bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining Self-Perceived First-aid Abilities After the Northridge Earthquake
Authors: Nguyen Loc H. , Shoaf Kimberley I. , Rottman Steven J. , Bourque Linda B. 
Published: July 2016

AbstractIntroduction:This study examines those factors predictive of self-perceived first-aid abilities among a community-based sample after the 1994 Northridge earthquake.Methods:A probabilities-proportionate to-size (pps) sample of residents of Los Angeles County and 11 pre-selected zip codes from southeastern Ventura County was selected using computer-generated random digit-dialing (rdd) procedures 7–11 months after the earthquake. Data were collected from 506 individuals in 45 minute interviews. A unidimensional scale of self-perceived first-aid ability was created and represents the dependent variable in a causal path model.Results:In a causal path model, standardized path coefficients suggested that while reports of taking first-aid courses were the most influential factors in predicting higher self-perceived first-aid abilities, other factors including being white, younger, speaking English in the home, and lower income also predicted higher self-perceived first-aid abilities that were independent from taking formal first-aid courses.Conclusion:First-aid training should be directed towards target segments of the population that are not likely to have had instruction in these basic skills. Those individuals who self-report high first-aid proficiency, independent of formal first-aid training, should be evaluated to assess their abilities to perform these skills.
Does Number of Beds Reflect the Surgical Capability of Hospitals in Wartime and Disaster? The Use of a Simulation Technique at a National Level
Authors: Levi Lion , Bregman David , Geva Hana , Revah Moshe 
Published: July 2016

AbstractIntroduction:The raw number of hospital trauma beds and occupancy has been used assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations.Methods:Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of “standard wartime casualties.” Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A “what-if” module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of “standard casualties.” Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load.Results:Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital.Recommendations:The use of simulation techniques might be useful method to asses the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.
A Meta-Analysis of Hepatitis B Serologic Marker Prevalence in EMS Personnel
Authors: Menegazzi James 
Published: July 2016

AbstractIntroduction:The risk of exposure to the Hepatitis B Virus (HBV) is a known occupational health risk in medical personnel. The specific risk in emergency medical services (EMS) personnel in the United States (U.S.) is not known. Estimates have ranged from 0.6 to 30.0% The purpose of this investigation was to provide an estimate of the prevalence of this exposure, to determine if this risk is homogeneous throughout the U.S., and to provide an estimate of relative risk. The study hypothesis was that the risk of exposure to HBV is not homogeneous throughout the U.S.Methods:All articles containing HBV studies of non-immunized EMS personnel (physicians, nurses, and emergency medical service technicians [EMTs]) were considered, provided they reported at least two of the following seromarkers: hepatitis B (HB) surface antigen; HB surface antibody; and/or HB core antibody. A computerized literature search of a database (MEDLARS) from 1980–1989 was performed. Reference sections of relevant articles and texts also were searched. The chi-square test of homogeneity of proportion was used, assuming binomial distribution. The alpha error rate was set at 0.05.Results:Seven articles from 1982 to 1989 qualified for inclusion. The average rate of prevalence for all studies was 14.04% (160/1,140), with a 95% confidence interval of 11.40 to 16.68%. The chi-square test was statistically significant (chi-square=12.59, 6 df, p<.01), suggesting that the risk of exposure is not homogeneous throughout the U.S., and may not be homogeneous within a city, nor between prehospital and hospital personnel. When compared to CDC estimates for the general population in the U.S., this analysis suggests that the EMS personnel tested run three times (2.8) greater risk of HBV exposure than does the general population.Conclusion:EMS personnel run a great risk of exposure to HBV with a nationwide prevalence of 14.04%, but this risk is not spread homogeneously throughout the country.
Opportunity for Seatbelt Usage by ALS Providers
Authors: Cook Richard T. , Meador Steven A. , Buckingham Barry D. , Groff Lee V. 
Published: July 2016

