bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma System Development and Future Directions
Authors: Braslow Judith B. , Snyder Joan A. 
Published: July 2016

AbstractTraumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems.
Complication Rates for the Esophageal Obturator Airway and Endotracheal Tube in the Prehospital Setting
Authors: Hankins Daniel G. , Carruthers Nancy , Frascone R. J. , Long Linda Ann , Campion Brian C. 
Published: July 2016

AbstractPurpose:The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) a the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGT during the treatment of patients with prehospital cardiac arrest.Methods:A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments.Results:The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gas lube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopha ryngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively).Conclusions:The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use. Serious questions also arise concerning the complication rates associated with the use of the ET: is the complication rate of 2.5% acceptable or should other airway alternative be considered for use in prehospital care?
Physician In-field Observation of Prehospital Advanced Life Support Personnel: A Statewide Evaluation
Authors: Spaite Daniel W. , Valenzuela Terence D. , Meislin Harvey W. 
Published: July 2016

AbstractStudy Hypothesis:Direct physician observation of advanced life support (ALS) personnel is rare in a demographically diverse state.Study Population:Twenty ALS agencies from throughout Arizona.Methods:A board-certified emergency physician performed on-site interviews with the emergency medical services (EMS) supervisor of each agency to approximate the number of days per year that physicians observe ALS personnel in the field.Results:Only 11 agencies (55%) reported that physicians ever observed ALS personnel. Among all agencies, an estimated total of 84 observer-days occurred per year. The agencies staffed a total of 86 ALS units, resulting in an estimated 0.98 observer-days/unit/year (84/86). On the average, it took 3.4 ALS personnel to staff a given unit over time and the probability that an ALS provider would be on a unit on any given day was 0.29 (1/3.4). The probability of a given provider being observed during one year was approximately 0.29 (0.98 x 0.29). Thus, on the average, an ALS provider would be observed by a physician approximately once every 3.5 years (1/0.29). Among urban agencies, the “average” ALS provider would be observed once every 2.9 years. This compared to a likelihood of in-field observation of only once every 6.7 years for non-urban providers (p = .036).Conclusions:The skills of ALS providers in Arizona are observed by a physician in the field very infrequently. Although an uncommon occurrence in urban agencies, observation of non-urban ALS personnel occurs even less frequently. In addition, nearly one-half of the agencies surveyed never had a physician-observer. Although a variety of skills evaluation methods exist, it remains unclear whether any method is as useful as direct observation. Future investigations are needed to evaluate whether in-field physician observation impacts skills, patient care, or outcome in EMS systems.
Prehospital Do-Not-Resuscitate Orders: A Survey of State Policies in the United States
Authors: Adams James G. 
Published: July 2016

AbstractIntroduction:Many states in the United States ‘have developed policies that enable prehospital emergency medical services (EMS) providers to withhold cardiopulmonary resuscitation (CPR) in the terminally ill. Several states also have policies that enable the implementation of do-not-resuscitate (DNR) orders.Objectives:1) assess which states have statutes governing DNR orders for the prehospital setting; 2) determine which states authorize DNR orders in ways other than by specific state statue; and 3) define those states that had regional protocols which address prehospital DNR orders.Methods:Survey of the state EMS directors in each of the 50 U.S. states, the District of Columbia, and Puerto Rico.Results:As of 1992, specific legislation authorizing the implementation of DNR orders was in place in 11 states. In addition, six others have a legal opinion or policy allowing the implementation of DNR orders. Fourteen additional states have either working groups or legislation pending that address prehospital DNR orders. In only five were there no existing regional protocols for implementation of DNR orders in the prehospital setting.Conclusions:There exists great variation in legal authorization by states for implementation of DNR orders in the prehospital setting. Despite the existence of enabling legislation, many state, regional, or local EMS systems have implemented policies dealing with DNR orders.
Mouth-to-Mouth Ventilation of Cardiac Arrested Humans Using a Barrier Mask
Authors: Lufkin Kirk C. , Ruiz Ernest 
Published: July 2016

