bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computer Modeling of Rural Emergency Medical Services Delivery Systems
Authors: Shuman Larry J. , Sepulveda Jose , Wolfe Harvey , Esposito Gerald 
Published: July 2016

RURALSIM is a sophisticated computer simulation model designed as an aid in planning and evaluating rural emergency medical services (EMS) systems. Written in SIMULA, it has been successfully used in Indiana County, Pennsylvania, to study the potential effects of changes in existing vehicle placement and relocation strategies, vehicle dispatching policies and alternative forms of prehospital care, including the ability of the system to respond to a disaster.RURALSIM is a stochastic, dynamic, event-oriented computer model. Stochastic means that all random events, such as the occurrence of an incident, are generated according to appropriate probability distributions obtained from empirical data. Dynamic means that events occur over time and that the model selects the appropriate incident rates and response strategies for the particular time and day simulated.
Investigations of Vital Functions of Severely Injured Patients in the Early Period after Trauma
Authors: Schmitz J. E. , Ahnefeld F. W. , Grunert A. , Kilian J. , Dick W. 
Published: July 2016

The main aim of the primary treatment of polytraumatized patients at the accident site is the stabilization and maintenance of vital functions, especially the cardiocirculatory and the respiratory systems. The next step in the rescue chain is rapid transport to the nearest hospital with the ability to manage critically injured patients. Because of the difficulty in carrying out measurements in such critical situations, very little reliable data concerning trauma induced changes in respiratory function and metabolism is available. Clinical experience has shown that even after successfully recovering from the acute stress phase, a trauma related progressive respiratory distress syndrome can nevertheless develop during the first few days following injury.Recent studies led to the conclusion that the late development of respiratory distress syndrome is already induced during the early shock phase. Early discovery and adequate treatment of trauma related metabolic and respiratory dysfunctions have a decisive influence on current status and outcome.
Emergency Cervical Splints — Their Value and Limitation
Authors: Marsden Andrew K. 
Published: July 2016

A good deal of controversy currently surrounds the role of collars and extrication devices in the on-site immobilization of suspected injuries to the cervical spine. The plethora of manufactured items readily available for this purpose reinforces the general impression that no one device is universally acceptable.In his book,Spinal Cord Injuries–Comprehensive Management and Research, Sir Ludwig Guttman stressed the importance of keeping all cervical movements to a minimum. Flexion, hyperextension and rotatory movements are particularly dangerous. The most difficult circumstances are those in which an unconscious front-seat occupant requires extrication from a damaged motor vehicle. Here the strict first-aid drill of gentle lifting by a six man team maintaining rigid traction in the line of the spine becomes impracticable and the rescuers have to resort to the use of aids.
Area Disaster Planning in the UK: A Preliminary Report
Authors: Savage P. E. A. 
Published: July 2016

The title of my paper,Area Disaster Planning in the UK, is perhaps grandiose. However, while the need for disaster planning at hospital level is well-recognized, few studies have been published on the results of getting a number of hospitals in a metropolitan area to co-operate in planning on a larger scale.Following a series of railway accidents, the Ministry of Health in the UK issued a memorandum in 1954 to hospitals in the National Health Service on the arrangements hospitals should make for dealing with major accidents. The main points of this memorandum were that ambulance authorities should be told which hospitals in an area were able to receive casualties; that suitable hospitals should send a senior doctor to the site together with mobile medical teams; and that one doctor at a hospital should be in charge of all the medical arrangements.
The Role of Amateur Radio in National and International Disasters
Authors: Higgins Lawrence S. , Smith Jan D. 
Published: July 2016

Appreciation of reliable commuications might seem universal; yet when natural disasters strike, few communities are equipped to handle these essential needs. In many instances their ability to notify the rest of the world about their disaster is seriously impaired. Why this is so and why Amateur Radio Operators, or “hams”, always seem to play such a vital part in community survival is the topic of this article.The best communication systems can fail from traffic overload. As an example, there may be little if any loss of telephone lines or commerical radio links; yet the local population can totally paralyze a system simply by picking up the phone and calling someone. An analogy to this stoppage of communications traffic is seen daily on our expressways as too many cars enter and exceed some critical density at which all traffic must stop.
Terrorist Bomb Explosion at 1980 Oktoberfest in Munich
Authors: Konzert-Wenzel J. , Bartels H. 
Published: July 2016

