bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Medical Services in the Reconstruction Phase following a Major Earthquake: A Case Study of the 1988 Armenia Earthquake
Authors: Becker Bruce M. , Handrigan Michael T. , Jagminas Liudvikas , Becker Tanya J. 
Published: July 2016

AbstractStudy Objective:To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.Methods:The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).Results:Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.Conclusion:In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.
Gender Issues and Partner Preferences Among a Sample of Emergency Medical Technicians
Authors: Gonsoulin Sheryl , Palmer C. Eddie 
Published: July 2016

AbstractIntroduction:From its beginnings, the provision of emergency medical services in the United States has been a male-dominated occupation. The objective of this exploratory study was to determine if and how such issues might influence partner preferences of male and female emergency medical technicians (EMTs).Methods:Initially, unstructured interviews were conducted with 10 EMS workers enrolled in a paramedic training program in order to see whether and how such issue might affect partner preferences. From the data obtained during these interviews, a questionairre was developed and distributed to participants in an annual meeting of Louisiana Association of Nationally Registered EMTs. Participation was voluntary and uncompensated.Results:A total of 49 EMTs (22 women, 27 men) completed the questionairre. The major gender-related issues could be class fied into three dimensions: 1) physical strength; 2) assumption of authoritative roles; and 3) structural (organizational) preparedness to implement gender-friendly working environments. In general, the gender of a partner now “makes no difference”.Conclusion:Overall, the EMS work worlds are reflective of the larger society of which they are a part. Now is the time for EMS systems to examine the gendered nature of their organization and of the issues of gendered expectations prevalent in EMS work. Future research should document the changes now due in the field of emergency medical services.
The Efficacy of Advanced Life Support: A Review of the Literature
Authors: Bissell Richard A. , Eslinger Dawn Gyory , Zimmerman Lynn 
Published: July 2016

AbstractIntroduction:Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature.Methods:An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies.Results:Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies.Conclusion:While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.
Constructing a World Wide Web Site for Disaster Management and Humanitarian Assistance
Authors: Piper Paul S. , Burkle Frederick M. , Murray Ronald J. 
Published: July 2016

AbstractThere is a huge need for access to information in the areas of disaster relief disaster medicine, and humanitarian assistance. The extraordinarily rapid increase in the literature in these subject areas attests to this need. However, use of the printed word has substantial limitations that are even more profound in the developing world.Currently, the information available tends to be fragmented and sequestered by the specific interests of the organizations and governments involved. The evolving electronic methods for the storage, organization, and retrieval of information makes coordination between organizations concerned with disasters within our grasp.This paper discusses the Center of Excellence in Disaster Management and Humanitarian Assistance and describes the World Wide Web and the implications it has in disaster management and medicine. It describes methods for obtaining user input to the techniques used for the development of the world wide web for the areas of disaster management and disaster medicine. The implementation of an on-line Internet reference desk that will provide: 1) a list of “experts;” 2) a searchable disaster database; and 3) on-line simulation courses and training exercises also is discussed.
Sonomatic Confirmation of Tracheal Intubation Using the SCOTI
Authors: Petroianu Georg , Maleck Wolfgang , Bergler Wolfgang , Rüfer Roderich 
Published: July 2016

AbstractThis study compares the performance of two commercially available devices (Ambu. TubeChek™ and SCOTI™ in establishing endotracheal (ET) tube position (oesophageal vs. tracheal) in a mannequin and in miniature pigs. The Ambu TubeChek is a syringe-type, Oesophageal Detector Device (ODD) that fits to the endotracheal tube connector. Air is aspirated easily from the rigid trachea, but not from the collapsing esophagus. The Sonomatic Confirmation of Tracheal Intubation device (SCOTI) is a lightweight battery-powered, sonomatic device. It emits sound waves into the tube and analyzes the reflection. The SCOTI purports to enable a user-independent and carbon-dioxide-independent assessment of tube position following intubation.Intubation followed by tube position assessment with Ambu TubeChek (ODD) was significantly faster and easier with the ODD than with the SCOTI. The SCOTI cannot differentiate tracheal from oesophageal ET-tube position in mini-pigs.In situations in which capnometry is not available or the CO2 production and transport are compromised (CPR), we recommend the use of an Oesophageal Detector Device (ODD) rather than the SOCTI.
Evaluation of Intravenous Tramadol for Use in the Prehospital Situation by Ambulance Paramedics
Authors: Ward Michael E. , Radburn John , Morant Steve 
Published: July 2016

