bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Physician in a Helicopter Emergency Medical Service
Authors: Schwartz Robert J. , Jacobs Lenworth M. , Lee Margaret 
Published: July 2016

AbstractThe purpose of this study was to measure the contributions of a physician crew member in a helicopter emergency medical service (HEMS) and to develop a method to utilize physician services more efficiently. A two-part study utilizing two independent sets of measurements of physician necessity was conducted. A post-flight questionnaire and the success rate for endotracheal intubation were used as measurement tools.With the passage of time, the fight nurses perceived the physician crew member' contribution to clinical judgment decreased from 21% to 1% of the flights and that the physician's contribution of technical skills (intubation) declined from 11% to 3%. The contribution to clinical decisions seemed more important on interhospital transports than on scene responses. The technical skills (judged by the tracheal intubation success rates) of a physician seemed more cogent on responses to the scene. When in the capacity of a second crew member with an experienced flight nurse, the endotracheal intubation success rate increased from 71% to 90%. Therefore, it seems that physician services could be restricted primarily to scene response flights. This limited utilization of flight physicians should make these physicians available for other duties.
Prehospital and Emergency Department Verification of Endotracheal Tube Position Using a Portable, Non-Directable, Fiberoptic Bronchoscope
Authors: Hutton Kevin C. , Verdile Vincent P. , Yealy Donald M. , Paris Paul M. 
Published: July 2016

AbstractVerification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be “difficult.” FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.
Correlation between Motor Vehicle Mortality Rate and Density of Medical Resources
Authors: Maio Ronald F. , Burney Richard E. , Lazzara Scott , Takla Robert B. 
Published: July 2016

AbstractAn inverse correlation has been reported between motor vehicle crash mortality rate (MVCMR) and population density. The reasons for this are unknown, but variations in prehospital and hospital resources are a possible explanation.Hypothesis:Densities of prehospital and hospital resources correlate inversely with motor vehicle crash mortality rates.Methods:Data regarding population, area, number of motor vehicle deaths, and number and types of hospital and prehospital care resources for 1987, were obtained from the Michigan State Department of Public Health and transformed to create measures of resource per square mile by county. Correlation coefficients were computed between motor vehicle death rate and medical resource densities.Results:Small negative correlations were seen for all variables. Correlation coefficients ranged from -0.224 (EMTs per sq mi) to -0.167 (beds per sq mi). Only the coefficient for EMTs per square mile was statistically significant (p=0.043).Conclusion:Small negative correlations exist in Michigan counties between MVCMR and medical resources. We conclude that only a small proportion of MVCMR variation can be accounted for by the density of medical resources.
Effects of Early Prehospital Life Support to War Injured: The Battle of Jalalabad, Afghanistan
Authors: Husum Hans 
Published: July 2016

AbstractObjective:To study the effects of early, advanced prehospital life support on the survival rate of war casualties during the battle of Jalalabad, Afghanistan from 1989–1992.Method:The outcomes of simple trauma care administered from 1989–1990 were compared to the outcomes of advanced trauma care administered from 1991–1992 in the combat zone. The outcomes were measured by the number of deaths at admission to the referral surgical hospitals in Pakistan.Results:A total of 3,890 war casualties were treated in the combat zone by paramedics, and were evacuated through light, forward, field clinics to surgical hospitals in Pakistan. Advanced trauma care that was administered in the combat zone reduced the prehospital mortality rate from 26.1% to 13.6% (95% confidence interval for difference = 9.7–15.4%).Conclusion:In scenarios with protracted evacuation, early and advanced trauma care should be included in the chain of survival. Local paramedics can provide such trauma care with a minimum of resources.
Adenosine Conversion of Supraventricular Tachycardia Associated with High-Dose Epinephrine Therapy for Cardiac Arrest
Authors: Gerhardt Robert T. , Furlong Richard , Schrank Kathleen , Ress Bradford D. 
Published: July 2016

