bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicalization (Physician-Staffing) of Extra-Hospital First Aid
Authors: Margenet Alain , Desfemmes Catherine , Dufeu Nicolas , Huguenard Pierre
Published: July 2016

All requests for medical assistance need to be answered. In France, the public “Service d'Aide Medicale d'Urgence” (SAMU) receives the calls and can send, if necessary, mobile physician-staffed ambulances. SAMU works in coordination with the police, the fire brigade and general practitioners.

Response to the request for medical assistance from the public has been solved in different ways, such as agreement on a single call number for certain countries, and whether or not to use a physician-staffed system. In France, the first mobile emergency and resuscitation units (SMUR) were created in 1967. This initiative was taken by anesthesiologists, some surgeons, and military physicians belonging especially to the fire brigade of Paris, and to the seafaring-men of Marseille. The necessity of centralizing coordinating calls and radio controlling the public means of assistance has led to the creation of the Emergency Aid Services or SAMU.
Prehospital and Intrahospital Specialized Management of Severe Multiple Trauma Cases
Authors: Cowley R Adams , Conn Alasdair K.T.
Published: July 2016

Multiple trauma is the leading cause of death of all Americans below the age of 37. The estimated cost to American society is between 70 and 80 billion dollars per year. In our present day society, one person in four will require the use of a trauma facility during his or her lifetime. Several studies have now been performed to demonstrate that the management of trauma is woefully inadequate. Stemming from the classical studies of Trunkey, Lim and West comparing San Francisco with Orange County, California; it was demonstrated that approximately 30% of fatalities resulting from traumatic injury were preventable in Orange County as compared to an extremely small percentage in San Francisco which does have a designated trauma center. Recent advances in the management of head injury may further increase this salvageable percentage.
Five Improved Methods of Emergency Care in Yugoslavia
Authors: Jekic Miodrag Lj.
Published: July 2016

An Approach to First Aid Programming: The Yugoslavian Red Cross Society has had the unique opportunity to design, develop and commence implementation of a full National First Aid Service. The program is divided into four areas: (1) first aid skill components of existing programs; (2) student training courses; (3) leadership courses; and (4) public education. The movement toward a National First Aid Service has been rapid. The radical change in delivery systems, principles upon which the program is built, and the overall philosophy are recognized as potential risks but ones well worth taking.
Disaster Resuscitology: Report on the Second World Congress on Emergency and Disaster Medicine
Authors: Safar Peter
Published: July 2016

The Second World Congress on Emergency and Disaster Medicine was held on May 31–June 3,1981, in Pittsburgh, Pennsylvania, USA, under the auspices of the “Club of Mainz for Emergency and Disaster Medicine Worldwide.” The First World Congress organized by the Club of Mainz was held in Mainz, West Germany on September 30–October 3, 1977 (Chairman, Rudolf Frey), and the Third World Congress will be held in Rome, Italy on May 23–27, 1983 (Chairman, Corrado Manni). It is appropriate to report here on the World Congress in Pittsburgh, since the first four issues of this new Journal consist of edited papers and abstracts presented at that Congress.
Volume Resuscitation — A Comparison of Delivery Rates for Various Fluids and Catheters
Authors: Blythe Donald S. , Fisher Charles J. , Foulke Garrett E.
Published: July 2016

There is controversy concerning the best method for rapid fluid administration in shock secondary to severe or continuing blood loss. Some authors recommend immediate cutdown, while others support percutaneous central intravenous lines. In addition, the data available on maximum flow rates for various catheters is limited and does not compare different solutions. To gain more insight into these problems we have studied the flow rates for different lengths and gauges of catheters utilizing various physiologic solutions.
Shock Complicating Acute Myocardial Infarction during Hot Weather
Authors: Kolar Jiri , Bhatnagar Sudhir K. , Al-Yusuf Abdul Razak
Published: July 2016

Shock appears to complicate acute myocardial infarction (AMI) more often during the hot summer in Kuwait, than it does in winter. The aim of this study was to define the forms of shock, investigate its frequency, and evaluate the effects of fluid therapy.

Material and Methods

In a 3 month period during the hot summer of 1980, 21 shock patients (pts.) (18 male, 3 female) with AMI were studied. Their average age was 55 years (yrs.) (range 30–82), all had definite AMI (18 anterior, 3 inferior) and at least 3 known criteria of shock. Observations were made for 24 hours (hrs.) in the CCU, within one hour of admission. Initial hemodynamic pressures were obtained and hemoglobin (Hb), hematocrit (Hct) and serum glutamic oxaloacetic transaminase (SGOT) on blood samples were estimated.
Topical Therapy of Traumatic Wounds in Disaster
Authors: Fox Charles L.
Published: July 2016

Major trauma in disasters leading to open wounds is frequently followed by infection with a variety of microorganisms. Usually, antibiotics are administered systemically to prevent the onset of sepsis. In thermal burns, topical therapy with 1% silver sulfadiazine (AgSD) cream has proven effective and now supersedes systemic therapy. Experimentally standardized traumatic wounds in animals have been difficult to obtain. Standardized burn wounds in mice subsequently infected with pseudomonas facilitated demonstration of the efficacy of silver or zinc sulfadiazine (ZnSD) which has also shown an advantage in improved wound closure. (Fox CL, fr: Burns 1978;4:223). In a limited series of 18 patients with a variety of surgical trauma and infected wounds, topical silver sulfadiazine was utilized after prolonged systemic antibiotics had failed to eradicate the infection.
Animal Experiments on the Effects of PEEP and Different Ventilation-Compression Ratios in Neonatal Cardiopulmonary Resuscitation
Authors: Dick W. F. , Traub E. , Engels K. , Lindner K. -H.
Published: July 2016

The physiological range of respiratory rates and heart rates in neonates is approximately 40 per min and 120 per min, respectively, which yields a theoretical ventilation-compression ratio of 1:3ratherthan 1:5.

