bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of an Equipment and Supply List for Emergency Medical Services Delivery at an Annual Air Show
Authors: Sullivan Francis M. , Kleinman Gary , Suner Selim , St.Jean Jack
Published: July 2016

Introduction:

Reports of medical care at mass gatherings reflect variability in mission and delivery models. Equipment recommendations are similarly varied. Thoughtful pre-planning and experience-based analysis are the best mechanisms for defining general and specific equipment recommendations.

Objective:

This report presents a suggested supply and equipment list developed over a six-year period of medical coverage at an air show, with an emphasis on the usage and cost of expendable supplies.

Methods:

The authors were involved in the planning for and execution of emergency medical care for a large, local, military air show on an annual basis, including provision of expendable medical supplies. A list of such supplies was developed over the initial two to three years, formalized and refined over the subsequent two years, and analyzed in the final, highest patient volume year of coverage. Detailed usage and cost was tracked over the final year for expendable supplies.

Results:

The results of this analysis indicate that comprehensive emergency medical care from first aid to mass casualty care can be offered at reasonable equipment and supply costs, if existing equipment resources can be supplemented by expendable supplies from a pre-determined list. Given the need for large quantities of supplies for a mass casualty contingency and the low likelihood of occurrence, a loan arrangement with a supplier, with return of unused supplies, is particularly convenient and economical. The approach used in this study should be appreciable in other similar settings. In concurrent scheduled events, the iterative process described can lead to greater specificity of needs for expendable supplies.
Differences in Mortality Rates Among Trauma Patients Transported by Helicopter and Ambulance in Maryland
Authors: Kerr Walter A. , Kerns Timothy J. , Bissell Richard A.
Published: July 2016

Introduction:

A comprehensive state wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient out comes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (Maryland State Police) Aviation Division contribute to an improved trauma patient survival rate in Maryland.

Methods:

A retrospective study was conducted on the records of all patients transported by helicopter or ground ambulance and admitted to the R Adams Cowley Shock Trauma Center (R Adams Cowley Shock Trauma Center of the University of Maryland Medical System) of the University of Maryland Medical System. Data were obtained from the Maryland Institute of Emergency Medical Services Systems (Maryland Institute for Emergency Medical Services Systems) Shock Trauma Clinical Registry for the period January 1988 through July 1995, covering 23,002 patients. Patients included those transported directly from the scene of injury to the Maryland Institute for Emergency Medical Services Systems as well as those from interfacility transfers. All patients were stratified by injury severity and compared by outcome (mortality) using Mantel-Haenszel statistics.

Results:

During the study period, 11,379 patients were transported by ground and 11,623 were transported by Maryland State Police helicopter. The mean Injury Severity Score (Maryland State Police) for patients transported by ground was 12.7 (standard deviation = 12.52) and the mean Injury Severity Score for patients transported by air was 14.6 (Injury Severity Score = 13.42), p <0.001. Among patients classified as having a high index of injury severity, the mortality rate was lower among those transported by Maryland State Police helicopter than among those transported by ambulance. The mortality rate was significantly lower for air transported patient with an Injury Severity Score higher than 31.

Conclusion:

The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.
The National (United States) Disaster Medical System: A Survey and Analysis
Authors: Clark William D. , Moskop John C. , Whitley Theodore W.
Published: July 2016

The National Disaster Medical System (NDMS) was formulated to provide medical care for casualties of future large-scale natural disasters and military conflicts. We sent questionnaires to the 59 emergency medical directors of North Carolina's participating hospitals in order to assess their views regarding the need for NDMS and the level of their hospital's preparedness. Responses were received from 78% (46) of the physicians surveyed. Of those responding, an overwhelming majority supported the need for a national plan like NDMS to treat casualties of a natural disaster or an overseas military conflict. Respondents also agreed that the participation of emergency department personnel, other physicians, and support personnel is essential for successful activation of NDMS. Responses to questions regarding level of preparedness, however, suggested that there is less than an optimal degree of preparedness for participation in NDMS.
International Emergency Health Care Systems Survey
Authors: Bissell Richard A. , Conover Jean
Published: July 2016

Medical emergencies occur in every country regardless of its level of socio-economic development. Little comparative data are available which define the characteristics of the system by which some emergencies are managed. Without such comparisons, it is difficult for countries to establish appropriate priorities within their geographic, cultural, and economic constraints. In an effort to gather some of these needed data, a survey was distributed to the participants in an International Conference on Emergency Health Care (EHC) Development convened in Washington, D. C, in August 1989. Each country participating was classified as Industrialized (INDUS), Developing (DC), or Least Developed (LDC) in accordance with World Health Organization definitions. Responses are expressed as proportion of total participants.

