bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Standing Orders on Medication and Skill Selection, Paramedic Assessment, and Hospital Outcome: A Follow-up Report
Authors: Pointer James E. , Osur Michael , Campbell Colleen , Mathews Ben H. , McCall Chet 
Published: July 2016

AbstractIntroduction:A prior report demonstrated a five-minute decrement in scene and total prehospital times in the standing order and limited standing order intervals as compared to control.Methods:The Alameda County Emergency Medical Service (EMS) District studied the impact of standing orders on field times, comparison of paramedic assessments with emergency department diagnoses, field drug use and procedures, and hospital outcome. These variables were studied over three discrete, six-week, time-study intervals, which represented three different levels of base-hospital medical control (control, standing order, and limited standing order).Results:There were no statistically significant differences between the three time-study intervals for the following variables: 1) incidence of prehospital administration of three cardiac arrest drugs; 2) incidence of prehospital administration of no drugs; 3) incidence of performance of endotracheal intubation; 4) incidence of performance of defibrillation; 5) assessment comparison; and 6) hospital outcome. There were statistically significant differences between intervals for incidence of: 1) administration of naloxone; 2) administration of 50% dextrose; 3) intravenous (IV) starts; and 4) paramedic performance of no procedures.Conclusion:Although there are several potential flaws in method, the data suggest that standing orders result in decreased incidence of drug administration and IV starts in non-critical situations without a negative impact on paramedic assessments or hospital outcome.
In-Field Comparison between Fully Automatic and Semi-Automatic Defibrillators
Authors: Bocka Joseph J. , Swor Robert 
Published: July 2016

AbstractThe purpose of this clinical study was to compare the prehospital use of fully automatic defibrillators versus semi-automatic defibrillators.Methods:Fully and semi-automatic defibrillator use by EMTs in neighboring communities was compared.Results:Both programs had similar response times, age and gender distribution, proportion of witnessed arrests, and proportion of patients found initially with ventricular fibrillation (VF). The time-to-shock from proper lead placement was shorter when the fully automatic defibrillator was used (16.6 vs. 44.3 seconds; p<.001) and the survival to hospital discharge rate was greater (26% vs. 0%; p=.O4). The semi-automatic defibrillators were more sensitive in detecting VF than were the fully automatic devices.Conclusions:These data support the need for further comparison of the efficacy and effectiveness of semi- and fully automatic, external defibrillators.
Evaluation of a New Cervical Immobilization/Extrication Device
Authors: Joyce Steven M. , Moser Chris S. 
Published: July 2016

AbstractA new cervical immobilization device (the Philadelphia Red E.M. Collar with Head Immobilizer/Stabilizer), has been introduced as an adjunct in extricating potentially neck-injured patients. This study compared the efficacy of immobilization using the collar to that of the short spine board. In addition, experienced EMS personnel rated the collar in simulated field situations.Methods:In Part I of the study, the collar and a short spine board were applied to 25 adult volunteers in a sitting position, using standard methods. Each subject then exerted maximal force inflexion, extension, rotation, and abduction. Degrees of head motion from neutral position were measured in each direction. Mean values were compared using Student's t-test. For Part II, 10 EMS personnel were asked to apply the collar to volunteers. Each rated the performance of the collar on a scale of 1 (poor) to 4 (excellent) regarding: ease of application (sitting and supine), ease of extrication (lifting, logrolling, transfer), access to patient (chest auscultation, CPR, airway management), storage, and overall utility.Results:The collar was significantly better than the short spine board in both lateral and rotational immobilization (p<0.001). There was no significant difference for flexion or extension (p>0.05). The Red E.M. limited motion to a mean of 15° or less in any direction. Ratings by EMS personnel for the device (meant±standard error) were: ease of application (sitting) 3.5±0.2, (supine) 2.7±0.2; ease of extrication 3.1±0.2; access to patient 3.4±0.2; storage 3.1±0.3; and overall utility 3.1±0.2.Conclusion:This study indicates that the Philadelphia Red E.M. Collar with Head Immobilizer/Stabilizer is an effective and practical adjunct to stabilization and extrication of potentially neck-injured patients.
Developing EMS Quality Assessment Indicators
Authors: Dagher Michel , Lloyd Robert J. 
Published: July 2016