On September 26, 1980, at 22:19, a bomb exploded at the main entrance to the Oktoberfest in Munich. The bomb, which had been put together by an apparently politically motivated individual, had planted at waist level in a litter bin. Reconstruction from the fragments found at the site and in the bodies of the victims indicated that the bomb was made from a British mortar projectile, manufactured in 1954, which had been modified to ensure particularly intensive fragmentation. The area affected by the explosion was the size of a soccer field. The effects of the explosion were extremely severe (Figures 1-3): 13 fatalities and approximately 225 nonfatal casualties, of which approximately 50 were severely injured.Thanks to quick, accurate reporting of this major disaster to the Munich Emergency Control Center, which acts as the central coordinating point in case of emergencies, a contingency plan was put into action, which had proved to be effective for disasters involving more than 35 injured. This plan calls for the dispatching of 5 ambulances staffed with physicians, all other available ambulances and the alerting of all hospitals which may have to receive casualties.
Experiences of Critical Medical Care After the Earthquake in China in 1976
Authors: Yung Shieh 
Published: July 2016

A strong earthquake occurred in the Tangshan-Fengnan area in Hopei Province of North China at 03:42 hours on July 28, 1976. A general headquarter was set up immediately to perform the functions of organization and administration. This was the most essential authority in keeping everything in order in such a disaster area. Mine Rescue Corps and mobile medical teams from many parts of the country were called and rushed to the scene. Critical care was organized into 3 stages: (1) digging and rescue; (2) preliminary treatment and transfer; and (3) treatment after transfer.The Mine Rescue Corps, existing normally in every coal mine, was the most efficient and valuable element in digging out victims and carrying out the most urgent resuscitative management. They dug and rescued, and also patrolled in the pits. They cleared the way for the coal miners. More than 10,000 miners, who were working in the pits during their night shift, were less able to return to the ground safely. As it was very difficult to locate every working group in such a labyrinth pits system, some coal miners had been left in the pits for long periods of time. There were, for instance, five coal miners who were working 850 meters underground and could not find their way out because the pits were badly damaged.
55. Analysis of Calls Under-triaged by Priority Medical Dispatch in San Diego
Authors: Strukel W. Eric , Dunford James V. 
Published: July 2016

Purpose: To identify calls “under-triaged” by priority medical dispatch and determine causes and pre-hospital outcomes.Methods: 6 month retrospective analysis identified calls dispatched “low priority” to which medics assigned “high acuity” transports (acute status or requiring ALS meds; not just IV/O2/monitor). CAD data, paramedic run-sheets, and audiotapes were reviewed to determine optimal dispatch levels and transport codes. “Under-triage” was defined as calls warranting “high priority” dispatch based on evidence from the run-sheet. Dispatcher, calling party, and patient data influencing “undertriage” were assessed.Results: In 1995, 11,178/70,887 (16%) medical aid requests were dispatched “low priority”. 201(1.8%) were subsequently assigned “high acuity” transport codes by paramedics. 105/5,737 such consecutive patients were analyzed from July-December 1995. 6 were excluded due to incomplete data. After review, 42/99 actually warranted “high priority” dispatch. 7 had potential life/limb threatening injuries; 35 required ALS intervention. None had adverse prehospital outcome. Undertriage was associated with dispatcher error, information relayed from law enforcement officers (OR =3.4, CI: 1.2-10) calls involving alcohol (OR = 2.8, CI: 0.9-9.2) or patients with ALOC(OR= 3.4, CI: 1.2-10).
20. Circadian Variation in Paramedic-Initiated Turndowns to Basic Life Support
Authors: Rubin Jonathan M. , Pirrallo Ronald G. 
Published: July 2016