AbstractIntroduction:An evaluation of the opioid analgesic tramadol (Zydol, Searle United Kingdom) was carried-out by ambulance paramedics to assess its efficacy in providing pain relief in the prehospital situation.Methods:Type of subjects—Patients suffering severe pain from any cause uncontrolled by other simple methods.Number of subjects—101 patients received tramadol and 41 patients served as a control. Study design—Random, open study.Statistical tests—Pain score at scene and on arrival at hospital were compared using Fisher's exact tests (2 sides). Logistic regression analyses also were applied to other factors.Results:Pain scores improved for 93.1% of the tramadol treated patients and for 44.0% of the controls. A total of 30.7% of patients treated with tramadol complained of nausea after treatment compared with 17.1% before treatment and with 12.2% of the control patients.Conclusion:Pain was significantly decreased by the administration of tramadol. It was safe with only minimal side effects, the major one being nausea. Suggestions are made for areas of further study.
The Utilization of Bicycles in the Delivery of Emergency Medical Services: A Preliminary Report
Authors: Gorham John F. , Kramer Todd S. 
Published: July 2016

AbstractIntroduction:Bicycles may be useful in the delivery of out-of-hospital emergency medical services. The use of bicycles in providing emergency medical services was investigated by surveying currently existing bicycle-medic systems.Methods:Two questionnaires were developed to gain information on service areas, injuries, gear used, missions, and specific data from bicycle-medic response.Results:Of 210 surveys mailed to bicyclemedics, 21 (10%) were completed and returned by the pre-established deadline. Of 11 surveys mailed to bicycle-medic supervisors, four (36%) were returned. Preliminary results showed that 76% of respondents are career providers and the remainder serve as volunteers. Mean age for respondents was 33±7.4 years, with 96% being males. Most teams have been in existence for three to four years. Job satisfaction was greater when participating on the bicycle crews than when not performing on the bicycle crew, t = 4.15, p = 0.0002. The teams varied in size (6–100 persons) with a mean value of 31. On the average, team size represented 10% of total number of personnel for the respective organizations.The majority of bicycle teams operate all year in all conditions. Most bicycle-medic teams were initiated for special events. Nineteen percent reported injuries while on duty or in training. Ninety percent of units that responded use existing agency protocols and have no special protocols related to the bicycle team. Eighty percent of the units are dispatched through the normal agency procedures. Eighty-five percent of respondents coordinate for transport units via dispatch. Reported response times were under two minutes for special event responses. These were within established agency response times. In approximately 25% of the responses, the patients refused transport, and another 65% of the responses were for relatively minor injuries or complaints that did not require transport to a hospital.Conclusion:This survey begins to characterize the utilization of bicycles as a tool to gain patient access in specialized situations. The use of bicycle-medics may be cost-effective, may help to improve employee morale, and possibly reduce employee health-care costs. Further study is needed to determine the impact of bicycle-medics on patient outcomes and response times.
Development and Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia: A Retrospective Study
Authors: Thompson Randy H. , Wolford Robert W. 
Published: July 2016

