bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analgesia in the Field
Authors: Stewart Ronald D. 
Published: July 2016

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).
Prehospital Use of Pulse Oximetry in Rotary-Wing Aircraft
Authors: Valko Peter C. , Campbell Jack P. , McCarty David L. , Martin Dennis , Turnbull Joe 
Published: July 2016

AbstractA prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of critically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of the 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft.
Medical Planning for Mass Gatherings: A Retrospective Review of the San Antonio Papal Mass
Authors: Hnatow David A. , Gordon Donald J. 
Published: July 2016

AbstractThere are limited data available and no recognized standards or guidelines for providing emergency medical care at large public event The organizational planning of emergency medical care for the 1987 San Antonio Papal Mass was reviewed. Medical care was provided using a multi-tiered system. The San Antonio EMS system played a leading role in the design, administration, and implementation of this medical care.An analysis of the types and frequencies of emergency medical problems encountered by health care providers is detailed. The total attendance was approximately 100,000, 1.5% (1553) required medical attention, and 241 were evaluated on-site by physicians. The majority of medical problems encountered were managed by non-physician, health care providers.Severe environmental conditions with a heat index exceeding 102°F were responsible for 174 cases (72%) of heat-related illness. A total of 55 patients required transport to local emergency department. There were no cardiopulmonary arrests, major injuries, or deaths.
The Integration of a Helicopter Emergency Medical Service in a Mass Casualty Response System
Authors: Jacobs Lenworth M. , Gabram Sheryl G. A. , Stohler Sherry A. 
Published: July 2016

AbstractSince 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level I, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital.This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and the three hospital-based emergency medical helicopter programs that operate in the New England states.This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.
Analysis of Hospital Ability to Provide Trauma Services: A Comparison between Teaching and Community Hospitals
Authors: Neely Keith W. , Norton Robert L. , Bartkus Ed , Schiver John A. 
Published: July 2016

AbstractHypothesis:Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).Methods:A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiogaphy (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.Results:With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p<.01).Conclusions:In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability analysis can be performed in other communities to help guide trauma center designation.
Emergency Evacuations in Disasters
Authors: Leonard Ralph B. 
Published: July 2016

AbstractSome disasters produce circumstances that require the emergency removal of some or all of the citizens from a geographic area. Emergency or mass evacuation can be divided into immediate evacuation, in which the citizens are given no warning of their need to evacuate, and potential evacuation, in which citizens are given time (usually a day or two) to evacuate. The mass evacuation aspect of disaster planning frequently is neglected, but must be planned in detail. An essential ingredient of a plan is the designation of a person who has the authority to order an evacuation and that that person or an authorized alternate, is available instantly 24 hours a day. The plans should identify likely scenarios which could require emergency evacuation for a given community requiring, means of communicating with the citizens, evacuation routes, evacuation mechanisms, and shelter arrangements. All plans need to take into account human behavior during such a stressful situation.
Advanced EMS Anatomical Workshop
Authors: Griffin Stephanie , Gough John E. , Allison E. Jackson 
Published: July 2016

AbstractDue to time constraints, most Emergency Medical Services (EMS) certification and continuing education programs offer no more than an overview of the principles of anatomy, physiology, and pathology. In an effort to strengthen the EMS professionals' knowledge of these concepts, an EMS Anatomical Workshop was developed. This workshop is a day-long program consisting of lectures and laboratory sessions covering anatomy, physiology, and pathology of major body systems. The workshop has been successful, and its fourth offering has been completed. This program could serve as a model for areas that desire to enhance the education of their EMS providers.
A New Model for Evaluating the Impact of Major System Changes on Emergency Air Medical Scene Responses in a Regional EMS System
Authors: Spaite Daniel W. , Brophy Toni , Valenzuela Terence D. , Meislin Harvey W. , Criss Elizabeth A. , Hinsberg Paul 
Published: July 2016

AbstractHypothesis:Centralized dispatch data can provide useful information regarding the impact of major air medical system changes in a regional emergency medical services (EMS) system.Methods:Prospective evaluation of helicopter dispatch data from a centralized EMS dispatch agency. During the study period, four alterations in the total number of helicopters available to the system occurred (1,2,3,2,3). Statistical analysis consisted of Chi-Square with Yates' correction and comparison of sample proportions with p<.05 considered significant.Results:A total of 667 helicopter dispatches occurred during the 20-month study period from April 1989 through November 1990.Conclusion:Changes in dispatch patterns could result either from increased availability or alterations in the dispatchers' “threshold” for use based upon a perceived lessening of the need to save a “scarce” resource. Had the second possibility played a significant role, the rate of cancellation by ground personnel after arrival at the scene would be expected to have increased. Since this did not occur, it is likely that the increased use actually was a result of increased availability. In systems that dispatch helicopters prior to arrival of ground personnel, this method of evaluation may provide a useful model for analyzing the impact of major system alterations.
The Extracorporeal Joining of Donor (Pig) Spleen (EJDS) for the Treatment of Patients with the Complications of Shockogenic Trauma
Authors: Grinev Michael V. , Tarelkina M. N. , Frolov G. M. , Tsibin Yu. N. 
Published: July 2016