AbstractPurpose:Prehospital care providers commonly indicate that they cannot wear seat belts owing to their need to be unrestrained while delivering care to the patient in the back of the ambulance. Each year, providers are injured in situations in which seat belts have been shown to be protective. Are ALS providers able to wear a seat belt and provide care in an ambulance?Methods:The ALS providers were asked to complete a form following calls during which they rode with a patient in the back of an ambulance. They indicated the amount of time which they felt they would have needed to have been unrestrained by seat belts and the reasons. There were no attempts to regulate or quantify seat belt usage. Additional information was gathered from the trip report.Results:The percentage of the time of each trip during which they felt they needed to be unrestrained was calculated for each trip. The mean was 41%. The mean transport time was 14.7 minutes. Sub-groupings by protocol type, showed that for cardiac arrest patients, providers felt they needed to be unrestrained for 82% of the duration of transport, for patients with “chest pain or cardiac dysrhythmia” 63%, for “shortness of breath” 38%, and for trauma patients 41%. Excluding cardiac arrest patients, the nine patients were assigned by the providers to have the most critical level of case severity required unrestrained time of 72%. Those nine patients with the lowest severity level requires that the provider by unrestrained only 18% of the time. Management of intravenous line and patient assessments most frequently were cited as reasons for needing to be unrestrained.Conclusion:Perceived need of ALS providers to be unrestrained varied with respect to the type of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of calls. The ALS providers should be able to wear seat belts for at least part of the time, on most ALS calls.
Multi-Agency, Prehospital Evaluation of the Pharyngeo-Tracheal Lumen (PTL) Airway
Authors: McMahan Sabina , Ornato Joseph P. , Racht Edward M. , Cameron Julia 
Published: July 2016

AbstractIntroduction:The purpose of this study was to assess subjectively the performance of the pharyngeo-tracheal lumen (PTL) airway in a multi-agency, prehospital emergency medical service (EMS) environment.Methods:Data were recorded by the EMS provider on 1,647 adult patients (age range 16–92 years) in whom a PTL or endotracheal (ET) airway insertion was attempted. Analysis of variance and Fisher's Exact tests were used for statistical analysis.Results:There were no significant differences between the PTL and ET groups, either in patient demographics or in rates of successful ventilation with either airway overall or in trauma-related versus non-trauma-related cases, male versus female patients, or volunteer versus paid EMS providers. Basic life support (BLS) providers were able to ventilate successfully with the PTL as frequently as were ALS providers using the ET tube.Conclusions:The PTL appears to be a useful primary airway for BLS providers and for ALS providers who are called upon infrequently to manage an airway acutely. The PTL also may be used as an alternate airway for ALS providers when tracheal intubation cannot be accomplished. Further study is needed to define the effectiveness of the PTL in the management of patients with trauma-related injuries.
Endogenous Digoxin-Like Factor: Possible Emergency Implications
Authors: Bagrov Alexey Ya 
Published: July 2016

SummaryThe existence of endogenously produced, digoxin-like factor(s) is clear. The implications of die presence of this circulating substance are substantial for the practice of emergency medical care. Clearly, EDLF plays an important role in the generation of dysrhythmias associated with an AMI. Treatment with AA could become routine early in the course of management of some patients with AMI and in die treatment of some forms of hypertension
A Cost-Effectiveness Analysis of Pediatric Intraosseous Infusion as a Prehospital Skill
Authors: Garrison Herbert G. , Downs Stephen M. , McNutt Robert A. , Griggs Thomas R. 
Published: July 2016

AbstractPurpose:To determine the clinical efficacy, patient volume, and program costs that justify pediatric intraosseous (IO) infusion as a routine skill for the treatment of patients with cardiac arrest in a prehospital system.Methods:A decision analytic model was constructed to include patient outcomes and costs to society. Critical variables for the analysis were: 1) time to vascular access; 2) success of vascular access; 3) clinical efficacy (i.e., the percentage of lives saved by early vascular access); 4) number of patients requiring IO annually; and 5) the cost of an IO program. Program costs included training and equipment expenses. Sensitivity analysis, which repeatedly evaluates the model using different values for the critical variables, identified those values at which IO would be cost-effective.Results:With an estimated 80% success rate for IO access within five minutes, the cost-per-life-saved would be [US] $161,000. This cost-effectiveness ratio assumed annual program expenses of $2,000 and one patient per year needing IO. The cost-effectiveness ratio also required a clinical efficacy of 2% for vascular access. To prove that the clinical efficacy of vascular access is in fact 2%, epidemiologic studies would require a sample of nearly 9,000 patients.Conclusions:This analysis suggests IO probably is cost-effective given a clinical efficacy above 2%. While the true efficacy may be below this value, clinical studies are unlikely to have sufficient size to prove it. Therefore, emergency medical services (EMS) medical directors must make the decision to utilize IO based on their own beliefs about its clinical efficacy. Further, it must be considered in the context of other prehospital programs which may be more cost-effective. Such analyses permit establishment of rational priorities to rank programs in prehospital systems.
Emergency Physician Interpretation of Prehospital, Paramedic-Acquired Electrocardiograms
Authors: Schaffer Jeffrey A. , Valenzuela Terence D. , Wright Arthur L. , Clark Lani , Brakema Riemke M. , Goldman Steven , Spaite Daniel W. 
Published: July 2016