There were 450 participants from 74 countries. Only 17% of the surveys were returned. The sample included 78 participants from 40 (57%) countries. (INDUS: 30%; DC: 48%; LDC: 22%). All showed considerable dependence on ambulance services, but DC and LDC indicated substantial reliance on friends, neighbors, community health workers, and physician's offices. Prehospital EHC services were available to 93% of INDUS, 63% of DC, and possibly one-third of the LDC. Emergency Health Care is taken to the patients in the same proportions as noted above. The types of manpower dispatched varied widely with a great proportion of the respondents from DC and LDC indicating that care was delivered by non-professionally trained individuals. Interestingly, INDUS had the greatest proportion of volunteers. Response and transport times were shorter for INDUS than for DC. When no prehospital EHC services were available, patients reached the receiving facilities by alternate means such as walking (33%), private automobile (48%), or public transportation (33%). Central emergency access was available for 80%. Considerable variation exists as to the mechanisms by which such services are financed: poorer countries depend more on government support than do INDUS who rely heavily on donations and fee-for-service. Lastly, regardless of level of economic development, cardiovascular disease, trauma, and medical illness comprise the most important reasons for accessing the EHC systems.

This preliminary study points to the need for individualizing EHC systems in concert with the priorities of the country for which they are designed. Direct application of operational systems across countries does not seem an appropriate mechanism for the development of EHC. However, the delivery of EHC must be made an important element of overall health care in all the countries of the world.
Evaluation of a Simplified Index of Initial Prognosis in Polytrauma
Authors: Scherpereel Philippe , Vandenameele Jean-Pierre , Hochart Daniel , Marson Jean-Claude , Goldstein Patrick
Published: July 2016

Three hundred cases of polytrauma were investigated to evaluate the reliability of the Lindsey severity index. This simplified injury score can be used by paramedics or low-skilled emergency practioners to obtain a correct screening of patients and an initial prognosis on the basis of a simple injury severity scale. An evaluation by the Lindsey index was done in the field and at the emergency care unit. Results compare the final status of the patient which was obtained using the Patel score, derived from the patient's chart after his discharge. The Lindsey index demonstrated a correct assessment of the patient's status in 60% of the cases at the scene of the accident and 77% in the emergency unit. Most of the errors were due to underevaluations of the skull and spinal trauma. Patel's scale emphasizes locomotor sequellae, while skeletal injuries seldom provide life-threatening events, widely considered in the Lindsey index. Lindsey's index is a simple and reliable tool for initial assessment and a useful method of teaching.
Intravenous Regional Analgesia (Biers Block) — Safe or Not?
Authors: Cembrowicz Stefan , Baskett Peter J. F.
Published: July 2016

The concept of using Intravenous Regional Analgesia (IVRA) in the mass casualty situation is potentially an attractive alternative to the use of general anesthesia in the management of limb fractures. The purpose of this paper is to outline the history and development of the technique and emphasize important guidelines designed to increase the safety of the method.
New Swedish Equipment for Disaster Relief
Authors: Norberg Karl-Axel , Hellron Georg , Unger Helena , Wallenstrom Marten
Published: July 2016

Within the Stockholm region there are eleven emergency hospitals, six of which can send medical teams to the site of a disaster within fifteen minutes after an alarm. This ensures qualified first aid to the injured at the disaster site. Each team consists of the surgeon and anesthetist on duty and three nurses with special training in emergency medicine, anesthesia or intensive care. The personnel leaving the hospital are replaced by other personnel in the hospital. All members of the team are equipped with special clothing: an overall with dressings and other equipment in the pockets, a helmet and boots and warm underwear, allowing outdoor work at the low temperatures not infrequently met in the Swedish winter (Figures 1,2). Doctors and nurses have special markings, so that they are easily recognized.
Ten Years of Obligatory Education of Life Support for Medical Students
Authors: Dworacek B. , van Poorten J.F. , Rutten F.L.P.A.
Published: July 2016

In 1979, Eisenberg et al. evaluated the survival rate after an out-of-hospital cardiac arrest in a population of approximately half a million people. It was concluded that the survival rate definitely depended on the time before the initiation of cardiopulmonary resuscitation (CPR) and the time the definitive care was received. Both were equally important. The time limits found were four minutes for initiation of CPR and eight minutes for definitive care.
Countermeasures Against Earthquake Disasters in Relation to Medical Treatment in Japan
Authors: Osawa Yutaka
Published: July 2016

Planning of earthquake disaster prevention is of great concern in Japan, since we have frequently been subjected to serious damage due to severe earthquakes. The medical treatment after a disastrous earthquake is undoubtedly one of the most serious items to be considered.