Objectives: Paramedic-initiated turndowns-to-BLS are a high-risk area for EMS. One non-clinical factor that might affect paramedics’ decision-making is a 24-hour work schedule. We attempted to determine the presence of circadian variation in the turndown rate from ALS to BLS when paramedics work 24-hour shifts.Methods: Retrospective analysis of all 1994 ALS patient evaluations. Encounters were classified as: ALS transport; turndown-to-BLS; patient-initiated refusal of transport; other transport; field death. Analysis of variation in turndown rate by hour of ALS dispatch was performed using logistic regression to make paired comparisons for each hour.Results: 17,877 patients were evaluated by ALS. Of these, 10,956 (61%) were ALS transports, 6,200 (35%) were not transported by ALS, and 721 (4%) were dead. Of the 6,200 alive non-ALS transports, 4,291 (69%) were turned down to BLS, 1,748 (28%) refused transport, and 161 (3%) were transported by others. One turndown-to-BLS was excluded due to missing dispatch time; for the remaining 4,290 the overall turndown rate was 25%. The turndown rates for 15 of 24 hours did not differ significantly (p >0.01) from any other hour. The rates at the following hours differed significantly: hour 3 < 13; hour 5 < 8,9,10,13,16,22; hour 9 > 20,22; hour 10 > 22; hour 13 > 20,22; hour 16 > 20,22.
66. Field Research in EMS: Who is Doing the Work?
Authors: Johnson David R. , Napier Mark B. 
Published: July 2016

Purpose: To determine what types of EMS systems (public vs. private) are contributing to the peer reviewed field research in EMS and what type of research is being done by these agencies.Methods: A Medline literature search was conducted of all peer reviewed journals using the search terms: EMS, emergency medical services, EMT, paramedic, and ambulance. Studies published between 1976 and 1995 meeting these criteria were reviewed and classified as field or non-field studies. Studies were classified as field studies if they evaluated clinical outcomes or overall EMS system structure and performance. The type of EMS system in which the study was conducted was classified as: public (PB), private (PR), or a mixture of public and private agencies (PP). If the type of system was not evident in the paper, the primary author or EMS agency was contacted by phone. The primary affiliation of the first author was classified as being with: an educational institution, hospital, government agency, or EMS agency. Each study was also classified as being primarily clinical or evaluating EMS system structure. Review articles, editorials, and meta-analyses were excluded as were studies in which critical data elements could not be verified. Fischer's exact test was used for statistical analysis.Results: A total of 365 studies were evaluated with 66 non-field studies being excluded from analysis. 75 studies did not meet inclusionary criteria. This left 224 studies for analysis. PB systems accounted for 167 (74.5%) of field studies, with PP 44 (19.6%) and PR 13 (5.8%). Clinical studies were more commonly done by PB systems (72.5%) when compared to PR systems (38.5%), p = 0.02. System structure studies accounted for the majority of studies done by PR systems (61.5%). An affiliation with an educational institution such as a university occurred in 61.2% of the studies. The number of field studies done by PB systems has increased steadily over the last 10 years while field studies published by PR and PP systems has remained at a low level, with none published from 1992–1994.
05. EMS and the Pediatric Arrest: Are EMTs Getting the Whole Story?
Authors: Graham Susan , Olson Lenora , Sapien Robert , Tandberg Dan , Sklar David 
Published: July 2016

Purpose: Among pediatric patients, cardiopulmonary arrests account for a small, but important, percentage of responses by emergency medical services (EMS). EMS prehospital assessment of medical and traumatic arrests in the pediatric patient were compared with that of the Office of Medical Investigator (OMI) autopsy reports to assess differences and implications for EMS training and prevention in pediatric arrests.Methods: Retrospective review of ambulance run forms from an urban EMS system with OMI autopsy correlation. Patients less than fifteen years of age and younger who were treated by prehospital personnel from November 1, 1990, to October 31, 1991, for a medical or traumatic arrest. Proportions were analyzed using chi-square analysis or Fisher's exact test and agreement was assessed using the Kappa statistic.Results: Ambulance runs were reported for 2,586 pediatric patients. Of these, forty-two (1.6%) suffered arrests, with thirty-two (76%) medical arrests and ten (24%) traumatic arrests. Children one year of age or less accounted for 75% of the medical arrests while children greater that one year of age accounted for 80% of the traumatic arrests (p = 0.003). Overall mortality was 81%. When EMS prehospital assessment of medical and traumatic arrests were compared with OMI reports, there was good agreement (kappa = 0.70) for Sudden Infant Death Syndrome (SIDS), but poor agreement (kappa = 0.37) for child abuse.
37. Mechanism of Injury is Not a Factor in Prehospital Clinical Evaluation of Potential Spine Injury
Authors: Domeier Robert M. , Evans Rawden W. , Swor Robert A. , Hancock J. Brian , Fales William , Krohmer Jon , Frederiksen Shirley M 
Published: July 2016

