bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Organization and Alert of Medical Aid at Italian Airports
Authors: Mezzetti M.G. , Serra G.C. , Romano R. , Bianchi F. 
Published: May 2019

In the event of a disaster, all personnel present in the airport area must modify their own everyday rules to ensure the best response to the emergency situation. For medical aid there are two main objectives: (a) organization of rescue operation; and (b) mustering medical resources. The initiators of the rescue operation must be the control tower staff and each Italian airport is provided with emergency plans which have been carefully studied.Information systems between the accident site and the centers of available medical resources, however, are less well organized. These can be simplified by the use of a video terminal, connected with a data system elaborator. The Lombardy region plans to install a video-terminal in every Regional Hospital in order to be able to present the airport with the up-to-date situation of vacant beds and of medical staff present in the hospital for emergency tasks.It is proposed that the alert from the accident site should be in two phases. Initially, a general alert must be given, followed after a short time by a more detailed specific alert. The first phase must be addressed to those departments that, independently of the type of the disaster, will always be involved in any critical situation, e.g., Ambulance Headquarters, ICUs, Blood Centers, Emergency Departments. The second phase will be used to inform hospital departments specializing in treating the pathology prevailing in the particular disaater. In airport disasters, the pathology which prevails will include major and multiple injuries with blood loss and burns.
Triage in Airplane and Airport Disasters
Authors: deSinner F. 
Published: May 2019

Triage or sorting means recognition and selection of the injured for treatment and transport. It is a very important and difficult task and has the aim of saving as many lives as possible, ensuring the best possible treatment, leading to the best possible recovery. Triage requires judgment, courage to assume responsibility and determination to act rapidly. The examination of a patient to assess his priority includes his vital functions, his specific injuries and his environment. Triage leads to the following priorities:(1) immediate, compulsory treatment;(2) early treatment, within hours;(3) delayed treatments; and(4) slightly injured and hopeless cases.Although triage is primarily a physician's job, trained paramedical personnel or firstaiders may be the first to arrive at the scene and should to able to recognize and treat casualties requiring immediate care on the spot.The first physician at the disaster site may not be well qualified in emergency medicine, and indeed may have little or no experience in handling casualties. He may be a passenger involved in the emergency landing of an airplane. Let us therefore examine three possible situations:
The Potential of Emulsified Fluorocarbon Blood Substitutes in Treating Disaster Victims
Authors: Geyer Robert P. 
Published: May 2019

As with many manmade and natural disasters, those involving airports and aircraft give rise to a number of emergency medical situations that require prompt and sometimes drastic responses. The number of casualties can be very large and adequate hospital facilities can be quite distant from the disaster site, even when the latter is at an airport. Obviously, the situation is compounded when the accident has occurred at a remote place or involves a landing on water. Emergency measures are therefore of great importance to minimize loss of life and reduce exacerbations of initial injuries. Fortunately, major disasters are infrequent. This very fact, however, makes it even more impractical at most airports to have on hand at all times a large supply of blood and the facilities for typing and cross-matching rapidly and accurately. No supply of blood, of course, exists on any ordinary aircraft. There are therefore good reasons why artificial preparations capable of carrying oxygen and carbon dixoide and maintaining blood volume have potential usefulness in airport and airplane disasters.These disasters can involve one or more forms of bodily injury including physical trauma, burns, and asphyxiation (Table 1). All can lead to shock, and some form of emergency treatment is often required to restore blood volume and oxygenation levels. Since any delay in initiating treatment must be avoided, the required materials should be on hand and in a form which allows their being used without delay. Artifical blood replacement preparations (1-4) based on liquid perfluorochemicals have a number of desirable attributes in this regard.
The Application of Entonox for Pain Relief
Authors: Baskett Peter J.F. 
Published: May 2019