The countermeasures against earthquake disasters, in relation to medical treatment, may be divided into two categories; a) prevention of damage to medical facilities and instruments, b) planning for emergency and disaster medicine. This paper introduces the countermeasures against earthquake disasters in relation to medical treatment in Japan.
The “World Association for Emergency and Disaster Medicine” (WAEDM) (Club of Mainz)
Authors: Safar Peter
Published: July 2016

The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”
Suspension of Combatant Status of Wounded Soldiers (Abstract)
Authors: Schultze Reinhold R.
Published: July 2016

Trends in recent warfare show a movement in the proportion of wounded soldiers to wounded civilians from 20:1 in World War I to a conjectured 1:100 in the case of atomic, biological or chemical warfare. Modern methods of waging war mean that for every fighting man, a group is engaged in logistics, and that for every dead soldier, an increasing number are wounded. Furthermore, the number of severely wounded cases is proportionately increasing.
National Disaster Medical System (NDMS) Planning for the USA: A Unique Opportunity for the Peaceful use of Military Assets
Authors: Silverstein Martin E.
Published: July 2016

Magnitude and Configuration of Disasters. The increasing number of disasters and consequent casualties in an era of growing sophistication of care for the emergency patient mandates a systematized disaster response utilizing all of a nation's resources in optimum fashion. Life in the second half of this century has grown more complicated and in so doing has laid the basis for more complex disasters. Larger groups of people are vulnerable to individual catastrophic events. Population increases and sociopolitical alterations have accelerated the trend toward the establishment of residential and industrial centers in areas subject to natural disasters. Societal and political pressures are increasing tensions, producing ever more disasters along a broad spectrum, ranging from isolated terrorist events through low intensity conflict to limited conventional warfare. Perhaps most important, our increasingly technological society has not only contributed significantly to the menu of conflicts but has brought a variety of new transportation and industrial hazards to the ordinary course of life.
Medical Aspects of Mountain Rescue by Helicopter
Authors: Hossli Georg , Bühler Christian
Published: July 2016

In summer, mountain accidents may include falls, causing contusions and open wounds; fractures and torn ligaments; external bleeding;internal bleeding in the head, thorax and abdomen; injuries to the spinal column and extremities; falling rocks causing skull injuries; and falls into crevasses causing additional hypothermia, frostbite and drowning. In winter, there are skiing accidents with fractures and torn ligaments; and avalanches resulting in asphyxia, hypothermia and frostbite. In addition, there are mountain sickness; pulmonary edema of high altitude; snow blindness; heatstroke; sunstroke; heart attack; diarrhea and vomiting; pneumonia; snakebite; drowning in torrents or lakes; and burns, explosions and cuts acquired in huts. First aid, medical support and transport to hospital may vary widely.
Military and Civilian Air Rescue in Italy
Authors: Manni Corrado , Rotondo Gaetano
Published: July 2016

In contrast to other European countries, Italy lacks a Civil Defense Organization. Air Rescue is a task for the Italian Air Force Search and Rescue (S.A.R.) organization. It may also draw, if necessary, on the cooperation of the other Armed Forces and State Corps, the Merchant Navy, civilian organizations, the Italian Red Cross (C.R.I.), and the Mountain Rescue Service of the Italian Alpine Club (C.A.I.). The S.A.R. units intervene at the request of civil, state, public and private, national and international organizations. The tasks currently performed by the S.A.R. in Italy include search and rescue of civilian and military air crews lost at sea or over land and of shipwrecked survivors; emergency transport of doctors and supplies to the seriously sick or injured patients from ships at sea; inaccessible localities, earthquakes, floods, and other disasters.
The Need for a Global Health Disaster Network
Authors: Libman Ingrid M. , LaPorte Ronald E. , Akazawa Shunichi , Boostrom Eugene , Glosser Caryle , Marler Eric , Pretto Ernesto , Sauer Francois , Villasenor Anthony , Young Frank , Ochi Genro
Published: July 2016

When a disaster occurs, a major difficulty is knowing where to find accurate information, and how to help coordinate efforts to share accurate information in a quick and organized manner. The establishment of a global information network, that is in place before a disaster occurs, could link all the communication efforts for relief. We propose that a Global Health Unit for Disaster and Relief Coordination be set up as part of the Global Health Network, utilizing the Internet as its backbone. This Unit would establish the links for the disaster information mosaic.
The Flight from Rwanda in 1994: What Were (Are) the Priorities?
Authors: Domres Bernd , Mang Andreas
Published: July 2016

Extent of the Catastrophe:

More than 2 million refugees, 2–3 million displaced persons internally, thousands of unaccompanied children, and a total number of reported fatalities of 48,347 in Goma, Zaire.