Objective: Traditional EMS teaching identifies mechanism of injury as an important predictor of spine injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with “a positive mechanism” clearly capable of producing spine injury. The purpose of this study is to determine if mechanism of injury effects the ability of clinical criteria to select patients with spine injury.Design: Multicenter Prospective Cohort.Methods: EMS personnel completed a check-off data sheet on out-of-hospital spine immobilized patients. Data included mechanism of injury and yes/no determinations of the clinical criteria: altered mental status, neurologic deficit, evidence of intoxication, spinal pain or tenderness, and suspected extremity fracture. Hospital outcome data included confirmation of spine injury and treatment required. Mechanisms of injury were tabulated and rates of spine injury for each mechanism was calculated. The patients were divided into high-risk and low-risk groups.Results: Data was collected on 6,500 patients. There were 213 (3.3%) patients with spine injuries identified. There were 1,065 patients with 100 (9.4%) injuries in the high-risk mechanism group, and 5435 patients with 113 (2%) injuries in the low-risk group. Clinical criteria identified 96 of 100 (96%) injuries in the high risk mechanism group and 106 of 113 (94%) in the low-risk group.
47. Comparison of Devices Used While Ventilating a Non-Intubated Mannikin Model
Authors: Updike Glenn , Mosesso Vince , Auble Tom 
Published: July 2016

Purpose: The purpose of this study was to determine if there were differences in tidal volume (Vt), minute volume (MV), average mask leak per breath (ML), gastric insufflation (GI), and peak airway pressure (PAP) when ventilating a non-intubated mannikin with a bag-valve (BV), manually triggered ventilator (MTV) and automated ventilator (AV). Our hypothesis was that there would be no differences among devices for any of these variables.Methods: This was a prospective in vitro experimental model. A convenience sample of 19 emergency medical technicians (EMTs) ventilated a non-intubated mannikin-mechanical test lung model with BV, MTV (flow rate 40 L/min; pressure relief 55 cm H2O), and AV (800 ml/breath; rate 12). Each subject, blinded to volume and pressure gauges, used each device for two minutes at both normal (0.1 cm H2O) and poor (0.04 cm H2O) compliances. Vt, MV, GI, and PAP were measured directly and ML was calculated. Data were analyzed with repeated measures ANOVA and Bonferoni-Dunn multiple comparison test with alpha set at 0.05.
59. The Epidemiology of Bridge Jumpers
Authors: Purpura Patti , Brice Jane H. , Delbridge Theodore , Shakir Abdulrezzak , Byrne Laurie , McCaughan Robert , Wecht Cyril , Kuntz Joanne 
Published: July 2016

Purpose: Treatment and prevention strategies regarding people who jump from medium height bridges over water could be optimized by an improved understanding of patient demographics and injury spectra. Currently, little is known about this EMS patient population. We sought to describe the demographics and injuries sustained by those who jumped or fell from medium height bridges.Methods: We searched the River Rescue and EMS reports of a medium size city for the ten year period 1986–1995 to identify cases involving a person who jumped/fell from a bridge into water. Additional cases were identified by searching coroner and trauma center registries. For each case, we reviewed applicable EMS, hospital, and coroner records to determine patient demographics, treatment provided, and injuries sustained.Results: We identified 76 cases of individuals who jumped/fell from bridges into water. Eighteen of the region's 24 bridges (40 to 100 feet high) were involved. Average patient age was 34.8 years, 87% were male, and 29% jumped during July. These jumps/falls resulted in 25 (33%) deaths and 22 (29%) uninjured persons. Of those who died, 18 (72%) drowned, sustaining no other detectable injuries. Hospitalized survivors and injured coroner cases suffered predominantly extremity and rib fractures, pneumo/hemothoraces, and closed head injuries. No neck injuries were identified. No patient whose advanced level EMS treatment exceeded basic monitoring and IV access survived.
60. The Impact of AEDs on Cardiac Survival in an Urban Out-of-Hospital Setting
Authors: Dhindsa Harinder S. , Fitzgerald Dennis , Milzman David , Bass Robert R. 
Published: July 2016

