bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences on the Development of Aviation
Authors:   His Royal Highness, The Prince Philip, Duke of Edinburgh, K.G.
Published: July 2016

It is, of course, a very great honour and pleasure for me to act as Honorary President of the Royal Aeronautical Society in its Centenary Year. This would be true even if I did not know the first thing about aviation but for someone who enjoys flying and takes a close interest in the whole subject of aeronautics this is a very special experience.

I have already been able to extend a very warm and cordial welcome to all the delegates attending this Congress but I want to repeat how delighted the Society is to have so many distinguished guests from abroad. Aeronautics is one of the few truly international activities right through from research and development to the carriage of passengers and freight all over the world.
The Heavy Assault Transport Helicopter
Authors: Lightfoot R. B.
Published: July 2016

The military tactics of vertical envelopment require the transport of 8000 pounds of payload to a radius of 100 nautical miles at a speed of 150 knots. The aircraft should be able to hover at 6000 feet on a standard day and with one engine inoperative maintain level flight in turbulent air. The helicopter should be readily convertible to carry cargo or troops.

The CH-53A meets these requirements. Additional design constraints, including emergency water landing, rear loading, self-contained navigation system and weight and dimensions compatible with aircraft carriers have been imposed.

With special attention having been given to the vibrational environment two General Electric T-64 engines have been installed. The 72-foot diameter main rotor is equipped with six blades with 26 inch chord and a NACA 0012 aerofoil modified to improve the characteristics at high Mach number. To achieve low drag and interference the fuselage and rotors have been developed in the wind tunnel. Tail surfaces have been especially developed to provide good handling qualities. An automatic stabilisation system was provided to relieve the pilot of various flight duties and to permit him to give more attention to the military situation.

Special design procedures have been followed to control weight, drag, reliability and vibration. The final helicopter is within 3-7 per cent of the desired weight and the performance is in substantial accord with predictions. The vibration level is generally about ±0-10 g throughout the cockpit and cabin.

During the flight development phase the control system was modified to provide appropriate coupling to relieve the pilot and automatic flight control system of any unnecessary compensating control motions. The structural integrity tests revealed the need for improvement of the main rotor blade attachment spindle. The engine-to-transmission shafting required a damped support.

The finally developed version of the CH-53A meets the mission requirements already stated. The hovering ceiling on a standard day Is over 5000 feet. The maximum level flight speed is 170 kt. The handling qualities and vibration are superior to any helicopter previously built by Sikorsky Aircraft. The reliability and maintenance features have been demonstrated by extensive testing. The overhaul periods will be 1200 hours in early service operation; 5-5 direct maintenance man-hours per flight hour are required to accomplish all maintenance except overhaul of repairable components. The dynamic components have been developed to such a high degree of reliability that they will be overhauled “on condition” only and continued in service throughout the normal military usage.

In terms of commercial service, the CH-53A (S-65) will have a direct operating cost of approximately 4c per seat mile.
Applications of the Vapour Core Pump to Aero Engine Fuel Systems
Authors: Tyler S. R.
Published: July 2016

This paper relates the advantages of centrifugal, mechanically-driven fuel pumps and quotes their ability to operate with hot contaminated fuel. It also shows the substantial weight saving when compared with positive displacement pumps. The poor part load efficiency of the conventional centrifugal pump at its design speed, giving considerable temperature rise in the fuel, has resulted in the development of the vapour core principle where flow regulation is effected by a throttle at the eye of the impeller.

Reference is made to the associated control and distribution equipment which, although not peculiar to the vapour core pump must be made compatible with a pump having an inherent pressure-raising capability which decreases with engine speed. The inlet throttle feature permits adequate control of the temperature rise to be maintained over the whole working range of the gas-turbine fuel systems.

The fundamentals of the pump are explained and the development progress reviewed for application to main and reheat fuel systems. Reference is also made to control methods that are being currently developed for combined engine and reheat systems supplied from a common pump.

The spill nozzle, which was developed specifically for use with hot contaminated fuel, possesses satisfactory characteristics for use with the vapour core pump. The temperature rise data associated with combination of vapour core pump and spill nozzle are quoted, and temperature rise data are also given where the pump is used either for reheat supply or for both combined reheat and main engine fuel systems.
Receptance Methods in the Iterative Solution of Torsional Vibration Problems
Authors: Mahalingam S.
Published: July 2016