Thirty-six anesthetized pigs with an average body weight of 4–5 kg were used in the study. After establishing a steady state by artificial ventilation with 100% oxygen, a cardiac arrest was induced by an intravenous injection of potassium chloride. Following the cardiac arrest, the animals were resuscitated with ventilation rates of 30 and 40 per min, respectively, while external cardiac compression was performed at rates between 60 and 160 per min. Randomly selected animals were resuscitated with ventilation-compression ratios of 1:2, 1:3 and 1:4 for 10 min each, 6 animals each were ventilated using a ventilation rate of 30 per min, 40 per min, or positive end-expiratory pressure.
High Frequency Jet Ventilation Prevents Aspiration during Cardiopulmonary Resuscitation
Authors: Keszler Hugo , Klain Miroslav , Nordin Ulf
Published: July 2016

Ventilation is an integral part of cardiopulmonary resuscitation (CPR). Early intubation is recommended not only for the sake of better ventilation but also to prevent aspiration since aspiration is a common occurrence during CPR. It probably not infrequently contributes to an unfavorable outcome. Endotracheal intubation is sometimes very difficult especially under field conditions. Cricothyroid membrane puncture or transtracheal puncture with a 14g or 16g catheter needle enables high frequency jet ventilation (HFJV) and can often be performed more easily than intubation.
Systematic Studies of Cerebral Resuscitation Potentials after Global Brain Ischemia (GBI)
Authors: Gisvold Sven Erik , Safar Peter
Published: July 2016

Resuscitation of the brain after ischemic-anoxic brain injury remains a controversial topic. There is, however, presently a certain therapeutic optimism in this field. Ours is partly based on the recognition of a post-resuscitation disease, that is, treatable pathologic processes in all organsafterrestoration of adequate perfusion pressure and arterial oxygenation. Also, Hossmann has shown that neurons can survive longer periods of anoxia than previously assumed.

There have been reports on experimentalfocalischemia indicating beneficial effects of barbiturates and moderate hemodilution before and after initiation of focal ischemia. After complete temporaryglobalbrain ischemia (GBI), as in cardiac arrest, however, results so far have been conflicting and controversial.
Experimental Study of Reversibility of a Diazepam Overdose by Physostigmine or Galanthamine
Authors: Havasi George , Gintautas Jonas , Warren Philip R. , Hayasi Ilona , Kraynack Barry J.
Published: July 2016

Diazepam is a commonly used drug for suicidal attempts. The antagonistic effect of physostigmine in these patients is poorly understood.

We studied the interaction of large doses of diazepam and either physostigmine or galanthamine hydrobromide using dose-response curves in 21 cats. After establishing dose-response curves for diazepam, half of the animals received 0.02 mg/kg of physostigmine intravenously. Two minutes later 8, 10, 12, or 14 mg/kg of diazepam was administered intravenously. After 2, 5, and 10 min, animals were evaluated for their response to noise and pain stimuli. The other half of animals were given 0.2 mg/kg of galanthamine intravenously and evaluated for diazepam effect using the same criteria. Sufficient number of days were allowed for the animals to recover from diazepam.
Induction of Ether Anesthesia Using Adjuvants for Emergency Treatment
Authors: Müller-Suur Niels , Kleemann Peter P. , Brost Frank , Halmagyi Miklos B.
Published: July 2016

Ether is almost a unique anesthetic agent, because it may be given to traumatized patients without any additional oxygen supply. But the significantly high stage of excitement during ether anesthesia can be dangerous, especially in disaster situations.

In the Netherlands, Crul developed a training program for application of ether anesthesia combined with droperidol as adjuvant. Incited by Crul's clinical training method, we studied, in comparison with Guedel's Table, the behavior of clinical signs during induction of ether anesthesia, using droperidol, diazepam or ketamine as adjuvants. We controlled especially the duration of induction, as well as the intensity of clinical signs in the stage of excitement.
The American Heart Association
Authors: Thwaites J. Keith
Published: July 2016

The American Heart Association is a voluntary health agency with approximately 100,000 members. It has affiliate offices in every state and in major cities throughout the country. The primary objective of the organization is to decrease and eventually eliminate disability and death from cardiovascular disease. This is accomplished through three general areas of program responsibility, namely support of research, community programs, and public and medical education. Its financial support is derived from public voluntary contributions.

