bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feedback to Emergency Medical Services Providers: The Good, the Bad, and the Ignored
Authors: Mock Elisabeth F. , Wrenn Keith D. , Wright Seth W. , Eustis T. Chadwick , Slovis Corey M. 
Published: July 2016

AbstractHypothesis:To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel.Methods:Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale.Results:In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (<1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill.Conclusion:The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.
A Comparison of Field Techniques Used to Pressure-Infuse Intravenous Fluids
Authors: White Steven J. , Hamilton William A. , Veronesi James F. 
Published: July 2016

AbstractApplication of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in turn trials using a 1-liter bag of saline though a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80cm served as the control.Pressure infusers generated flow rates of 257±54 ml/min and 296±53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2–2.5 times that of gravity flow (123±2 ml/min) and significantly greater than those rates obtained by any other method (p<.0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184±6 ml/min and 173±40 ml/min achieved by each of two different squeezing methods (p<.01). Neither blood pressure (BP) cuff application and inflation (135±28 ml/min) nor kneeling on the bag (125±36 ml/min) was better than gravity alone.These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field.
Assessment of a Triage Label System during a Major Incident Exercise
Authors: Barton D. , Bodiwala G. G. 
Published: July 2016

AbstractThe Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties—Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards.
Estimated Cost-Effectiveness of Dispatcher CPR Instruction via Telephone to Bystanders During Out-of-Hospital Ventricular Fibrillation
Authors: Valenzuela Terence D. , Spaite Daniel W. , Clark Lani L. , Meislin Harvey W. , Sayre Raymond O. 
Published: July 2016

AbstractHypothesis:Emergency cardiopulmonary resuscitation (CPR) instruction via telephone (ETCPR) is cost-effective compared to prehospital, emergency medical technician (EMT)/paramedic treatment alone of witnessed, ventricular fibrillation (VF) in adult patients.Methods:A total of 118 patients, age >18 years, with prehospital, witnessed ventricular fibrillation were studied. Patient data were extracted from hospital records, monitor-defibrillator recordings, paramedic reports, dispatching records, and telephone interviews with bystanders. No ETCPR was available during this period. The costs of ETCPR implementation were estimated retrospectively. Marginal cost of the paramedic service attributable to treatment of VF was calculated from fire department records. Years-of-life saved were estimated from age, gender, and race matched norms.Results:Of the 53 patients receiving bystander CPR (BCPR), 14 (26%) survived to hospital discharge versus 4/65 patients (6%) lacking BCPR, These groups did not differ significantly (p>.05) in age, EMS response times, or time from collapse to defibrillation. The mean time interval from collapse to CPR was significantly less for patients with BCPR (1.8 min) than for patients without BCPR (7.1 min). Had all patients received BCPR and survived at the rate of 0.26, 13 additional patients would have survived to hospital discharge. The cost per year-of-life saved by the EMS system with ETCPR would have been [US]$2,834 versus $4,881 without ETCPR. The cost per additional year-of-life saved by ETCPR was estimated to be $560 in patients experiencing out-of-hospital ventricular fibrillation.Conclusion:The use of ETCPR instruction of callers by 9-1-1 dispatchers potentially is a cost-effective addition to a two-tier, EMS system for treatment of prehospital ventricular fibrillation.
A Model Strategy for Teaching Prehospital Personnel Management of Patients with Alzheimer's Disease
Authors: Cason Debra , Wilson Rosemary Wade , Chafetz Paul K. , McIntire Donald D. 
Published: July 2016

AbstractAccompanying the graying of America is the increased incidence of Alzheimer's Disease (AD) and the need to teach prehospital personnel how to manage these patients. The purpose of this project was to develop an instructional strategy to teach prehospital personnel about AD and some basic management techniques. This information includes: causes of acute and gradual onset confusion in the elderly; symptoms and course of AD; mental status exam; methods to facilitate communication; techniques to avoid confrontation; and means to identify personal feelings about the elderly and AD.Teaching methodology includes instructional objectives, videotape presentation of didactic/clinical material, videotape situations demonstrating patient management techniques, role playing exercises, and discussion groups.The videotape presentation portion of the teaching methodology was shown to be effective as a single instructional strategy. One hundred and thirty-four EMS personnel were given a sixteen item exam before and after the videotape presentation. Pre-test to post-test difference was significant at p=.001. The additional instruction components may further impact the knowledge of AD and positive delivery of care to the elderly.
Vital Signs Records Omissions on Prehospital Patient Encounter Forms
Authors: Moss Robert L. 
Published: July 2016

