bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Ambulance Crew Size Affect On-Scene Time or Number of Prehospital Interventions?
Authors: Brown Lawrence H. , Owens Charles F. , March Juan A. , Archino Elizabeth A. 
Published: July 2016

AbstractIntroduction:While large cities typically staff ambulances with two emergency medical services (EMS) professionals, some EMS agencies use three people for ambulance crews. The Greenville, North Carolina, EMS agency converted from three-person to two-person EMS crews in July 1993. There are no published reports investigating the best crew size for out-of-hospital emergency care.Hypothesis:Two-person EMS crews perform the same number and types of interventions as three-person EMS crews. Two-person EMS crews do not have longer on-scene times than do three-person EMS crews.Methods:Data for the two most common advanced life support calls in this system—seizures and chest pains—were collected for the months of June and August 1993. Three-person EMS crews responded to both types of calls in June. In August, two-person EMS crews responded to seizure calls; two-person EMS crews accompanied by a fire department engine (pumper) with additional manpower responded to chest pain calk. The frequency of specific interventions, number of total interventions, and scene times for the August calls were compared to their historical control groups, the June calls.Results:One hundred twenty-six patient contacts were included in the study. There were no significant differences in total number or types of procedures performed for the two patient groups. Mean on-scene time for patients with seizures was 11.0±4.2 minutes for three-person crews and 19.4±8.3 minutes for two-person crews (p <0.001). Mean on-scene time for patients with chest pain was 13.6±4.9 minutes for three-person crews, and 15.4±3.2 minutes for two-person crews assisted by fire department personnel (p >0.05).Conclusion:Two-person EMS crews perform the same number of procedures as do three-person EMS crews. However, without the assistance of additional responders, two-person EMS crews may have statistically significantly longer onscene times than three-person EMS crews.
Sources of Stress Among Emergency Medical Technicians (Part I): What Does the Research Say?
Authors: Boudreaux Edwin , Mandry Cris 
Published: July 2016

AbstractResearch repeatedly has demonstrated that organisms exhibit adaptive physiological, emotional, and behavioral responses when exposed to noxious or threatening environmental stimuli. However, when the noxious stimuli are excessive or prolonged, efforts to cope may become overwhelmed, and the adaptive responses can turn into maladaptive reactions (e.g., illness, depression, and impaired performance). According to this model of stress, people who work in occupations that continually place them in danger or repeatedly force them to encounter psychologically demanding or distressing situations would appear to be at greater risk for developing adverse stress reactions.Both anecdotal evidence and empirical research suggest that prehospital emergency medical services (EMS) may be a particularly high-stress field, placing emergency medical technicians (EMTs) at risk for developing such maladaptive stress reactions. This article reviews and synthesizes the empirical literature investigating the sources of stress among EMTs, and concludes with critical comments and guidelines for future research. The authors intend this review to be a resource for investigators conducting research in this area, as well as a convenient summary for anyone interested in learning more about the stressors EMTs experience, particularly mental health professionals and EMS administrators coordinating stress-management programs for EMTs.
Emergency Medicine in the United Kingdom—How It Is Taught
Authors: Marsden Andrew K. 
Published: July 2016

The staff of accident and emergency departments in the United Kingdom are realizing their increasing role in teaching the elements of emergency care. This paper highlights some recent developments which have influenced the way in which emergency medicine is taught.First Aid instruction aims to impart the universally agreed and accepted principles to a wide ranging audience. Traditionally these principles have been embodied in the combined manual of the St. John Ambulance Service, St.
The SAMU System of France
Authors: Cara M. , Lareng L. , Gaston J.T. 
Published: July 2016

Our emergency medical services (EMS) system is called SAMU (“Service d'Aide Medicale d'Urgence”). It was initiated in Paris in 1956. Since that date, it has developed a new concept of emergency transportation, which excludes speed as the best way for saving life threatened by danger. Indeed, this EMS System is based upon the same principles that are used everywhere, but there are some practical differences which are characteristic of the service in France. One example is the medicalization (physician-staffing), which permits excluding speed in transportation.Everywhere, the fundamental EMS principle is to struggle against time to give efficient care as soon as possible. In emergency situations, all things are simpler and all treatment is more efficient if you can do it within the limit of time available for resuscitation. If this limit is surpassed, success is dubious. The means to reach it are more sophisticated and cost increases tremendously; however, the mortality goes up inexorably to death in all severe cases.
Hyperthermia with Cardiac Arrest, CPR and Irreversible Shock in Monkeys
Authors: Sassano John , Eshel Gideon , Safar Peter 
Published: July 2016