There are close to one million deaths in the United States annually from cardiovascular disease, which include over 640,000 heart attack victims. Those of us working in the area of heart disease regard the problem as one of catastrophic proportions, and in fact, “disaster medicine.” With the cause of most cardiovascular diseases unknown, special emphasis is placed on research. However, the American Heart Association also has a responsibility to impart to the medical profession, and the public at large, what knowledge is known. Therefore, a great deal of emphasis is placed on prevention, particularly how it relates to heart attacks.
Disaster Assistance by Department of State, USA
Authors: Brooks Joyce A.
Published: July 2016

The Agency for International Development (AID) of the U.S. Department of State administers most U.S. bilateral foreign aid for development. The AID Administrator is the President's Special Coordinator for International Disaster Assistance. The office of U.S. Foreign Disaster Assistance (ofDA) coordinates all U.S. Government assistance to help alleviate suffering of people affected or threatened by natural or manmade disasters that occur abroad. Persons in developing countries are the main beneficiaries of the program. In addition to providing emergency relief, AID's disaster assistance program aims to strengthen the capabilities of other governments to respond to disasters. It is hoped that such efforts will help decrease dependence on the donor community.

OFDA response to disasters takes place only at the request of a foreign government to the U.S. Ambassador in the affected area. The Ambassador must then declare the existence of a situation warranting U.S. Government assistance. Once that disaster declaration has been made, he/she has the use of up to $25,000 which may be used as a donation or as a vehicle to purchase locally-available supplies to aid in relief efforts. Any amount above $25,000 must be approved by the OFDA.
The World Federation of Societies of Intensive and Critical Care Medicine
Authors: Grenvik Ake
Published: July 2016

Following the founding of the Society of Critical Care Medicine (SCCM) in the USA in 1970, and of other national Critical Care Medicine (CCM) societies in Europe, Australia and New Zealand, Japan, Israel, South Africa and Central and South America, a World Congress on Intensive Care Medicine (ICM) was held in London in 1973. This first World Congress was organized by Drs. Alan Gilston of the National Herat Hospital in London and Iain McA. Ledingham of Western Infirmary in Glasgow. During the Congress, Dr, Gilston initiated formation of The World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) which sponsored the second World Congress on Intensive and Critical Care Medicine (ICCM) in Paris in 1977 and the Third World Congress on ICCM in Washington, D. C. in 1981. The Fourth World Congress will be held in Jerusalem, June 23–28, 1985.
Private International Assistance in Major Disasters: The Brother's Brother Foundation
Authors: Hingson Luke L.
Published: July 2016

Over the past two decades, the general public in affluent western societies has become vividly aware of major disasters from around the world through the improving technology of the news media. Each one of us can readily recall the instantaneous reports on earthquake ravaged Guatemala in 1976; war-torn Nicaragua and Cambodia in 1979; and devastating earthquakes in Italy and Algeria in 1980.

Once alerted to the magnitude of these disasters, private organizations (churches, foundations, civic clubs, etc.), some 300–400 in number, in dozens of countries mobilized public support through news reports, ads, public service announcements, speeches and circular letters. For example, the Pittsburgh area raised over one half million dollars for refugees in Southeast Asia in 1980 that was channeled through such groups as UNICEF, Catholic Relief Services, and the International Rescue Committee.
Computer Modeling for Predicting and Planning for Worldwide and Regional Problems
Authors: Lesh Donald R.
Published: July 2016

How can the results of computer modeling be used most effectively to serve the public policy decision-making process? In considering that question, I find it useful to keep two factors very clearly in mind:

First, simulation modelsneverprovide any final answers; they simply offer an accurate, rapid, and mathematically precise means of analyzing a number of complex variables and tracing their dynamic interactions over time.

Second, the use of computer modeling therefore presupposes—evendemands—an ultimate higher level of decision —political, medical, or what have you—among the policy alternatives analyzed and compared in the model.
Disaster Preparedness in Nigeria
Authors: Shyngle Joseph A. , Sodipo Joseph O. A.
Published: July 2016

The River Ogunpa flood disaster was an event which created difficulties from every conceivable angle and provided many of the problems to be experienced in disaster management generally. It should be emphasized that every state hospital should have a disaster plan so that one could assume that it is adequately prepared for major accidents. Some of the teaching hospitals in Nigeria have disaster plans. However, the mere presence of a paper plan did not guarantee that it was up to date, comprehensive and understood by all staff concerned, in some of the major disasters which recently occurred in Nigeria. This article highlights some of the major natural and man-made disasters in our country, the magnitude of the damage done, factors affecting the response of the nation to the disasters, as well as some of the major deficiencies in our disaster plans.
Air Disaster in Antarctica
Authors: Fahey Morgan
Published: July 2016

On the 28th of November 1979, the fourth largest air disaster in the world occurred on the icy slopes of Mount Erebus, deep in Antarctica and 50 km from Scott Base. The 237 passengers and 20 crew were all killed instantly on impact, and their bodies and the wreckage were spread over an area 500 m long and 100 m wide. It had started out as a scenic flight, the 14th to Antarctica, and it had ended in tragedy. It was suffered, too, by an airline company which had maintained the highest standards of aviation safety.

In an account of Scott's last Antartic expedition in 1910, Cherry Garrard wrote of the “worst journey in the world,” and he said, “I have seen Fuji, the most dainty and graceful of mountains—and also Kanchenjunga; only Mechelangelo among men could have conceived such grandeur.
Medical Mission to a Refugee Camp in Thailand
Authors: Adler Jakov , Bodner E. , Bornstein S. , Goldfarb J. , Englehard D. , Naparstek J. , Norkin B. , Sack J. , Shemer S. , Weiler D.
Published: July 2016

During the latter part of 1979, hundreds of thousands Kampuchean refugees fled from all parts of their war- and hunger-ridden country to the Thai-Cambodian border, thousands perishing from hunger, disease and stepping on mine fields on the way. The majority of those who survived settled in several large villages straddling the border in relative security from the advancing Vietnamese army, receiving food and medical supplies from many international welfare organizations.