AbstractAn emergency medical service (EMS) system is part of a broad health care system which no longer can be concerned exclusively with patient transportation. Integration of prehospital and in-hospital emergency care must be achieved to provide quality patient care. This article suggests modifications in the Joint Commission on Accreditation of Healthcare Organization's (JCAHO) 10-Step Model indicators that should help in an evaluation of the issues associated with the diversion of patients from Emergency Departments. The JCAHO model is one that can be used to help integrate prehospital and inhospital care.
Involuntary Commitment in the Prehospital Setting
Authors: Adams James G. , Gerard Jody , Verdile Vince P. , Paris Paul M. 
Published: July 2016

AbstractIntroduction:Suicidal patients who refuse prehospital transport pose a difficult problem for emergency medical services. A survey was conducted in an attempt to assess the current strategies for involuntary transport of such patients.Methods:The medical directors of 135 of the largest EMS systems in the United States were mailed a questionnaire requesting descriptions of the operating procedures for dealing with suicidal patients who refuse transport.Results:Fifty-nine of 130 questionnaires (45%) were returned. Seventeen emergency medical services (EMS) systems (29%) serve populations of less the 250,000, while 41 (69%) serve populations greater than 250,000. Cumulatively, respondents represent an excess of 2.1-million EMS responses per year, of which 0.5%-10.0% involve behavioral emergencies. Eleven of the 59 responding systems (19%) have urritten, explicit policies guiding the management of suicidal patients who refuse to be transported. Involuntary commitment proceedings are initiated in the prehospital setting in 25 of the 59 services (42%). Of these 25, the initiation of commitment proceedings is performed by the following (more than one may apply to a given system): 11 (44%) by base-station physicians, six (24%) by the emergency medical technician (EMT), 23 (92%) by a police officer, and five (20%) by family or friends. Ten of the 59 systems (17%) require a mental health delegate to authorize commitment. Two physicians can mandate involuntary commitment in one of the responding systems. Of the 25 systems that actually perform involuntary commitment in the prehospital setting, seven (28%) have established policies. Of the 34 systems which do not perform involuntary prehospital commitment, four (12%) have policies to guide the care of suicidal patients who refuse care.Conclusion:Suicidal patients commonly confront emergency medical services, yet many systems lack explicit policies for dealing with such patients. Widely varied strategies are used to authorize transport of patients who are suicidal and refuse to be transported.
Air Medical Transport Utilization Review in North Carolina
Authors: Benson Nicholas H. , Alson Roy L. , Norton Eve G. , Beauchamp Ann P. , Weber Rita , Carreras Jorge L. 
Published: July 2016

AbstractObjective:To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria.Design:Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated.Setting:All six hospital-based helicopter services in North Carolina.Type of participants:All available flight records for November and December 1989.Interventions:None.Measurements and main results:Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively.Conclusions:Review of all flights over a period of two months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.
Physician Integration into Mass Gathering Medical Care: The United States Air Show
Authors: Boyle Michael F. , De Lorenzo Robert A. , Garrison Richard 
Published: July 2016

AbstractIntroduction:Limited information exists concerning physician staffing at mass gathering events.Methods:A retrospective review of the preparation, planning, and provision of medical care for the United States Air Show was performed. Patient encounters from the air show for the years 1981–1991 also were evaluated.Results:The frequency rate of overall encounters was 8.45 patients/10,000 spectators and hospital transport rate was 0.6/10,000 spectators. The majority of complaints were related to heat or minor injuries. During this period, emergency physicians played a vital role in both medical planning and on-site staffing. Emergency medicine residents also participated. A small patient population received direct benefit from on-site physician intervention.Conclusion:The on-site emergency physician is of benefit in event preplanning and reducing the burden on the EMS system during mass gathering events.
Prehospital Treatment with Dobutamine
Authors: Oberg Bjarne , Sorensen Mogens Bredgaard 
Published: July 2016

AbstractPurpose:To assess the effectiveness of the use of dobutamine hydrochloride in out-of hospital emergency situations.Population:Patients with severe circulatory insufficiency caused by acute illness or injury encountered by the Mobile Intensive Care Unit of Copenhagen (population 467,000) during a 15-month study period.Methods:A newly developed dobutamine solution was administered by infusion pump to patients in whom normal emergency treatment failed to restore an acceptable circulatory state.Results:A total of 40 patients were treated with 4–48 μg dobutamine/kg/minute. The treatment was judged to be primary life-saving in 15 patients, the condition was improved in 16 patients, and nine patients died. Systolic blood pressures (in those who survived) rose from a mean value of 45 mmHg (range 0–80 mmHg) to 105 mmHg (range 65–180 mmHg). No tachycardia or arrhythmias were noted.Conclusion:This newly developed dobutamine solution is very useful in prehospital treatment of patients with circulatory failure and is recommend for use by mobile intensive care unit teams.
The 1989 Loma Prieta Earthquake: Issues in Medical Control
Authors: Palafox Jorge , Pointer James E. , Martchenke Julie , Kleinrock Marie , Michaelis Janet 
Published: July 2016