Priorities for International Relief:

International relief support started with coordination provided by the United Nations High Commissioner for Refugees (UNHCR). In the first phase, availability of potable water was the highest priority. Current priorities are to intensify repatriation of Rwandan refugees under conditions that will guarantee human rights and allow for dignified daily living.

Conclusion:

Education beginning at childhood, to overcome conflicts, social inequality, and overpopulation should be promoted by assisting governments, instead of pursuing policies aimed largely at forwarding their own national interests.
How to Cope with a Visit from the Pope
Authors: Federman Jane H. , Giordano Lorraine M.
Published: July 2016

A mass gathering always presents a challenge to the medical providers of a city since preparations must be made to cover any potential disasters, big or small. With a prediction of several hundred thousand people coming to the New York City area to participate in the Papal Masses, the New York City-Emergency Medical Services readied its forces of physicians, paramedics, and emergency medical technicians from throughout the region. Extensive multiagency planning involving a Total Quality Management process was integral to the success of covering the events.
Triage By Emergency Medical Dispatchers
Authors: Stratton Samuel J.
Published: July 2016

Purpose:

This study is an evaluation of the ability of medically trained and controlled emergency medical dispatchers to use telephone triage techniques to direct the appropriate prehospital unit to an emergency scene.

Methods:

Emergency dispatchers, educated in a formal emergency medical dispatch program, were assigned one of four triage priorities to incoming 9-1-1 calls. The actual field management delivered for each patient was compared with the dispatcher's triage to determine the appropriateness of triage.

Results:

A total of 1,045 consecutive calls were reviewed with 74.4% sorted as needing advanced life support (ALS) units on scene; 65.3% (95% CI, 61.9 to 68.6%) of these calls required ALS intervention. A total of 3.4% of the runs sorted to the non-ALS response groups were identified to have required ALS intervention. Comparing the need for ALS intervention, a significant difference was found between the triage groups.

Conclusion:

Emergency medical dispatchers, using a formal system for telephone triage, are able to direct appropriate prehospital resources to the emergency scene.
Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge
Authors: Houtchens Bruce A. , Clemmer Terry P. , Holloway Harry C. , Kiselev Alexander A. , Logan James S. , Merrell Ronald C. , Nicogossian Arnauld E. , Nikogossian Haik A. , Rayman Russell B. , Sarkisian Ashot E. , Siegel John H.
Published: July 2016

Introduction:

The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.

Methods:

During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.

Results:

Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.

Conclusion:

These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Joint Position Statement on Emergency Medical Services and Emergency Medical Services Systems
Authors:   National Association of State EMS Directors and National Association of EMS Physicians
Published: July 2016

In 1966, a National Academy of Science's National Research Council white paper described inadequacies in the emergency health care available in the United States. Entitled “Accidental Death and Disability: The Neglected Disease of Modern Society,” this paper cited a diversity or lack of standards for many aspects of emergency medical services (EMS) and a general absence of a systemized approach.

Federal response in the early 1970s, through the National Highway Traffic Safety Administration and the EMS System Act of 1973, addressed the fragmented delivery of EMS, and set standards for planning and developing such services within the context of an EMS system. The System Act addressed the primary prevention of injury and acute, critical illness as well as methods for comprehensive intervention, from system access and prehospital care through stabilization and rehabilitation, in those cases where primary prevention fails.
The Emergency Medical Response to the Cantara Hazardous Materials Incident
Authors: Koehler Gus A. , Van Ness Carol
Published: July 2016

On 14 July 1991, at 2150 h, a train derailment occurred near the Cantara rail curve about six miles above Dunsmuir in Northern California. The derailment spilled approximately 19,000 gallons of metam-sodium into the Sacramento River. When mixed with loater, metam-sodium degrades to methylisothiocyanate (MITC) and other gases. The contaminated river water passed the town of Dunsmuir and other occupied areas exposing residents to MITC gas.

From 15 July to 20 July (five days), a total of 360 people underwent triage. The majority of patients displayed minor exposure symptoms that did not require hospital care. Mercy Mt. Shasta Hospital, a small rural hospital close to Dunsmuir, received the majority of patients. As of 29 July, 15 days after the incident, Mercy Mt. Shasta Hospital had seen 244 exposed patients in its emergency department, and had admitted five. Three had symptoms that could have been spill-related. Three Regional Poison Control Centers provided medical toxicology advice.

