bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Preparedness Medical Disaster Response in Costa Rica
Authors: Bissell Richard A. , Pretto Ernesto , Angus Derek C. , Shen Bern , Ruíz Victor , Ceciliano Norma , Sawyers Roberto , Shurtleff Dawn , Abrams Joel 
Published: July 2016

AbstractIntroduction:The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness.Hypothesis:Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent.Methods:Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office.Results:Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake.Conclusion:To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.
Emergencies in the School Setting: Are Public School Teachers Adequately Trained to Respond?
Authors: Gagliardi Monte , Neighbors Marianne , Spears Caile , Byrd Scott , Snarr Jamin 
Published: July 2016

AbstractIntroduction:This study attempted to determine the extent of training and emergency care knowledge of public school teachers in midwestern states. A secondary purpose was to assess the frequency of injury and illness in the school setting requiring the teacher to first respond.Method:A questionnaire and 14-item, scenario-based, emergency medical care test was developed and pretested. A discrimination index was used for validation of the instrument and a reliability coefficient of .82 was computed using the Kuder-Richardson Formula 20. A randomly recruited group of public school nurses from Arkansas, Kansas, and Missouri administered the instrument to 334 teachers who had no prior knowledge of the test. A random telephone survey of local school patrons also was completed to determine parental assumptions and expectations for emergency care and cardiopulmonary resuscitation (CPR) training in teachers.Results:One-third (112 teachers) had no specific training in first-aid and 40% never had been trained in CPR. However, most (87%) of the respondents strongly agreed that emergency care training should be required in teacher preparation programs. Eighteen percent of the teachers responded to more than 20 injured or ill students annually, and 17% reported that they had encountered at least one life-threatening emergency in a student during their career. The average score for all respondents on the emergency care test was 58% (X2= 8.12±2.42). Those with prior first-aid training averaged 60.5% (X2= 8.47±2.32). Significant deficiencies were noted for recognition and appropriate treatment of student emergencies involving basic life support (BLS) and airway interventions, diabetic emergencies, and treatment of profuse bleeding. Forty of the 50 (80%) parents surveyed assumed that all teachers were adequately trained in first-aid and CPR.Conclusion:Public school teachers represent a potentially effective first-response component during disasters and isolated emergencies in the school environment. Overall, most of public school teachers in this study were deficient in both training and knowledge of emergency care and BLS modalities. Lack of effective, formal emergency care training in teacher preparation programs coupled with no continuing education requirement is a possible explanation of these results. Emergency medical services providers should seek opportunities to help with first-responder training and continuing education in their schools.
Outcome of Patients After Air Medical Transport for Management of Nontraumatic Acute Intracranial Bleeding
Authors: Silbergleit Robert , Burney Richard E. , Draper Janine , Nelson Kris 
Published: July 2016

AbstractIntroduction:Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system.Methods:Charts of all patients with spontaneous, acute ICB who were transported by air from 1986 through 1989 were reviewed. Age, gender, time of transport, transport management measures, pre- and post-transport Glasgow Coma Scale (GCS) score, intensive care unit (ICU) and hospital days, operations, and mortality were compiled for all patients and analyzed.Results:Eighty-seven patients ranging in age from 2 to 83 years (mean: 47.5 ±18.5 years) met entry criteria. The source of bleeding was cerebral aneurysm in 37 patients; intraparenchymal hemorrhage in 29; an unidentified vascular source in 11; and arteriovenous malformation (AVM) in 10. Mean GCS score measured in 69 patients before and after transport was 10.5 ±4.5 Glasgow Coma Scale score did not change during transport in 61 patients (88%), improved in three (4%), and deteriorated in five (7%). Fifty-nine patients (69%) underwent operations, 36 (41%) within 24 hours of arrival. Mean ICU stay was 14 days (95% CI: 12–15); mean hospital stay was 36 days (95% CI: 27–45 days). Overall mortality was 25% (95% CI: 16–34 days). A GCS score of 3 to 8 at time of transport was associated with both increased hospital length of stay and higher mortality. Patients transported within eight hours of symptom onset had lower GCS scores, but out-come measures were not significantly different from those transported later.Conclusion:Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.
Treatment of Casualties of Military Conflicts at the Critical Medicine Clinic of the Central Hospital in Georgia
Authors: Kheladze Zurab , Kajaia Samson , Gorgoshidze George , Bendeliani Vladimir 
Published: July 2016

