bluuebunny/crossref_metadata_2025_split huggingface dataset:
Volume Kinetics of Intravenous Fluid Therapy in the Prehospital Setting
Authors: Svensén Christer , Sjöstrand Fredrik , Hahn Robert G. 
Published: July 2016

AbstractIntroduction:To study the volume effect of isotonic and hypertonic crystalloid fluid during ambulance transports after mild trauma, a prospective case-control study was initiated, using the ambulance and helicopter transport system in Stockholm.Methods:The hemodilution resulting from intravenous infusion of 1.0 L of Ringer's acetate solution (n = 7) or 250 ml of 7.5% sodium chloride (n = 3) over 30 minutes (min) was measured every 10 min during 1 hour when fluid therapy was instituted at the scene of an accident, or on arrival at the hospital. The dilution was studied by volume kinetic analysis and compared to that of matched, healthy controls who received the same fluid in hospital.Result:The hemodilution at the end of the infusions averaged 7.7% in the trauma patients and 9.1% in the controls, but the dilution was better maintained after trauma. The kinetic analysis showed that the size of the body fluid space expanded by Ringer's solution was 4.6 L and 3.8 L for the trauma and the control patients, respectively, while hypertonic saline expanded a slightly larger space. For both fluids, trauma reduced the elimination rate constant by approximately 30%.Conclusion:Mild trauma prolonged the intravascular persistence of isotonic and hypertonic crystalloid fluid as compared to a control group.
Theme 4. Effective Models for Medical and Health Response Coordination: Summary and Action Plan
Authors: Noji Eric K. , Gunn SWA , Aziz A. Abdul , Chi Huan-Teng , Dauphinee Wayne , Davenport Deborah , Gonzales Roberto , Jaeger Hilary , Kipor G.V. , Mares Carlos A. , Shrestha R. P. , Yoshinaga Kazumasa 
Published: July 2016

AbstractIntroduction:To effectively respond to this relatively new, complex mandate it is essential to find effective models of coordination to ensure that medical and health services can meet the standards now expected in a disaster situation. This theme explored various models, noting both the strengths that can be built on and the weaknesses that still need to be overcome.Methods:Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 1 and Theme 4 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.Results:The main points developed during the presentations and discussion included: (1) preplanning (predisaster goals), (2) information collection (assessment), (3) communication (materials and methods); and (4) response centres and personnel. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.Discussion:Action plans presented include: (1) creation of an information and data clearinghouse on disaster management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) action on lessons learned from evidence-based research and practical experience.Conclusions:There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.
Theme 6. Multidisciplinary Team Interaction: Summary and Action Plan
Authors: Cruz-Vega Felipe , Sun Charles , Brink Bruce , Bugslag Robert (Bob) , Del Castillo Beatriz González , Hastings Patricia , Kipor G.V. , Lee Sung Woo , Lo Chi-Biu , Poles Lion , Robinson Peter , Ronquillo Eleanor L. , Staña Jirí , Sydor Jody , Thani Haresh 
Published: July 2016

AbstractIntroduction:Multidisciplinary team interaction has become a commonplace phrase in the discussion of disaster response. Theme 6 explored multidisciplinary team interactions and attempted to identify some of the key issues and possible solutions to the seemingly intractable problems inherent in this endeavour.Methods:Details of the methods used are provided in the introductory paper. The Cochairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The Cochairs then presided over a workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.Results:Main points developed during the presentations and discussion included: (1) promotion of multidisciplinary collaboration, (2) standardization, (3) the Incident Command System, (4) professionalism, (5) regional disparities, and (6) psychosocial impact.Discussion:Action plans recommended: (1) a standardized template for Needs Assessment be developed, implemented, and applied using collaboration with international organizations, focusing on needs and criteria appropriate to each type of event, and (2) team needs assessments be recognized for local responses and for determination of when international assistance may be required, for planning a command system, and for evaluating the psychosocial impact.Conclusions:There is a clear need for the development of standardized methods for the assessment of needs, development and implementation of a command structure, and for appreciation of regional differences and the psychosocial impact of all interventions.
Study Design and Pre-Trial, Peer Review in EMS Research
Authors: Yealy Donald M. , Scruggs Kevin H. 
Published: July 2016