Medical management of the emergency medical services (EMS) response to the event was piecemeal and weak. There did not appear to be a medical operations component at local Emergency Operations Centers (EOC). Most health care personnel interviewed complained about inadequate information about the substance and the situation. Local fire service mutual- aid agreements to obtain additional fire service and ambulance personnel worked well. It is important to emphasize that everyone who believed they had been exposed to the chemical underwent triage and received appropriate acute medical care.
Airway Control in Trauma Patients with Cervical Spine Fractures
Authors: Lord S. Alan , Boswell William C. , Williams James S. , Odom John W. , Boyd Carl R.
Published: July 2016

Introduction:

Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial.

Purpose:

This study was undertaken to survey the preferred methods of airway management in cervical spine fracture (CSF) patients, to evaluate the experience of handling such patients at a level-I trauma center, and to contrast the findings with recommendations of the American College of Surgeons Committee on Trauma.

Hypothesis:

The methods used for control of the airway in patients with fractures of their cervical spine support the recommendation of the American College of Surgeons (ACS) Committee on Trauma.

Methods:

The study consisted of two parts: 1) a survey; and 2) a retrospective study. Survey questionnaires were sent to 199 members of the Eastern Association for the Surgery of Trauma and to 161 anesthesiology training programs throughout the United States. Three resuscitation scenarios were posed: 1) Elective airway—CSF—breathing spontaneously, stable vital signs; 2) Urgent airway—CSF—breathing spontaneously, unstable vital signs; and 3) Emergent airway—CSF—apneic, unstable. In addition, a three-year retrospective study was conducted at a level-I trauma center to determine the method of airway control in patients with cervical spine fractures.

Results:

Responses to the questionnaires were received from 101 trauma surgeons (TS) and 58 anesthesiologists (ANESTH). Respondents indicated their preference of airway methods: Elective airway: Nasotracheal intubation: TS 69%, ANESTH 53%. Orotracheal intubation: TS and ANESTH 27%. Surgical airway: TS 4%. Intubation with fiberoptic bronchoscope (FOB): ANESTH 20%. Urgent airway: Nasotracheal intubation: TS 48%, ANESTH 38%. Orotracheal intubation: TS 47%, ANESTH 45%. Surgical airway: TS 4%. FOB: ANESTH 16%. Emergent airway: Orotracheal intubation: TS 81 %, ANESTH 78%. Surgical Airway: TS 19%, ANESTH 7%. FOB: ANESTH 15%.

The retrospective review at the trauma center indicated that 102 patients with CSF were admitted; 62 required intubation: four (6%) on the scene, seven (11%) en route, five (8%) in the emergency department, 42 (67%) in the operating room, and four (6%) on the general surgery floor. Airway control methods used were nasotracheal: 14 (22%); orotracheal: 27 (43%); FOB: 17 (27%); tracheostomy: one (2%); unknown: three (4%). No progression of the neurological status resulted from intubation.

Conclusion:

The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.
Agreement Between Paramedic-Estimated Weights and Subsequent Hospital Measurements in Adults with Out-of-Hospital Cardiac Arrest
Authors: Martin Daniel R. , Soria David M. , Brown Charles G. , Pepe Paul E. , Gonzalez Edgar , Jastremski Michael , Stueven Harlan , Cummins Richard O.
Published: July 2016

Objective:

To assess the accuracy of paramedic estimates of adult body weights in cardiac arrest cases.

Hypothesis:

Paramedics could accurately estimate the weights of out-of-hospital cardiac arrest patients.

Design:

Retrospective data analysis of a 15-month, multicenter study involving nontraumatic out-of-hospital cardiac arrest patients. Paramedic estimates of body weights were compared to weights measured in the hospital. Patients were included in the analysis only if both a paramedic weight and a measured in-hospital weight were recorded.

Setting:

Six urban emergency medical services systems.

Participants:

The study population included adults with return of spontaneous circulation who subsequently were admitted to the hospital.

Measurements:

Pearson correlation analysis of paramedic-estimated weights and measured weights.

Results:

Among the 133 study patients, the correlation coefficient (R) for paramedic estimates and the actual measured weight was 0.93. Paramedic estimates of weight were within 10% of the measured weights in 74% of the patients, and within 20% of measured weights in 93% of the patients.