The Holzer method is widely used in the solution of the modes and frequencies of lumped parameter torsional systems. Basically the method consists of assuming an approximate value of the required frequency and, starting from one end of the system, determining the amplitudes of vibration station by station. Since the assumed frequency is an approximate one there will be a residual (torque or displacement) at the last station. The true frequency to be determined is that for which the residual is zero. Among the special advantages of the method are that any natural frequency may be obtained directly without a knowledge of the lower modes and, with the use of transfer matrices, the method may be readily adapted for the solution of complex vibration problems using a computer.
Operational Aspects of Locust Control
Authors: Yeo D.
Published: July 2016

The crops of every continent of the world have been devastated from time to time by locusts or grasshoppers. To mention three major locust species, the Desert Locust (Schistocerca gregaria Forsk.) has caused havoc in a broad band of the world stretching from East Pakistan to Senegal and from the Mediterranean to Central Africa, the Red Locust (Nomadacris septemfasciata Serv.) has infested East, Central and Southern Africa, and the African Migratory Locust (Locusta migratoria migratorioides Rch. and Frm.) has plagued most of Africa south of the Sahara.

What happens in one part of a plague area can significantly affect the situation in others and locust control is therefore an international problem, requiring international co-operation. Many of the threatened areas are countries where standards of living are not high and local agriculture is a mainstay of the economy; the regions are often inhospitable and lack modern roads, aerodromes and lines of communication.
On the Stability of Planar Librations of a Dumb-bell Satellite in an Elliptic Orbit
Authors: Brereton R. C. , Modi V. J.
Published: July 2016

The planar librational motion of a dumb-bell satellite has been studied by several authors. In most cases the analysis has been restricted to circular or nearly circular orbits. In an elliptic orbit, the variation of the angular velocity of the satellite around the central body together with the change in the local gravity gradient provides the satellite with a mechanism for exchanging energy between the librational and orbital modes. In general, this imposes a limit on the orbit eccentricity for which stable (non-tumbling) librational motion is possible. This note investigates the bounds that must be placed on a disturbance applied to a slender gravity gradient stabilised satellite so that it will librate and not tumble. The determination of the stability boundary as presented here was arrived at by the numerical solution of the exact equation of motion, obtained using an IBM 7040 computer.
The Royal Aeronautical Society The First Fifty Years–1866 and All That
Authors: Laurence Pritchard J.
Published: July 2016

“To conceive extravagant hopes of the future, are the common dispositions of the greatest part of mankind.”

Edmund Burker, 1728-97.

The opening of the second year of the Society's existence found the Council facing the inevitable slowing down after the first waves of enthusiasm. Indeed, before the year ended, only Wenham and Brearey attended the December Council meeting, and no business could be transacted. Brearey reported that he had sent out sixty-eight letters to people who were likely to be interested, but none had shown any interest whatever.

The difficulties of keeping the aeronautical infant alive were great. Few scientists or engineers could be persuaded to believe in heavier-than-air flight, although a number lent a readier ear to the possibilities of the airship.
Australia's Internal Air Transport
Authors: Watkins John L.
Published: July 2016

The Eighteenth British Commonwealth Lecture, “Australia's Internal Air Transport” by Mr. John L. Watkins, O.B.E., B.E., D.I.C., F.R.Ae.S., Director of Engineering, Trans-Australia Airlines, was given in the Lecture Theatre of the Society on 11th October 1962. The President of the Society, Mr. B. S. Shenstone, M.A.Sc, F.R.Ae.S., F.I.A.S., F.C.A.S.I., presided.

Before the lecture Sir Roy Dobson, President of the Society of British Aircraft Constructors, presented certificates of S.B.A.C. University Scholarships to the following who had completed, or were about to complete, their courses: J. M. Chaney (Blackburn Aircraft, College of Aeronautics and Massachusetts Institute of Technology), B. C. Latter (Blackburn Aircraft and College of Aeronautics), R. A. Newnham (Handley Page—College of Aeronautics), R. A. Williamson (A. V. Roe & Co.—College of Aeronautics), D. F. Pilkington (A. V. Roe & Co.— Imperial College), R. J. G. Archer (de Havilland Engine Co.—Imperial College) and C. E. H. Joy (Bristol Siddeley—Imperial College).

Introducing the Lecturer, Mr. Shenstone said that unlike many of the lecturers in this series, Mr. Watkins had been raised in the country of which he was to speak. He had taken his degree of Bachelor of Engineering at the University of Adelaide in 1930 and then took a post-graduate course at Imperial College, London. In 1932 he joined Vickers-Armstrongs and worked on early geodetic work under Dr. Barnes Wallis. Returning to Australia in 1934, Mr. Watkins joined the Air Board, which later became the Australian Department of Civil Aviation. During the war Mr. Watkins had worked on special projects for the RAAF in the Australian Department of Aircraft Production, with the Army Inventions Directorate, and on many other projects. When Trans-Australia Airlines was formed in 1946 he was appointed Technical Superintendent and since 1953 had been Director of Engineering. One of the jobs he was most noted for outside Australia was his responsibility for choosing aircraft for TAA and also for British Commonwealth Pacific Airlines when that Airline existed as a separate entity. In 1950 Mr. Watkins had been loaned to the Government of India as Technical Adviser to the Indian Air Transport Inquiry Committee.