AbstractIntroduction:Concern for possible disease transmission during mouth-to-mouth resuscitation has decreased the incidence of bystander cardiopulmonary resuscitation (CPR). Barrier masks have become available that may be effective in CPR as well as protective against cross-contamination.Hypothesis:A silicone rubber barrier mask incorporating a one-way-valved airway (Kiss of Life [KOL]) designed to prevent contamination of the rescuer, permits satisfactory mouth-to-mouth ventilation of victims of cardiopulmonary arrest.Methods:Ten adult patients who did not survive non-traumatic cardiac arrest were ventilated with exhaled room air using a KOL barrier mask while external cardiac massage continued. Arterial blood gases were obtained every two minutes for a maximum of 10 minutes. The operator was blinded to the results of these blood tests.Results:Eight men and two women with ages from 55 to 99 years were studied. Four patients were edentulous and two of these had marked mandibular atrophy. The two patients with mandibular atrophy were poorly ventilated with the barrier mask. One other patient was not ventilated successfully. This patient had undergone multiple attempts at endotracheal intubation and had transtracheal needle ventilation performed prior to use of the barrier mask. One patient had elevated PaCO2 despite being well-ventilated clinically. Six patients were ventilated well clinically and had satisfactory PaCO2 and PaO2 values.Conclusion:The barrier mask studied appears to be an effective aid to ventilation in CPR Patients without facial support, as in edentulous patients with mandibular atrophy, are not ventilated well with this device.
Emergency Medical Training in the 82d Airborne Division: The Gulf War Experience
Authors: Cancio Leopoldo C. , Goforth Gary A. 
Published: July 2016

AbstractThe 82d Airborne Division, as the Army's worldwide contingency division, places unique demands on its medical personnel. This was true particularly during Operations Desert Shield and Desert Storm in 1990–1991. An unprecedented emergency medical training program was carried out in preparation for the Gulf War.All levels of expertise were involved: non medical Combat Lifesavers, medics, physician assistants, and physicians. Courses provided included Combat Lifesaver provider and refresher training, Basic Trauma Life Support (BTLS) provider and instructor training, Chemical Casualty courses, and a Combat Surgical Skills course. Approximately 736 personnel, including 80 Saudi and allied physicians and medics, participated in these courses. Confidence and competence in handling war casualties at all levels was enhanced greatly. Prepackaged courses such as BTLS enabled the rapid training of large numbers of medical personnel under challenging conditions.
Natural Hazards: Causes and Effects: Lesson 1—Introduction to Natural Disasters
Authors: Perez Eddie , Thompson Paul 
Published: July 2016

This course is an introduction to the topic of natural hazards, their causes and their consequences. The subject is so vast that this course cannot begin to provide a definitive treatment of all aspects of these hazards. Instead, it seeks to present an overview of the general subject.The course begins with a definition of each major natural hazard that disaster managers may encounter in developing countries. Historical examples are presented to give perspective to the potential scope of these natural events and their actual effects within a community or country. The geographical distribution of the hazard type, indicating the possibility of its occurrence in all parts of the world, is shown. The natural pre-conditions that must exist for the phenomenon to occur are described. The actual event is described in its physical/natural manifestation, with a detailed account of what happens and why, before, during, and after the event. The impact on the natural and human-produced environment—the reason it becomes a “disaster” rather than simply a natural phenomenon—is reviewed. Each lesson then discusses what disaster managers, in particular, and the public, in general, can do to respond.
An Analysis of Prehospital Mortality in an Earthquake
Authors: Pretto Ernesto A. , Angus Derek C. , Abrams Joel I. , Shen Bern , Bissell Richard , Castro Victor M. Ruiz , Sawyers Roberto , Watoh Yukihiro , Ceciliano Norma , Ricci Edmund ,   other members of the Disaster Reanimatology Study Group
Published: July 2016