Conclusion:

Paramedic weight estimates correlated well with measured weights.
Intravenous Maintenance with a Saline Lock Intermittent Infusion Device in the Prehospital Environment
Authors: Carducci Bryan , Stein Kurt
Published: July 2016

Introduction:

A study was done with EMS personnel to determine the ease of use and accetance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance.

Study Hypotheses:

Saline lock, intermittent infusion device use in specific clinical scenaios is easier, less expensive, and as effective traditional TV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical servics (EMS) system.

Methods:

This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlin Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects.

Results:

There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four-month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65 %) and facilitated patient transportation (73 of 79 or 92%). Medications were administered according to protocol or command dirtion in the prehospital setting through 20 (25%) SL. Intravenous access was maintained by 52 of 79 SL (65 %), and seven (9%) SL were converted to fluid infusions in the prehospital setting after contact with the medical command physician. In the ED, two (3%) SL were judged by nurses to be nonpatent and 17 (22 %) were converted to maintenance fluid infusions. Systemwide use of SL was favored by 73 of 79 (92.4%) EMS providers. Each device and 2 ml 0.9% saline flush carpuject cost [U.S.]$1.62 versus the cost of IV tubing and a 250 cc bag of lactated Ringer's at $2.11, resulting in a cost savings of 23.2%.

Conclusion:

The saline lock, intermittent infusion device is an effective method of maintaining prehospital IV access. When compared to traditional IV fluid bags, EMT-Ps judged the device to be easier and less time-consuming to initiate, and facilitated patient transportation. A cost savings was realized when SL usage was compared to traditional IV fluid bag infusion. Systemwide implementation of the saline lock was desired.
Post-Preparedness Medical Disaster Response in Costa Rica
Authors: Bissell Richard A. , Pretto Ernesto , Angus Derek C. , Shen Bern , Ruíz Victor , Ceciliano Norma , Sawyers Roberto , Shurtleff Dawn , Abrams Joel
Published: July 2016

Introduction:

The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness.

Hypothesis:

Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent.

Methods:

Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office.

Results:

Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake.

Conclusion:

To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.
Emergencies in the School Setting: Are Public School Teachers Adequately Trained to Respond?
Authors: Gagliardi Monte , Neighbors Marianne , Spears Caile , Byrd Scott , Snarr Jamin
Published: July 2016

Introduction:

This study attempted to determine the extent of training and emergency care knowledge of public school teachers in midwestern states. A secondary purpose was to assess the frequency of injury and illness in the school setting requiring the teacher to first respond.

Method:

A questionnaire and 14-item, scenario-based, emergency medical care test was developed and pretested. A discrimination index was used for validation of the instrument and a reliability coefficient of .82 was computed using the Kuder-Richardson Formula 20. A randomly recruited group of public school nurses from Arkansas, Kansas, and Missouri administered the instrument to 334 teachers who had no prior knowledge of the test. A random telephone survey of local school patrons also was completed to determine parental assumptions and expectations for emergency care and cardiopulmonary resuscitation (CPR) training in teachers.

Results:

One-third (112 teachers) had no specific training in first-aid and 40% never had been trained in CPR. However, most (87%) of the respondents strongly agreed that emergency care training should be required in teacher preparation programs. Eighteen percent of the teachers responded to more than 20 injured or ill students annually, and 17% reported that they had encountered at least one life-threatening emergency in a student during their career. The average score for all respondents on the emergency care test was 58% (X2= 8.12±2.42). Those with prior first-aid training averaged 60.5% (X2= 8.47±2.32). Significant deficiencies were noted for recognition and appropriate treatment of student emergencies involving basic life support (BLS) and airway interventions, diabetic emergencies, and treatment of profuse bleeding. Forty of the 50 (80%) parents surveyed assumed that all teachers were adequately trained in first-aid and CPR.

Conclusion:

Public school teachers represent a potentially effective first-response component during disasters and isolated emergencies in the school environment. Overall, most of public school teachers in this study were deficient in both training and knowledge of emergency care and BLS modalities. Lack of effective, formal emergency care training in teacher preparation programs coupled with no continuing education requirement is a possible explanation of these results. Emergency medical services providers should seek opportunities to help with first-responder training and continuing education in their schools.
Outcome of Patients After Air Medical Transport for Management of Nontraumatic Acute Intracranial Bleeding
Authors: Silbergleit Robert , Burney Richard E. , Draper Janine , Nelson Kris
Published: July 2016

Introduction:

Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system.

Methods:

Charts of all patients with spontaneous, acute ICB who were transported by air from 1986 through 1989 were reviewed. Age, gender, time of transport, transport management measures, pre- and post-transport Glasgow Coma Scale (GCS) score, intensive care unit (ICU) and hospital days, operations, and mortality were compiled for all patients and analyzed.

