bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Race, Age, Gender, and Insurance Status Determinants in Interhospital Helicopter Transport Time and Frequency?
Authors: Furlong Brendan R. , Heller Michael B. , Auble Thomas E. 
Published: July 2016

AbstractObjective:To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers.Design:A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites.Setting/Participants:A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion.Results:The TTT (mean ± SD) was longer (2666 ± 3940 minutes (min.) versus 619 ± 909 min., respectively) for adult than pediatric patients (p <O1), and (2588 ± 4041 min. versus 640 ± 1301 min., respectively) for insured versus uninsured patients (p <.O1). The observed proportion of non-whites transported was less than expected (.41% versus 2.1 %) based on the proportion of non-whites in the region (p <.O5).Conclusion:The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted.
A Hospital-Based, Hazardous Materials Decontamination and Treatment Unit: Utilization Patterns Over a Nine-Month Period
Authors: El Sanadi N. , Grove C. , Takacs M. , Daly S. , Ellenberger D. 
Published: July 2016

AbstractFederal [U.S.] law and the Joint Commission on the Accreditation of Healthcare Organizations mandate plans and mechanisms for response by hospitals to hazardous material incidents/accidents be developed and implemented. This paper describes the response of the University Hospitals of Cleveland to these regulations and to the anticipated needs of the community and local industiy. The physical plant constructed and its relationship to the emergency department personnel for staffing this unit are described. Utilization patterns since implementation of this program are presented.
Emergency Medical Services Systems in the United States and China: A Developmental Comparison
Authors: Burkle Frederick M. , Zhang Xiaoping , Patrick Walter , Kalinowski Edward , Li Zonghao 
Published: July 2016

AbstractInternational emergency medical services (EMS) consultation requires many sensitivities to cross-cultural issues. Contemporary EMS models in developed countries have, by necessity, a systems framework. This study compares evolving EMS systems in the United States and China. It is concluded, that, no matter what the potential and cultural differences might be, a systems framework inherently will emerge in EMS development. As such, the EMS components recognized often will expose an evolving systems approach with more similarities than differences and can reveal strategies for improvement. Providing a developmental comparison process is a necessary first phase in analysis of a country's systems development or restructuring.
Complex, Humanitarian Emergencies: I. Concept and Participants
Authors: Burkle Frederick M. 
Published: July 2016

AbstractComplex, humanitarian emergencies, the result of civil strife and armed conflict affecting large populations at the brink of extinction, represent the most compelling of disaster relief challenges. They require the coordination of the United Nations agencies, the International Committee of the Red Cross, international nongovernmental relief organizations, and military forces. An increasing number of civilian and military health-care providers find themselves involved in the planning, coordination, and direct patient-care aspects of these emergencies, often without proper initiation and understanding of the unique nature of these disasters. This article provides a primer on the concept of complex, humanitarian emergencies and the contributions, characteristics, capabilities, and limitations of each major participant.
Emergency Medical Care in the Athletes' Village: World University Games 1993
Authors: Janicke David M. , Jacob Donald J. , LaFountain Richard B. , Pundt Mark R. , Young Gregory E. 
Published: July 2016

AbstractObjective:Little information exists concerning special medical needs at the athletes' residence (as distinct from the sport venues) at major international sporting events. During the summer of 1993, Buffalo, New York became the first city in the United States to host the World University Games. Approximately 6,000 athletes and accompanying staff from 118 countries attended. This report seeks to characterize emergency medical care use and the degree of language difficulty encountered at the athletes' village medical center (AVMC) set up at the athletes' residence for this event.Methods:Demographic data were collected prospectively for each athlete or staff member housed in the athletes' village who presented to AVMC for medical evaluation rather than being cared for by a team physician or at one of the venues. Difficulty in medical treatment secondary to language differences was assessed, by the treating physician on a scale of 0–3.Results:Over the 14 days that the AVMC was in operation, for 24 hours a day, a total of 362 athletes (mean age: 22.9 ±2.9 years, 257 males, 105 females) and 149 accompanying staff (mean age: 39.8 ±11.6 years, 110 males, 39 females) were treated. More than 90 % of the patients were seen between the hours of 0800 and 2400. A broad spectrum of minor medical problems occurred, with musculoskeletal injuries accounting for most of the visits for both athletes (54 %) and staff (27%). Nonsteroidal anti-inflammatory agents and oral antibiotics were the most commonly prescribed medications. On-site radiographic facilities were used for 22% of the athletes and 11% of the staff treated. The majority of patients (92% of athletes, 91% of staff) were discharged from the AVMC. Four of the 12 patients that were transferred to a hospital-based emergency department were admitted to the hospital. Language problems, as assessed by the treating physician, were mostly minor; 25% of the patients had accompanying interpreters. One volunteer Physician, and two to three nurses adequately staffed each shift.Conclusion:The AVMC provided medical care for a large variety of medical problems that could, be treated on-site without transfer to a higher-level facility, thereby providing directed medical care for this special population in a secure environment. Language differences were perceived as a minor problem. This report should be valuable in the planning of medical care at the athletes' residences for similarly large sporting events.
Comparison of Prehospital Cervical Immobilization Devices Using Video and Electromyography
Authors: Manix Thomas , Gunderson Michael R. , Garth Geoffrey C. 
Published: July 2016