Mr. Watkins had been awarded the O.B.E. for his services to Australian Civil Aviation in 1958 and had been a Fellow of the Society since 1956. He was a past Chairman of the Melbourne Branch of the Australian Division.
A Theory of the Cylindrical Ejector Supersonic Propelling Nozzle
Authors: Dunham J.
Published: July 2016

In their paper, “A Theory of the Cylindrical Ejector Supersonic Propelling Nozzle”, Pearson, Holliday and Smith analysed the conditions under which two unmixed streams of air pass together through a nozzle. Two criteria were used to determine the flow conditions at the exit, when the nozzle is choked: —

(a) That the stagnation pressure in the secondary (subsonic) jet should be a minimum for a given flow quantity.

(b) That the velocity of propagation of small plane waves at the exit should be zero.

Either criterion, applied independently, led to the same result but, as the authors observed, neither has the status of an axiom in fluid mechanics, and a direct proof without invoking either would be preferable.
Note on Cylindrical Bending of a Heated Long Rectangular Plate
Authors: Przemieniecki J. S.
Published: July 2016

In reference 1 a general analysis was presented for the calculation of thermal stresses and deflections due to temperature gradients in long rectangular plates having lengthwise edges supported elastically. The edge support was idealised as equivalent rotational and extensional stiffnesses depending on the elastic characteristics of the surrounding structure. The special case of infinite extensional stiffness and freely hinged edges (seeFig. 1) was discussed in greater detail and a number of graphs were included for the calculation of edge reactions in terms of the thermal force and thermal moment parameters. Since these graphs used an excessive number of non-dimensional parameters their practical application is unwieldy; four non-dimensional parameters were used instead of three parameters which would be sufficient to describe the required functional relationship. This note shows an alternative presentation of the results which can be used more conveniently in any design calculations.
Whirling with Spring Bearings and Rough Snubbers
Authors: Irons B.
Published: July 2016

To an increasing extent, aero gas turbine manufacturers are supporting high speed rotors on spring bearings, in order to escape the consequences of lightly damped and inconveniently placed critical speeds. While experience has been generally good, engineering doubts periodically arise.

(a) By introducing the flexible bearings, the critical speed is reduced, say, from 9,000 r.p.m. to 3,000 r.p.m. At 3,000 r.p.m. a peak amplitude response is experienced, although the bearing load is comparatively low. (Some spring bearing designs incorporate damping as an accidental feature, many do not, and very few have damping designed into them.) The peak amplitude at 3,000 r.p.m. can rub the seals or overstress the spring, and to prevent this the bearing amplitude is restricted by a circular stop known here as the “snubber.”
Loading and Heating of a Simple Structure with Linear Work Hardening
Authors: Mansfield E. H.
Published: July 2016

An analysis is made of the stresses and strains in a loaded two-bar tie when one of the bars is subjected to heating. The material of the bars is assumed to possess linear work hardening characteristics, i.e. a constant tangent modulus in the plastic range, and these characteristics are assumed to be independent of temperature. The following cycles of loading and heating are considered: load-heat-cool-unload, load-heat-unload-cool, heat-load-unload-cool, heat-load-cool-unload, and it is shown how, and when, these cycles produce differing stresses and strains and, in particular, differing residual stresses and strains. The effect of repeated applications of these cycles, when incremental shake-down may occur, is also considered.
Parental monitoring and knowledge: Testing bidirectional associations with youths’ antisocial behavior
Authors: Wertz Jasmin , Nottingham Kate , Agnew-Blais Jessica , Matthews Timothy , Pariante Carmine M. , Moffitt Terrie E. , Arseneault Louise
Published: July 2016