AbstractIntroduction:The role of the base-hospital and on-line medical control in a disaster has not been investigated previously. This study assesses the roles of base-hospitals and the value and feasibility of on-line medical control during the 1989 Loma Prieta earthquake.Methods:The researchers studied five Bay Area counties most affected by the earthquake: San Francisco, Alameda, San Mateo, Santa Clara, and Santa Cruz. Researchers sent questionnaires to all 1,498 registered EMTs and paramedics in these counties; 620 were returned (41.4%). Respondents answered questions about activities performed, contacts with base-hospitals and other agencies, and problems encountered the night of the earthquake. Researchers selected 63 paramedics for in-depth interviews based on their performance of significant advanced life support (ALS) activities performed during the disaster. The coordinators of the 13 base-hospitals (BHCs) in the region also received and returned questionnaires about medical control, base-hospital roles during the disaster, and problems encountered. Researchers interviewed all five county emergency medical services (EMS) agency directors.Results:The surveys of EMS directors, base-hospital coordinators, and paramedics indicate that confusion existed over the status of medical control after the earthquake. There was general agreement among base-hospital coordinators (BHCs) that suspension of medical control is appropriate in a major disaster.Three bases had appropriate equipment to function as back-up dispatch centers. Eight bases had adequate personnel, but only one BHC felt his personnel had adequate training to function in a dispatch capacity. Nine paramedics did not start or continue resuscitation on patients whom they ordinarily would have begun resuscitation.Conclusion:Emergency medical services should suspend medical control immediately following a major disaster and ensure that all prehospital and base personnel are notified. Disrupted communications protocols for prehospital personnel should reflect the skill and knowledge level of paramedics and the need for rapid, advanced practice in a disaster. Disaster planners should consider other roles for base hospitals in major disasters.
Adverse Events during Interfacility Transfers by Ground Advanced Life Support Services
Authors: Wuerz Richard , Meador Steve 
Published: July 2016

AbstractObjective:To identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS).Design:A four-year, retrospective, case series.Setting:Three ALS units in a rural/suburban emergency medical services (EMS) system.Participants:351 transports to or from twelve acute care facilities; two patients records could not be located.Interventions:Patients were classified by illness/injury, transporting staff, and ongoing therapy; these were correlated with frequency of ALS intervention and patient deterioration.Results:During the study period, the number of transfers as a percentage of total calls (1.1%–5.2%) rose consistently. There were 11 illness/injury categories; the largest was cardiac (44%, 154 patients). Hospital staff accompanied the patient in 15% (52). Advanced life support (ALS) therapy was required in 4.9% (17): one monitored cardiac arrest was defibrillated successfully, 13 patients required unanticipated medication therapy, and three were noted to have clinical deterioration en route. The upper 95% confidence limit for cardiac arrest is 12.9/1,000 transfers or 20.8/1,000 hours. Patient deterioration and the need for ALS intervention were associated with the presence of medication infusions (p <.O5), but not with hospital staff (p >.40).Conclusions:Interfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.
Humanitarian, Noncombat Role for the Military
Authors: Gunn S. William A. 
Published: July 2016

This paper is being composed on Olympic Day 1994, exactly 10 years after its historic flame illuminated the skies of Sarajevo for a festival of peace and friendship. Today, the flames sadly come from incendiary bombs, shell streaks, and fratricide hatred. Against this tragic degradation, the role of the military and the international community has been changing from that of aggressive interference to one of humanitarian assistance and negotiated settlement. In this new setting, disaster and emergency medicine have a special opportunity to prove a noble calling and obligation.Conflict, unfortunately, and help, fortunately, are as old as humanity. The thoughts expressed herein concern the latter aspect with special reference to the military. As long as man has had a heart, some adrenaline, and the physiological reflex for protection, he has had compassion and an urge to bring succor to those who suffer. The sufferer may be a friend or he may be an enemy, but in humanitarian medical actions, there is no foe.
Review of Accidents/Injuries Among Emergency Medical Services Workers in Baltimore, Maryland
Authors: Gershon Robyn R.M. , Vlahov David , Kelen Gabor , Conrad Bruce , Murphy Larry 
Published: July 2016