AbstractIn order to identify the study designs andthe type of pre-trial peer review in published EMS research, we reviewed three refereed emergency medicine journals during the period from 1985 through 1988. All original scientific manuscripts utilizing human subjects in prehospital care were analyzed. Ninety-six issues were examined, and 79 manuscripts met the criteria for analysis. The research design was cross-sectional in 7.5%, retrospective in 51%, and prospective in 41.5%. Pre-trial peer review had been sought in nine (11%). Each was performed by a hospital or university-based Institutional Review Board (IRB). Only four (5%) manuscripts contained statements about pre-trial peer review. All reviewed trials were prospective in design (9/33, 27%). A follow-up telephone survey of the authors of the non-reviewed prospective trials indicated that 96% were unaware of the potential need for pre-trial review, 16% anticipated difficulty obtaining approval from traditional IRB committees, and 11% feared that the protocol would be interfered with by the review committee.We conclude that 92.5% of the current published EMS research is retrospective or prospective in design, and that pre-trial peer review is not obtained in the majority of prehospital EMS research. Guidelines should be developed to educate EMS researchers about the need for and the value of pre-trial peer review. Journal editors should clearly state and enforce policies about manuscripts lacking information about pre-trial peer review when human subjects are involved.
Education about Prehospital Care during Emergency Education Residency Training: The Results of a Survey
Authors: Paris Paul M. , Benson Nicholas H. 
Published: July 2016

AbstractThe Society of Teachers of Emergency Medicine's, EMS Educators Committee performed a mail survey of emergency medicine residency training directors regarding their curricula for EMS. The Committee was interested in determining the quality and quantity of EMS training in emergency medicine residencies. Out of 66 programs, 48 responded (73%). The programs reported that they provide medical control for a mean of 4837 calls per year (range 0–20,000) and interact with a mean of eight EMS agencies. Ten programs (21%) do not offer any formal EMS administrative experience, while 42 (87%) programs require residents to participate in paramedic training, and 31 (65%) require participation in EMT training. Both the type and the amount of “in-field” experience reported by programs varied considerably, with some programs offering it only as an elective. Similarly, there was great diversity in the type and amount of experience with helicopter ambulances. In conclusion, there is wide disparity among the offerings from all residency programs. Each training program must evaluate its own EMS curricula and expand it to fill existing gaps. Specific topics to be covered are suggested.
Utilization of Military Support in the Response to Hurricane Marilyn: Implications for Future Military-Civilian Cooperation
Authors: Weddle Michael , Prado-Monje Hugo 
Published: July 2016

AbstractIntroduction:The past decade has been a period of evolution for the Federal disaster response system within the United States. Two domestic hurricanes were pivotal events that influenced the methods used for organizing Federal disaster assistance. The lessons of Hurricane Hugo (1989) and Hurricane Andrew (1992) were incorporated into the successful response to Hurricane Marilyn in the U.S. Virgin Islands in 1995. Following each of these storms, the Department of Defense was a major component of the response by the health sector. Despite progress in many areas, lack of clear communication between military and civilian managers and confusion among those requesting Department of Defense health resources may remain as obstacles to rapid response.Methods:This discussion is based on an unpublished case report utilizing interviews with military and civilian managers involved in the Hurricane Marilyn response.Results:The findings suggest that out-of-channel pathways normally utilized in the warning and emergency phase of the response remained operational after more formal civilian-military communication pathways and local assessment capability had been established.Conclusion:It is concluded that delays may be avoided if the system in place was to make all active pathways for the request and validation of military resources visible to the designated Federal managers located within the area of operations.
Intubation with Transillumination: Nasal or Oral?
Authors: Petroianu Georg A. , Subotic S. , Heil P. , Jatzko A. , Maleck W. H. 
Published: July 2016