In the present study, we used separate measures of parental monitoring and parental knowledge and compared their associations with youths’ antisocial behavior during preadolescence, between the ages of 10 and 12. Parental monitoring and knowledge were reported by mothers, fathers, and youths taking part in the Environmental Risk (E-Risk) Longitudinal Twin Study that follows 1,116 families with twins. Information on youths’ antisocial behavior was obtained from mothers as well as teachers. We report two main findings. First, longitudinal cross-lagged models revealed that greater parental monitoring did not predict less antisocial behavior later, once family characteristics were taken into account. Second, greater youth antisocial behavior predicted less parental knowledge later. This effect of youths’ behavior on parents’ knowledge was consistent across mothers’, fathers’, youths’, and teachers’ reports, and robust to controls for family confounders. The association was partially genetically mediated according to a Cholesky decomposition twin model; youths’ genetically influenced antisocial behavior led to a decrease in parents’ knowledge of youths’ activities. These two findings question the assumption that greater parental monitoring can reduce preadolescents’ antisocial behavior. They also indicate that parents’ knowledge of their children's activities is influenced by youths’ behavior.
Strategic considerations in the search for transactional processes: Methods for detecting and quantifying transactional signals in longitudinal data
Authors: Roisman Glenn I. , Fraley R. Chris , Haltigan John D. , Cauffman Elizabeth , Booth-Laforce Cathryn
Published: July 2016

Over the last four decades the transactional model has emerged as a central fixture of modern developmental science. Despite this, we are aware of no principled approach for determining (a) whether it is actually necessary to invoke transactional mechanisms to explain observed patterns of stability in a given domain of adaptive functioning and (b) the extent to which transactional processes, once identified in aggregate, are accounted for by measured domains with which an aspect of adaptive functioning is theoretically in transaction. Leveraging the fact that transactional mechanisms produce excess stability in an outcome domain above and beyond autoregressive processes, along with the basic logic of mediational analysis, we introduce two novel indexes for studying transactional processes strategically. We apply these metrics to data from the NICHD Study of Early Child Care and Youth Development cohort on mother- and teacher-reported externalizing problems and social competence along with teacher-reported and objective assessments of academic skills acquired in Grades 1, 3, and 5. During this developmental period we find that (a) transactional contributions to stability are strongest for teacher-reported outcomes, next strongest for mother-reported outcomes, and relatively weak for objective assessments of academic skills and (b) observed maternal sensitivity (but not child-reported friendship quality) accounts for a modest proportion of the total transactional effects operative in most of the domains of adaptive functioning we studied. Discussion focuses on extending the logic of our approach to additional waves of measurement.
Better self-management and meaningful activities thanks to tablets? Development of a person-centered program to support people with mild dementia and their carers through use of hand-held touch screen devices
Authors: Kerkhof Yvonne J. F. , Graff Maud J. L. , Bergsma Ad , de Vocht Hilde H. M. , Dröes Rose-Marie
Published: July 2016

Background:

To offer good support to people with dementia and their carers in an aging and Internet society the deployment of hand-held touch screen devices, better known as tablets, and its applications (apps) can be viable and desirable. However, at the moment it is not clear which apps are usable for supporting people with dementia in daily life. Also, little is known about how people with dementia can be coached to learn to use a tablet and its apps.

Methods:

A person-centered program, with tools and training, will be developed that aims to support people with mild dementia and their (in)formal carers in how to use the tablet for self-management and meaningful activities. The program will be developed in accordance with the Medical Research Council's (MRC) framework for developing and evaluating complex interventions and the study will cover the following phases: a preclinical or theoretical (0) phase; a modeling phase (I) and the exploratory trial phase (II). The users (people with dementia and their carers) will be involved intensively during all these phases, by means of individual interviews, workshops, focus groups, and case studies.

Discussion:

The iterative process inherent to this framework makes it possible to develop a user-oriented intervention, in this case a person-centered program, for the use of tablets in dementia care. Preparatory work will be done to perform a methodologically sound randomized controlled trial (RCT) in the near future, which aims to investigate the contribution of this person-centered program for tablet use to the quality of life of people with dementia and their carers.
Theme 1. Disaster Coordination and Management: Summary and Action Plans
Authors: der Heide Eric Auf , Lafond Raymond , Eyre Anne , Fertel Nurit , Fisher Judith M. , Gunn SWA , Hampton Dianna , Lederman Bianca , Posner Z. , Preobrajensky V.N. , Rebonato M. , Riboni Vincenzo , Rodriguez Daniel , Shih Chung-Liang , Yamamoto Yasuhiro
Published: July 2016

Introduction:

Disaster is a collective responsibility requiring coordinated response from all parts of society. This theme focused on coordination and management issues in a diverse range of scenarios.

Methods:

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Although the main points developed in Themes 1 and 4 were different from each other (as reported in the Results section), their implementation was similar. Therefore, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.

Results:

The main points developed during the presentations and discussions included: (1) the need for evidence-based assessments and planning, (2) the need for a shift in focus to health-sector readiness, (3) empowerment of survivors, (4) provision of relief for the caregivers, (5) address the incentives and disincentives to attain readiness, (6) engage in joint preparation, response, and training, (7) focus on prevention and mitigation of the damage from events, and (8) improve media relations. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.