AbstractIntroduction:Previous evaluations of prehospital devices intended for spinal immobilization have focused on the device's ability to restrict motion only. This study defines six relevant criteria for evaluation of cervical immobilization device (CID) performance.Objectives:To suggest relevant criteria for evaluation and use available technology to improve measurements for performance testing of prehospital-care devices.Methods:Six parameters (motion restriction, access, ease of application, environmental performance, radiolucency, and storage size) were used to evaluate three types of CIDs: Device A—a single-use corrugated board; Device B—a reusable foam-block CID; and Device C—hospital towels and adhesive tape. To test motion restriction, the most frequently compared parameters for immobilization devices, 20 volunteers were asked to move their heads and necks through a series of motions (flexion, extension, lateral bending and rotation). Their movements were videotaped, still images of each movement were generated, and the degrees of deflection recorded from these still images. To ensure a consistent level of force, electromyography (EMG) of the sternodydomastoid and extensor muscles was employed.Results:Data were produced for each parameter and presented for comparison. The use of video to determine deflection proved to be a useful and highly accurate (±1°) method for measurement. The use of EMG technology enabled force to be controlled indirectly when the subjects used moderate levels of exertion. Overall, Devices A and C restricted motion better than Device B. Although Device C required the shortest time for application, it took the longest to prepare for application. The total time required for preparation and application of A and B essentially were equivalent, with A requiring no preparation time but taking the longest for application, and B having an intermediate interval for application. Device A allowed for the best examination of the head and neck. No differences were detected in performance in extreme environmental conditions or in radiolucency for cervical spine X-ray examinations. Device A consumed the smallest storage volume, B the greatest storage volume, and C an intermediate volume substantially greater than that required for A.Conclusion:Device evaluation should include examination of all relevant performance parameters using the most accurate and meaningful methods possible.
Hand Injuries From Snow Blowers: A Report of an Epidemic
Authors: Tetz David J. , Aghababian Richard 
Published: July 2016

AbstractDuring a record snowfall in Worcester, Massachusetts, 11–13 December 1992, 37 male patients with hand injuries suffered during snow blower operation were seen at three area hospitals. Two previous reports describe 13 patients seen over a 3-year period and 28 patients over a 12-year period. This report describes the largest number of hand injuries from snow blowers that have occurred over a 48-hour period. The snow was unusual because of the high water density in the initial 9 inches (23 cm) that fell at an average temperature of 33° F (0.6° C) with the final depth of 30 inches (76 cm), causing the machines to become clogged. Patients admitted to reaching into a running machine in 35/37 (95%) cases, 11/37 (30%) claimed the auger and impeller blades were disengaged, and 2/37 (5%) patients claimed their injuries occurred with the engines turned off. All injuries occurred when the patients placed their hands down the chute, contacting the impeller blades. Injuries involved 32 long, 15 ring, 13 index, and five small fingers and ranged from simple lacerations to partial phalangeal amputations. The majority, 27/37 (73%), were managed in emergency departments without interventions in the operating suites. Infection occurred in one patient who had the lesion repaired in the operating suite. As in previous studies, no differences were found for the variables of snow blower age, type, or horsepower, or on experience level or age of the operators. Despite the safety defaults provided on newer machines, warnings posted on equipment and in owner's manuals, or public-service announcements provided by the media during the storm, injuries continued to occur. Operator error was the common denominator, suggesting that a change in snow-blower design that prevents hand access or impeller rotation is necessary to prevent these devastating injuries.
Physicians' Experiences with Prehospital Do-Not-Resuscitate Orders in North Carolina
Authors: Travers Debbie A. , Mears Greg 
Published: July 2016