AbstractHypothesis:Emergency physician interpretation of prehospital, paramedic-acquired, electrocardiograms (ECG) is accurate judged by comparison with that of a reference cardiologist.Methods:Twelve-lead ECGs were obtained by paramedics in the field from 150 patients with acute chest pain. The ECGs were transmitted by cellular telephone to a central location. Each ECG was assessed for evidence of acute myocardial infarction (AMI) by: 1) a third-year, emergency medicine resident (EMP-R); 2) a residency-trained, board-certified, emergency physician (EMP-RT); 3) an emergency physician board certified under the practice option (EMP-PT); and 4) a board-certified cardiologist. Agreement between each emergency physician and the cardiologist was assessed by the kappa statistic. Hospital records were reviewed for final diagnosis of each patient.Results:Sixteen of 150 (10.7%) patients received a hospital discharge diagnosis of AMI. Sensitivity of physician interpretation ranged from 0.31 to 0.56. All physicians achieved specificity of 0.99. False-positive rates for the physicians ranged from 0.18–0.29. The mean positive predictive value for the four physicians was 0.77±0.05; the mean negative predictive value was 0.94±0.01. The total agreements between the EMP-R, EMP-RT, and EMP-PT and the cardiologists were 0.97, 0.96, and 0.97, respectively. Kappa values for agreement between the emergency physicians and the cardiologist ranged from 0.65–0.79.Conclusions:Residency-trained or board-certified emergency physician interpretations of prehospital, paramedic-acquired 12-lead ECGs show a high degree of agreement with reference cardiologist interpretations.
Unexpected ALS Procedures on Non-Emergency Ambulance Calls: The Value of a Single-Tier System
Authors: Wilson Bryan , Gratton Matthew C. , Overton Jerry , Watson William A 
Published: July 2016

AbstractBackground:In a single-tier, advanced-life-support (ALS) emergency medical service (EMS) system, ALS-trained staff in ALS-equipped vehicles respond to all ambulance calls. In some two-tier systems, basic life support (BLS) vehicles respond to calls which are determined initially to be non-emergency based on dispatcher triage. I emergency requiring ALS is discovered (or recognized) by BLS personnel, then a subsequent ALS response can be requested.Purpose:The purpose of this study was to determine the frequency of ALS care provided on ambulance calls initially dispatched as non-emergency.Setting:A single-tier, all-ALS provider, EMS system, serving an urban population of 475,000 with an annual response volume of 45,000 calls.Methods:A retrospective review of all prehospital transports initially dispatched as non-emergency from 1 January 1989 to 1 January 1990 that resulted in an ALS intervention being performed was conducted. An ALS intervention was defined as, “administration of a medication, endotracheal intubation, attempted IV insertion, and/or ECG monitoring.”Results:A total of 6,362 non-emergency calls were identified; of these 309 (5%) were upgraded to emergency while the responding unit was in route. Of 6,053 non-emergency calls remaining, 710 (11.7%) involved the provision of one or more ALS interventions. Of these, 296 (42%) received an IV, 24 (3%) a medication, and three (0.4%) were intubated. Calls that were upgraded by dispatchers required one or more interventions in 144/309 calls (46.6%). This was statistically significantly different than for the non-upgraded calls.Conclusion:Despite the use of strict dispatching protocols, 11.7% of patients prioritized as non-emergent unexpectedly received ALS care after evaluation by ALS personnel. These results add support for the use of a single-tier, ALS ambulance system.
Use of Selective Decontamination in the Prevention of Infection After Accidental Irradiation
Authors: Brook Itzhak , Ledney G. David 
Published: July 2016

AbstractExposure to radiation induces a reduction in the number of gastrointestinal, anaerobic bacterial flora, and an increase in the number of Enterobacteriaceae that are associated with sepsis and mortality. Antimicrobials that suppress anaerobic flora have a deleterious effect on survival by promoting earlier enterobacterial sepsis. In contrast, in studies of animals and immunosuppressed patients, antimicrobials that inhibit gram-negative enteric bacteria and preserve the anaerobic flora have shown a beneficial effect by preventing bacterial translocation and fatal sepsis. The quinolone antimicrobials hold potential for therapy of endogenous and exogenous infection after irrodiation.
Guidelines for Rescue Training of the Lay Public
Authors: Abrams Joel I. , Pretto Ernesto A. , Angus Derek , Safar Peter 
Published: July 2016