Discussion:

Action plans presented include: (1) creation of an Information and Data Clearinghouse on Disaster Management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) act on lessons learned from evidence-based research and practical experience.

Conclusions:

There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.
Emergency Medical Services Assessment and Treatment of Children with Special Health Care Needs Before and After Specialized Paramedic Training
Authors: Spaite Daniel W. , Karriker Katherine J. , Conroy Carol , Seng Marsha , Battaglia Norma , Salik Ronald M.
Published: July 2016

Introduction:

This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management.

Methods:

Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program.

Results:

Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items.

Conclusion:

Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.
External Chest Compression in the Management of Acute Severe Asthma—A Technique in Search of Evidence
Authors: Fisher Malcolm M. , Whaley Anne P. , Pye Roger R.
Published: July 2016

Compelling anecdotal evidence exists for the potentially lifesaving benefits of mechanical external chest compression (MECC), but no published trials of the technique exist. The history and technique for MECC are discussed and illustrated by a case report. Although the technique is not discussed in the Resuscitation Guideline 2000, and the need for it within the intensive care unit has reduced, the use of MECC will have its greatest impact when initiated in the prehospital setting for patients suffering from severe, sudden-onset, asphyxic asthma.
Medical Relief Personnel in Complex Emergencies: Perceptions of Effectiveness in the Former Yugoslavia
Authors: VanRooyen Michael J. , Eliades M. James , Grabowski Jurek G. , Stress M.E. , Juric Josip , Burkle Frederick M.
Published: July 2016

Humanitarian medical assistance and intervention during the civil war in Bosnia and Croatia was felt by national health workers to be relatively ineffective (2.8 on a 5-point Likert scale), compared to other forms of humanitarian assistance such as medical supplies (4.4/5) and non-medical materials (3.9/5). Bosnian physicians treating civilians noted that the most helpful types of personnel were surgeons and emergency physicians. This study suggests that assessment of personnel needs at the recipient level, in addition to standard relief assessments, is required early in models of complex emergencies. This study supports existing epidemiological models of complex emergencies, especially when high trauma-related mortality and morbidity are likely to occur.
Withholding CPR in the Prehospital Setting
Authors: Stratton Samuel J.
Published: July 2016

The expansion of hospices and recognition of living wills have made it necessary for emergency care providers to re-evaluate the appropriateness of universal application of cardiopulmonary resuscitation (CPR) in the field. The prehospital care community is coming to realize that CPR is beneficial only in certain specific situations. Some believe that when CPR is not likely to be beneficial, it should be withheld. Withholding CPR seems to be a simple matter of law and science, but a number of factors complicate the issue, especially in the prehospital setting: What are the definitive signs of irreversible, sudden death? When is the application of CPR futile? What are the responsibilities of the prehospital emergency care provider who announce someone dead? What is the lay public's perception of stopping or withholding CPR? Withholding CPR in this environment is a complicated social and emotional issue as well as a scientific and legal one.
Issues of Patient Consent and Liability for Unauthorized Treatment
Authors: Ayres R. Jack
Published: July 2016

Obtaining and maintaining patient consent for treatment should be one of first considerations in every encounter between the health care practitioner and the patient. The emergency health care provider must be able to make rapid and correct assessments of the patient's consent to treatment before such treatment is commenced. The following paper will discuss the primary issues in this area.
Management of Persons Internally Contaminated with Radionuclides
Authors: de Lima Valverde Nelson José
Published: July 2016

Aspects of internal contamination with radionuclides are reviewed. The possible association of this kind of accident with radiation and conventional accidents is addressed. The most important mishaps in the initial diagnosis, the need for prompt treatment, and a well-prepared plan to cope with radioisotopes at the workplace are discussed. The metabolic behavior and specific treatment for radionuclide contamination is reported.
Ganbaro Ya!
Authors: Hanson Kristin
Published: July 2016

“Ganbaro ya!” was a phrase of encouragement that could be heard, seen, and felt all over Kobe, Japan following the devastating 1995 Great Hanshin Earthquake. Having the collective meaning of “It's hard, but keep trying! Together we'll succeed! Go! Go! Go!” Ganbaro ya became the mantra of the citizens of Kobe as they struggled to rebuild their lives and community.
Pain, Painrelieving Mechanisms and Trauma
Authors: Sjolund B.
Published: July 2016