AbstractIntroduction:Many states are implementing prehospital do-not-resuscitate (DNR) programs through legislation or by state or local protocol. There are no outcome studies in the literature regarding the utilization of, access to, or barriers to prehospital DNR programs, nor are there studies that evaluated whether they meet the patients' needs.Study Objective:To explore physicians' perceptions of the utilization of, access to, and barriers to a southeastern state's prehospital DNR program, and to identify key professional groups needing information about prehospital DNR issues.Methods:A convenience sample survey and a descriptive review using retrospective, self-report questionnaires sent to all physicians who requested and obtained a supply of the state's out-of-facility DNR forms in 1993.Results:Respondents reported that the most common terminal conditions for patients with prehospital DNR orders are cancer and multiple chronic diseases in elderly patients. More than half of the physicians recalled that enrolled patients had engaged the services of emergency medical services (EMS), most often because the patients' conditions worsened, and the families were uncertain about what to do. Most of the enrolled patients have at least one other DNR order in another health-care setting, and are at home with hospice care or home-health care at the time of the prehospital DNR order implementation. The most frequent barrier to honoring dying patients' wishes in the prehospital environment is a lack of knowledge of prehospital issues by patients, families, primary care physicians, and nursing home staff. Ninety-eight percent of the respondents support a single, universal DNR order that would apply across all health-care settings.Conclusions:Patients, families, and key health-care professional groups need to be targeted with educational programs regarding prehospital DNR issues. Primary care physicians, using the current prehospital DNR program, support more comprehensive approaches to DNR orders across health-care settings.
Does the Level of Prehospital Care Influence the Outcome of Patients with Altered Levels of Consciousness?
Authors: Adams James , Aldag Gene , Wolford Robert 
Published: July 2016

AbstractHypothesis:Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers.Methods:Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included: trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records.Results:Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the “alert, verbal, painful, unresponsive” scale (ALS vs BLS) were: “verbal” (40% vs 51%), “painful” (23% vs 23%), and “unresponsive” (37% vs 25%). The mean value for scene time was 15±6 minutes for ALS versus 10±4 minutes for BLS (p <0.001). On arrival in the emergency department, the LOC of 72 (64 %) ALS patients and 58 (64%) BLS patients had improved to “alert.” The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS provider had significantly shorter emergency department treatment times than did those transported by BLS providers (160±62 minutes ALS vs 229±67 minutes BLS [p <0.005]).Conclusion:Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.
In Memoriam, Asmund S. Laerdal
Authors: Safar Peter 
Published: July 2016

Asmund Laerdal, a patron, catalyst and leader for resuscitation developments worldwide, died from cancer at his home in Stavanger, Norway on November 19, 1981. At the funeral services on America's Thanksgiving Day, we said thanks for what he has given the world. He was a great man, whose quiet, but determined, manners and eagerness to help whenever he perceived a need, earned him much respect and love.Asmund Laerdal was born in Norway on October 11, 1913. He went to business school, traveled throughout Europe by bicycle during his youth, married Margit in 1939, and started a small printing business in 1940. Nazi occupation between 1941 and 1945 threatened his life, but did not wreck his little company. Throughout the 1940s and 1950s he printed childrens' books and calendars and made inexpensive wooden and plastic toys. The latter included “Anne Doll,” the “toy of the year,” made of soft plastic, with sleeping eyes and natural hair.
Development of a Mathematical Constant for the Prediction of Casualties at Mass Gatherings
Authors: Franaszek Jacek , Jayne Harold , Morkovin Vera , Krome Ronald , Baker Frank 
Published: July 2016

In preparation for the visit of Pope John Paul II on Oct. 5, 1979 to Chicago, Illinois, a multi-departmental committee met for a number of months prior to the Pope's visit to prepare for possible mass casualties at the outdoor papal mass held in Grant Park. Data taken into consideration in preparation for this mass gathering included predictions of the number of people to attend the event, calculations by the National Safety Council of the possible number of victims and type of casualties, a review of the literature and the experience of others at outdoor events of the same scale.On this basis, it was predicted that aproximately 3,000 to 3,500 casualties would occur simply as a result of a mass gathering of one million individuals. The actual total number of casualties was 400, with twenty being transported to the hospital and no deaths. On the basis of this experience a formula was described to predict the number of casualties based on total attendance figures.
Adapting First Aid to Actual Needs
Authors: Laerdal Asmund S. 
Published: July 2016

The purpose of first aid remains the same through the ages: to prevent pain, disease and death. But the need is different in different places and at different times.It should not be forgotten that in large parts of the world the most immediate threat to human life is starvation and malnutrition, together with lack of hygiene and basic medical care. The kind of first aid most needed under such circumstances is food and medicine. The key to a long-term solution is education in self-help. The prosperity and experience of the Western world must, in the future, be used more systematically to booster development towards self-sufficiency in the less developed countries. These are most important aspects that should be dealt with more often. The time frame of this article forces me to concentrate on conditions in the industrial world.
Medical Student Education in Advanced Cardiac Life Support
Authors: Jastremski Michael S. , Grogono Alan W. 
Published: July 2016

