marilyn: Implications for Future Military-Civilian Cooperation
Authors: Weddle Michael , Prado-Monje Hugo
Published: July 2016

Introduction:

The past decade has been a period of evolution for the Federal disaster response system within the United States. Two domestic hurricanes were pivotal events that influenced the methods used for organizing Federal disaster assistance. The lessons of Hurricane Hugo (1989) and Hurricane Andrew (1992) were incorporated into the successful response to Hurricane Marilyn in the U.S. Virgin Islands in 1995. Following each of these storms, the Department of Defense was a major component of the response by the health sector. Despite progress in many areas, lack of clear communication between military and civilian managers and confusion among those requesting Department of Defense health resources may remain as obstacles to rapid response.

Methods:

This discussion is based on an unpublished case report utilizing interviews with military and civilian managers involved in the Hurricane Marilyn response.

Results:

The findings suggest that out-of-channel pathways normally utilized in the warning and emergency phase of the response remained operational after more formal civilian-military communication pathways and local assessment capability had been established.

Conclusion:

It is concluded that delays may be avoided if the system in place was to make all active pathways for the request and validation of military resources visible to the designated Federal managers located within the area of operations.
Intubation with Transillumination: Nasal or Oral?
Authors: Petroianu Georg A. , Subotic S. , Heil P. , Jatzko A. , Maleck W. H.
Published: July 2016

Transillumination-guided intubation is a useful back-up method when laryngoscopic intubation proves to be difficult or impossible. The Trachlight™ (Laerdal, N-4001 Stavanger, Norway) is suited for both nasal and oral use. Intubation times (intubation time) and success rates (success rate) for nasal and oral intubation with the Trachlight were compared.

Twenty-four medical students, inexperienced in intubation were instructed in the use of the Trachlight. A demonstration also was performed. Subsequently, they were asked to intubate a Laerdal Airway Management Trainer™ (Laerdal, Stavanger, Norway) using the Trachlight. Each student intubated 10 times orally and 10 times nasally (five times through the right and five times through the left nostril). The succession of the students was randomized The intubation times were measured and the position of the tube noted. Nasal and oral intubation times for the tenth trial (steady state conditions) were compared using the rank-order test for paired observations. Oral and nasal success rates were compared using the sign test for paired observations.

The differences between nasal and oral intubation concerning intubation time and the success rates were not significant. Nasal intubation with the Trachlight seems to be more difficult than the oral intubation.
Complications from Supervised Mask Use in Post-operative Surgical Patients during the Gulf War
Authors: Rivkind Avraham I. , Eid Ahmed , Weingart Efrat , Izhar Uzzi , Barach Paul , Richter Elihu D. , Belzberg Howard
Published: July 2016

This is a report of three patients in a surgical ward of a hospital who developed complications seemingly related to the use of full-face-fitting masks associated with the first Scud Missile attack on Israel durng the Gulf War. Patient 1 developed atrial fibrillation with an uncontrolled ventricular rate; Patient 2 redeveloped a gastrointestinal hemorrhage; and Patient 3 developed a severe anxiety attack. Each of the three was severely ill prior to the event. Special attention should be given to severely ill patients during such events.
Geriatric Trauma Patients at a Suburban Level-I Trauma Center in Japan
Authors: Sugimoto Katsuhiko , Aruga Toru , Hirata Mitsuhiro , Shindo Masateru
Published: July 2016

Background:

Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (emergency medical services) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma.

Patients and Methods:

From July 1996 through June 1997, a group of geriatric trauma (Group G, n = 22) and a control group of younger trauma patients (n = 173) were compared with respect to transfer method to an Emergency Center (direct or indirect), Revised Trauma Scores on the scene of the accident (revised trauma score-l) and on admission to the Emergency Center (revised trauma score-2), and outcome (survival).

Results:

The mean values for revised trauma score-l in the Control Group (Group C) were not different from those in Group G, but revised trauma score-2 of the indirect-transfer patients (indirectly transported patients) in Group G were significantly lower than were those for Group C. Group G mortality rates were significantly higher than were the control rates (p = 0.0001). The mortality rate of the indirectly transported patients subgroup was significantly lower than that of the direct transfer subgroup (directly transported patients) (30/68 vs. 5/70, p<0.0001) in the Group C, but mortality rate of the indirectly transported patients subgroup exceeded that of the directly transported patients subgroup of Group G (8/14 vs. 5/8).

Conclusion:

The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for injury severity score. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.
Cardiovascular Mortality — The Hidden Peril of Heat Waves
Authors: Wainwright Sherrilyn H. , Buchanan Sharunda D. , Mainzer M. , Parrish R. Gibson , Sinks Thomas H.
Published: July 2016

Objective:

— Define the mortality associated with extremely hot weather during the 04 July through 14 July, 1993 heat wave that struck the northeastern United States.