Pain relief is important — not only for humane reasons — but also for protection of the circulation and tissue perfusion which suffer as a result of the enormous secretion of catecholamines which occur. In the operating room during anesthesia we take care to combat this trend by giving adequate analgesics, and it is logical that we should attempt to take similar steps in the prehospital care phase.One of the reasons why the provision of analgesia is so poor in practice is that the usual parenteral agents — the opiates — are accompanied by side effects which are particularly dangerous in the seriously ill or injured patient. The introduction of low dose ketamine, however, has altered this position somewhat, offering, as it does, good analgesia without significant depression of respiration or the circulation.A major practical difficulty in providing analgesia outside hospital lies in the fact that the majority of the patients are being cared for by personnel who are not physicians. We, therefore, need an agent which can be administered by an ambulance attendant or trained rescuer. In many countries the opiates and ketamine may only be administered by a physician and therefore they are effectively ruled out for the majority of patients.Let us look at the properties of an ideal analgesic for use outside hospital. It should be: 1) effective but safe; 2) have no undesirable side effects; 3) have a rapid onset and short duration of action; 4) be easy to administer; and 5) be capable of being used by paramedical personnel.
Simple Oxygen Supply
Authors: Serra G.C. , Mezzetti M.G. , Romano T. , Bianchi F. , Parabiaghi R. 
Published: May 2019

The use of oxygen in emergency situations outside hospitals is limited by difficulties in supply. Low capacity cylinders (100-120 1) weigh 3-4 kg, and have cumbersome mechanisms for pressure and flow reduction. Disposable cylinders of oxygen from a chemical source create the possibility of the contents running out, and are fragile. Particularly when exposed to high pressures or temperature.Mouth-to-mouth remains most rational and effective. Problems include aesthetic concern and exhaustion in rescuer. It is possible, however, to adapt a Brooke or a Safar airway for use with oxygen, by attaching a tube with tape near the proximal outlet of the airway. This apparatus has been tried on 4 patients during general anesthesia with thiopentone-succinylcholine-neuroleptics—for appendectomies using controlled ventilation with expired air with oxygen added. Tidal volumes of 350-500 ml of air/oxygen were delivered at a frequency of 6-8 breaths per minute. The nose was closed by a clip. Sellik's maneuver could prevent gastric inflation. The color of blood was normal, arterial pressure and pulse did not change, and skin was dry. No fatigue or other effects were reported by the anesthesiologist-“rescuer”. In outdoor use, where oxygen from a chemical source is used, the problems associated with the exothermic reaction can be limited by cylinder lagging with openings to disperse heat. A flow of O2 6-7 1/min is sufficient to support a critical situation. It allows O2 enrichment for mouth-to-mouth, mouth-to-mask, mouth-to-airway, or bag valve ventilation. Modest cost, and low weight allow large numbers to be stored for airport disasters, when resuscitation is performed on a large scale for many victims.
Comments on the Social Dimension of Airplane Disasters
Authors: Clausen Lars 
Published: May 2019

There are different social actors (or “collective social actors”) in a disaster who may have differing ideas on the “ideal passenger in a disaster”.This is an euphemism; it includes a gang of hijackers. Any suggested human failure in a complicated technical environment might be threatened or committed deliberately. Some attitudes of the ideal passenger, as seen from the point of view of the pirate, show that: i) the passenger ought to keep quiet, should not panic and should readily obey orders of the hijackers and must be easily persuaded by bullying tactics; and ii) the passenger must be selective in observing his situation —neither apparently looking at anybody nor recognizing anything, except to obey the commands he might receive from the hijackers.This one did not want the disaster to happen, e.g., a rescue team. It also has an “ideal passenger” in mind: i) he should not panic, and should keep quiet, after having given a signal that he is alive and needs help; ii) he should follow orders and should place his trust in personnel; and iii) he should do his best to help himself and identify emergency situations in his co-passengers and help them. The moment rescuers arrive he has to change his role and follow orders.This is the company operating the flight, as presented by the pilot and his crew: i) this party is interested in a quiet and non-panicking passenger; ii) expect him to follow their advice on trust; and iii) require him to take precautions seriously; i.e., reading the emergency regulations put in front of his seat, without unduly worrying about them, but remembering them when disaster strikes.
Lessons from a DC10 Crash, American Airlines, Flight 191, Chicago, Illinois
Authors: Baker Frank J. , Franaszek Jacek B. 
Published: May 2019