Activity in nociceptive nerve fibers does not only trigger the sensation of pain but it also starts a variety of nocifensive reflexes to protect the organism from the noxious agent. Some of these reflexes may, if active long enough, be harmful themselves, causing ischemia in visceral organs or other inadvertent reactions. Recently, several endogenous mechanisms have been discovered that can inhibit the transmission of nerve impulses from nociceptive afferents to other nerve cells, thus not only preventing the pain sensation but also modulating the nocifensive reflex responses. Several such mechanisms may involve the release of endorphins. These are small peptides, with opiate-like activity that were first discovered in 1975 by Hughes and Kosterlitz in Great Britain and by Terenius in Sweden. The distribution of such endorphins in the central nervous system was first investigated by Hökfelt and his coworkers. They found terminals and cell bodies containing endorphins in several areas of interest from the point of view of nociception. Thus the dorsal horn of the spinal cord, the corresponding area of the fifth cranial nerve and the periaqueductal gray matter contained such material.
Ventilation in Emergency Situations and During Transport
Authors: Paravicini D. , Hartenauer U. , Lawin P.
Published: July 2016

In acute respiratory failure, an immediate restoration of respiratory functions is imperative. Depending upon the available equipment and the qualifications of the physician and nursing staff, the most suitable ventilation procedure should be selected. In every case, accurate ventilation is accomplished by Intermittent Positive Pressure Ventilation (IPPV). If emergency equipment is not available, the simplest method of achieving this is mouth-to-mouth or mouth-to-nose breathing. The efficacy of this method is limited by the low FiO2 (about 17%) and by the physical condition of the first aider; after 30 minutes of resuscitation, even an experienced and well conditioned emergency rescuer will be exhausted.
A Head Injury Record Form for an Accident Unit
Authors: Marsden Andrew K. , Price David J.
Published: July 2016

In 1981 we described the introduction and development of a coma scale for use in Head Injured patients. The scale has become adopted for routine use in the Accident and Emergency Unit at Pinderfields General Hospital, Wakefield, and at other centers, for example the Emergency Department at the Glasgow Royal Infirmary finds the scale more sensitive than its own Glasgow Coma Scale in monitoring the course of accident victims.
Coordination of Major Accident Services within a British Health Region
Authors: Marsden Andrew K. , Willis Michael I.
Published: July 2016

The arrangements for dealing with Major Accidents in the United Kingdom are set out in the Health Circular (HC(77)1) which places the onus for planning on Health Districts—each district serving a population of no greater than 200,000. The Metropolitan Area of West Yorkshire, served by the West Yorkshire Metropolitan Ambulance Service, the West Yorkshire Metropolitan Police and the West Yorkshire Fire Service, takes in nine such districts and covers an area of 794,000 square miles and a population of just over two million. West Yorkshire is traversed by two motorways and a major trunk road.
The Rapid Prehospital Estimation of Blood Glucose Using Chemstrip bG
Authors: Hogya Paul T. , Yealy Donald M. , Paris Paul M. , Stewart Ronald D.
Published: July 2016

The accuracy of the glucose reagent strip, Chemstrip bG, for the determination of the presence of hypoglycemia, euglycemia, or hyperglycemia was assessed in the prehospital setting when used by paramedics treating patients with an altered level of consciousness. Venous blood specimens were obtained from each of sixty-two patients. Serum glucose levels of the sample were determined by paramedics in the field using the Chemstrip bG and within three hours after sample acquisition by standard laboratory techniques. The sensitivity and specificity of detecting true hypoglycemia (serum glucose<61 mg/dl) using the field reagent strips were 100% and 83.3% respectively. The corresponding 95% lower limits of confidence (LLC) were 81.3% and 83 .3%. The sensitivity and specificity of field detection of the absence of hypoglycemia (serum glucose ≥ 61 mg/dl) were 86.6 % (LLC=80.9%) and 100% (LLC=81.3%) respectively. The accuracy of the reagent strips is specific but not sensitive for the determination of the presence of hyperglycemia (serum glucose > 179 mg/dl). Thus, the Chemstrip bG is an accurate means for the rapid identification of the presence or absence of hypoglycemia in the field setting by paramedics.
Occult Hypoxemia During Aeromedical Transport: Detection by Pulse Oximetry
Authors: Melton James D. , Heller Michael B. , Kaplan Richard , Mohan-Klein Karen
Published: July 2016