Methods:

Design — A rapid field assessment was used to compare mortality occurring during the heat wave to mortality occurring during a period in which there was no heat wave using copies of death certificates. The findings of the rapid field assessment were validated, and it was determined whether increases in mortality occurred in other metropolitan east-coast counties also affected by the heat wave, by reviewing computerized mortality files. Setting —Information was collected on all deaths occurring in Baltimore City, Maryland; Baltimore County, Maryland; Essex County, New Jersey; Newcastle County, Delaware; and Philadelphia County, Pennsylvania; during these specified study periods: 08–18 June (comparison period) and 06–16 July (heat wave study period), 1993.

Main Outcome Measures — Ratios for total mortality, cause-specific mortality, and variables such as age, sex, race, residence, and day and place of death, that were available from death certificates were calculated.

Results:

From the rapid field assessment, the following were observed: a 26% increase in total mortality and a 98% increase in cardiovascular mortality associated with the heat wave in Philadelphia. Data from the computerized mortality files showed an increase in total mortality in four of five counties examined and an increase in cardiovascular mortality in all five counties. The risk for death for those dying from cardiovascular disease increased significantly for people older than 64 years, for both sexes, and all races.

Conclusion:

Conclusion: As initially indicated by the Philadelphia Medical Examiner, there was excess mortality associated with a heat wave in Philadelphia. All other nearby counties examined also experienced excess mortality associated with the heat wave, although this excess was not recognized by the local health officials. The true impact of a heat wave that causes excess preventable mortality must be appropriately and rapidly ascertained. Using a national standard to certify a death as heat-related will provide the needed information rapidly so that public health resources can be more effectively allocated and mobilized to prevent further heat-related illnesses and death.
On Disaster Research Part I: Introduction
Authors: Silverstein Martin Elliot
Published: July 2016

The study of disasters has become a new, applied science. The increasing global population is dependent on fragile links of communication and transportation, and the modern technology of weaponry has led to new forms of armed conflict. These combined factors have made our need to understand the process of disaster research ever more pressing. Similarly, workers and researchers in the field must reappraise their methodologies and their contributions to the literature of catastrophe. The end result of good research and its promulgation in journals, articles, and even press conferences should lead to the saving of lives, the protection of property, and the stability of our communities. Hastily performed research and misleading reporting can and does lead to unnecessary death and injury, and to the wasteful expenditure of scarce resources.
The World Heath Organization's Disaster Reduction Policies in Africa at the Dawn of 1990's: Steps in the Right Direction?
Authors: Zaman Maniza S. , Calvani Sandro
Published: July 2016

The World Health Organization, Panafrican Centre for Emergency Preparedness and Response (WHO/EPR) was established in 1988, and officially opened in March 1989, as a practical and functional response to the identified need for a regional institution to deal effectively with the health and related consequences of both natural and man-made disasters. The principal objective of the Centre is to aid member countries in the prevention and/or reduction of the adverse health effects of disasters, be they direct or indirect, by strengthening national capacities for disaster preparedness and response. The WHO has reoriented its disaster operations unit to incorporate preparedness activities, particularly within an overall developmental framework which is crucial for reducing losses, both human and material, in the event of a disaster. In keeping with this focus, the Centre has defined its goals and activities: development of national disaster preparedness programs; training of national and international personnel in health emergency preparedness and response; production and dissemination of technical publications on disaster preparedness and management; undertaking risk assessment missions; and executing relevant research projects.
Flood Disaster in the Czech Republic in July, 1997 — Operations of the Emergency Medical Service
Authors: Pokorny Jiri R.
Published: July 2016

This report is a review of the response and the activities of the Emergency Medical Services during a huge flood that devastated one-third of the territory of the Czech Republic in July 1997. The Emergency Medical Services personnel extracted by helicopter a great number of citizens who were trapped in their flats and homes. For diabetics and cardiacs who were isolated from the surface transport, the EMS personnel supplied necessary medication, and transported patients to hemodialysis.

The cooperation between non-medical emergency services and the district crisis staff of the Integrated Rescue System, varied in different districts. However, in most flooded districts, the cooperation was satisfactory. In addition, a large number of volunteers helped in the first days of the flood.

Unfortunately, 49 people died because of the flood. Nevertheless, since the EMS was able to manage the extraordinary needs, the number of emergencies and hospitalizations was low.
Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results
Authors: Klain Miroslav , Ricci Edmund , Safar Peter , Semenov Victor , Pretto Ernesto , Tisherman Samuel , Abrams Joel , Comfort Louise
Published: July 2016

In general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).
International Military-Civilian Collaboration for Disaster Medicine
Authors: Gemma William R.
Published: July 2016

Throughout the world, experience is growing in the development of plans for military-civilian collaboration in disaster preparedness. This involves the complex problems associated with the coordination of various components of military and civilian Emergency Medical Services (EMS) systems and organizational differences between countries.