With the development and deployment of commercial jet aircraft in the mid 1950's, airline travel has become commonplace throughout the world. A rapid increase in the numbers of aircraft, airline routes, and flying time has occurred. New technology has added sophisticated and complicated gear to aircraft and their support systems. Every new system has the potential for failure and to some extent additional components increase the risk of technological breakdown. The increased chance of technological breakdown favors an increase in aircraft accidents. Fortunately, development and utilization of sophisticated redundant electronic and mechanical improvements aimed specifically at improving safety have also occurred. The results of these changes over the past twenty-five years has been a decreasing rate of accidents per mile flown. Due to the tremendous increase in flying, however, the absolute numbers of accidents associated passenger morbidity and mortality have risen (1). For the health care system, the major impact has resulted from the absolute increase in aircrash victims.Aircraft accidents have regularly produced mass casualty incidents with the number of victims ranging from a few to several hundred. Aircraft accidents can be divided into essentially four types: mid-air crashes (so called “hard impact”); crashes on takeoff; crashes on landing; and on-ground accidents (“soft impact”). Mid-air accidents are frequently away from population centers and usually there are no survivors. The medical impact therefore is minimal. Accidents occurring on takeoff, landing, and on the ground, occur at or close to airports, and the nature of the accident is such that there may be many victims (1).
Importance of Early Fracture Stabilization in Preventing Post-Traumatic Pulmonary Changes
Authors: Jansson I. , Eriksson R. , Liljedahl S.O. , Lovén L. , Rammer L. , Lennquist S. 
Published: May 2019

Adult respiratory distress syndrome (ARDS) is the most fatal complication after severe trauma (1,3). ARDS is seen in multiple injured patients with fractures and the risk for ARDS increases with the number of fractures (9). One of the theories concerning the etiology in ARDS is, that tissue thromboplastine from the site of the fracture and surrounding soft tissue activates the coagulation system resulting in pulmonary microembolism (6). Riska (8) has noticed by clinical experience that increased frequency of early fracture stabilization by internal fixation in multiply injured patients has dramatically reduced the frequency of post-traumatic respiratory insufficiency. The aim of the present study was to investigate the effect of primary fracture immobilization on post-traumatic pulmonary changes in pigs. We used a model in which anesthetized pigs can be subjected to trauma and then observed for several days, while still under anesthesia, under careful respiratory and circulatory control, by means of repeated chest x-rays and postmortem macroscopic and microscopic examination of lung tissue.Twenty-six pigs (Swedish Landrace), weight 17–23 kg were used. Chest x-rays were done in all animals before the experiment excluding those pigs with any pulmonary changes. The pigs were anesthetized with pentobarbital and pethidine, and tracheostomy, carotid artery cateterization and cystostomy were performed.
Noninvasive Core Rewarming in Hypothermia (Abstract)
Authors: Kristensen G. , Gravesen H. , Jortening H. 
Published: May 2019