Widespread public interest in the plight of these refugees arose in Israel after a television program late in October 1979, and a public campaign initiated by Mr. Abie Nathan, an Israeli citizen. The ensuing fund-raising efforts resulted in 1.2 million dollars, most of which originated from private donations. These contributions enabled the Israeli government to equip 5 medical teams and send them to Thailand, covering the last two months of 1979 and the first 4 months of 1980.
Injuries from Nuclear Accidents
Authors: Wald Niel
Published: July 2016

In view of public concern about health impairment from accidental radiation exposure, the record of forty years experience in the utilization of nuclear energy was reviewed. All reported exposure incidents producing health effects from external radiation sources and internal radionuclide contamination in the United States and some in other countries have been included. Preparations for the management of such accidents will be considered briefly. The relationship of this actual accident experience to the unresolved problems in management planning and professional and public education for future accidents like that at the Three Mile Island nuclear power station in Middletown, Pennsylvania, March 1979, but with potential associated health impairment, was discussed. The complete paper is published in the Proceedings of the 3rd World Congress for Emergency and Disaster Medicine, organized by the “Club of Mainz” in Rome, Italy, 1983 (see Manni, C and Magalini, S, Springer Publ, Heidelberg, 1984).
Disaster Management During a Nuclear Accident
Authors: Donovan J. Ward , Trautlein Joseph J. , Miller Kenneth L. , Muller H. Arnold
Published: July 2016

Disaster preparedness as developed by civil authorities and hospitals has not adequately addressed the special characteristics of mass casualties from nuclear accidents, as demonstrated during the accident at the Three Mile Island (TMI) Nuclear Power Generating Plant. Experiences gained by the Radiation Emergency Task Force of the Milton S. Hershey Medical Center, established during the TMI incident, have resulted in reexamination of emregency medical services (EMS) systems response, population and hospital evacuation, decontamination procedures, communications, triage and psychologic impact during such an event. From these investigations, it is now possible to restructure disaster protocols to accommodate accidents involving toxic contamination. Although this report primarily deals with nuclear accidents, it is also useful in planning for large-scale biologic or chemical accidents.
The Earthquake in Algeria in 1980
Authors: Domres B. , Dürner P. , Heinrich R.
Published: July 2016

On October 10, 1980, the town of El-Asnam (130,000 inhabitants) and villages within a 50 km radius (229,000 inhabitants) were 80% destroyed by an earthquake of intensity 7.5 on the Richter scale (Figure l). The first unofficial estimates reported 50,000 dead and 100,000 injured. These numbers were probably based on data from the Agadir earthquake of February 29, 1960, when 12,000 out of the 30,000 inhabitants were killed. The official figures now list for the El-Asnam earthquake 2,600 dead and 8,250 injured. That was nevertheless a sufficiently heavy toll to fully justify the volume of relief that came from practically all over the world. The relief of Baden-Wurttenberg was organized by the German Air Rescue Guard of Stuttgart, in collaboration with the German Red Cross in Karlsruhe, as well as with physicians from Karlsruhe, Stuttgart and Tubingen. In a very short time the necessary aircraft (Merlin IV/Metro and BAC 1–11) for the transport of material and personnel from the German Headquarters were ready for takeoff.
12. The Potential Benefits of a Fire Safety Program Within Emergency Medical Services: A Point-of-Contact Intervention
Authors: Pirrallo Ronald G. , Rubin Jonathan M. , Meyer Ronald K. , Murawsky Gloria A.
Published: July 2016

Purpose: To determine how often house fires occur at addresses visited previously for emergency medical services (EMS) and were these visits missed opportunities for a point-of-contact fire safety intervention.

Method: Retrospective analysis of all Fire Department (FD) responses during 1994. Data studied with descriptive statistics: reason for response, property type, dollar loss estimate, injuries, fatalities, fire cause, smoke detector operation.

Results: The FD responded to 94,378 requests for service at 43,556 addresses. 27,406 addresses generated one response. However, 16,150 addresses had multiple requests, receiving 66,972 responses. For the multiple requests, 1,162 addresses had a fire condition of which 728 addresses requested EMS prior to the fire condition. 215 were one/two-family dwelling addresses receiving 489 responses; mean 2.3 EMS responses prior to the fire condition. 182/215 (85%) of these addresses had complete data, incurring a dollar loss estimate of [US]$2,017,470, 33 injuries and 0 fatalities. The top five causes for the fire condition were children playing with smoking materials, arson, suspicious, scorched food and undetermined. 87/182 (49%) of the one/two-family dwellings had a smoke detector present. However, only 31/182 (17%) of the dwellings had an operational smoke detector.
24. Comparison of a Transillumination Versus Direct Visualization for Endotracheal Intubation by Basic Emergency Medical Technicians
Authors: March Juan A. , Manring Eric , Lovelace Scott , Brown Lawrence H. , Yarborough Kimmie
Published: July 2016

Purpose: The new Emergency Medical Technician (EMT) basic curriculum includes an optional session on intubation. Unfortunately little data is available regarding retention of endotracheal intubation skills by basic EMTs. The objective of this study was to examine endotracheal intubation skills by basic EMTs, and compare skills retention for a transillumination (TI) versus a direct visualization (DV) technique.