EMS are dependent on relationships between hospitals, police-fire-ambulance services, and municipal, county and state governments. In an emergency, their integration is accomplished in: (1) detection and assessment; (2) call for ambulance and hospital; (3) organization; and (4) emergency medical treatments.
Helicopter Rescue in the Vietnam War
Authors: Scofield T.
Published: July 2016

The medical successes realized in Vietnam can be attributed to several factors: rapid evacuation of casualties by helicopter or ambulances; the availability of whole blood; well-equipped field hospitals; highly skilled and well-organized surgical teams; and improved medical management. Of these important factors, rapid evacuation by helicopter contributed the most to saving the lives of the wounded. Without effective helicopter evacuation, it would have been difficult to exploit the other factors and management of medical resources would have been less efficient.
Mountain Air Rescue in the Alps
Authors: Flora Gerhard
Published: July 2016

For over 100 years, Innsbruck, Austria had been a center for Alpine and winter sports. In 1896, it became necessary to found an Alpine rescue service to come to the help of mountain climbers and skiers who were injured or stranded in our mountains. The reason for today's accidents are the same as they were 50 years ago. On the one hand, Alpine accidents are a consequence of preventable dangers, such as inadequate equipment, carelessness, and too little Alpine experience. On the other hand, they are caused by objective dangers, e.g., falling rocks, weather, lightning and avalanches. The rescue methods, however, have undergone a fundamental change over the last 3 years.
Emergency Medical Services in the Reconstruction Phase following a Major Earthquake: A Case Study of the 1988 Armenia Earthquake
Authors: Becker Bruce M. , Handrigan Michael T. , Jagminas Liudvikas , Becker Tanya J.
Published: July 2016

Study Objective:

To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.

Methods:

The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).

Results:

Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.

Conclusion:

In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.
Gender Issues and Partner Preferences Among a Sample of Emergency Medical Technicians
Authors: Gonsoulin Sheryl , Palmer C. Eddie
Published: July 2016

Introduction:

From its beginnings, the provision of emergency medical services in the United States has been a male-dominated occupation. The objective of this exploratory study was to determine if and how such issues might influence partner preferences of male and female emergency medical technicians (EMTs).

Methods:

Initially, unstructured interviews were conducted with 10 EMS workers enrolled in a paramedic training program in order to see whether and how such issue might affect partner preferences. From the data obtained during these interviews, a questionairre was developed and distributed to participants in an annual meeting of Louisiana Association of Nationally Registered EMTs. Participation was voluntary and uncompensated.

Results:

A total of 49 EMTs (22 women, 27 men) completed the questionairre. The major gender-related issues could be class fied into three dimensions: 1) physical strength; 2) assumption of authoritative roles; and 3) structural (organizational) preparedness to implement gender-friendly working environments. In general, the gender of a partner now “makes no difference”.

Conclusion:

Overall, the EMS work worlds are reflective of the larger society of which they are a part. Now is the time for EMS systems to examine the gendered nature of their organization and of the issues of gendered expectations prevalent in EMS work. Future research should document the changes now due in the field of emergency medical services.
The Efficacy of Advanced Life Support: A Review of the Literature
Authors: Bissell Richard A. , Eslinger Dawn Gyory , Zimmerman Lynn
Published: July 2016

Introduction:

Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature.

Methods:

An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies.

Results:

Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies.

Conclusion:

While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.
Constructing a World Wide Web Site for Disaster Management and Humanitarian Assistance
Authors: Piper Paul S. , Burkle Frederick M. , Murray Ronald J.
Published: July 2016

There is a huge need for access to information in the areas of disaster relief disaster medicine, and humanitarian assistance. The extraordinarily rapid increase in the literature in these subject areas attests to this need. However, use of the printed word has substantial limitations that are even more profound in the developing world.

Currently, the information available tends to be fragmented and sequestered by the specific interests of the organizations and governments involved. The evolving electronic methods for the storage, organization, and retrieval of information makes coordination between organizations concerned with disasters within our grasp.

This paper discusses the Center of Excellence in Disaster Management and Humanitarian Assistance and describes the World Wide Web and the implications it has in disaster management and medicine. It describes methods for obtaining user input to the techniques used for the development of the world wide web for the areas of disaster management and disaster medicine. The implementation of an on-line Internet reference desk that will provide: 1) a list of “experts;” 2) a searchable disaster database; and 3) on-line simulation courses and training exercises also is discussed.
Sonomatic Confirmation of Tracheal Intubation Using the SCOTI
Authors: Petroianu Georg , Maleck Wolfgang , Bergler Wolfgang , Rüfer Roderich
Published: July 2016

This study compares the performance of two commercially available devices (Ambu. TubeChek™ and SCOTI™ in establishing endotracheal (ET) tube position (oesophageal vs. tracheal) in a mannequin and in miniature pigs. The Ambu TubeChek is a syringe-type, Oesophageal Detector Device (ODD) that fits to the endotracheal tube connector. Air is aspirated easily from the rigid trachea, but not from the collapsing esophagus. The Sonomatic Confirmation of Tracheal Intubation device (SCOTI) is a lightweight battery-powered, sonomatic device. It emits sound waves into the tube and analyzes the reflection. The SCOTI purports to enable a user-independent and carbon-dioxide-independent assessment of tube position following intubation.

Intubation followed by tube position assessment with Ambu TubeChek (ODD) was significantly faster and easier with the ODD than with the SCOTI. The SCOTI cannot differentiate tracheal from oesophageal ET-tube position in mini-pigs.

In situations in which capnometry is not available or the CO2 production and transport are compromised (CPR), we recommend the use of an Oesophageal Detector Device (ODD) rather than the SOCTI.