Each year 4,000–9,000 people die in the USA from hyperthermia-related crises, such as heat stroke and febrile convulsions. In most of these cases, variable combinations of hot environment, physical exercise, dehydration, and infection can be identified. Heat stroke is a complex clinical picture with poorly understood pathophysiology and unexplored resuscitation potentials. Protection of vital organs against hyperthermia is also important for cancer therapy.This study (1978–1980) was aimed exclusively at the effects of controlled hyperthermia. In pilot experiments on lightly anesthetized dogs and rhesus monkeys, brain temperature was raised to 42°C for 1/2–1 hour by immersion heating. This was followed by cooling to normothermia. Partial recovery with a lucid period of 1 hour or longer was followed by diffuse gastrointestinal bleeding and irreversible shock in spite of standard life support measures.
Disaster Planning in the Stockholm Region of Sweden: Medical Teams for Qualified First Aid
Authors: Brismar Bo , Norberg Karl-Axel 
Published: July 2016

Although in Sweden the risk of natural catastrophes is small, several have occurred in recent years. Two examples are a storm disaster in 1970 and a landslide in 1978—both causing extensive personal and material damage.Other disasters can be caused by human activity in different forms, for instance, fires, explosions and accidents involving public transport, and also—a subject of much concern today—accidents at nuclear power plants. Terrorist actions have also led to serious disaster situations in recent years.Common to the different types of disasters from the viewpoint of medical care is the fact that locally available resources are often inadequate. Even with very good access to ambulances and other forms of medical transport the waiting time at the scene of the accident can be so long that many patients suffer from acute respiratory distress, major hemorrhages and shock. Under such circumstances qualified first aid can be expected to reduce the morbidity and mortality considerably.
Refugee Camp Medical Care During Cambodian Disaster Relief
Authors: Feldstein Bruce , Weiss Robert 
Published: July 2016

The Khao I Dang Holding Center for Kampucheans opened November 21, 1979 as part of an effort to bring relief to the thousands of Cambodian on the eastern frontier of Thailand. The camp population increased from 4800 that first day to 50,000 by December 1, 1979 and 110,000 by mid-January, 1980. Sixty-one percent (61%) of the population were 15 years of age and older; 12% of these over 44. Thirty-nine percent (39%) were children under 15.Although each disaster is unique, the medical problems for a type of disaster in a stated area are considered predictable. This was not the case at Khao I Dang for hospital pysicians in providing patient care. It has been shown that relief efforts are amenable to study, yet such studies have been handicapped by a lack of data. Since major disasters involving international aid are reported several times a year, the problem is considerable.
43. Prehospital Determination of Eligibility for Thrombolytic Therapy
Authors: Delozier T , White LJ , Dougherty JM ,   the Summit County Prehospital Research Group
Published: July 2016

Purpose: To determine the degree of concordance between thrombolytic checklists completed by emergency medical technicians (EMTs) in the field and corresponding checklists completed by emergency physicians in the emergency department (ED).Methods: This was a comparative analysis of matched pairs of thrombolytic checklists. Subjects included patients 35 years or older with clinical signs or symptoms of cardiac origin who were transported to the ED by ambulance. The checklist contained 12 items and was completed by EMTs during transport of eligible patients. An identical checklist was completed in the ED by an emergency physician upon arrival of the patient. The main outcome measurement was concordance between the matched pairs.
48. Age, Sex, Ethanol Levels, and Helmet Use Among Injured Motorcyclists
Authors: Lober William B. , Judkins Daniel G. 
Published: July 2016

Introduction: Previous studies of motorcycle injuries show that helmet use is associated with a decrease in head trauma. Understanding patterns of helmet use is important in selecting and assessing injury prevention strategies.Methods: All 470 motorcyclists presenting to either of two regional Level I trauma centers from 7/93 through 12/95 comprise this case series. Thirty-three patients were excluded due to unknown helmet use or outcome, and 50 due to age under 18 years (for whom helmet use was required by state law).Results: Of 386 patients, 42% wore helmets, and 58% did not, with no difference in the mean ages of the groups. 13% of patients were women (n = 50), and 10% were passengers (n = 38). Women were 25 times more likely than men to be passengers (95% CI: 11 to 50), and passengers were 5 times more likely than drivers to not wear a helmet (95% CI: 2 to 16). Helmet use was not related to sex, even when the data were controlled for driver vs. passenger. Of 265 patients assayed for ethanol, 30% had >100 mg/dL, 7% had <100 mg/dL, and 63% had none. Non-helmeted patients were 3.6 more likely than helmeted ones to have detectable ethanol (95% CI: 2.0 to 6.5), but there was no association with sex or age. The mean ethanol level was 80 mg/dL in non-helmet users, and 24 mg/dL in helmet users (p <0.001). 39% of non-helmeted patients were legally intoxicated (ethanol > 100 mg/dL), compared to 11% of helmeted ones.
25. A Prospective Time-Motion Study of The EMS Turnaround Interval
Authors: Cone David C. , Nguyen Que , Davidson Steven J. 
Published: July 2016