Methods: A prospective, randomized trial was conducted over a five week period during a basic EMT class. EMT classes were randomized to train students to perform endotracheal intubation using either a transillumination or a direct visualization technique. Initial education was performed using an airway mannequin during a modified, accelerated three hour course, consisting of both a didactic and skills session. To assess performance, participants were tested using an airway mannequin and checklist currently implemented by our flight nurse program. Without further education or practice, students were then tested one week and five weeks later to assess short and long term retention.
41. Gastric Trauma and Pulmonary Aspiration at Autopsy After Cardiopulmonary Resuscitation
Authors: Felegi William B. , Doolittle Richard L. , Conston Alfred S. , Chandler Stephen V.
Published: July 2016

Purpose: To determine the prevalence of gastric trauma and pulmonary aspiration after cardiopulmonary resuscitation (CPR) and to examine factors which may be associated with increased prevalence of these complications.

Methods: Retrospective review of 1,928 consecutive autopsy reports in a suburban teaching hospital from January 1, 1977 – June 1, 1986 of which 860 received CPR and 1,037 did not. Of the 860 who received CPR, 527 received prehospital CPR and 333 arrested in hospital and received only hospital CPR. Thirty-one cases were excluded because of inability to accurately examine the stomach.

Results: There were 3 cases of stomach mucosal laceration and 4 cases of through and through laceration of the stomach in the CPR group and only one occurred in the non-CPR group (p <0.03). All gastric trauma in the CPR group occurred in the prehospital group (p <0.05). Pulmonary aspiration occurred in 31% of prehospital CPR patients and only 10% of hospital CPR patients (p <0.0001). The prehospital group differed from the hospital group in the following factors: longer basic life support times without intubation, 14.0 minutes vs. 2.0 minutes (p <0.0001) and longer total resuscitation time 46.9 minutes vs. 34.6 minutes (p <0.0001).
46. The Accuracy of Medical Records and Police Reports in Determining Motor Vehicle Crash Characteristics
Authors: Grant Robert J. , Gregor Mary Ann , Maio Ronald F. , Huang Shaun S.
Published: July 2016

Objective: To determine the accuracy of ambulance (AR), emergency department (EDR) and police (PR) records in describing motor vehicle crash (MVC) characteristics when compared to a standard - an in-depth motor vehicle crash investigation record (CIR).

Methods: Fifty-six MVC patients transported to a suburban, university hospital emergency department via ambulance and included in a crash investigation were identified. The time period was January 1993 through December 1995. Data sources were the AR, EDR, PR and CIR. The CIR was abstracted to a standard form. The other data sources were abstracted to a standard form using a retrospective, blinded review. Variables included occupant position, restraint use, air bag deployment, type of impact, ejection, and external cause of injury code. Accuracy was measured by determining percent agreement and Kappa for each data source compared to the CIR.

Results: Forty-six cases (82%) had one or more episodes of discordance. The mean percent agreement for the sources studied was AR 0.813, EDR 0.893 and PR 0.932. Mean values for Kappa were AR 0.712, EDR 0.831 and PR 0.885. Among variables, restraint use was determined with the least accuracy with means for percent agreement and Kappa of 0.792 and 0.674, respectively. For the AR, discordance was due to missing information almost 50% of the time.
35. Emergency Medical Services Use of Trauma Triage Criteria to Stratify Patients by Injury Severity and Need for Emergent Intervention
Authors: O'Connor Robert E. , Tinkoff Glen H. , Mascioli Susan , Megargel Ross E.
Published: July 2016

Purpose: Prehospital triage criteria (PTC) have been used to classify patients according to risk of serious injury. This study was conducted determine whether PTC could be used to identify serious injury, the need for intensive care (ICU), or immediate operative intervention (IOI).

Methods: Data for this observational study were gathered prospectively, at a level-I trauma center, from a patient cohort admitted to the trauma service from 01 February to 31 July 1995. Specific triage criteria, based on information given by EMS prior to arrival were used to categorize patients by severity. Patients classified as most serious (codes) had the following: shock, major anatomic injury or proximal penetrating trauma. Patients classified as more serious (alerts) had one of the following: abnormal vital signs, Glasgow Coma Scale <13, moderate anatomic injury, high-risk mechanism of injury, or co-morbid factors. Patients not meeting either set of criteria, but were admitted, served as controls (consults). Injury severity scores (ISS) and probability of survival (Probsurvival) were calculated for each patient. The percentage admitted to the ICU, operating room (OR), or requiring IOI, were tabulated. Statistical analysis was performed using ANOVA, Mest and chi-square.
23. Ambulance Sphygmomanometer Accuracy: Can It Affect Triage to the Trauma Center?
Authors: Cady Charles E. , Pirrallo Ronald G. , Grim Clarence E.
Published: July 2016

Objectives: To determine the accuracy of sphygmomanometers (SPHYGs) from a metropolitan EMS system and quantitate the mis-triage of adult blunt trauma patients based on erroneous systolic blood pressure (SBP) readings.