AbstractIntroduction:Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy.Methods:A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991.Results:Fifty-four deaths occurred prior to hospitatization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two percent (2/9) were judged preventable if earlier emergency medical care had been available. Most injuries and deaths occurred in victims who were inside wooden buildings (p <.O1) as opposed to other building types or were pinned by rubble from building collapse. Autopsies performed on a sample of victims showed crush injury to be the predominant cause of death.Conclusions:A substantial proportion of earthquake mortality in Costa Rica was protracted. Crush injury was the principal mechanism of injury and cause of death. The rapid institution of enhanced prehospital emergency medical services may be associated with a significant life- saving potential in these events.
Transfusion Therapy During War and Peace in Sarajevo
Authors: Begovic Mirza , Kozlicic Abdulah 
Published: July 2016

AbstractObjective:To investigate surgical blood usage during the siege of Sarajevo.Methods:Data on blood usage and pre-transfusion hematocrit (Hct) values from blood transfusion request forms in 250 wartime emergency surgical procedures during August through October 1992 (experimental group), and in 146 peacetime elective surgical procedures (control group) during April through June 1991 at the State Hospital of Sarajevo, were reviewed.Results:The mean number of blood units transfused per patient (blood usage rate) was 1.13 in the experimental group versus 2.56 in the control group (p <0.001). During the war, for blood conservation, normovolemic hemodilution was practiced widely. A significantly lower mean pre-transfusion Hct value of 0.21 was observed in the experimental group versus 0.27 in the control group (p <0.001).Conclusion:Blood-usage rate was lower during emergency surgical procedures in war than during elective surgical procedures in peacetime without apparent adverse patient outcome. This decrease in blood-usage rate in the face of increased numbers of trauma victims was the result of a planned blood-conservation program which included: stringent blood-usage criteria, and widespread implementation of casualty resuscitation using normovolemic hemodilution with colloid and crystalloid plasma substitutes.
The Effect of Hospital Resource Unavailability and Ambulance Diversions on the EMS System
Authors: Neely Keith W. , Norton Robert L. , Young Gary P. 
Published: July 2016

AbstractHypotheses:1) There is no increase in transport or scene time of diverted patients and no increase in distances traveled; 2) hospital resource shortages bear no relationship to the number of patients diverted; and 3) paramedics are able to match their patient correctly with the resources available at a given hospital.Methods:This was a five-month, prospective, observational study in an urban area with a population of 600,000 comparing all 9-1-1 ambulance diversions against a randomly selected sample of 5% of all other 9-1-1 originated patients. All patient diversions that originated from the 9-1-1 center are included in the study.Results:Hospitals identify their diversion status on a community-wide computer system monitored at the 9-1-1 center and base station. Accepted categories include: 1) diversion of all patients through the 9-1-1 center from the emergency department (ED); 2) trauma system patients (T); 3) psychiatric secure beds (PSB); 4) general acute ward beds (AW); 5) critical care (CC); 6) computed tomography scan (CT); 7) labor and delivery (LD); and 8) pediatric beds (PEDS). Data were abstracted from 481 patients' records. A total of 111 were diverted from their intended destination. Transport times were longer and diverted patients traveled further (p <.002). Hospitals showing ED and LD diversion categories were more likely to have patients diverted away (r2 = .895, multilinear regression, p <.001). Of the 111 patients, 21 (19%) were diverted because of CC unavailability. Six of these (28%) were inappropriate because they did not fit the CC definition.Conclusions:In this system, hospital diversions increase transport times and distances traveled. Diversion of patients correlated strongly to unavailability of specific categories. Paramedics make errors in determining appropriate CC diversions. Systems reviewing their diversion problems need to assess the impact of longer out-of-hospital times and of certain diversion categories, and to clarify definitions.
Patient Outcome Using Medical Protocol to Limit “Lights and Siren” Transport
Authors: Kupas Douglas F. , Dula David J. , Pino Bruno J. 
Published: July 2016