Purpose: Because overall EMS system response depends on ambulance availability, we conducted a prospective study of the EMS turnaround interval. This interval consists of the delivery and recovery intervals as defined in Spaite's EMS time-interval model.Methods: An on-site observer, while monitoring EMS radio traffic, recorded the delivery and recovery activities of personnel from a large urban EMS system at a university hospital ED. System policy permits a maximum 30 minute turnaround interval. Prospectively defined subintervals were analyzed.Results: A convenience sample of 122 patient deliveries was collected. Observed and radio-reported arrival at the hospital differed by -1′24″; to +11′8″. Time from arrival to removal of the patient from the ambulance averaged 59″ (range 13″-2′53″), and time from patient removal to ED entry averaged 42″ (10″ - 5′22″). While the mean time for the verbal report to ED staff was 33″ (2″-5′20″), it was 0 = 15″ in 36% of cases. Time from ED entry to placement of the patient on an ED bed averaged 2′11″ (33″-9′35″). Writing the report averaged 17′12″ (5′20″-52′11″). The mean time off radio was 29′51″ (ll′43″-53′37″) and the mean time the ambulance was at the ED was 30′01″ (11′25″-1°17′53″). Observed and radio-reported ambulance departures differed by -4′31″ to +23′32″. In 22% of cases, departure was reported on radio more than 5′after actual departure.
History Made: The Rise of Republican Tim Scott
Authors: Huffmon Scott H. , Knotts H. Gibbs , McKee Seth C. 
Published: July 2016

ABSTRACTIn a time of unprecedented racial polarization in partisan voting, and in a staunchly Republican Deep South state, one black Republican managed to reach the pinnacle of public office. This article examines Tim Scott’s rise by analyzing precinct-level data to better understand his 2010 election to the US House and data from the Winthrop Poll to explore his more recent US Senate victory. To better understand support for Scott, we also report results from an embedded-survey experiment to assess respondents’ favorability toward Scott when he is characterized by two different frames: (1) “Tea Party favorite,” and (2) “first African American Senator from South Carolina since Reconstruction.” We found that conservatives, evangelicals, and less-educated individuals respond more positively to Scott when he is described as a “Tea Party favorite.” More than an intriguing case study, Scott’s rise tells a broader story of the complicated relationships among race, ideology, and partisanship in the contemporary American South.
Never saw one – first-person null subjects in spoken English1
Authors: WAGNER SUSANNE 
Published: July 2016

While null subjects are a well-researched phenomenon in pro-drop languages like Italian or Spanish, they have not received much attention in non-pro-drop languages such as English, where they are traditionally associated with particular (written) genres such as diaries or are discussed under a broader umbrella term such as situational ellipsis. However, examples such as the one in the title – while certainly not frequent – are commonly encountered in colloquial speech, with first-person singular tokens outnumbering any other person.This article investigates the linguistic and non-linguistic factors influencing the (non-) realisation of first-person singular subjects in a corpus of colloquial English. The variables found to contribute to the observed variation are drawn from a variety of linguistic domains and follow up on research conducted in such different fields as first language acquisition (FLA), cognitive linguistics, discourse analysis, sociolinguistics and language variation and change. Of particular interest is the finding regarding the link between null subjects and complexity of the verb phrase, which patterns in a clearly linear fashion: the more complex the verb phrase, the more likely is a null realisation. Not discussed in this form before, this finding, given its high significance and its robustness in light of alternative coding, may prove to be an important candidate for inclusion in future studies on (English) null subjects.
A systematic review and meta-analysis of the antibiotic treatment for infectious bovine keratoconjunctivitis: an update
Authors: Cullen J. N. , Yuan C. , Totton S. , Dzikamunhenga R. , Coetzee J. F. , da Silva N. , Wang C. , O'Connor A. M. 
Published: July 2016