Methods-A: A cross-sectional, convenient sample of 150 SPHYGs was checked for accuracy using industry standards. Mean high and low deviations were calculated at 90 mmHg.

Methods-B: Retrospectively, a frequency distribution of the initial SBPs of all blunt trauma patients, age ≥21, seen in 1994 was plotted to characterize our study population. The numbers of patients potentially over- or under-triaged were identified when their reported SBP was corrected for using the mean high and low deviation plus 2 SDs.

Results-A: Overall, 25.3% of the SPHYGs were inaccurate. At 90 mmHg, 28.0% (42/150) were inaccurate with 16.7% (7/42) high by 4.6±1.5 mmHg and 81.0% (34/42) low by 6.2±4.2 mmHg; one was inoperable.

Results-B: 1,005 adult blunt trauma patients were evaluated; 61 were eliminated: 35 had initial SBPs of 0 mmHg and 26 had no SBP recorded (n = 944). The mean initial SBP was 138 ±30mmHg, and 3.8% (36/944) of the patients had SBPs <90 mmHg. Potentially, 2.0% (19/944) of the patients were undertriaged (initial erroneously high SBP reading 90–98 mmHg) and 2.5% (24/944) over-triaged (initial erroneously low SBP reading 74–90 mmHg).
71. Prospective Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia
Authors: Wolford Robert W. , Tisol William , Vasilenko Peter , Domeier Robert M. , Owensby Susan Bignall
Published: July 2016

Purpose: Criteria (T&R) have been proposed to identify hypoglycemic patients who may be treated in the field and released without transport to the hospital. We prospectively evaluated the validity of these criteria.

Methods: Patients presenting with hypoglycemia (blood glucose [BG] <80 mg/dL) to paramedics of 2 EMS systems were prospectively enrolled and the presence of T&R criteria determined. T&R criteria did not influence transport. Hospital records were reviewed to determine interventions and outcomes.

Results: A total of 151 patients were enrolled (58% male, age 56 years (range 12–94), BG 33 ±16 mg/dL) and 99 (66%) were transported to the hospital and used to test the T&R criteria. Fifty-six patients (57%) were discharged from the ED and 43 (43%) received additional medications, or were admitted. T&R criteria identified 28 (29%) patients as appropriate for treatment and release. Of these, 5/28 (18%) received additional dextrose 50% (D50) or admission; 3 received D50 (despite normal mental status and documented ED BG >100 mg/dL), and 2 were admitted (transient ischemic attack and 1 hospital day, hypoglycemia and gastroenteritis and 2 hospital days). Sensitivity, specificity, negative and positive predictive values for the T&R criteria were: 41%, 88%, 51%, and 82%, respectively, and 44%, 95%, 54%, and 93%, respectively, if the 3 cases receiving D50 despite BG>100 mg/dL are excluded.
14. Health Related Quality of Life Among Survivors of Prehospital Cardiac Arrest
Authors: Jain Vipin , Brancel Jennifer A. , Bullard David A. , Sayre Michael R. , Breaux Todd F. , Uphus Michael F.
Published: July 2016

Purpose: The purpose of this study was to measure the quality of life of cardiac arrest long-term survivors.

Design: Prospective outcome evaluation.

Setting: The emergency medical system of a mid-sized city.

Type of participants: Prehospital cardiac arrest victims who had a resuscitation attempt from 5/93 through 12/95 and were discharged alive. Patients <18 were excluded.

Measurements: Patients were surveyed by mail. Non-responders were telephoned. The questions assessed Glasgow-Pittsburgh overall performance (GPOP) scores before and after the cardiac arrest. Additional items assessed physical, role, affective, and cognitive functioning, and global health status.

Main Results: 760 cases were collected. 40 had unknown vital status at hospital discharge. The survival rate to hospital discharge for the 270 patients with cardiac etiology and initial rhythm of ventricular fibrillation was 15%, and it was 6% for the other 450 patients. Of 68 survivors, 23 died before a survey was sent; two had unknown addresses. 21 patients (49%) responded, and four refused to participate. The mean interval from cardiac arrest to survey response was 531 days. Ten reported good post-arrest GPOP scores, 5 had moderate disability, 4 severe disability, and 2 were comatose. Cognitive function was improved in 1, unchanged 6, slightly worse 7, markedly worse 4, and none in 3. Eleven patients reported feeling happy. Global healdi was excellent for 2, very good 8, good 5, fair 2, and poor 3.
19. A Breathing Manikin Model for Teaching Nasotracheal Intubation to EMS Professionals
Authors: March Juan , Dunn Kathleen , Brown Lawrence , Farrow Johnny , Perkins Phillip
Published: July 2016

Purpose: The wide spread use of orotracheal intubation with rapid sequence induction has made it difficult for EMS professionals to gain experience in nasotracheal intubation (NTI) in a controlled supervised setting. The purpose of this study was to determine if a training session on NTI with a breathing manikin can be used to improve skill and comfort of EMS professionals.