AbstractAdenosine has received wide acceptance as the drug of choice for initial treatment of supraventricular tachycardias (supraventricular tachycardia), and as a diagnostic adjunct in hemodynamically stable, wide-complex tachycardias. This report describes the successful use of adenosine for the treatment of supraventricular tachycardia occurring after successful initial resuscitation from ventricular fibrillation, in which a high dose of the epinephrine protocol was used.
Predictors of Demand for Emergency Prehospital Care: An Australian Study
Authors: Clark Michele J. , Purdie Jennifer , FitzGerald Gerry J. , Bischoff Noelene G. , O'Rourke Peter K. 
Published: July 2016

AbstractIntroduction:Determining the predictors of demand for emergency prehospital care can assist ambulance services in undertaking policy and planning activities.Hypothesis:Demand for prehospital care can be explained by demographic, health status, and economic determinants.Methods:The study used a cross-sectional design to investigate the association of demographic, health status, and insurance factors with the use of prehospital, ambulance care. Core data items including age, gender, marital status, country of origin, triage score, diagnosis, time of presentation, method of arrival, and patient disposition were collected for every patient who pre-sented at the Emergency Department of the study hospital over a four-month period. Ambulance usage was analysed using Poisson regression.Results:For the 10,229 patients surveyed, only a small number were triaged as having the highest level of urgent medical need (0.8%), but the majority of these used prehospital emergency medical care (90.2%). Predictors of ambulance use included age >65years (Prevalence Ratio [Prevalence Ratio] = 2.92; 95% confidence interval [ Confidence Interval]: 2.35–3.63), being married or in a defacto relationship (Prevalence Ratio = 0.69; 95% Confidence Interval: 0.60–0.79) or divorced, separated, or widowed (Prevalence Ratio = 0.83; 95% Confidence Interval: 0.70–0.98), triage score level 1 or 2 (Prevalence Ratio = 1.95; 95% Confidence Interval: 1.68–2.28), or triage score level 3 (Prevalence Ratio = 1.54; 95% Confidence Interval: 1.38–1.72), diagnosis involving either mental (Prevalence Ratio = 4.29; 95% Confidence Interval: 1.84–10.01), nervous (Prevalence Ratio = 2.74; 95% Confidence Interval: 1.19–6.31) or trauma (Prevalence Ratio = 2.33; 95% Confidence Interval: 1.03–5.27) conditions, and insurance status (Prevalence Ratio =1.54; 95% Confidence Interval: 1.40–1.71). Ethnicity, gender, and time of day were not associated with usage.Conclusion:Demand for ambulance services can be predicted by a number of demographic, medical status, and insurance variables. Age and triage levels are key influences on demand for ambulance services. Ambulance insurance status provides an economic incentive to use ambulance services regardless of the urgency of the medical condition.
Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study
Authors: Richards John R. , Ferrall Stephen J. 
Published: July 2016

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.
Fred C. Cuny Memorial Continuing Education Series: Principles of Disaster Management Lesson 6: Personnel and Personnel Management
Authors: Cuny Fred C. 
Published: July 2016

AbstractRelief operations require capable resposible staff. This lesson discusses the types of staff and workers required. It stress the importance of employing locals an refugees infilling many of these positions and examines the role of volunteers, paid personnel, and expatriates and the issues involved.
Age-related Utilization of Advanced Life Support Services
Authors: Meador Steven A. 
Published: July 2016

AbstractPurpose:To investigate the relationship between age and Advanced Life Support (ALS) utilization.Population:All patients from 1 January 1987 to 31 December 1988 transported by ALS ambulances within Lebanon County, a rural/urban county of 112,000.Methods:All runs resulting in patient treatment by ALS personnel were tallied at five-year age intervals and sub-grouped by trauma- and non-trauma-related calls. Utilization rates for each age group were obtained by dividing the calls by the population of each group. Correlation with age was tested by Spearman's rank correlation. Treatment rates for age groups were calculated for the six most frequent medical etiologies. To illustrate the effect of age distributions, age rates were applied to projected state and national population distributions.Results:There was a significant correlation with age for all transports (p < .01; r=.93) and for those not related to trauma (p<.01; r=.98). Correlation was not detected for trauma-related responses (p>.10; r=.19). Non-trauma-related case incidence varied among age groups, ranging from 1.1/1,000 for age five through nine years to 89/1,000 for age 80–84 years. Congestive heart failure, cardiac ischemia, syncope, myocardial infarction, and cardiac arrest evidenced increased incidence with age. Seizure did not. Older populations had a higher projected utilization of ALS services than did the younger age groups.Conclusion:Non-trauma ALS utilization is highly dependent on the age of the patient. Due to projected aging of the population and increased utilization of ALS by the elderly, projected utilization will increase at a rate faster than will the population. Age:rate data can be combined with population projections to estimate future need.
Improving Reliability of Abstracted Prehospital Care Data: Use of Decision Rules
Authors: Maio Ronald F. , Burney Richard E. 
Published: July 2016

AbstractOur experience suggests that even with standard definitions, information on ambulance report forms may be abstracted inconsistently.Hypothesis:The use of written decision rules will improve agreement between paramedics abstracting data from records of prehospital cardiac arrest.Methods:Sixty-three ambulance reports were selected by a random sample of all out-of-hospital cardiac arrests. Four paramedic abstractors each were given a set of definitions for use in abstracting data and one pair, randomly assigned, also was given a set of decision rules. Abstractors recorded whether there was: (1) underlying cardiovascular disease; (2) a witnessed arrest; (3) bystander CPR; and (4) the presenting rhythm. Agreement between pairs of abstractors was determined by computing kappa values.Results:Kappa values for each variable, for abstractors without and with decision rules were: (1) 0.23, 0.33; (2) 0.39, 0.41; (3) 0.43, 0.66; and (4) 0.65, 0.80. Kappa values consistently were higher for the pair of abstractors using decision rules. The degree of improvement varied with the difficulty of the decision required.Conclusion:The addition of decision rules to variable definitions is worthwhile but does not ensure good or excellent levels of agreement in data abstracted from records by paramedics.
Analysis of Prehospital Scene Time and Survival from Out-of-Hospital, Non-Traumatic, Cardiac Arrest
Authors: Spaite Daniel W. , Criss Elizabeth A. , Valenzuela Terence D. , Meislin Harvey W. , Ross John 
Published: July 2016

AbstractThe purpose of this study was to determine whether shorter prehospital scene time (ST) is associated with an increased survival rate in non-traumatic, out-of-hospital, cardiac arrest (CA) in a medium-sized, metropolitan EMS system. Information was retrieved for all adult victims (age ≥18 years) of CA treated and transported by a metropolitan fire department over a 16month period (6/87–9/88). Data were retrieved from the fire department's database, hospital records, and death certificates. Statistical analysis of continuous variables was performed using the two-tailed, Student's t-test and non-parametric evaluations were performed by square analysis with p<0.05 considered significant. Two hundred ninety-eight cases were recorded of which 293 patients (98.3%) had documented ST (study group). Seventy-nine patients (27.0%) had ST <12 minutes, while 214 (73.0%) had ST≥12 minutes. Patients with ST <12 minutes were more likely to have return of spontaneous circulation in the field (26.6% vs. 15.9%, p<0.05) and also were more likely to survive than were patients with ST ≥12 minutes (13.9% vs. 6.5%, p<0.05). Mean ST for survivors was significantly less than for non-survivors (12.8 vs. 15.3 min., p<0.05).We conclude that, in our system, adult victims of CA with ST <12 minutes are more likely to survive than are patients with longer ST. In addition, the mean ST for survivors is shorter than for non-survivors. It remains unclear whether shorter ST actually has an impact on survival or is merely a reflection of a sub-group with rapid resuscitation and consequently a higher likelihood of survival. Future investigations are needed to determine whether shorter ST actually impacts the likelihood of survival from CA.
Diagnosis of Premature Ventricular Complexes: Common and Often Forgotten Rules
Authors: Jansen Diana J. , Robinson Nancy E. , Birnbaum Marvin L. 
Published: July 2016

Prehospital and hospital emergency medical care providers frequently rely on the electrocardiogram (ECG) to assist them in the differential diagnosis of complex patient problems and as such, the ECG often constitutes a major determinant of the definitive treatment selected. The purpose of this exercise is to review a small portion of the vast area of ECG interpretation: specifically, those rules that guide the practitioner in the diagnosis of Premature Ventricular Complexes (PVCs).Premature ventricular complexes (PVCs) occur in multiple individuals in multiple settings. Due to these differences, the causes, implications, and treatment of PVCs must be individualized. Thus, the scope possible for this discussion is huge. Consequently, this exercise will focus only on helping the practitioner correctly identify PVCs.
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 two 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±46 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.
Measures for Increased Nutrition and Utilization of Non-Conventional Food Resources during Disasters in Africa
Authors: Nur Idris M. 
Published: July 2016

AbstractThe basic causes of the poor performance of the food and agricultural sector in the different parts of Africa are external, internal, and natural. The general recession in the Continent limits the capacity of the respective countries to import food to supplement inadequate domestic production and supplies.There are a number of nutritious food resources, both cultivated and gathered in the different ecological zones of Africa, whose production and consumption can be increased to ensure adequate food security and a nutritious diet, especially during disasters. These food resources could include: cereals, legumes, fruits, vegetables, fish, and insects. These food resources already are available over wide geographical areas in Africa and are utilized or utilized to a limited extent.Therefore, strategies to increase food supply, eradicate hunger and malnutrition, and keep people alive in times of disasters should have as a priority, the cultivation and consumption of non-conventional food resources in the respective communities and countries.
DC Defibrillators: The Difference Between Selected and Delivered Energy
Authors: Shiner Stephen L. , Gold Martin I. 
Published: July 2016

AbstractThere is controversy over the “ideal” electrical energy needed for defibrillation. Furthermore, too massive an electrical shock decreases the possibility of survival by direct damage to an already ailing myocardium and too little energy results in further deterioration of myocardial physiology and metabolism. Therefore, delivery of an erroneous amount of electrical energy decreases the likelihood of successful defibrillation and survival. All 190 defibrillators within 3 medical school hospitals were investigated. Each defibrillator was analyzed at four selected settings ranging from 100-400 Joules (J). Only 29 of 190 defibrillators delivered 100% of the energy selected, while 161 of the 190 (85%) delivered an average of 74% of the energy selected. This discrepancy between selected and delivered energy should be corrected by regulations and standards for manufacturers.
Training Course in First Aid Under Disaster Conditions
Authors: Korver Adriaan J.H. 
Published: July 2016

Under the auspices of the Organization for Civil Defence, the Netherlands Red Cross and the National Union for Lifesaving and First Aid “The Orange Cross”, a training course in First Aid under Disaster Conditions was started in 1979.This training course is meant for laymen, who, after having obtained their First Aid certificate, will participate in the medical care of disaster victims. The contents of the training course are discussed. In order to obtain a clear insight into the training course, attention is also paid to the Medical Disaster Relief Organization.
1980 Earthquake in Basilicata
Authors: Molfese Antonio 
Published: July 2016

On November 23rd, 1980 at 7:34 p.m. a violent earthquake, 6 on the Richter scale, hit the South of Italy, at precisely the Regions of Campania and Basilicata. The shock lasted 80 seconds, causing death and destruction.Basilicata, one of Italy's Southern Regions, has already been hit by several other earthquakes in the past, which seriously damaged its population and territory. It is a most mountainous region, with the only exception being a very small plain stretching towards the sea.
Pre-Earthquake Vulnerability Assessment
Authors: Eldar Reuben , Adler Jakov 
Published: July 2016

AbstractHealth planning for disasters builds on an awareness of ways in which the disaster affects health and on anticipation of tasks to be performed by the health sector.In view of the possibility of an earthquake of significant magnitude in Israel, and in the absence of previous earthquake experience, published data of earthquake health effects were studied, such as causes of death and injury, casualty rates and factors influencing these, distribution of injuries and their severity, effect on health care facilities and on physical, social and psychological environments. Implications of the studied data were applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, and space and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel.On the basis of this assessment some recommendations for the preparation and preparedness of the health sector for such an occurrence are submitted.