A standardized approach to advanced cardiac life support (ACLS) improves the morbidity and mortality from cardiac arrest. Physicians should receive formal training, certification, and periodic recertification in ACLS. This paper describes the system we have developed to provide all the medical graduates of our university with training and American Heart Association (AHA) certification in ACLS.MethodThe course takes place during the third year of medical school in four afternoons during the students' medical clerkship. The students are required to take this course and are freed from all other commitments during these afternoons. Several weeks before the course, the students are given a brief introductory lecture, registered, and strongly encouraged to read the AHA manual for providers of advanced cardiac life support.
The Integration of Emergency Care in a Total Critical Care Medicine (CCM) System
Authors: Delooz Herman H. 
Published: July 2016

The goal of critical care medicine is to provide specific care to the patient in whom one or more vital systems are threatened or deficient. The methods of critical care medicine are monitoring, support or temporary substitution of vital systems, and the application of titrated therapy. The specific objective of each link in the chain of medical facilities involved with the critical patient deserves to provide the same expertise and should act according to the same protocol.The different links of the chain are these: (l)recognition of the critical condition; (2) emergency call; (3) care on the spot of the emergency; (4) care during transport; (5) further diagnostic and therapeutic work in the emergency department; and finally (6) if indicated, continued intensive care.
The Pediatric Emergency Transport System: Momentum toward Regionalization
Authors: Dobrin Robert S. , Cunningham Janet , Dexter Mary , Gifford Chelle , Ivancie Liz , Mayer Kathy , McCabe Mary Kay , Massaro Thomas A. 
Published: July 2016

Tertiary care for critically ill children requires a safe, efficient transport modality designed for the pediatric patient. This system should be capable of delivering mobile intensive care en route after resuscitation and stabilization at the sending hospital.In July 1979, a Pediatric Emergency Transport Service (PETS) was organized at The Children's Hospital, Denver, to provide physicians of the Rocky Mountain-Plains Region with the capability of triaging pediatric nonneonatal patients to three Denver Pediatric Intensive Care Units (PICU's). The components of the system included: (1) a transport team comprising of a medical attending-director, twelve transport physicians including nine pediatricians, two anesthesiologists and one surgeon, six pediatric transport nurses, six pediatric transport respiratory therapists, and four emergency medical technicians; (2) a communication dispatch system; (3) an answering service with Wide Area Telecommunications Service capability; (4) an equipment depot within the PICU at The Children's Hospital; (5) a complete dispatch log; (6) a continuing education and information system for the team, providers, consumers and health planners; (7) a cost and administrative center with established billing procedures and support services; (8| management, drug and equipment protocols, and (9) specifically designed air and ground ambulances which are owned and/or leased by The Children's Hospital.
Superiority of Colloid over Electrolyte Solution for Severe Normovolemic Hemodilution (NVHD) in Concurrent Treatment of Hemorrhage
Authors: Brinkmeyer Scott , Safar Peter , Motoyama Etsuro 
Published: July 2016

Treatment of severe hemorrhage with adequate concurrent administration of plasma substitutes leads to acute normovolemic hemodilution (NVHD). Advantages of hemodilution include: l) reduced risk of infection; 2) decreased thromboembolic phenomena; 3) improved microcirculation; and 4) less use of banked blood resulting in reduced patient cost.In the 1960's, Takaori and Safar described the types of response to various degrees of hemodilution (HD) and demonstrated that dogs survived when hemodiluted with dextrans to a hematocrit (hct) of 10%. In contrast, HD with Lactated Ringers (LR) was unable to support survival.
Low Molecular Hydroxyethyl Starch (HES) (200/0.5) Infusion
Authors: Skrobek Wulf 
Published: July 2016

In fluid therapy, colloid plasma substitutes are especially suitable for emergencies and mass disasters because they can be obtained in unlimited quantities and can be used immediately.The initial volume effect is greater than that of Gelatin or HES 40 but is much weaker than 10% Dextran 40. In this respect, HES 200/0.5 is comparable with 6% Dextran 70. The volume effect of HES 200/0.5 lasts for about 3 hrs and thus is comparable to Gelatin, HES 40 or 10% Dextran. Six percent Dextran 70, however, lasts for 6–8 h. Ten percent HES 200/0.5 is more easy to regulate.Hydroxyethyl starch does not influence the coagulability to the extent that can occur with Dextran.