Results:

Eighty-seven patients ranging in age from 2 to 83 years (mean: 47.5 ±18.5 years) met entry criteria. The source of bleeding was cerebral aneurysm in 37 patients; intraparenchymal hemorrhage in 29; an unidentified vascular source in 11; and arteriovenous malformation (AVM) in 10. Mean GCS score measured in 69 patients before and after transport was 10.5 ±4.5 Glasgow Coma Scale score did not change during transport in 61 patients (88%), improved in three (4%), and deteriorated in five (7%). Fifty-nine patients (69%) underwent operations, 36 (41%) within 24 hours of arrival. Mean ICU stay was 14 days (95% CI: 12–15); mean hospital stay was 36 days (95% CI: 27–45 days). Overall mortality was 25% (95% CI: 16–34 days). A GCS score of 3 to 8 at time of transport was associated with both increased hospital length of stay and higher mortality. Patients transported within eight hours of symptom onset had lower GCS scores, but out-come measures were not significantly different from those transported later.

Conclusion:

Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.
Treatment of Casualties of Military Conflicts at the Critical Medicine Clinic of the Central Hospital in Georgia
Authors: Kheladze Zurab , Kajaia Samson , Gorgoshidze George , Bendeliani Vladimir
Published: July 2016

Introduction:

Local military conflicts continue in many areas of the world. These conflicts produce multiple casualties to military personnel and civilians. This paper describes one aspect of the medical care required for victims of the civil conflict in the Republic of Georgia.

Methods:

Interviews with patients and their accompanying persons and abstraction of medical records.

Results:

Data were acquired on 108 victims admitted to the Center for Critical Medicine in Tbilisi. Three stages in the care of these victims are described: 1) battlefield and transportation; 2) regional, front-line hospitals; and 3) the Central Hospital. The performance of each stage is described. Distribution of injuries and procedures performed in the third stage of treatment are described and survivors are defined. For illustration, two cases are reviewed in detail.

Conclusions:

The results are encouraging. Major problems existed in the treatment and evacuation of the wounded. Furthermore, many of the victims were injured because of their carelessness and lack of experience on the battlefield.
An Analysis of Demand for First-Aid Care at a Major Public Event
Authors: Flabouris Arthas , Bridgewater Franklin
Published: July 2016

Introduction:

First aid is the initial care of the ill or injured. It aims to preserve and protect life, prevent further injury or deterioration of illness, and help promote recovery. At major public events, there is a large gathering of people, physical spectacles, and equipment within a concentrated area, where organized first-aid care is provided.

Objective:

To analyze the demand for primary medical care at a public event by identifying the patients and initial symptoms that may predict that demand, and to use such information to improve the efficiency and delivery of medical care.

Methods:

A questionnaire was completed by St. John Operations Branch personnel after each patient consultation and a retrospective analysis of the data was conducted.

Results:

A total of 1,276 questionnaires were returned. Mean patient presentation rate (PPR) was 1.9±0.47 per 1,000 show attendees. This correlated best with the maximum daily temperature (r = 0.715, p <0.02) and show day (r = 0.615, p <0.05). There was poor correlation with daily attendance (r = −0.235, p >0.54). Mean presentation time was 15:13 h. Of those whose gender was recorded, 58.4% were females, and 41.6% were males. The most frequent age group was 13 to 20 years. The nature and number of initial symptoms are listed. Basic first-aid skills were used for 96.7% of symptoms; 2.4% of patients were referred to the hospital.

Conclusions:

Temperature and show day significantly contributed to variability of PPR. These factors, together with an estimated PPR and predicted attendance, can be used to forecast demand. Most cases required only basic first-aid skills. Guidelines are suggested for management by nonmedical personnel. A medical officer's role is not reliably defined, but involvement in consultation is suggested.
Planning, Implementation, and Process Monitoring for Prehospital 12-Lead ECG Diagnostic Programs
Authors: Aufderheide Tom P. , Kereiakes Dean J. , Weaver W. Douglas , Gibler W. Brian , Simoons Maarten L.
Published: July 2016

Prehospital 12-lead electrocardiographic (ECG) diagnostic strategies have been proven feasible and effective, provided they are designed and implemented properly. The authors of this communication have expended considerable time and effort in determining appropriate planning, implementation, and process monitoring necessary for successful implementation of a variety of prehospital diagnostic strategies. Many of these issues may not be obvious to an emergency medical services (EMS) director initiating a 12-lead ECG program. This level of attention to protocol development, education, training, inservice education, coordination of the health-care community, objective program assessment, monitoring and continuos quality improvement can serve as a model for other diagnostic EMS programs that may develop as an expanded role for EMS.
A Survey of Emergency Medical Services Systems on College and University Campuses
Authors: King Brent R. , Zachariah Brian S. , Cone David C. , Clark Peter
Published: July 2016

Introduction:

Many colleges and universities appear to exist in relative isolation from community-based emergency medical services (EMS) systems. In response, some have developed their own EMS systems.