Methods: A prospective trial was conducted with a convenience sample of 16 emergency medical service professionals, previously trained in nasotracheal intubation techniques. For the training session a Laerdal airway manikin was modified by replacing the lungs with a bag-valve mask device, to simulate breathing with an inspiratory and expiratory phase. Following verbal instruction, and with direct supervision, each participant practiced NTI using the breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre and post intervention scores were compared using the Wilcoxon signed-rank test, £ = 0.01.
42. Paramedic Evaluation of Clinical Indicators of Cervical Spine Injury
Authors: Sahni Ritu , Menegazzi James J. , Mosesso Vincent N.
Published: July 2016

Purpose: Standard prehospital practice includes frequent immobilization of blunt trauma patients, some based solely on mechanism. Unnecessary cervical spine (c-spine) immobilization does have disadvantages, including morbidity such as low back pain and splinting, increased scene time and costs, and patient-paramedic conflict. Emergency physicians (EPs) use clinical criteria to clear trauma patients of c-spine injury. If paramedics were able to apply clinical criteria in the out-of-hospital setting, then unnecessary c-spine immobilization could be safely avoided. We designed a prospective, randomized, simulated trial to determine the level of agreement between paramedic and EP assessment of clinical indicators of cervical spine injury. We hypothesized that there would be substantial agreement between paramedic and EP evaluation of standardized patients.

Methods: A convenience sample of ten paramedics and ten attending EPs participated. Ten standardized patients, with various combinations of positive and negative findings, were examined simultaneously by EP-paramedic pairs. Each pair evaluated five randomly assigned patients for six clinical criteria, which were: 1) alteration in consciousness, 2) evidence of intoxication, 3) complaint of neck pain, 4) cervical tenderness, 5) neurologic deficit or complaint, and 6) distracting injury. If any criterion was positive, that was considered an immobilization decision. The kappa statistic was utilized to determine level of agreement between the two groups for each individual criterion and for the immobilization decision. A kappa of 0.40 to 0.75 denotes good reproducibility and >0.75 denotes excellent reproducibility.
74. Location of Cardiac Arrests: Implications for AED Placement
Authors: Atkins James M. , Zachariah Brian S.
Published: July 2016

Hypothesis: First responder organizations with automated external defibrillators (AEDs) can have a larger impact on survival of out-of-hospital cardiac arrest than placing AEDs in large buildings.

Methods: To evaluate the impact, all cardiac arrests handled by a large urban fire department for 1994 were analyzed. Each 5.6 square mile area of the city was defined as business (Bus), high (HilRes), middle (MilRes), or low income (LoIRes) residential. For each area, the CPR rates were calculated for the number of arrests/100 ambulance dispatches, and were stratified by percent of adults over age 65.

Results: Of the 1,222 cardiac arrests, only 85 occurred in business and industrial areas, 1,041 occurred in residential areas. The downtown business district had only 77 arrests with half of those being outside of buildings or in shelters.
10th World Congress for Disaster and Emergency Medicine
Authors: Dick Wolfgang F.
Published: July 2016

A little over 20 years ago, a small number of highly respected and internationally known scientists and experts in prehospital and in-hospital emergency and disaster medicine met under the chairmanship of Professor Peter Safar and the late Professor Rudolf Frey to found the Club of Mainz, with the aim of creating an association comparable to the renowned Club of Rome.

The goals of the new club were primarily to foster and improve disaster medicine worldwide and to better prepare for future natural and manmade disasters. After little more than 20 years, the former Club of Mainz, later renamed the World Association for Disaster and Emergency Medicine (WADEM) celebrates its 20th anniversary and, at the same time, organizes the 10th World Congress on Emergency and Disaster Medicine. Over the past 10 years, the Congress has been held throughout the world, first in Mainz and later, e.g., Pittsburgh, London, Rio de Janeiro, Hong Kong, Stockholm, Jerusalem, to return in 1997 to its place of origin.

To celebrate these events, the Congress program consists of three Plenary Sessions dedicated to aspects that already were of concern 20 years ago to assess the developments and progress made during that period of time.
Monster El Niño Not Enough to Quench California Drought
Authors: Lipuma Lauren
Published: July 2016

New research shows that the Sierra Nevada snowpack will likely not recover from the current drought until 2019.
New-Found Dwarf Planet Points to Solar System's Chaotic Past
Authors: Hall Shannon
Published: July 2016

Astronomers have discovered an icy ball in the dark and frigid regions of the outer solar system, which they suspect harbors secrets to the solar system's formation and evolution.
Use of CRISPR/Cas9-engineered INS-1 pancreatic β cells to define the pharmacology of dual GIPR/GLP-1R agonists
Authors: Naylor Jacqueline , Suckow Arthur T. , Seth Asha , Baker David J. , Sermadiras Isabelle , Ravn Peter , Howes Rob , Li Jianliang , Snaith Mike R. , Coghlan Matthew P. , Hornigold David C.
Published: July 2016