Profound hypothermia has a high mortality if not treated with active rewarming. Most successful is central core rewarming. Many methods have been designed for this purpose: mediastinal irrigation, colon irrigation, peritoneal dialysis, and warm water via a Sengstaken-Blakemore esophageal tube.A new esophageal tube was constructed for this study. The tube consists of a small, stiff and narrow inner tube, placed inside a larger thinwalled outer tube. Warm water (41-42°C) is circulated from a waterbath via the inner tube to the outer tube and then back to the waterbath. Five healthy mongrel dogs were anesthetized, intubated and made hypothermic. All dogs were paralyzed with pancuronium to eliminate shivering. The only fluid given was isotonic saline to compensate urine loss (50-75 ml/hour). At a core temperature below 30°C the esophageal tube was inserted, and rewarming started when temperatures had reached 27.1-24.7°C. Rectal and peripheral temperatures were monitored, and in 3 dogs blood temperature was also followed.Up to the cardiac safety temperature (31°C) the blood temperature increased 4.6°C ± 0.79 (SD) (Fig. 1, whereas the rectal temperature rose 3.74°C ± 0.76 (SD) (Fig. 2). The peripheral temperature showed only a minor increase below a central core temperature of 30°C. This means that a secondary temperature decrease is eliminated with this method. No cardiac arrhythmias or other complications were noted. these results correspond to those with peritoneal dialysis (1), and show a greater temperature rise than with use of a modified Sengstaken-Blakemore tube (2). (Supported by the Danish Medical Research Council.)
Rationale for Open-Chest Cardiopulmonary Resuscitation
Authors: Alifimoff J.K. , Stajduhar K. , Safar P. , Bircher N. , Steinberg R. , Sotosky M. , McNulty P. , Stezoski W. 
Published: May 2019

Present national and international guidelines for resuscitation call for open-chest cardiopulmonary resuscitation (CPR) instead of standard external CPR under the following circumstances associated with pulselessness:1) chest already open;2) penetrating thoracic trauma;3) suspected intrathoracic hemorrhage;4) suspected pulmonary embolism (thoracotomy permits disruption or removal of emboli);5) deep hypothermia (open chest allows direct warming of the heart for defibrillation); and6) no palpable artificial pulse during standard external CPR basic life support, as is sometimes encountered in cases of barrel chest or spine deformities.We will present evidence in support of a 7th indication, that is when standard external CPR advanced life support efforts do not result in the prompt restoration of spontaneous circulation, as may be the case after prolonged unwitnessed cardiac arrest or in patients with severe myocardial disease.Historically, open-chest CPR has been used effectively to reverse cardiac arrest in laboratory animals since the 1980s and in patients since 1900. We conducted interviews with Drs. DelGuercio, Johnson, Stephenson and Leighninger (for Beck), who have had extensive experience with open-chest CPR. All confirmed personal experience of one of us (PS) with open-chest CPR in the 1950s, and anecdotal reports, that during direct cardiac massage, the heart usually regained color, spontaneous breathing returned, survivors had a very low incidence of neurologic deficit, and complications were almost non-existent. Stephenson's review of 1200 cases of open-chest CPR hospital-wide between 1900 and 1950 (1) report an overall recovery rate of 30%. However, after Kouwenhoven's report on closed-chest CPR in 1960 (2), open-chest CPR became a forgotten art.
Effect of Methylprednisolone and Reduced Glutathione on Survival in Mice and Hepatic Energy Metabolism in Rats with Endotoxin Shock
Authors: Kosugi I. , Tajimi K. , Okada K. 
Published: May 2019

Reduced glytathione (GSH) is the tripeptide of glycine, cysteine and glutamic acid and is widely distributed in the body. FSH has been reported to comprise at least 90% of the nonprotein sulfhydryl (NPSH). Although the role of GSH in the tissue has not been clearly established, it is known to be a cofactor for enzymes, a substrate in detoxifications, and a free radical scavenger.Several investigators have reported that the level of NPSH, mainly GSH, in the tissue was decreased in several types of shock and that exogenous administration of GSH has beneficial effects on shock (1,2). This study was designed to evaluate the effects of GSH on the survival rate in mice and the hepatic energy metabolism in rats after administration of endotoxin. These results were compared with those of methylprednisolone sodium succinate (MP), since many investigators have reported that the large doses of glucocorticoid have beneficial effects in several types of shock in experimental animals and in man (3,4).
Emergency and Disaster Medicine: Assignments and Perspectives
Authors: Koslowski L. 
Published: May 2019