Objective:

To determine the extent of this phenomenon and to delineate the characteristics of these systems.

Design/Methods:

Questionnaires were mailed to 1,503 colleges/universities in the United States and Canada. The questionnaire asked whether the institution had an EMS system and included 19 questions about the characteristics of the system.

Results:

A total of 919 (61 %) responses were received. Of the institutions responding, 234 (25%) had an EMS system and 31 (3.4%) were considering starting a system. Characteristics of the systems were as follows: 1) Types of patients—the two most common call types were medical and trauma/surgical; 134 (57%) reported one-fourth of calls to be medical and 91 (39%) reported one-fourth of calls to be trauma/surgical. 2) Type of service—133 (57%) services transport patients; 195 (83%) respond only to the campus or other university property; the remainder also respond to the community; and 135 (58%) function all year. 3) Dispatch—178 (76%) are dispatched by the campus police, although most services are dispatched by several sources; 46 (20%) use 9-1-1. 4) Personnel—two systems (0.85%) exclusively employ paramedic; 141 systems (60%) have at least one emergency medical technician; the remainder use emergency care attendants and first-aid providers; 118 (50%) have medical directors, of these 76 (64 %) are student health physicians and 21 (18%) are community physicians. 5) Demographic Information—The majority of the campus-based EMS systems exist on small campuses in urban areas.

Conclusions:

A significant number of colleges/universities have EMS systems and one-half transport patients. However, the level of training of the personnel and medical direction may be below the standard for the EMS systems in the communities in which these campus-based systems exist.
Developing Public Health Indicators in Complex Emergency Response
Authors: Spiegel Paul B. , Burkle Frederick M. , Dey Chayan C. , Salama Peter
Published: July 2016

During the past decade, indicators for the assessment, monitoring, and evaluation of services provided by humanitarian organizations to populations affected by complex emergencies (CEs) were developed to improve the effectiveness and accountability of humanitarian response. The quality of data used to develop individual indicators and their relationship to positive health outcomes varies greatly. This article states the essential characteristics necessary for the development and implementation of effective indicators in CE response and proposes the establishment of an evidence-based grading system. The importance of trend analysis and the modification or addition of various indicators and their thresholds, according to phase and location of CEs, are stressed. Limitations in the development, implementation, and interpretation of these indicators, including those outside of the organizations' control are discussed. More evidence-based research is needed as to the type and thresholds of indicators that lead to improved health outcomes in populations affected by CEs. The use of indicators by non-governmental organizations, and how they affect their program's decision-making in different phases and settings within CEs need further study. Finally, the establishment of a regulating body with the authority to enforce the attainment of standards by use of these indicators is necessary to avoid inappropriate humanitarian assistance causing loss of life in the future.
The Club of Mainz (1983)
Authors: Safar Peter
Published: July 2016

“The Club of Mainz for Improved Emergency and Disaster Medicine Worldwide” was founded in 1976 by ten concerned resuscitologists from seven countries under the leadership of the late Rudolf Frey, who then was Chairman of the Department of Anesthesiology at the Johannes Gutenberg University in Mainz, West Germany. The Club was founded because the potentials of modern resuscitation and life support are not realized in most everyday emergencies and natural and manmade disasters throughout the world. The idea was initiated in discussions between Frey and Safar during the International Symposium on Advanced Emergency Medical Services (EMS) Delivery Systems in Mainz in September 1973.
New Respiratory and Circulatory Support Concepts
Authors: Klain Miroslav
Published: July 2016

Preservation of the brain is the obvious goal of every cardiopulmonary resuscitation, but resumption of heart and lung function is the only chance to achieve that goal. In the field, basic life support without equipment remains the mainstem of resuscitation. But what should we do if we are not successful, if even advanced life support does not restart the heart? Should we give up or should we add to the advanced life support a new concept: extended cardiopulmonary resuscitation by mechanical support? This would allow more time for the heart to recover or to begin definitive therapy. Prolonged mechanical support could support weak function of the failing heart or lungs until they return to full performance.