AbstractIntroduction:Local military conflicts continue in many areas of the world. These conflicts produce multiple casualties to military personnel and civilians. This paper describes one aspect of the medical care required for victims of the civil conflict in the Republic of Georgia.Methods:Interviews with patients and their accompanying persons and abstraction of medical records.Results:Data were acquired on 108 victims admitted to the Center for Critical Medicine in Tbilisi. Three stages in the care of these victims are described: 1) battlefield and transportation; 2) regional, front-line hospitals; and 3) the Central Hospital. The performance of each stage is described. Distribution of injuries and procedures performed in the third stage of treatment are described and survivors are defined. For illustration, two cases are reviewed in detail.Conclusions:The results are encouraging. Major problems existed in the treatment and evacuation of the wounded. Furthermore, many of the victims were injured because of their carelessness and lack of experience on the battlefield.
An Analysis of Demand for First-Aid Care at a Major Public Event
Authors: Flabouris Arthas , Bridgewater Franklin 
Published: July 2016

AbstractIntroduction:First aid is the initial care of the ill or injured. It aims to preserve and protect life, prevent further injury or deterioration of illness, and help promote recovery. At major public events, there is a large gathering of people, physical spectacles, and equipment within a concentrated area, where organized first-aid care is provided.Objective:To analyze the demand for primary medical care at a public event by identifying the patients and initial symptoms that may predict that demand, and to use such information to improve the efficiency and delivery of medical care.Methods:A questionnaire was completed by St. John Operations Branch personnel after each patient consultation and a retrospective analysis of the data was conducted.Results:A total of 1,276 questionnaires were returned. Mean patient presentation rate (PPR) was 1.9±0.47 per 1,000 show attendees. This correlated best with the maximum daily temperature (r = 0.715, p <0.02) and show day (r = 0.615, p <0.05). There was poor correlation with daily attendance (r = −0.235, p >0.54). Mean presentation time was 15:13 h. Of those whose gender was recorded, 58.4% were females, and 41.6% were males. The most frequent age group was 13 to 20 years. The nature and number of initial symptoms are listed. Basic first-aid skills were used for 96.7% of symptoms; 2.4% of patients were referred to the hospital.Conclusions:Temperature and show day significantly contributed to variability of PPR. These factors, together with an estimated PPR and predicted attendance, can be used to forecast demand. Most cases required only basic first-aid skills. Guidelines are suggested for management by nonmedical personnel. A medical officer's role is not reliably defined, but involvement in consultation is suggested.
Planning, Implementation, and Process Monitoring for Prehospital 12-Lead ECG Diagnostic Programs
Authors: Aufderheide Tom P. , Kereiakes Dean J. , Weaver W. Douglas , Gibler W. Brian , Simoons Maarten L. 
Published: July 2016

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

AbstractIntroduction:Many colleges and universities appear to exist in relative isolation from community-based emergency medical services (EMS) systems. In response, some have developed their own EMS systems.Objective:To determine the extent of this phenomenon and to delineate the characteristics of these systems.Design/Methods:Questionnaires were mailed to 1,503 colleges/universities in the United States and Canada. The questionnaire asked whether the institution had an EMS system and included 19 questions about the characteristics of the system.Results:A total of 919 (61 %) responses were received. Of the institutions responding, 234 (25%) had an EMS system and 31 (3.4%) were considering starting a system. Characteristics of the systems were as follows: 1) Types of patients—the two most common call types were medical and trauma/surgical; 134 (57%) reported one-fourth of calls to be medical and 91 (39%) reported one-fourth of calls to be trauma/surgical. 2) Type of service—133 (57%) services transport patients; 195 (83%) respond only to the campus or other university property; the remainder also respond to the community; and 135 (58%) function all year. 3) Dispatch—178 (76%) are dispatched by the campus police, although most services are dispatched by several sources; 46 (20%) use 9-1-1. 4) Personnel—two systems (0.85%) exclusively employ paramedic; 141 systems (60%) have at least one emergency medical technician; the remainder use emergency care attendants and first-aid providers; 118 (50%) have medical directors, of these 76 (64 %) are student health physicians and 21 (18%) are community physicians. 5) Demographic Information—The majority of the campus-based EMS systems exist on small campuses in urban areas.Conclusions:A significant number of colleges/universities have EMS systems and one-half transport patients. However, the level of training of the personnel and medical direction may be below the standard for the EMS systems in the communities in which these campus-based systems exist.
Developing Public Health Indicators in Complex Emergency Response
Authors: Spiegel Paul B. , Burkle Frederick M. , Dey Chayan C. , Salama Peter 
Published: July 2016