Introduction: Prior studies have documented less than 3% survival for out-of-hospital cardiac arrest (CA) in D.C. EMS intubation has failed to improve extremely poor survival rates for out of hospital CA. This study will investigate whether the addition of automatic external defibrillator (AED) use will improve the negligible survival rate experienced in a system that transports 80,000 pts/yr; Thus replicating success with AED for CA in other centers.Methods: Retrospective review of all CA data from D.C. EMS system from 1-12/91 (no AED) vs. 1-12/93 (AED in use). Supporting data from run sheets and hospital records was compared for years with and without the AED using student's t test, chi-square with p <0.05.Results: In 1991 there were 414 out of hospital CAs arrests with an overall survival rate of 2.3% with a mean EMS arrival time of 10 minutes. There were no significant differences with respect to CA patients’ age, bystander CPR or BLS/ALS response times between two years (1991 and 1993) p = NS. In VF patients who comprised 26% and 24% of presenting rhythms for ’91 and ’93 respectively, the use of AEDs improved survival 3.8% vs. 29% with AEDs in ’93 (p <0.05). There was no difference in percentage of non-VF presenting rhythms or patient outcomes between the two groups.
73. Lack of Prehospital Death Pronouncement by Air Medical Programs May Waste Health Care Resources
Authors: Tortella Bartholomew J. , Simon Robert , Lavery Robert F. 
Published: July 2016

Statement of Purpose: Prehospital death pronouncement policies are common among ground ambulances. No previous report has addressed such policies among Air Medical (AM) programs.Statement of Methods: Statement of Methods: Structured telephone interviews of 125 of 143 (87%) AM programs (14 fixed wing, 68 rotor wing, 43 both) were conducted by research staff from 6 to 8/95.Summary of Results: Summary of Results: Only fifty percent of AM crews are permitted to pronounce death in the field. Of those AM programs which permit pronouncement, direct medical command physician contact is required in 35% of pronouncements while 25% of programs utilize protocols. Of those AM programs which permit pronouncement, 77% of flight nurses can pronounce while only 33% of paramedics. Most programs (95%) conduct QA reviews of all deaths.Statement of Conclusions: Prehospital death pronouncement is permitted in only 50% of AM programs. Since prehospital death pronouncement may obviate the need for AM transport, AM programs may be transporting clinically dead but unpronounced patients wasting scarce medical resources. This differs greatly from ground EMS programs where death protocols are common. Particularly puzzling is the small percentage of flight paramedics who are allowed to pronounce when compared to flight nurses since ground EMS pronouncements are performed by paramedics. AM programs should review their prehospital pronouncement protocols since managed care initiatives will drive health care organizations to abandon the wasteful practice of transporting clinically dead, but unpronounced, patients.
Prevalence of tuberculosis, brucellosis and trypanosomiasis in cattle in Tanzania: a systematic review and meta-analysis
Authors: Alonso Silvia , Dohoo Ian , Lindahl Johanna , Verdugo Cristobal , Akuku Isaiah , Grace Delia 
Published: July 2016

AbstractA meta-analysis was performed to derive prevalence estimates for Brucella spp., Mycobacterium spp. and Trypanosoma spp. in cattle in Tanzania using data derived from a systematic review of zoonotic hazards in cattle production systems. Articles published before 2012 reporting prevalence and considered at least moderate in quality were included in the analysis. Results showed high heterogeneity between studies, with wide ranges in the reported prevalence: Brucella (0.3–60.8%), Mycobacterium (0.1–13.2%) and Trypanosoma (0.82–33.3%). Overall meta-analytic mean prevalence estimates were 8.2% (95% CI 6.5–10.2), 1.28% (95% CI 0.35–4.58) and 10.3% (95% CI 6.20–16.70) respectively, for Brucella spp., Mycobacterium spp. and Trypanosoma spp. Time and region were predictors of variability of Brucella spp. prevalence, while diagnostic test was a strong predictor of Mycobacterium spp. prevalence, with higher prevalence estimates given by skin tests compared with post-mortem inspection. None of the studied factors were associated with prevalence of Trypanosoma spp. The small sample sizes, range of study locations, study designs and diagnostics used, contributed to high variability among prevalence estimates. Larger and more robust prevalence studies are needed to adequately support risk assessment and management of animal and public health threats.