AbstractIntroduction:A retrospective study of patients transported by paramedics to a community teaching hospital was conducted to: 1) determine the response of hypoglycemic patients to prehospital treatments, 2) develop criteria to identify patients who safely could be released without transport to a hospital, and 3) evaluate the prehospital release criteria.Methods:Patients presenting to EMT-paramedics with an altered level of consciousness were identified retrospectively. Pre- and post-treatment blood glucose levels were measured and response to treatment noted (Phase 1). Criteria were established using these data and a second sample was evaluated using these criteria (Phase 2).Results:During a 12-month period, 60 patients with an altered level of consciousness (ALOC) were encountered. Of the 60 patients, 27 (45%) were documented to be hypoglycemic (blood glucose [BG] <80 mg/dl, mean 27±13 mg/dl). Of the 27 hypoglycemic patients, 24 (89%) were discharged from the emergency department (ED) and three patients (11%) were admitted. Criteria were developed to identify patients who could be treated and released safely without transport to a hospital: 1) history of insulin (IDDM) or non-insulin (NIDDM) dependent diabetes mellitus; 2) pre-treatment BG <80 mg/dl; 3) post-treatment BG >80 mg/dl; 4) return to normal mental status within 10 minutes of treatment; and 5) absence of complicating factors (renal dialysis, chest pain, arrhythmia, dyspnea, seizures, alcohol intoxication, focal neurological signs/symptoms). The criteria were applied retrospectively to 27 hypoglycemic (mean BG=28±14 mg/dl) patients during a different 10-month period. Of the 27 hypoglycemic patients, 23 (85%) were discharged from the ED, and prehospital release criteria correctly identified 19 of 23 (83%). The prehospital release criteria did not select for release any patient who required an additional, major intervention or who was admitted.Conclusion:This study demonstrates that there is a group of hypoglycemic patients who respond favorably to paramedic interventions. Retrospectively, the prehospital release criteria were successful in selecting patients who did not require additional interventions. A larger prospective study must be conducted before prehospital treatment and release can be recommended for general practice.
Non-Traumatic Prehospital Sudden Death in Young Patients: An Urban EMS Experience
Authors: Weiss Larry D. , Janasiewicz Stanley , Perper Joshua A. , Verdile Vincent P. , Yealy Donald M. , Menegazzi James J. 
Published: July 2016

AbstractNon-traumatic, sudden death in young patients has been described in several studies, but most of these studies have involved highly selected populations. This study examined consecutive cases of non-traumatic, prehospital, sudden death in young patients (age 2–35 years) in a six-year period in an urban EMS system. One-hundred-seven cases were identified; however, seven cases were excluded because of occult trauma or lack of documentation. Of the 100 cases studied, drug and/or toxin exposure was the most common etiology (32%), followed by cardiac (22%) and pulmonary (20%). This is the first study which describes all cases of non-traumatic, prehospital, sudden death in young patients presenting to an EMS system. Implications of these data for EMS personnel are discussed.
A Paramedic Peer-Review Quality Assurance Audit
Authors: Swor Robert A. , Bocka Joseph J. , Maio Ronald F. 
Published: July 2016

AbstractIntroduction:A daily EMS audit was performed to assess whether a paramedic peer review audit would improve the quality of documentation and radio communications in cases transported to a single receiving facility.Methods:Prehospital EMS run sheets and run tapes were reviewed for adherence to standards developed for the county EMS system. Items evaluated were run sheet documentation of care and paramedic radio presentation. Checklists were used and multiple parameters evaluated for each case. Two periods, 1987–88 and 1989 were compared to evaluate the effectiveness of this system. Care rendered by a total of 106 paramedics was evaluated. Confidence intervals of 0.95 were calculated on the differences between groups. Practicing paramedics audited 63% of the days in 1987–88 and 80% in 1989. Data from each case were tabulated and a profile, average deficiencies per run calculated for each paramedic.Results:A total of 4175 run sheets and tapes were audited for the period 1987–88 with an average of deficiencies/run of 0.27, and for 1989 a total of 1872 run sheets and tapes were reviewed with a deficiency/run rate of 0.21, indicating a statistically significant improvement (0.95 CI= 0.02, 0.08). Twelve paramedics were not auditors in 1987–88, but audited in 1989. Their deficiencies/run decreased from 0.13 to 0.08Conclusion:A peer review audit in this system appears to be effective in improving documentation and radio performance. Performance also improved when paramedics served as auditors.
Evaluation of a New Device for Simultaneous Compressions and Ventilations
Authors: Thomson David P. , Yealy Donald M. , Heller Michael B. , Stoy Walt A. 
Published: July 2016

AbstractThe resuscitator bag has been considered the standard for prehospital, ventilatory managment. Recently, the Berg Resuscitation Apparatus (BRA) was developed as an alternative. Two devices were compared for their ability to deliver adequate tidal volumes and efficacy during simulated, single-rescuer CPR In the first phase, emergency care providers ventilated a test lung using a resuscitator bag, BRA, and demand valve. No significant differences between methods were found. During the second phase of the study, subjects performed single-rescuer CPR on a resuscitation mannikin for two minutes, using the bag-valve-mask and the BRA with a mask. The BRA delivered a volume of 0.81±0.26 liters compared to 0.35±0.19 liters using the resuscitator bag. The BRA allows ventilation to be performed as does the traditional equipment. When used in single rescuer CPR, it appears to provide a substantial increase in the tidal volumes delivered.
Infant Ventilation and Oxygenation by Basic Life Support Providers: Comparison of Methods
Authors: Terndrup Thomas E. , Warner Daniel A. 
Published: July 2016