AbstractObjectives:To characterize the types of occupational exposures and injuries reported by emergency medical service (EMS) workers.Methods:A blinded review of accidents/exposures among EMS workers employed by a Baltimore County fire department was conducted. Medical records for 1992 were reviewed.Results:Two hundred and twenty-six reports were filed by EMS workers (n = 197) employed by a large, urban fire department in 1992. The most commonly reported injuries were sprains (23%), strains (20%), and exposure to blood and body fluids (15%). The body site most commonly injured was the back (20%) followed by the respiratory system (10%). Most incidents were treated at the employee health clinic, and 13% of the incidents resulted in a hospital visit. Fifteen percent of the injuries resulted in more than seven lost work days. Most incidents were caused by stretcher mishaps, especially during transport of heavy patients. Walkway impediments (e.g., icy steps, wet leaves, broken and uneven pathways) also played an important role in creating slipping and tripping hazards.Conclusion:These results suggest a variety of prevention strategies aimed at reducing accidents and exposures among EMS workers.
Can Correct Closed-Chest Compressions Be Performed During Prehospital Transport?
Authors: Stone C. Keith , Thomas Stephen H. 
Published: July 2016

AbstractIntroduction:The resuscitation rate from out-of-hospital cardiac arrest is low. There are many factors to be considered as contributing to this phenomenon. One factor not previously considered is the impact of a moving ambulance environment on the ability to perform closed-chest compressions.Hypothesis:Proper closed-chest compressions can be performed in a moving ambulance.Methods:A cardiopulmonary resuscitation (CPR) training mannequin with an attached skill meter (Skillmeter ResusciAnnie®, Laerdal, Armonk, N. Y., USA) that measures each chest compression for proper depth and hand placement was used. Ten emergency medical technician-basic (EMT-B) certified prehospital providers were assigned into one of five teams. Each team performed a total of four sessions of five minutes of continuous closed-chest compressions on the mannequin. Two sessions were done by each team: one in the control environment with the mannequin placed on the floor, and the other in the experimental environment with the mannequin placed in the back of a moving ambulance. The ambulance was operated without warning lights and siren, and all traffic rules were obeyed. The percentage of correct closed-chest compressions was recorded for each session, and the mean values were compared using Student's t-test with alpha set at 0.01 for statistical significance.Results:Ten sessions of compressions were done in both environments. The mean percentage of correct compressions was 77.6 ±15.6 for the control group and 45.6 ±18.3 for the ambulance group (p = 0.0005).Conclusion:A moving ambulance environment appears to impair the ability to perform closed-chest compressions.
Spirituality of EMTs: A Study of the Spiritual Nature of EMS Workers and Its Effects on Perceived Happiness and Prayers for Patients
Authors: Backus Candace J. , Backus William , Page David I. 
Published: July 2016

AbstractIntroduction:There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients.Purpose:This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness.Methods:Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies.Results:Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62 % pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p <0.025>0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182,p<0.025>0.005).Conclusion:Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.
Prehospital Transport Time and Mode of Transportation in Zenica, Bosnia
Authors: Tom Prentice A. , Music Lejla 
Published: July 2016

AbstractStudy Objectives:To provide a descriptive analysis of the prehospital emergency medical transportation system operating in and around a major Bosnian city, and to discuss the effect of the war on that transportation system.Design:A prospective, consecutive sample study.Setting:The largest tertiary-care referral hospital currently operating in central Bosnia.Participants:158 consecutive patients who sought care in the trauma and medical receiving rooms at Zenica Hospital.Method and Measurements:Patients were surveyed as to time of transportation to the site of first medical care and to Zenica Hospital, and modes of transportation used.Results:Time to transport to first care within the city of Zenica is 30±21 minutes. Time to transport to Zenica Hospital from within Zenica is 51±39 minutes. Time to transport to first care outside of Zenica is 77±56 minutes. Time to transport to Zenica Hospital from outside the city of Zenica is 178±94 minutes. The prehospital emergency medical service was used in 11.7% of cases reviewed.Conclusion:The majority of patients with major injury and illness are unable to obtain prehospital transportation and medical care through informal modes of transportation. The existing prehospital emergency medical services system is inadequate for the numbers of patients requiring such services, and transportation time from outside the city of study is especially prolonged.