The use of pulse oximetry as an adjunct to clinical evaluation of oxygenation during aeromedical transport by helicopter and fixed-wing aircraft was evaluated. As evidenced by an oxygen saturation of 90% or less, 29 of 150 patients (29%) were hypoxemic in the presence of the flight team. Airway interventions were carried out by the flight team in 17 of these 29 hypoxemic patients. In 11 of these 17 instances, desaturation noted by pulse oximeter was the first evidence that airway interventions were indicated. In the other 12 cases of hypoxemia, no new airway interventions were carried out despite oximeter evidence of desaturation. Three of these patients subsequently required aggressive airway interventions following their arrival at the receiving emergency department. Of the 32 patients transported by fixed-wing aircraft, 27% had evidence of unsuspected hypoxemia detected only by the pulse oximeter. The hypoxemia seemed related to increasing altitude in eight of this latter group. Pulse oximetry is a valuable and feasible technique for monitoring patients during aeromedical transport. Its use may allow detection of physiologic hypoxemia before such becomes apparent clinically.
A New Method for Simulated Mass Casualty Evaluation: The Beilinson Hospital Exercise
Authors: Simon D. , Danon Y.L. , Chaimoff C. , Shachar A.
Published: July 2016

A new method for evaluating the capabilities and performance of a general hospital in masscasualty exercises is described. This method is based on the use of simulation techniques which are realistic relative to the types and availability of the manpower required and to the time consumed by the assessments, interventions, and administrative duties and demands for each casualty encountered and the total workload thrust on the hospital by the cumulative requirements of all of the casualties. The simulation can be accomplished only after the time and equipment required for every possible diagnostic, therapeutic, and administrative procedure has been assessed for the specific hospital. Thereafter, it is possible to define the exact type and quantity of resources, in terms of time and manpower, consumed cumulatively by every simulated casualty assessed and treated during the exercise. The simulated victims are selected from a pool of young physicians who are briefed thoroughly by senior staff physicians prior to the exercise. Thus, the simulated subjects are provided lists of problems and the appropriate options for treatment. They also serve as controllers in the definition of time and manpower consumed for their specific injury set. Given this setting, it is possible to assess the functional performance of a hospital as a unit and for each of its components and also realistically estimate its capacity to manage disaster victims using a simulation of a disaster situation with mass casualties.
The Falkland Islands Campaign Resuscitation and Anesthesia in a Battle Situation
Authors: Jowitt Malcolm D.
Published: July 2016

During the early summer of 1982, Her Majesty's Armed Forces embarked upon an operation to repossess the Falkland Islands. The campaign was fought over a difficult terrain and under hostile climatic conditions, 8,000 miles from home shores. Resupply was difficult, sometimes unreliable and, during the initial battles, medical practitioners supporting combat troops had to practice ingenuity and improvisation. During the battles, 225 British Soldiers were killed and 777 wounded. Of the wounded who presented at the British Advanced Surgical Centers, only 7 subsequently died (1%). 658 battle casualties were dealt with at the various land-based surgical facilities. About 270 general anesthetics were given.
Long Distance Casualty Transportation and Treatment in the Vietnam War
Authors: Tarrow Arthur B.
Published: July 2016

At the beginning of many of its armed conflicts, the United States has found itself unprepared for large numbers of casualties. The Vietnam War was no exception. In August 1965, Marines landed at Chu Lai, just south of Danang in South Vietnam, for their first major unit combat effort. They suffered more casualties than anticipated. They were cared for by Navy physicians and corpsmen in the combat area and then flown by helicopter to the Danang airbase. There, they were further triaged in a small field hospital, which quickly became saturated with those casualties which could not be moved. Those less seriously wounded and those who could be made transportable were flown directly to Clark Airforce Base in the Philippines by C130 combat aircraft, a flight of approximately 3 hours. They arrived unwashed, in their combat gear, with weapons on the litters. A C130 aircraft carries 72 litter casualties when fully loaded. At Clark AFB, after word had been received of the combat action, all patients, who could be discharged, were sent out. All personnel at the base, including wives and dependents, were mobilized to help at the hospital. They washed and moved the casualties as they arrived.
An Inventory of Ambulance Service Regulatory Programs in California
Authors: Narad Richard A.
Published: July 2016

Introduction:

Ambulance regulation in California is the responsibility of numerous agencies on the state and local levels.

Objective:

By identifying and analyzing the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere.

Methods:

This study surveyed all California local EMS agencies (LEMSAs: California's equivalent of regional EMS organizations) to identify the types of regulatory programs used, the foci of these programs (e.g., equipment and personnel), and their application (e.g., public and private providers). All data acquired were analyzed using population parameters rather than inferential statistics.

Findings:

A response rate of 100% was obtained. Among the regulatory tools used are ordinances, contracts, and franchises. Regulatory standards vary widely as do their applications. Large counties and those that operate their own LEMSA have more extensive regulatory programs than do smaller counties and those who participate in multicounty agencies. Many of the enforcement mechanisms available are weak.