AbstractIntroduction:Little information is available in the performance of infant ventilation by basic life support (BLS) personnel.Hypothesis:There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers.Methods:Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO2) were recorded. The percent of breaths with excessive PAP (i.e., >30 mmHg), percent of acceptable breaths using loose (i.e., 25−125ml) and strict (i.e., 50−100ml) criteria, and FiO2at at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA.Results:For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths between the respective ventilation methods using loose or strict criteria. The proportion of excessive breaths produced by PBM (56±6) (mean±SEM; all subjects) and ABM (41±6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO2delivered with each ventilation method was significantly better in the patent airway group.Conclusion:For BLS providers, M-Ma ventilation with supplemental O2provided the best method of initial infant ventilation based upon the percent of acceptable breaths, oxygen delivery, and fewest excessive pressure breaths.
Prehospital Thrombolysis in Acute Myocardial Infarction
Authors: Varshavsky Sergey Yu 
Published: July 2016

AbstractIntroduction:The effectiveness and safety of thrombolytic treatment (TT) for acute myocardial infarction (AMI) in the prehospital setting have not been defined. Therefore, its use on a mobile coronary care unit (MCCU) was studied.Methods:A MCCU was provided with the equipment and supplies necessary for the administration TT and its personnel were trained in the indications for TT and in its administration. When an emergency medical team physician suspected the diagnosis from the presence of chest pain typical of an AMI, the patient's ECG was transmitted to the Cardiological Consulting Center. If the S-T segments were elevated and the patient met all of the screening criteria, the cardiologist ordered the MCCU personnel to carry out TT. Streptokinase (Avelyzin, Germed, GDR) was administered intravenously at a dose of 500,000 UE.Results:Sixty-seven patients with AMI were included in the trial. The mean interval between the onset of the symptoms and the beginning of the TT was 156±77 minutes; it was less than 3 hours for 54 patients. Thirty-four patients (50.7%) had non-invasive markers of successful reperfusion, while 33 (49.3%) did not. Three patients had non-fatal ventricular fibrillation (VF), ventricular tachycardia (VT) and/or ventricular premature beats of high grades (Lown classes 3–5) developed in six and 22 patients respectively. Five patients had conduction disturbances, and 40 had symptomatic hypotension. None of the patients died before arrival at the hospital. Four suffered reinfarction, and one died of VF during the in-hospital phase of care. Post-discharge follow-up (17.5±5.0 months) demonstrated a positive exercise test in 23 (43%), and a left ventricular ejection fraction >80% in 29 (85.2%) and <40% in five (14.8%) of the patients. The in-hospital and post-discharge mortalities were 1.5 and 4.8% respectively. There was not a single case of bleeding sufficient to require a transfusion.Conclusions:The study indicates that the administration of TT for AMI in the prehospital setting is both safe and effective.
Teaching Endotracheal Intubation Using Animals and Cadavers
Authors: Trooskin Stanley Z. , Rabinowitz Sidney , Eldridge Christopher , McGowan Dennis E. , Flancbaum Louis 
Published: July 2016

AbstractIntroduction:The effectiveness of using supplemental teaching sessions with animals and cadavers on the acquisition of technical skills of endotracheal intubation was studied.Methods:Paramedic students were evaluated for early endotracheal skill acquisition in the operating room and by questionnaire.Results:Supplemental practice skills using either sheep or cadavers did not produce a statistically significant improvement in the percentage of successful clinical operating room intubations as compared to a group trained solely using intubation mannequins. More paramedics, certified and in practice, reported a statistically significant psychological benefit to supplemental cadaver training compared to supplemental animal (p<.05) and mannequin (p<.05) training.Conclusion:Adjunctive teaching sessions using animals or cadavers do not improve the acquisition of initial technical success in clinical intubation over the use of the mannequin alone.