AbstractIntroduction:A reported in-field, prospective evaluation of 227 prehospital patient assessments by advanced life support (ALS) emergency medical technicians (EMTs) found a frequent failure to measure vital signs. The objective of this retrospective review was to report the omission frequency of vital signs found in a centralized emergency medical services (EMS) data collection system.Methods:The EMS database contained information from 90,480 optically scanned, prehospital patient encounter forms. Each record identified EMT skill levels, response times, dispatch type, vital signs, medical and trauma information, treatment, and patient disposition. Records for 1989 and 1990 were collected from 92 rural EMS providers who responded to emergency medical and trauma events.Results:Of 90,480 emergency responses, 14,129 (15.6%) were false alarms, deceased, or canceled without vital patient contact. Valid encounters were documented for 76,351 (84.4%) patient contacts. Systolic blood pressure measurements were not recorded for 13,262 (17.4%) patients. Diastolic blood pressure was not recorded for 14,272 (18.7%) patients. A pulse record was not recorded for 12,125 (15.9%) patients. A ventilatory rate was absent in 12,958 (17.0%) patient records.Conclusion:This study found a frequent failure by non-metropolitan basic life support (BLS) and advanced life support (ALS) EMTs to record vital signs on prehospital emergency patient encounter forms. It supports a previous report of direct in-field observations of ALS EMTs failing to measure vital signs during patient assessment. The impact of vital sign omissions upon individual patient care can be assessed only by receiving medical control physicians. In the absence of effective emergency physician networking, the statewide magnitude of the problem among BLS and ALS EMTs has not been recognized as a system issue.
ExacTech Blood Glucose Meter Clinical Trial
Authors: Bartkus Edward A. , Daya Mohamud , Hedges Jerris R. , Jui Jonathan 
Published: July 2016

AbstractIntroduction:Current prehospital protocols for the management of patients with altered mental status include the empiric administration of hypertonic glucose, naloxone, and thiamine. The injudicious use of 50% dextrose (D50W) may result in hyperosmolarity, a worsening of hypokalemia, and unwarranted additional health-care costs for the patient. The administration of D50W also may worsen the neurological outcome of patients with local or generalized ischemia.Objective:To evaluate the ExacTech blood glucose meter's ability to estimate blood glucose levels accurately and rapidly.Methods:Emergency medical technicians (EMTs) from selected advanced life support (ALS) units in the Portland, Ore., metropolitan area participated in a prospective clinical trial of the ExacTech blood glucose meter. A convenience sample, was drawn from emergency medical services (EMS) patients with suspected diabetic emergencies, altered mental status, and other neurological deficits. Venous blood samples were drawn from these populations at the same time as the ExacTech readings were obtained. The venous blood was submitted to the receiving hospitals for laboratory analysis of blood glucose levels, and a comparison was made between the results of the two methods.Results:A total of 80 matched sets of data were obtained from 1 April 1990 through 6 May 1991. The hospital blood glucose values ranged from 8 to 1233 mg/dl. Sixteen (20%) of the patients were hypoglycemic (<60 mg/dl) and 23 (28.8%) were hyperglycemic (>180 mg/dl). The ExacTech device sensitivity and specificity for hypoglycemia using venous samples were 94.6% and 89.2%, respectively. For hyperglycemia, these same parameters were 87.5% and 97.1%. Pearson's r over the range of the instrument (40–450 mg/dl) was 0.8656 (p <.001). If the prehospital “definition” of hypoglycemia (for threshold-to-treat) is raised to 65 mg/dl, the device has 100% sensitivity in the sample population.Conclusion:The device functioned accurately and consistently in the prehospital environment over a wide range of temperatures, and in the hands of many different individuals.
Public Perceptions of a Rural Emergency Medical Services System
Authors: Brown Lawrence H. , Prasad N. Heramba , Grimmer Kirk 
Published: July 2016

AbstractIntroduction:To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system.Hypothesis:Citizens and physicians are unaware of the capabilities of the EMS system.Methods:Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p <0.01.Results:A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p <0.001).Conclusion:This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.
The Effect of Prehospital Transport Time on the Mortality from Traumatic Injury
Authors: Petri Roland W. , Dyer Alan , Lumpkin John 
Published: July 2016

AbstractObjective:To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.Design:Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.Participants:A total of 5,215 injured persons with an Injury Severity Score (ISS) >10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.Measurements:Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.Results:Patient outcomes were significantly different statistically between ISS groups (p <0.001, X2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p <0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p <0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p <0.001, two-way analysis of variance).Conclusion:No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time <90 minutes exerted a significant adverse effect upon survival.
EMS Providers Do Not Accurately Note Motor-Vehicle Crash Patients With Positive Serum Alcohol Concentrations
Authors: Maio Ronald F. , Wu Audrey , Blow Frederic C. , Zink Brian 
Published: July 2016