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

Paramedic units have awakened a new concept in prehospital care in the USA. New emergency medical services (EMS) administrations, better educated personnel, and mass public awareness through media events have all contributed to the change.Operational changes designed to tighten control of the emergency medical technician (EMT) and paramedic came about through deployment of ambulances and categorization and designation of emergency hospitals. Clinical changes have given the EMS responder, particularly the paramedic, a great deal of freedom in the care given to patients. The paramedic, who uses subjective criteria, can administer care ranging from Standard First Aid to advanced cardiology. Subjective control should be rigid for the EMT or paramedic, when cognitive abilities include only knowledge, comprehension and application, but not for those who have had a chance to exercise analytic and synthetic skills in pre-hospital training programs.
Perspectives of Emergency Medical Services (EMS)
Authors: Nagel Eugene 
Published: July 2016

Many of the world leaders in emergency medicine and in disaster medicine systems have made advances in these fields, and I compliment them on the accomplishments that I have seen over the years. Dr. Safar charged me to look ahead, if that is possible, and offer some perspective—obviously my own—on the next five to ten years. Hopefully, our future can be controlled in certain limits. Toynbee philosophized that when new and unanticipated challenges are presented, they represent great opportunity for response. If we fail to respond or if we respond in an inappropriate way, we may become a fossil in history—in this case, in the history of medicine. I have attempted to look at important challenges that I see in emergency medicine, and to predict from these a course that I think represents a proper response.The first challenge, one that you have heard of before, clearly is the most important one. It is the challenge of limited or relative resources. The term “relative” means that fraction of a country's or region's output or wherewithall that is available in a logical or rational way for emergency medicine.
On-the-Scene Triage with a Rapid Response Vehicle
Authors: Dreifuss Rodney , Pascarelli Emil 
Published: July 2016

Perhaps the greatest operational problem faced by the New York City Emergency Medical Service (EMS) today is the sheer volume of calls entering the system, and the fact that many of those requests for medical aid are not life-threatening emergencies requiring ambulance transport. This creates two situations that New York City is all too familiar with: (l) ambulances are not available for true emergencies; and (2) response times for ambulances to arrive at the scene of an emergency are extended.A four-month pilot “on-scene triage” program was initiated by EMS as a possible solution to these problems. The program ran from May to August of 1980. A marked EMS car was designated as the “Triage Car” and was in operation during those hours when ambulance requests were at their peak (usually two to ten PM).
Intubation with an “Airway Intubator”
Authors: Williams R. Tudor 
Published: July 2016

Airway Intubators are obtainable from Williams Airway Intubator Limited, 405–206 7th Avenue S.W., Calgary T2P0W7 CanadaThe Airway Intubator serves two purposes: as an oropharyngeal airway and, should the need arise, an endotracheal tube can be passed through the center of the airway intubator into the trachea without the need for further instrumentation.Sykes, in 1937, described a divided airway made of aluminum; following the introduction of the endotracheal tube, both halves of the airway were removed leaving the endotracheal tube in place. A plastic airway, as designed in the 1970's by Berman, consisted of a tunnel along its whole length so that an endotracheal tube was compelled to follow this pathway.With the advent of plastic endotracheal tubes with a relatively fixed radius of curvature, the airway intubator has been more successful than its predecessors, both as an oropharyngeal airway and as a means of intubating the trachea.
A Multiple Purpose Airway Endoscope
Authors: MacAllister Niall , Beaudry Robert , MacMurray Adele , Brock Ben , Zorab John 
Published: July 2016