AbstractTransillumination-guided intubation is a useful back-up method when laryngoscopic intubation proves to be difficult or impossible. The Trachlight™ (Laerdal, N-4001 Stavanger, Norway) is suited for both nasal and oral use. Intubation times (intubation time) and success rates (success rate) for nasal and oral intubation with the Trachlight were compared.Twenty-four medical students, inexperienced in intubation were instructed in the use of the Trachlight. A demonstration also was performed. Subsequently, they were asked to intubate a Laerdal Airway Management Trainer™ (Laerdal, Stavanger, Norway) using the Trachlight. Each student intubated 10 times orally and 10 times nasally (five times through the right and five times through the left nostril). The succession of the students was randomized The intubation times were measured and the position of the tube noted. Nasal and oral intubation times for the tenth trial (steady state conditions) were compared using the rank-order test for paired observations. Oral and nasal success rates were compared using the sign test for paired observations.The differences between nasal and oral intubation concerning intubation time and the success rates were not significant. Nasal intubation with the Trachlight seems to be more difficult than the oral intubation.
Complications from Supervised Mask Use in Post-operative Surgical Patients during the Gulf War
Authors: Rivkind Avraham I. , Eid Ahmed , Weingart Efrat , Izhar Uzzi , Barach Paul , Richter Elihu D. , Belzberg Howard 
Published: July 2016

AbstractThis is a report of three patients in a surgical ward of a hospital who developed complications seemingly related to the use of full-face-fitting masks associated with the first Scud Missile attack on Israel durng the Gulf War. Patient 1 developed atrial fibrillation with an uncontrolled ventricular rate; Patient 2 redeveloped a gastrointestinal hemorrhage; and Patient 3 developed a severe anxiety attack. Each of the three was severely ill prior to the event. Special attention should be given to severely ill patients during such events.
Geriatric Trauma Patients at a Suburban Level-I Trauma Center in Japan
Authors: Sugimoto Katsuhiko , Aruga Toru , Hirata Mitsuhiro , Shindo Masateru 
Published: July 2016

AbstractBackground:Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (emergency medical services) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma.Patients and Methods:From July 1996 through June 1997, a group of geriatric trauma (Group G, n = 22) and a control group of younger trauma patients (n = 173) were compared with respect to transfer method to an Emergency Center (direct or indirect), Revised Trauma Scores on the scene of the accident (revised trauma score-l) and on admission to the Emergency Center (revised trauma score-2), and outcome (survival).Results:The mean values for revised trauma score-l in the Control Group (Group C) were not different from those in Group G, but revised trauma score-2 of the indirect-transfer patients (indirectly transported patients) in Group G were significantly lower than were those for Group C. Group G mortality rates were significantly higher than were the control rates (p = 0.0001). The mortality rate of the indirectly transported patients subgroup was significantly lower than that of the direct transfer subgroup (directly transported patients) (30/68 vs. 5/70, p<0.0001) in the Group C, but mortality rate of the indirectly transported patients subgroup exceeded that of the directly transported patients subgroup of Group G (8/14 vs. 5/8).Conclusion:The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for injury severity score. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.
Cardiovascular Mortality — The Hidden Peril of Heat Waves
Authors: Wainwright Sherrilyn H. , Buchanan Sharunda D. , Mainzer M. , Parrish R. Gibson , Sinks Thomas H. 
Published: July 2016