Eugene Ionesco once remarked that an excess of politics and an exaggeration of sports are characteristics of our contemporary civilization. The excess of politization affects all parts of our public life, including medicine and its specialty Disaster Medicine. Political ideologies try to usurp a field that has solely humanitarian objectives, that depends on providing for and applying relief to many people in acute distress. There are already many relief organizations and ambulance services, physician staffed emergency medical services systems and first aid trained laymen. There are state and federal disaster relief authorities. Why then was it necessary to add another organization to this sometimes confusing manifold, the German Society on Disaster Medicine?Emergency medicine is for the individual. It must provide optimal care for each single injured or sick person — except for the shortterm management of multiple casualties. Emergency medical missions are limited by time and locality. These missions are hospital services extended to the scene of the accident and work in connection with hospitals. Disaster medicine is for the masses. Its task is to do the best possible for the largest number of people at the right time and at the right place. This implies that in a disaster situation, optimal care for every single individual can and should not be the goal, but rather the best possible care for the largest number. Disaster medicine has to work in large areas, supraregional and long-term. It needs numerous treatment facilities and several steps or levels of treatment. Therefore it requires a firm medical coordination of lay help, primary professional help, transportation, and specialized hospital treatment with maximal efficiency.
Emergency Health Services Plan for the Tuscan Region
Authors: Galanti Claudio , Stratini Piero , Boncinelli Sergio , Marsili Massimo , Lorenzi Paola , Fontanari Paolo , Pezzati Silvia 
Published: May 2019

The aim of this planning project is to ensure prompt and efficient emergency health services to all people in the regional territory of Tuscany, and to establish suitable conditions for an efficient intervention by the National Health Service in situations brought about by unforeseen events which may have serious, often disastrous, consequences. This effort — quite demanding from an organizational and economic point of view — may be successful only if we assume that the time-space unpredictability of emergencies cannot be understood in absolute terms, but in relation to a series of conditions and situations present in everyday reality. Only by reducing to the minimum the unpredictability factor both quantitatively and qualitatively this purpose can be achieved. Risk factors should thus be accurately related to the territory's population distribution, geomorphology, and socio-health conditions.Since emergency medical care must be carried out without delay, each response must involve all components, concomitantly or in sequence so that the intervention is not regarded as concluded at any one stage. It must be open to integration best suited to the situation. There is need for a multidisciplinary approach to emergencies from the first response to definitive care.The model of health services planning necessary to achieve all this envisages a series of interventions — 1) to develop interconnections between intramural medicine and health services carried out in the field in order to allow rational use of existing structures, such as the emergency department; 2) to establish coordination focal points which can ensure, outside a hospital, the same level of treatment in emergency situations that will be carried out intramurally, despite the unavoidable changes in methodology; and 3) to activate information and self-training programs designed to encourage the development of a cultural and operative relationship between the health services and the needs of the community.
Organization of Hospital for Intra-Hospital Emergencies
Authors: Tresalti E. , Cicchetti A. , Rossi G. , Contegiacomo P. 
Published: May 2019

The need to arrange the assistance beforehand and therefore prepare for the prevention of damage to people and property that may result from accidents or events of considerable magnitude occurring inside the University Hospital, “A. Gemelli,” has led to several laws of the Constitution of the Italian Republic (Article 35), the Criminal Code (Articles 437 and 451), and the Civil Code (Article 2087): The law of Feb 12, 1955, #51 (Official Gazette 54, March 7, 1955); Decree 547 of April 27, 1955 “Regulations for the prevention of industrial accidents” and Decree 302 of March 19, 1956.The study of these assistance procedures has led to the formulation of an emergency plan divided into two basic parts: prevention of accidents, and rescue operations.By prevention we mean: a) The training of all staff and Managing Bodies of our Faculty/Staff to take effective action in the case of an intra-hospital accident, b) The need for detailed information on the various procedures to be used depending on the gravity of the event, c) Awareness of the civil and criminal responsibilities relating to the various management and non-management levels in case of emergency.The training plan for the whole staff, approved by the management administrative, technical and medical bodies, consists of theoretical and practical courses. These courses, which started in June 1983 are “modular.” The staff will take part in them as homogeneous groups, for a period of time which will vary, in regard to the number of hours and kind of instruction, and in relation to what each group has to learn about work safety, fire prevention and emergency measures.