Dual-agonist molecules combining glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) activity represent an exciting therapeutic strategy for diabetes treatment. Although challenging due to shared downstream signalling pathways, determining the relative activity of dual agonists at each receptor is essential when developing potential novel therapeutics. The challenge is exacerbated in physiologically relevant cell systems expressing both receptors. To this end, either GIP receptors (GIPR) or GLP-1 receptors (GLP-1R) were ablated via RNA-guided clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 endonucleases in the INS-1 pancreatic β-cell line. Multiple clonal cell lines harbouring gene disruptions for each receptor were isolated and assayed for receptor activity to identify functional knockouts (KOs). cAMP production in response to GIPR or GLP-1R activation was abolished and GIP- or GLP-1-induced potentiation of glucose-stimulated insulin secretion (GSIS) was attenuated in the cognate KO cell lines. The contributions of individual receptors derived from cAMP and GSIS assays were confirmed in vivo using GLP-1R KO mice in combination with a monoclonal antibody antagonist of GIPR. We have successfully applied CRISPR/Cas9-engineered cell lines to determining selectivity and relative potency contributions of dual-agonist molecules targeting receptors with overlapping native expression profiles and downstream signalling pathways. Specifically, we have characterised molecules as biased towards GIPR or GLP-1R, or with relatively balanced potency in a physiologically relevant β-cell system. This demonstrates the broad utility of CRISPR/Cas9 when applied to native expression systems for the development of drugs that target multiple receptors, particularly where the balance of receptor activity is critical.
Effects of serum amyloid A on the structure and antioxidant ability of high-density lipoprotein
Authors: Sato Megumi , Ohkawa Ryunosuke , Yoshimoto Akira , Yano Kouji , Ichimura Naoya , Nishimori Madoka , Okubo Shigeo , Yatomi Yutaka , Tozuka Minoru
Published: July 2016

Serum amyloid A (SAA) levels increase during acute and chronic inflammation and are mainly associated with high-density lipoprotein (HDL). In the present study, we investigated the effect of SAA on the composition, surface charge, particle size and antioxidant ability of HDL using recombinant human SAA (rhSAA) and HDL samples from patients with inflammation. We confirmed that rhSAA bound to HDL3 and released apolipoprotein A-I (apoA-I) from HDL without an apparent change in particle size. Forty-one patients were stratified into three groups based on serum SAA concentrations: Low (SAA ≤ 8 μg/ml), Middle (8 < SAA ≤ 100 μg/ml) and High (SAA > 100 μg/ml). The ratios of apoA-I to total protein mass, relative cholesterol content and negative charge of HDL samples obtained from patients with high SAA levels were lower than that for samples from patients with low SAA levels. Various particle sizes of HDL were observed in three groups regardless of serum SAA levels. Antioxidant ability of rhSAA, evaluated as the effect on the formation of conjugated diene in low-density lipoprotein (LDL) induced by oxidation using copper sulfate, was higher than that of apoA-I. Consistent with this result, reconstituted SAA-containing HDL (SAA-HDL) indicated higher antioxidant ability compared with normal HDL. Furthermore, HDL samples obtained from High SAA group patients also showed the highest antioxidant ability among the three groups. Consequently, SAA affects the composition and surface charge of HDL by displacement of apoA-I and enhances its antioxidant ability.
Exact support recovery via orthogonal matching pursuit from noisy measurements
Authors: Dan Wei , Fu Yu
Published: July 2016

The support recovery performance of orthogonal matching pursuit (OMP) for the l∞ bounded noise is presented. It is shown that OMP can exactly recover the support of arbitrary K‐sparse signal x from noisy measurements y = Φx + e in K iterations, provided that the matrix Φ and the minimum magnitude of all the non‐zero elements of x satisfy certain requirements. The proposed result is an improvement over the existing ones.
Experimental and Quantum Mechanical Study of Nucleophilic Substitution Reactions of meta- and para-Substituted Benzyl Bromides with Benzylamine in Methanol: Synergy Between Experiment and Theory
Authors: Sanjeev Rachuru , Ravi Ramavath , Jagannadham Vandanapu , Skelton Adam A.
Published: July 2016

This work involves the experimental and theoretical study of the nucleophilic substitution of meta- and para-substituted benzyl bromides with benzylamine. Conductometric rate experiments confirm the applicability of the Hammett linear free-energy relationship to this system. To gain a deep understanding of the physical chemistry at play, a quantum mechanical study of the reaction is also conducted. The quantum mechanical calculations not only reproduce the experimental free energy of activation, but also provide greater insights at the molecular and atomic level. Isolation of the calculated transition state structure and application of the Hammett equation to its electronic, structural, and energetic properties are studied.
Dietary composition of endangered seahorses determined by stable isotope analysis
Authors: Valladares S. , Soto D. X. , Planas M.
Published: July 2016

The lack of integrated measures for assessing the feeding ecology of seahorses may restrict the effectiveness of conservation actions on wild populations of worldwide threatened seahorse species. Identifying dietary sources will allow researchers to determine their degree of vulnerability to environmental changes, redefine their conservation status and apply appropriate management strategies. The resource use of the seahorse Hippocampus guttulatus inhabiting coastal waters of Galicia (north-western Iberian Peninsula) was assessed for three populations and 2 years using stable isotope mixing models. The Bayesian mixing model (MixSIAR) estimated the relative contributions of the dietary sources to the seahorse diet and revealed that Caprellidea were the primary source, followed by Gammaridea and Caridea. Mysidae and Annelida represented the less dominant prey. This prey preference can be explained by the foraging behaviour of seahorses. Different contributions of Gammaridea and Caridea to the diet were found among sites, indicating different habitat characteristics and hence different habitat use by seahorses within each site. In addition, differences were encountered among sexes. Caprellidea was the dominant prey for females, whereas Gammaridea was the dominant prey for males. The findings of the present study will contribute to the knowledge of feeding patterns of H. guttulatus, providing relevant data for conservation of this endangered species.