AbstractThe fundamental goal of emergency medical response in disaster is to save lives and reduce injury and permanent disability. It has been observed that urgent emergency medical care of seriously injured earthquake casualties trapped under building rubble, cannot be provided unless the victims have been extricated and transported to medical facilities by friends or relatives, or are accessible to field rescue and medical teams. Equally important is the fact that extrication of seriously injured, trapped victims by laypersons is hazardous, unless the following conditions are met: 1) the rescuer has basic knowledge of extrication, and; 2) there is early application of effective life-supporting first-aid (LSFA) and/or advanced trauma life support (ATLS) at the scene. Time is the critical factor in such an effort. In previous studies of death and dying in earthquakes, it was noted that extrication of trapped victims will be attempted by survivors. Therefore, it is suggested that citizens living in regions of high seismic risk and trained in basic search and rescue and in LSFA are the most immediate resource for early response after an earthquake. An accompanying paper addresses the issue of citizen LSFA training. This paper focuses on the basic concepts of search and rescue training for the lay public.
The Role of Health Sectors in Disaster Preparedness: Floods in Southeastern China, 1991
Authors: Xiaohong Shao 
Published: July 2016

AbstractDisasters, whether natural or man-made, usually are unpredictable. Efforts to reduce morbidity and mortality from a disaster should be put forth before it occurs.A brief survey is presented of the worst flood to occur in a hundred years that affected eight provinces in Southeast China. The disaster preparedness and reposnse for Anhui Province, the hardest hit area, is summarized. The disaster preparedness was comprehensive, and cooperation was achieved among various specialties: military forces; firefighters; civil engineers; mechanics; police; provincial governors; the medical sectors; and so forth. Among these groups, the role of medical sectors was of great importance in reducing disease that would have resulted from such a disasterThe measures undertaken by the medical sectors included development of an organization to reduce the impact of disaster; training of medical personnel in techniques of rescue and in treatment of victims in disaster areas; development of a plan to assist the leadership in decision-making and establishing support for disaster preparedness; and maintaining sufficient capacity in general hospitals for the admission of victims from disaster areas.
Intermediate ALS Providers' Level of Interest in Paramedic Education
Authors: Walz Bruce J. 
Published: July 2016

AbstractObjective:To examine the level of interest in paramedic upgrade education among a sample of intermediate-level emergency medical technicians, referred to as cardiac rescue technicians (CRT), to obtain education to upgrade to the paramedic level.Method:The design of this study was a descriptive, cross-sectional study utilizing a mailed survey instrument.Results:Most of the CRTs reported interest in advancement to the paramedic level with the most active CRTs significantly more interested in upgrading than were those with lower grade of activity. Preference was for the upgrade training to be offered as a single course, two nights per week. Respondents also indicated an interest in receiving college credits for the course.Conclusion:Active volunteer, intermediate-level emergency medical technicians (EMTs) in Maryland are interested in participating in the education necessary to advance them to the paramedic level.
Clinical Guidelines for Delayed or Prolonged Transport: III. Spine Injury
Authors:   Rural Affairs Committee,   National Association of Emergency Medical Services Physicians
Published: July 2016

Conventional emergency medical services (EMS) guidelines recommend that essentially every victim of any significant trauma be treated in the field as having an unstable spine injury. For example, any victim of any motor vehicle crash generally is assumed to have an unstable spine injury and is transported to the hospital in full-spine immobilization. This approach generally is reasonable and appropriate for the conventional EMS context of rapid transport, because patient symptoms and physical examination often are unreliable for the time period immediately following the event.The specialized context of delayed or prolonged transport, however, requires a closer look at assessment criteria and treatment procedures for spine injury. Full-spine immobilization, if it is not required, can be unnecessarily difficult, impractical, impossible, and even dangerous during prolonged evacuation, especially in severe environments or when using improvized equipment. Prolonged transport also provides an opportunity to repeat patient surveys and to observe changes in the patient's condition over time.
Natural Hazards: Causes and Effects: A Course in Disaster Management
Authors: Perez Eddie , Thompson Paul 
Published: July 2016

This self-study course will meet the needs of people involved in disaster management for both sudden-onset natural disasters (i.e., earthquakes, floods, hurricanes) and slow-onset disasters (i.e., famine, drought). The course is designed for government personnel, representatives of private, voluntary agencies, and other individuals interested in disaster management.The nine lessons for the course will be published successively in Prehospital and Disaster Medicine. Self-assessment tests will accompany each lesson. There also is a final examination offered for those who wish to earn continuing education units (CEUs) through the University of Wisconsin—Disaster Management Center (UW-DMC).