AbstractIntroduction:Emergency medical services vehicle collisions (EMVCs) associated with the use of warning “lights and siren” (L&S) are responsible for injuries and death to emergency medical services (EMS) personnel and patients. This study examines patient outcome when medical protocol directs L&S transport.Design:During four months, all EMS calls initiated as an emergency request for service and culminating in transport to an emergency department (ED) were included. Medical criteria determined emergent (L&S) versus non-emergent transport. Patients with worsened conditions, as reported by EMS providers, were reviewed.Setting:Countywide suburban/rural EMS system.Results:Ninety-two percent (1,495 of 1,625) of patients were transported non-emergently. Thirteen (1%) of these were reported to have worsened during transport, and none of them suffered any worsened outcome related to the non-L&S transport.Conclusion:This medical protocol directing the use of warning L&S during patient transport results in infrequent L&S transport. In this study, no adverse outcomes were found related to non-L&S transports.
The Impact of Variation in Trauma Care Times: Urban versus Rural
Authors: Esposito Thomas J. , Maier Ronald V. , Rivara Frederick P. , Pilcher Susan , Griffith Janet , Lazear Susan , Hogan Scott 
Published: July 2016

AbstractStudy Objectives:To document the existence and nature of variation in times to trauma care between urban and rural locations; to assess the impact of identified variations on outcome.Design:Retrospective case reviewSetting:Washington state, 1986Participants:Motor-vehicle-collision fatalitiesMethods:Previously unreported definitions of urban and rural location and possibly preventable death were used to conduct a comparative analysis of urban and rural fatalities. Trauma care times in the prehospital and the emergency department (ED) phases of care were abstracted. Their relationships to corresponding crude death rates and possibly preventable death rates also were examined.Results:Prehospital times averaged two times longer in rural locations than in urban areas. First-physician contact in the ED averaged six times longer in rural locations than in urban settings. Concomitantly, the crude death rate in rural settings was three times that of the urban areas. The overall possibly preventable death rate was double the urban rates in rural incidents. When stratified by phase of care, rate of possibly preventable death showed no urban/rural variation for the prehospital phase, but was three times greater for the ED phase in rural areas than in urban ones.Conclusions:Trauma care times and adverse outcome appear to be associated. Allocation of resources to decrease length of and geographic variation in time to definitive care, particularly in the ED phase, seems appropriate.
Isolated Intrathoracic Injury with Air Bag Use
Authors: Sama Andrew E. , Barnaby Douglas P. , Wallis Kevin J. , Gadaleta Dominick , Hall Michael H. , Nelson Roy L. , Naidich James , Ward Robert J. 
Published: July 2016

AbstractThe restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.
How Should an Unconscious Person with a Suspected Neck Injury be Positioned?
Authors: Gunn Barry D. , Eizenberg Norman , Silberstein Morry , McMeeken Joan M. , Tully Elizabeth A. , Stillman Barry C. , Brown Douglas J. , Gutteridge Geoffrey A. 
Published: July 2016

AbstractIntroduction:Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.Hypothesis:It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.Methods:Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.Results:For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).Conclusion:An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.
In-Field Extremity Amputation: Prevalence and Protocols in Emergency Medical Services
Authors: Kampen Kathryn E. , Krohmer Jon R. , Jones Jeffrey S. , Dougherty J.M. , Bonness Robert K. 
Published: July 2016

AbstractObjective:To determine current experience, attitudes, and training concerning the performance of in-field extremity amputations in North America.Design:Cross-sectional, epidemiological survey.Participants:Emergency medical services (EMS) directors from the 200 largest metropolitan areas in North America and attendees at the 1992 Mid-Year National Association of EMS Physicians Meeting.Interventions:The survey consisted of five questions focusing on demographic and operational data, the frequency of occurrence of the performance of in-field amputations, personnel responsible for performing the procedure, existing written protocols for the procedure, and the scope of training provided.Results:A total of 143 surveys was completed. Eighteen respondents (13%) reported a total of 26 in-field extremity amputations in the past five years. The most common cause for the injuries requiring amputations was motor-vehicle accidents. In the majority of cases (53.2%), trauma surgeons were responsible for performing the amputation, followed by emergency physicians (36.4%). Of respondents, 96% stated that there was no training available through their EMS agencies related to the performance of in-field extremity amputations. Only two EMS systems had an existing protocol regarding in-field amputations.Conclusions:The results suggest a need for established protocols to make the procedure easily accessible when needed, especially in large metropolitan EMS systems. This information should be emphasized during EMS training and reinforced through continuing education.