AbstractIntroduction:Alcohol use is associated with many motor-vehicle crashes and may increase the severity of injury. Because alcohol use also may mask injury, prehospital emergency care providers (PHECPs) may make inaccurate assessments. To assess and triage crash victims accurately, PHECPs must identify recent alcohol use.Study Objective:This study examines the accuracy of PHECPs in identifying motor-vehicle crash victims who had positive serum alcohol concentrations.Design:Retrospective cohort study.Population:Included in the study were motor-vehicle crash victims more than 17 years of age who were conveyed directly to a university medical center emergency department by ground ambulance (n = 372).Time Period:15 July 1990 to 15 July 1991.Methods:Data sources included ambulance report forms and hospital records. Variables that were abstracted included the Revised Trauma Score (RTS), the PHECPs' impression of alcohol use, and serum alcohol concentrations. Sensitivity, specificity, predictive-value positive, predictive-value negative, and 0.95 confidence intervals (0.95 CI) were calculated for the PHECPs' ability to identify patients with a serum alcohol concentration >0. The relationship between the RTS and the impressions of alcohol use was analyzed with chi-square testing: a p-value of <0.05 was considered statistically significant.Conclusion:This study suggests that tims with positive serum alcohol concentrations. Selection bias and retrospective design are significant limitations of this study. Future studies should develop and evaluate methods to improve PHECPs' accuracy in assessing alcohol use in motor-vehicle crash victims.
Using Interactive Videodisc to Test Advanced Airway Management Skills
Authors: Rubens Arthur J. , Stoy Walt , Piane Gina 
Published: July 2016

AbstractPurpose:To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration.Methods:The study was a nonrandomized, nonequivalent comparison group design of a convenience sample of 86 American Heart Association (AHA), advanced cardiac life support (ACLS) students, who obtained instruction in airway management by the interactive videodisc (IVD) learning system (n = 41), or by the traditional method of demonstration/return demonstration (n = 45). The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal (ET) intubation and esophageal obturator airway (EOA) insertion.Results:No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated. However, initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect (p = 0.004) compared to ACLS students learning by the traditional method. This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification. In a post-test satisfaction questionnaire, 34 IVD students reported satisfaction with learning airway management using this instructional method, but also expressed a preference to have an ACLS instructor available.Conclusion:This study highlights the role of IVD in teaching the complex skills of advanced airway management.
Medical Care at Mass Gatherings: Considerations for Physician Involvement
Authors: Parrillo Steven J. 
Published: July 2016

AbstractAlthough many authorities define a “mass gathering” as a group exceeding 1,000 persons, several times that number likely are to be present. The event for which the group will gather may be anything from a rock concert to an Olympic competition. Preparations for the event can be minor or major. This article reviews the issues that a physician should consider if he or she chooses to become involved in the delivery of medical care to such populations, as well as the evidence suggesting that a physician should be involved in most such gatherings.Emergency medical care at public gatherings is haphazard at best and dangerous at worst.There are surprisingly few data from which to plan the emergency medical needs for public events and no recognized standards or guidelines for providing emergency medical services at mass public gatherings.
The Consequence of Land Mines on Public Health
Authors: Kakar Faiz , Bassani Fabrizio , Romer C.J. , Gunn S.W.A. 
Published: July 2016

AbstractAn estimated 110 million land mines scattered in 64 countries continue to terrorize people and destroy human lives long after wars and fighting have ceased. Despite efforts to clear these devices, their numbers continue to increase and their presence, constitutes a substantial threat to public health in the affected countries. Direct consequences include both the physical and emotional injuries from the impact, flying debris, and structural collapse associated with their detonation. Indirect consequences include increases in the incidence of waterborne diseases, diarrhea, malnutrition, infectious diseases, and spread of the human immunodeficiency virus associated with the increased use of blood. Those at highest risk of these latter consequences are mostly the disadvantaged poor, especially children. Psychiatric disorders, such as post-traumatic stress disorder, occur in those not directly injured as well as those physically wounded by the explosion.Besides efforts to ban production, stockpiling and export of land mines, a comprehensive and integrated health program aimed at the prevention, treatment, and rehabilitation of those injured directly or indirectly by land mines is needed urgently. Strategies should include mine-awareness programs, enhanced transport of those directly injured, training the villagers in first aid, augmenting the capacity and quality of treatment facilities, improving the psychological support and treatment capabilities, development of rehabilitation programs, and the institution and enhancement of public-health programs directed at the indirect consequences associated with the presence of land mines.Land mines constitute a major public-health problem in the world that must be addressed.
Evaluation of the Pediatric Trauma Triage Checklist as a Prehospital Pediatric Trauma Triage Tool for the State of Florida
Authors: Johnson William P. 
Published: July 2016

AbstractIntroduction:Triage of injured children poses a significant challenge for prehospital-care providers because there is no single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not “user friendly” for field personnel. As such, the PTS has been modified to generate the more user-friendly ”pediatric trauma triage checklist (PTTC).”Methods:This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center.Results:The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0%. The PTTC demonstrate an overtriage rate of 58.3% and an under-triage rate of 13.8%. When compared with a previous study, the PTTC demonstrated a 74 % increase in overtriage. However, the 59% reduction in undertriage is more important.Conclusions:Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.