AbstractIntroduction:A principal cause of death following presumed recovery from an episode of shock is the development of shockogenic trauma [post-resuscitation syndrome]. The causes of this complication remain unclear and its various treatments continue to be controversial.Hypothesis:The use of perfusion of the blood of patients suffering shockogenic trauma through a donor pig spleen mill decrease the mortality from the complications of this process.Methods:Freshly harvested pig spleens were adjoined to the venous circulation of patients suffering severe shockogenic trauma and the patient's blood perfused through them for periods of 30-60 minutes. The mortality rates of similar patients treated in this manner were compared with those not treated. Blood analyses included measures of the functions of the renal, immune, and coagulation systems.Results:The experience with 212 Extracorporeal Joinings of Donor (pig) Spleens (EJDS) by means of a veno-venous shunt for the treatment of 86 patients with severe shock trauma and its complications is reported. The clinical effects consisted of decreasing signs of intoxication, namely reduction in fever and in the severity of associated encephalopathy. Extracoporeal joinings on donor (pig) spleens (EJDS) was followed by a decline in the concentration of “middle molecules,” fibrinogen levels, leucocyte intoxication index, and the number of circulating immune complexes at different times following complexion of the procedure. The number of blood cells remained constant. On the following day, there occurred an increase in the number of thrombocytes. In addition, there was a decline in the quantity of circulating particles in the plasma. The level of plasma creatinine remained constant.Conclusions:Extracoporeal circulation through donor (pig) spleens (EJDS) has an important influence on that part of the immune system that performs the functions of phagocytosis, and also increases the levels of chemokinetic and chemotaxc reactions.
A Prospective Evaluation of the Impact of Initial Glasgow Coma Score on Prehospital Treatment and Transport of Seizure Patients
Authors: Spaite Daniel W. , Valenzuela Terence D. , Meislin Harvey W. , Criss Elizabeth A. , Ross John 
Published: July 2016

AbstractHypothesis:The initial Glasgow Coma Score (GCS) obtained by prehospital personnel on seizure victims is associated with the likelihood of treatment and transport.Methods:Prehospital data were collected prospectively for all patients presenting with seizures to a mid-sized emergency medical services system during a five-month period. A total of 419 cases occurred (62.8% male, 37.2% female). Seizure frequency was highest in infants under the age of three years and in adults in their late 20s. A GCS was recorded in 378 cases (90.2%, study group). The GCS was >10 in 304 patients (80.4%) and ≤10 in 74 (19.6%). Patients with GCS≤10 were more likely to receive: oxygen (50.0% vs. 20.1%, p<.0001); IV (35.1% vs. 8.9%, p<.0001); intravenous (IV) medications (16.2% vs. 1.0%, p<.0001); and transport (97.3% vs. 76.3%, p<.0001).Conclusion:Seizure patients with a GCS of ≤10 were more likely to receive a variety of prehospital treatments and to be transported than were patients with GCS >10. However, the clinical indicators that were used to make the decision that it was “safe” not to transport nearly one-third of the patients are unclear. Essentially no data exist regarding the parameters impacting treatment and transport of seizure patients. Future investigations with outcome data, are needed to determine whether low risk criteria can be developed to identify those patients (if any) that do not require treatment or transport. A GCS may provide an objective, reproducible parameter upon which to begin formulating such criteria.
Integrated Information Management System
Authors: Wiederhold Richard 
Published: July 2016

AbstractThis article presents the concepts of a computerized information system and its potential applications to Emergency Medical Services (EMS). It is an informational article intended to provide administrators clear concepts of how computers may be best used to provide information in integrated networked systems for EMS needs. It addresses the function of a system, processes of computerizing a department, planning, and provides an overview of computer hardware.
International Children's Center for Disaster Medicine: A Proposal
Authors:   World Association of Emergency and Disaster Medicine: Task Force on Pediatric Disaster Medicine
Published: July 2016