Since early recorded use of the endotracheal catheter for controlled ventilation of the lung and protection of the airway from aspiration, the protection of airway integrity has been inconsistently obtained and not without significant morbidity.Trauma is the leading cause of death between the ages of 1 and 40. The three most common causes of trauma related death are inadequate ventilation, inadequate circulation and massive hemorrhage. Thus high priority must be given to airway management, breathing and circulation. The efficiency of the former is essential to optimal circulatory adjustment. No presently available instrument fulfills these needs within a single system.
Is the Use of Calcium Helpful in Cardiac Resuscitation? Experimental and Clinical Studies
Authors: Meuret G. , Roth V. , Borcherding D. , Scholler K. L. 
Published: July 2016

The effect of positive inotropic agents on circulation and ventricular fibrillation threshold are not fully understood during the influence of metabolic acidosis during circulatory arrest. This is the same case with alkalosis, caused by the over-correction of sodium bicarbonate. Furthermore, the role of calcium during CPR is not clear.Therefore, we investigated the influence of metabolic acidosis and alkalosis with and without the administration of the positive inotropic substances epinephrine and calcium upon contractility and ventricular fibrillation threshold.
Clinical Course of 61 Serious Immersion Incidents
Authors: Harries Mark G. 
Published: July 2016

Retrospective studies of the mechanisms of drowning are difficult to make for a number of reasons. First, the severity of the immersion incident is hard to classify; therefore, conclusions drawn from the outcome of a number of incidents grouped together may be erroneous. Second, confusion results from traditional attempts to separate victims into those who immerse in salt water from those who immerse in fresh. This is an analysis of 61 individual cases of immersion published in the last 20 years, but not previously subjected to group analysis such as those published by Modell, Conn and Simcock.ResultsIn 61 cases reviewed, males outnumbered females by almost 4 to 1 (48/13), 17 died and 44 survived (Table 1). When placed in age groups, those most at risk fell into the 0–5 years old group, comprising 43% of the total; but this group also contained the greatest proportion of survivors (Figure 1).
Actions of the World Health Organizations (WHO) and the United Nations (UN) in Disasters
Authors: Gunn S. William A. 
Published: July 2016

In essence, the United Nations Organization was born out of disaster to avert disaster. Be they the work of nature or of man, catastrophic emergencies are not rare occurrences and all studies indicate that they are increasing in frequency and severity.Within the international community, the UN and its component organizations is only one of the three principal partners in disaster relief. The other are the Non-Governmental Organizations (NGO) – including the Voluntary Agencies (VOLAGS) – and the bilateral donor countries. Collaboration among these sectors is vital if international action is to be effective.This article deals with the UN System only, and in particular with the role of the World Health Organization (WHO) in disaster relief and preparedness.
The International Society of Emergency Medical Services (ISEMS)
Authors: Gemma William 
Published: July 2016

In September 1980 at the International Aeromedical Evacuation Congress held in Munich, West Germany, the International Society of Emergency Medical Services (ISEMS) was formed. The purpose of this new society is to develop, promote, and improve EMS throughout the world. The founding members came from sixteen nations and represented such regions as Africa, the Americas, Europe, and the Middle East.This new organization, ISEMS, provides a permanent, ongoing focal point for studies and serves as a global clearinghouse for EMS technical assistance, training, management, and evaluation. The Society remains on an international level, and its eligible membership consists of all persons who participate in EMS throughout the world. The publication of a scientific journal for all EMS personnel is planned. Through ISEMS, International Centers of Excellence will be established to provide technical assistance to countries for improvement of their EMS programs; training seminars and educational programs will also be sponsored. In addition, annually sponsored meetings in key cities in various countries of the world are planned.
40. MVCs: Five Most Frequent Sources of Injury
Authors: Gough John E. , Hunt Richard C. 
Published: July 2016

Purpose: To determine the most frequent sources of injuries from the interior of motor vehicles involved in crashes.Methods: We searched the National Highway Traffic Safety Administration's National Accident Sampling System to determine the most frequent sources of injuries. This database includes sources of injuries resulting from crashes from January 1, 1991 to December 31, 1992.