AbstractInfectious bovine keratoconjunctivitis (IBK) is a common and important disease of calves. Without effective vaccines, antibiotic therapy is often implemented to minimize the impact of IBK. This review updates a previously published systematic review regarding comparative efficacy for antibiotic treatments of IBK. Available years of Centre for Biosciences and Agriculture International and MEDLINE databases were searched, including non-English results. Also searched were the American Association of Bovine Practitioners and World Buiatrics Congress conference proceedings from 1996 to 2016, reviews since 2013, reference lists from relevant trials, and U.S. Food and Drug Administration New Animal Drug Application summaries. Eligible studies assessed antibiotic treatment of naturally-occurring IBK in calves randomly allocated to group at the individual level. Outcomes of interest were clinical score, healing time, unhealed ulcer risk, and ulcer surface area. A mixed-effects model comparing active drug with placebo was employed for all outcomes. Heterogeneity was assessed visually and using Cochran's Q-test. Thirteen trials assessing nine treatments were included. Compared with placebo, most antibiotic treatments were effective. There was evidence that the treatment effect differed by day of outcome measurement. Visually, the largest differences were observed 7–14 days post-treatment. These results indicate improved IBK healing with many antibiotics and suggest the need for randomized trials comparing different antibiotic treatments.
Comparison of access to services in rural emergency departments in Quebec and British Columbia
Authors: Fleet Richard , Audette Louis-David , Marcoux Jérémie , Villa Julie , Archambault Patrick , Poitras Julien 
Published: July 2016

ABSTRACTIntroduction:Although emergency departments (EDs) in Canada’s rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged.Objective:The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec.Methods:Rural EDs were identified through the Canadian Healthcare Association’s Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services.Results:British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec.Conclusions:The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.
Tetanus: lest we forget
Authors: Dittrich Kenneth C. , Keilany Bashar 
Published: July 2016

ABSTRACTTetanus is a life threatening infection that is rarely encountered in clinical practice. Knowledge of the condition is necessary to ensure optimal management. A 30-year-old male presented with classic signs and symptoms of the disease, including trismus, risus sardonicus, paroxysmal muscle spasms and autonomic instability. The pathophysiology and modern management of this condition are reviewed.
The problem of consent in emergency medicine research
Authors: Gray Jonathan D. 
Published: July 2016

ABSTRACTThis paper outlines some of the ethical and practical dilemmas of securing true informed consent in resuscitation research in the prehospital or emergency department setting. Possible substitutes to such consent are discussed and evaluated. TheCanadian Tri-Council Policy Statementguidelines for emergency medicine research are compared to the US Food and Drug Administration rules, and the former are assessed and critiqued. Modifications to the current Tri-Council guidelines are suggested.
Shiftwork and emergency medical practice
Authors: Frank Jason R. , Ovens Howard 
Published: July 2016

ABSTRACTShiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. We conducted a systematic literature review to characterize the effects of shiftwork on physician health, well-being and practice, and to describe rational strategies to mitigate its impact on Canadian emergency physicians.
Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder?
Authors: Fleet Richard P. , Lavoie Kim L. , Martel Jean-Pierre , Dupuis Gilles , Marchand André , Beitman Bernard D. 
Published: July 2016

ABSTRACT

Objectives:
We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status.

Methods:
An interviewer, who was kept blind to patients’ initial medical and psychiatric diagnoses, attempted to contact all patients who participated in the initial study by phone. Patients who completed the phone interview were sent a battery of psychological questionnaires by mail.

Results:
A total of 301 (70%) patients completed the phone interview, and 228 (52%) patients completed the self-report questionnaires. Participants and non-participants did not differ with respect to age, gender, initial self-report scores, or initial cardiac or psychiatric diagnoses. At follow-up, significantly (p &lt; 0.05) more PD+ than non-PD (PD–) patients reported: 1) chest pains in the last month (57% vs. 31%); 2) one or more ED consultations in the past year for chest pain (40% vs. 14%); 3) one or more hospitalizations in the past year (31% vs. 11%); and 4) perceiving their general health as “poor” (22% vs. 9%). PD+ patients displayed a significant (p &lt; 0.05) worsening of their panic symptoms, agoraphobic avoidance, depression, and trait anxiety, and reported significantly (p &lt; 0.05) greater suicidal ideation compared to PD– patients (32% vs. 9%). Of all PD+ patients, only 22% (18/82) reported receiving some form of mental health treatment for their symptoms.

Conclusions:
Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs.