bluuebunny/crossref_metadata_2025_split huggingface dataset:
Y2K Medical Disaster Preparedness in New York City: Confidence of Emergency Department Directors in their Ability to Respond
Authors: Silber Steven H. , Oster Neill , Simmons Bonnie , Garrett Christopher 
Published: July 2016

AbstractObjectives:To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model.Methods:Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness.Results:The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management.Conclusions:Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.
Job Satisfaction in EMS: A Different Approach
Authors: Wirth Stephen R. 
Published: July 2016

AbstractThere has been limited organizational research applied to EMS, especially in the area of job satisfaction. In the midst of a general shortage of health care workers, effective recruitment and retention of a qualified and satisfied work force is a critical issue. The purpose of this study was to examine the factors and elements in the structure or “design” of the work of emergency medical technicians (EMTs) and paramedics that can create conditions for high levels of work motivation, satisfaction, and performance.A modified Job Diagnostic Survey was administered to a cross section of 102 paid and volunteer EMS personnel in Pennsylvania. The relationships between measured job characteristics, experienced psychological states, and job longevity on overall job satisfaction was examined.Significant positive relationships (p<.05) exist between a number of the job characteristic variables (such as task significance, autonomy, and job feedback) and job satisfaction. Job longevity did not have a significant relationship to job satisfaction. Volunteer EMS personnel experienced higher levels of job satisfaction than did paid providers.The results indicate that the EMT and paramedic perform complex jobs that have high levels of the characteristics that cause internal work motivation. Methods to increase the amount of these core job characteristics to improve overall job satisfaction are discussed.
Patient Distribution of an Urban-Rural Emergency Medical Services System
Authors: Jastremski Michael S. , Lagoe Ronald J. 
Published: July 2016

AbstractThis study describes a series of mechanisms to alleviate overcrowding of hospital emergency departments by distributing critically ill patients among facilities with available resources. The initial mechanism, which was based on the availability of critical care beds, was used successfully between 1982 and 1986, but had to be abandoned when several new factors caused the availability of emergency department resources to become the limiting factor. A second approach, based on the availability of critical care and emergency department resources, produced limited success over a one-year period. The system currently in use, implemented in 1989, includes a distribution system based on the availability of emergency department resources and critical care beds, as well as a mechanism for diversion of ambulances to hospitals in neighboring counties at times of extremely high utilization. This experience demonstrates that mechanisms for planning the distribution of emergency and critically ill patients have universal applicability.
Prehospital Administration of Rectal Diazepam in Pediatric Status Epilepticus
Authors: Drawbaugh Rodney E. , Deibler Christopher G. , Eitel David R. 
Published: July 2016

Seizures are a common pediatric problem encountered by prehospital personnel. Status epilepticus is defined as seizure activity lasting longer than 15 minutes, or recurrent seizures that occur close together without a period of consciousness between ictal periods. It is estimated that 60,000 to 160,000 cases of status epilepticus occur each year within the United States. Prior to 1960, status epilepticus carried a 50% morbidity rate. However, improved anticonvulsive medications, aggressive airway management, and the spread of EMS Systems throughout the nation have reduced the morbidity rate to a range of 8% to 12%.Prompt and vigorous treatment is paramount in the successful management of status epilepticus because delays can result in neuronal damage and death. Although intravenous diazepam currently is the drug of choice to terminate seizure activity, it may be difficult to rapidly establish a patent intravenous (IV) line during status epilepticus in young children with vigorous motor activity. Alternate routes, such as intramuscular injections, are unreliable due to unpredictable absorption. Rectal administration of diazepam may provide an useful alternate route for delivery of the drug during status epilepticus when IV attempts fail.In this review, the authors discuss a case of status epilepticus wherein intravenous access could not be established rapidly and the patient was given diazepam rectally with favorable results.
Predictors of Job Satisfaction Among Rural Emergency Medical Technicians
Authors: Whitley Theodore W. , Revicki Dennis A. , Allison E. Jackson , Landis Sandra S. 
Published: July 2016

AbstractThis study investigated the capacity of selected personal and work environment characteristics, in combination with occupational stress, to predict job satisfaction for 495 emergency medical technicians (EMTs) who provided emergency medical services in a rural area in the United States. Using data obtained during a three-year survey, multiple regression analysis identified work group cohesiveness and effective supervisory behavior as the best predictors of job satisfaction. The perceived level of occupational stress and years of experience as an EMT were inversely related to job satisfaction, but EMTs who responded to the survey as they were preparing to enroll in advanced training programs were more satisfied with their jobs than were other subgroups. These results suggest that job satisfaction can be enhanced by reinforcing cooperation and cohesiveness within EMS work groups, by establishing and maintaining effective communication networks between EMS administrators and EMTs, and by providing opportunities for professional growth and development for EMTs.
Rapid Volume Infusion in Prehospital Care
Authors: Rottman Steven J. , Larmon Baxter , Manix Tom 
Published: July 2016

AbstractThe ability to deliver large volumes of intravenous (IV) fluids may be critical to the successful prehospital resuscitation of hypovolemic patients. We compared the time required to deliver one liter of crystalloid solution, using an administration set-up consisting of a 16-guage (g), 1.25 inch, intravenous cannula, a pneumatic pressure bag, and either conventional intravenous tubing (3.2 mm internal diameter [ID]) or large bore (4.4 mm internal diameter [ID]) “shock” tubing. With the fluid bag positioned at 110cm (46 inches) above the level of the cannula, the mean elapsed time to deliver 1,000ml using the conventional tubing set-up was 6.0 minutes, while the same volume could be delivered in only 2.7 minutes with the shock tubing configuration. This time was reduced to 1.8 minutes when the intravenous cannula size was increased to 14g. By attaching a liter of fluid to each arm of the “Y” adapter of the shock tubing, virtually uninterrupted fluid flow may be maintained at this rate. We feel this intravenous configuration could enhance greatly the ability of paramedics to provide fluid resuscitation in the field setting. When such IVs are established en route to a receiving hospital, this technique may prove to be an important adjunct to improving patient outcome from hypovolemic shock.
Endotracheal versus Intravenous Epinephrine in the Prehospital Treatment of Cardiac Arrest
Authors: Schneider Sandra M. , Yealy Donald M. , Michaelson Edward A. , Kearns Thomas R. , Paris Paul M. 
Published: July 2016

AbstractWe performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.
Minimum Data Set for EMS Report Form: Historical Development and Future Implications
Authors: Hedges Jerris R. , Joyce Steven M. 
Published: July 2016

AbstractReport forms are used by Emergency Medical Services (EMS) systems for documentation of services provided and for self-analysis of EMS functions. Although the EMS Systems Act of 1973 originally intended for the development and implementation of a uniform EMS report form, items recorded on EMS forms vary throughout the United States. We review the governmental sponsored development of a recommended minimum data set (MDS) for EMS forms performed in 1974, and discuss areas of needed investigation regarding data set development and usage. The concepts used to develop the recommended MDS provide a useful resource for review of the purpose and content of one's own EMS report form. However, future data set development and applications should use outcome measure guided data set selection, on-line validation of data item accuracy and recordability, psychometric analysis of the process of form completion, and incorporation of new data entry and storage technology.
15 Years of Experience with Cardiopulmonary Resuscitation in the Kingdom of Saudi Arabia: A Critical Analysis
Authors: Seraj Mohamed A. , Harvey Paul J. 
Published: July 2016

AbstractThe objective of this review is to establish a framework about the educational activities of the Cardiopulmonary Resuscitation (CPR) National Committee of the Saudi Heart Association (SHA) and determine if it has had any effect on the survival rate in daily hospital work. Further, the review puts forward recommendations regarding the key to success for future implementations and improvement in the outcome of heart attacks in the Kingdom of Saudi Arabia (KSA).Cardiopulmonary resuscitation (CPR) was introduced into the Kingdom of Saudi Arabia in the 1980s. The birth of CPR in the Kingdom was conducted by the American Heart Association (AHA) provision of the first instructor course in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) in the spring of 1984. This educational activity was initiated by the Postgraduate Center of the College of Medicine and currently is a function of the Saudi Heart Association (SHA). The National Heart Center (NHC) continually expands its activities. The number of courses organized, conducted, and reported herein totaled 459 for providers and instructors in BCLS and advanced cardiac life support. This resulted in certification of 916 and 204 instructors in basic and advanced CPR respectively. There were 80 centers established in the Kingdom over the span of 15 years. They all provide BCLS courses; only 13 provide advanced cardiac life support courses. The SHA issued a total of 84,659 certificates.
Quantifiable Effects of Nuclear War on Health
Authors: Gunn S. William A. 
Published: July 2016

Superpower military competition has abated, but the specter of nuclear weapons still adds a completely new dimension to warfare. The destructive capacity of so-called conventional bombs was made cruelly evident in the Second World War. Yet, today, a single, thermonuclear bomb has the explosive power of a million times the largest conventional device, with not only devastatingly immediate consequences but also extremely harmful long-term effects, both at the site of the attack and far away, in time and space (Figure 1).In Figure 2, the small central circle with a radius of 1.4mm represents the combined area which would have been affected by the total of all the explosives used in the Second World War. The larger circle, with a radius of 100mm, represents the relative destructive power of the nuclear arsenals stockpiled today. This is a terrible and, hopefully, a sobering image.
Disaster Reanimatology Potentials: A Structured Interview Study in Armenia
Authors: Ricci Edmund M. , Pretto Ernesto A. , Safar Peter , Klain Miroslav , Angus Derek , Tisherman Samuel A. , Abrams Joel , Crippen David , Comfort Louise , Semenov Victor ,   other members of the Disaster Reanimatology Study Group
Published: July 2016

AbstractThe study of a disaster which has occurred cannot be researched using the traditional techniques as it is not possible to conceive or conduct controlled, randomized experiments for such an event. Paper I of this series described non-experimental, scientific methodologies which were applied to study the detection-extrication-resuscitation activities which occurred following the devastating 1988 earthquake in the Republic of Armenia, USSR. This paper critically evaluates the methodologies used for the Armenia study and proposes modifications in these methods for application to the study of future disasters.Approaches which could be applied to the study of future disasters are defined and critically evaluated from the view of reliability, validity, costs, and practicability. The revised set of protocols is discussed in terms of: 1) the structured interview process; 2) training of personnel to conduct, synthesize, and evaluate the interviews; 3) the time required to complete the interview process; 4) sampling techniques; 5) mechanisms for cross-checking the data; and 6) the addition of preliminary data collection immediately following or during the event. Use of this revised approach should assist in the collection and analysis of data associated with future disasters so that it is possible to: 1) further enhance life-saving and reduce mortality; 2) improve relief efforts; 3) reduce damage to communities; 4) evaluate the long-term effects of such events; and 5) assist in better preparation for future events.
Critical Incident Stress Intervention After Loss of an Air Ambulance: Two-year Follow Up
Authors: Macnab Andrew J. , Russell James A. , Lowe John P. , Gagnon Faith 
Published: July 2016

AbstractObjective:Following an air ambulance crash with five fatalities, critical incident stress debriefing (CISD) was provided for involved paramedics, physicians, and nurses. A study was conducted to evaluate the long-term effects of a critical incident with critical incident stress debriefing according to the Mitchell model.Methods:Six months following the incident, empirically designed questionnaires were mailed to all transport paramedics and directly involved medical staff, and a random sample of both nurses from the dispatch/receiving institution and paramedics from around the province. Twenty-four months post-incident, all members of the transport paramedics completed the Impact of Events Scale and the General Health Questionnaires.Results:There were no differences between groups on any scores, except for disturbed sleep patterns, bad dreams, and the need for personal counseling being greater among transport paramedics at one day. There was no correlation between how well the deceased individuals were known, amount of debriefing, and symptom severity. A trend was seen for those with pre-existing stress management routines to have less severe symptoms at six months (p = 0.07). At two years, 16% of transport paramedics still had significant abnormal behavior.Conclusion:CISD did not appear to affect the severity of stress symptoms, whereas having pre-existing stress management strategies may. These findings give justification for proceeding to a randomized, controlled trial of different levels of critical incident stress intervention.
Casualty Patterns in Disasters
Authors: Sklar David P. 
Published: July 2016

This brief examination of casualty patterns suggests that differences may exist in the numbers of immediately dead and critical patients, depending on the nature of the disaster. More data must be collected from future disasters to more accurately define relationships between critical patients and total numbers injured. Such characterization is essential for hospital disaster planning because critical patients require great resources and optimal hospital functioning.Knowledge of casualty patterns can make disaster planning more practical, disaster drills more realistic, and disasters less disastrous.
The Role of Veterinary Sciences In Chemical Disasters and Emergencies
Authors: Mantovani A. 
Published: July 2016

AbstractThe roles of the veterinary sciences in disasters and emergencies related to exposures of the environment to harmful chemicals are reviewed. Characteristics of chemical emergencies which require the use of the veterinary sciences are discussed. Veterinary services are important in the: 1) definition of the kind and severity of the pollution through biological monitoring; 2) use of animals as monitors of the environment; 3) use of changes in the health status of animals for identification of pathophysiologic changes to man and other animals (sentinels); 4) maintenance of the hygiene of elements of the food chain; 5) evacuation and management of animal populations; 6) disposal of carcasses; and 7) treatment and follow-up of involved animal populations. Veterinary services are important components of responses to incidents marked by chemical pollution and must be included in the development of contingency plans to meet the demands created by chemical pollution.
Cellular Telecommunications at Amtrak's Worst Crash
Authors: Wiles Charles E. , Ramzy Ameen I. , Belzberg Howard 
Published: July 2016

AbstractMedical communications associated with a collision between a passenger train and three locomotives which resulted in the death of 16 and injury to at least 177 persons quickly overwhelmed the relatively sophisticated EMS communications center (SYSCOM) serving the state of Maryland, U.S.A. Other than traditional talk-by and ambulance-hospital communications, the system was saturated by: 1) communications between seven prehospital sectors; 2) persons moved into the field from their usual in-hospital environment who were not familiar or experienced with the use of radio communications; 3) traffic generated through the operations of 11 helicopters; and 4) the usual confusion that accompanies such events. The use of cellular telephones during this incident, substantially enhanced all levels of communications. Many of the participants expressed preference for this form of communications compared to the use of radios.Problems associated with the use of cellular telephone communications included an insufficient number of channels made available by the telephonecommunications provider causing competition with non-essential personnel for use, and relatively short battery life. These problems can be solved by the provider opening more channels and by the use of larger power sources such as automobile storage batteries. It is concluded that portable and vehicle-mounted cellular telephones can serve as useful communications tools in mass casualty and disaster situations.
Resolutions Concerning Disaster Medicine and Nuclear War
Authors:   World Association for Emergency and Disaster Medicine (WAEDM)
Published: July 2016

The members of the World Association for Emergency and Disaster Medicine (WAEDM) (The Club of Mainz) have considered the medical consequences of a major nuclear war and would like to make the following recommendations to all relevant governments and powers, and their medical professions:1. That disaster medical preparedness should be continued and developed for conventional wars, nuclear accidents and the single small nuclear bomb explosion (e.g., by accident or terrorism).