AbstractObjective:— Define the mortality associated with extremely hot weather during the 04 July through 14 July, 1993 heat wave that struck the northeastern United States.Methods:Design — A rapid field assessment was used to compare mortality occurring during the heat wave to mortality occurring during a period in which there was no heat wave using copies of death certificates. The findings of the rapid field assessment were validated, and it was determined whether increases in mortality occurred in other metropolitan east-coast counties also affected by the heat wave, by reviewing computerized mortality files. Setting —Information was collected on all deaths occurring in Baltimore City, Maryland; Baltimore County, Maryland; Essex County, New Jersey; Newcastle County, Delaware; and Philadelphia County, Pennsylvania; during these specified study periods: 08–18 June (comparison period) and 06–16 July (heat wave study period), 1993.Main Outcome Measures — Ratios for total mortality, cause-specific mortality, and variables such as age, sex, race, residence, and day and place of death, that were available from death certificates were calculated.Results:From the rapid field assessment, the following were observed: a 26% increase in total mortality and a 98% increase in cardiovascular mortality associated with the heat wave in Philadelphia. Data from the computerized mortality files showed an increase in total mortality in four of five counties examined and an increase in cardiovascular mortality in all five counties. The risk for death for those dying from cardiovascular disease increased significantly for people older than 64 years, for both sexes, and all races.Conclusion:Conclusion: As initially indicated by the Philadelphia Medical Examiner, there was excess mortality associated with a heat wave in Philadelphia. All other nearby counties examined also experienced excess mortality associated with the heat wave, although this excess was not recognized by the local health officials. The true impact of a heat wave that causes excess preventable mortality must be appropriately and rapidly ascertained. Using a national standard to certify a death as heat-related will provide the needed information rapidly so that public health resources can be more effectively allocated and mobilized to prevent further heat-related illnesses and death.
The World Heath Organization's Disaster Reduction Policies in Africa at the Dawn of 1990's: Steps in the Right Direction?
Authors: Zaman Maniza S. , Calvani Sandro 
Published: July 2016

AbstractThe World Health Organization, Panafrican Centre for Emergency Preparedness and Response (WHO/EPR) was established in 1988, and officially opened in March 1989, as a practical and functional response to the identified need for a regional institution to deal effectively with the health and related consequences of both natural and man-made disasters. The principal objective of the Centre is to aid member countries in the prevention and/or reduction of the adverse health effects of disasters, be they direct or indirect, by strengthening national capacities for disaster preparedness and response. The WHO has reoriented its disaster operations unit to incorporate preparedness activities, particularly within an overall developmental framework which is crucial for reducing losses, both human and material, in the event of a disaster. In keeping with this focus, the Centre has defined its goals and activities: development of national disaster preparedness programs; training of national and international personnel in health emergency preparedness and response; production and dissemination of technical publications on disaster preparedness and management; undertaking risk assessment missions; and executing relevant research projects.
Flood Disaster in the Czech Republic in July, 1997 — Operations of the Emergency Medical Service
Authors: Pokorny Jiri R. 
Published: July 2016

AbstractThis report is a review of the response and the activities of the Emergency Medical Services during a huge flood that devastated one-third of the territory of the Czech Republic in July 1997. The Emergency Medical Services personnel extracted by helicopter a great number of citizens who were trapped in their flats and homes. For diabetics and cardiacs who were isolated from the surface transport, the EMS personnel supplied necessary medication, and transported patients to hemodialysis.The cooperation between non-medical emergency services and the district crisis staff of the Integrated Rescue System, varied in different districts. However, in most flooded districts, the cooperation was satisfactory. In addition, a large number of volunteers helped in the first days of the flood.Unfortunately, 49 people died because of the flood. Nevertheless, since the EMS was able to manage the extraordinary needs, the number of emergencies and hospitalizations was low.
Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results
Authors: Klain Miroslav , Ricci Edmund , Safar Peter , Semenov Victor , Pretto Ernesto , Tisherman Samuel , Abrams Joel , Comfort Louise 
Published: July 2016

AbstractIn general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).
International Military-Civilian Collaboration for Disaster Medicine
Authors: Gemma William R. 
Published: July 2016

Throughout the world, experience is growing in the development of plans for military-civilian collaboration in disaster preparedness. This involves the complex problems associated with the coordination of various components of military and civilian Emergency Medical Services (EMS) systems and organizational differences between countries.EMS are dependent on relationships between hospitals, police-fire-ambulance services, and municipal, county and state governments. In an emergency, their integration is accomplished in: (1) detection and assessment; (2) call for ambulance and hospital; (3) organization; and (4) emergency medical treatments.