AbstractThe International Children's Center for Disaster Medicine is conceived as a non-governmental, non-profit institution. Its goal is to provide medical help to children during environmental and military disasters and their resulting circumstances, vnthout regard for their nationality, religion, or the political views of their parents.The idea for an international children's center for disaster medicine grew out of the experiences of pediatricians active in disaster medicine, who were able to see at first-hand, the potential for assistance in such situations, but who also saw either overlapping services provided by well-intentioned organizations, or severe deficiencies in services because of a lack of communication and coordination between these organizations. Among the goals of this international children's center will be to provide volunteer medical help to children by the best specialists in pediatric care, including surgeons, pediatricians, traumatologists, orthopedists, neurosurgeons, intensive care and critical care specialists, experts in rehabilitation, and psychologists. A special training program will create a system of regional and inter-regional specialists, who can offer qualified help to children in catastrophic situations. This educational program will stress the preparation of local medical assets and simultaneously provide international support. The center will conduct scientific research devoted to the specific problems of assistance to children during catastrophic circumstances. A special surgical hospital will be built to care for children after catastrophes. Branches of this international center will be created to serve large regions of the world, allowing a reduction in mortality and morbidity of children, and leading to an improvement in the results of medical care.
The Effects of Intravenous Glucose Boluses on Serum Potassium Levels
Authors: Trueba Dan , Wolford Robert W. 
Published: July 2016

AbstractPurpose:To determine if intravenous (IV) glucose boluses cause significant alterations of serum potassium ([K+]) levels.Methods:A prospective, descriptive study of patients ≥18 years of age presenting with altered levels of consciousness (ALOC) to paramedics in the prehospital setting or to the emergency department (ED) of a community teaching hospital and who received 50% Dextrose (D50) intravenously (IV). At presentation, a blood sample (PRE) was obtained prior to D50 therapy. For patients treated by paramedics, a second blood sample (POST) was obtained upon arrival at the ED. For patients who initially were seen in the ED, the POST sample was obtained one hour after D50 therapy. Both samples were analyzed to determine [K+] and glucose levels.Results:Over a seven-month period, 40 patients met study criteria. The average age was 46±20 years. Sixty percent of patients (24/40) had PRE blood sugars (BS) <80 mg/dl (mean PRE BS = 37±12 mg/dl; mean POST BS = 140±45 mg/dl) and 40% (16/40) had a PRE BS >80 mg/dl, (mean PRE BS = 241±255 mg/dl; mean POST BS = 274±237 mg/dl). The mean PRE [K+] was 4.1±0.8 mEq/L and the mean POST [K+] was 4.2±0.7 mEq/L. Forty-two percent of patients (17/40) had a <5% change in [K+], 33% (13/40) had a >5% increase in [K+], and 25% (10/40) had a >5% decrease in [K+]. Ten percent of patients (4/40) had a >20% increase in [K+], and 3% (1/40) had a ≥20% decrease in [K+]. No patient was treated for symptoms of either hyperkalemia or hypokalemia.Conclusion:Boluses of IV glucose produce unpredictable changes in [K+]. The majority of these changes probably are insignificant clinically.
Demographics of Prehospital Helicopter EMS Responses in Rural Florida
Authors: Savitsky Eric , Rodenberg Howard 
Published: July 2016

AbstractIntroduction:Helicopter emergency medical service (HEMS) systems typically are described in terms of their role in the care and transport of trauma victims, while their function(s) in the care of patients with medical illness goes unrecognized.Methods:Review of 575 prehospital HEMS missions by a flight program located in rural, north-central Florida over a five-year period, was performed to define demographics regarding the nature of the call.Results:Scene responses for trauma victims comprised 63% of these missions, while patients with medical illnesses comprised 37%. The incidence of medical scene responses is significantly higher in this review than has been noted in previous reports.Conclusion:1) In rural settings, patients with medical illnesses comprise a major share of prehospital HEMS responses; 2) HEMS flight crews should be competent in treatment of prehospital medical patients, and their protocols reflect the needs of these patients; and 3) EMS providers must be aware of the role of HEMS in the transport of the medical patient.
Financial Triage: Strain, Stress, and Adaptation Within Today's Medical System
Authors: Palmer C. Eddie , Gonsoulin Sheryl M. , Bias Ray , Eaves Wanda 
Published: July 2016

AbstractIntroduction:This paper explores the interactional nexus surrounding the delivery of non-paying and/or uninsured patients by paramedics to hospital emergency departments (EDs).Methods:Interviews, direct observation, and participant observation were used as data-gathering techniques.Results:Twenty-four of 25 paramedics and 17 of 25 nurses in the sample responded affirmatively to a question which asked, “Does trouble ever arise regarding the ‘kind’ of patients …” brought to the emergency department. The majority of the respondents who said that trouble was produced by the kind of patient brought to the emergency department specifically mentioned that the poor financial or non-insured status of the patient produced trouble between paramedics and ED personnel.Conclusion:These circumstances present problematic situations in the United States especially within the context of recent COBRA and OBRA legislation.
The Non-Use of 9-1-1: Private Transport of Trauma Patients to a Trauma Center
Authors: Hammond Jeffrey , Gomez Gerardo A. , Fine Ellen , Eckes Jeanne , Castro Monica 
Published: July 2016

AbstractHypothesis:Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use.Methods:Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry.Results:In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult.Conclusion:Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for nonemergencies, the causes of underutilization should not be ignored.