Conclusion:

This study suggests several policy implications for California and other states. The wide variation in the types of regulatory programs and the standards that are used suggest that the purpose and impact of regulatory programs should be studied further. The decentralization of the ambulance regulatory program and the lack of integration of ambulance regulations into EMS system planning also raise policy questions. In addition, the role of multicounty EMS agencies, as it relates to regulation of ambulance services, should be reviewed.
Criteria for the Assessment of Disaster Preparedness-II
Authors: de Boer Jan
Published: July 2016

By defining the chain of medical care and the capacities of the successive phases within this chain, an attempt is made to analyze and grade the determinants of these capacities. In this way, calculations that indicate overall disaster preparedness can be expressed in a figure ranging from 1–5. The capacity of the system is taken as the lowest score obtained for the components of the system. The methodology used for this assessment of pre-paredness is described and an example is used to show the efficacy of this methodology.
An Eight-Year Review of Legal Cases Related to an Urban 9-1-1 Paramedic Service
Authors: Maguire Brian J. , Porco Frank V.
Published: July 2016

Introduction:

An eight year retrospective analysis was conducted to determine the type and outcome of lawsuits related to the provision of 9-1-1 paramedic service in an urban environment.

Methods:

For the evaluation period of May 1986 to March 1994, all litigation cases related to Ambulance Service or paramedics were collected and analyzed. This urban 9-1-1 Paramedic Service has an estimated call volume of >60,000 assignments resulting in >30,000 patient encounters during the evaluation period.

Results:

Seven lawsuits were filed against the service. No lawsuits were related to tardy response, failure to transport, or patient care negligence of any kind. All of the litigation was related to motor vehicle collisions (MVC).

Conclusion:

The data suggest that motor vehicle collisions are a significant medicallegal risk to the EMS community. In addition, it was found that the use and lack of use of seatbelts was an important component in many of the suits.
Primary Health Care in War and Disaster and the NorAid System
Authors: Fjaer Rannveig Bremer
Published: July 2016

When the infrastructure in a community is destroyed by manmade or natural disaster, even the simplest health services may be difficult to maintain. By the Alma Ata declaration, the World Health Organization (WHO) proclaimed, “Health for all by the year 2000.” The program is designed to cover the basic health needs as defined by the Primary Health Care (PHC) system. Therefore, a most important issue in a disaster, is to support, maintain, and rebuild the PHC system, to secure the population's basic health services.

Relevant and rapid aid is of great importance in disaster. The physical and psychological strain caused by disaster will increase the need for medical care compared to that during normal times. Child mortality and maternal complications will rise, Many of the 12 million children, who die every year, die as a result of war, refugee conditions, and/or other types of disaster.

The NorAid system is equipment composed to provide PHC, with special emphasis on vulnerable groups e.g., women and children. Provided the medical skills are available, it also may function as a hospital. The system already has been used in many countries, and has been found to be relevant, practical, and relatively cheap compared to the benefits achieved.
Examining Self-Perceived First-aid Abilities After the Northridge Earthquake
Authors: Nguyen Loc H. , Shoaf Kimberley I. , Rottman Steven J. , Bourque Linda B.
Published: July 2016

Introduction:

This study examines those factors predictive of self-perceived first-aid abilities among a community-based sample after the 1994 Northridge earthquake.

Methods:

A probabilities-proportionate to-size (pps) sample of residents of Los Angeles County and 11 pre-selected zip codes from southeastern Ventura County was selected using computer-generated random digit-dialing (rdd) procedures 7–11 months after the earthquake. Data were collected from 506 individuals in 45 minute interviews. A unidimensional scale of self-perceived first-aid ability was created and represents the dependent variable in a causal path model.

Results:

In a causal path model, standardized path coefficients suggested that while reports of taking first-aid courses were the most influential factors in predicting higher self-perceived first-aid abilities, other factors including being white, younger, speaking English in the home, and lower income also predicted higher self-perceived first-aid abilities that were independent from taking formal first-aid courses.

Conclusion:

First-aid training should be directed towards target segments of the population that are not likely to have had instruction in these basic skills. Those individuals who self-report high first-aid proficiency, independent of formal first-aid training, should be evaluated to assess their abilities to perform these skills.
Does Number of Beds Reflect the Surgical Capability of Hospitals in Wartime and Disaster? The Use of a Simulation Technique at a National Level
Authors: Levi Lion , Bregman David , Geva Hana , Revah Moshe
Published: July 2016

Introduction:

The raw number of hospital trauma beds and occupancy has been used assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.

Methods:

Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of “standard wartime casualties.” Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A “what-if” module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of “standard casualties.” Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.

Results:

Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.

Recommendations:

The use of simulation techniques might be useful method to asses the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.