bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disaster Triage by Advanced Emergency Medical Technicians
Authors: Doyle Constance J. , Birney Richard E. 
Published: July 2016

Many disaster plans are based on the presence of a physician at the scene to perform triage. This requirement originated when there were no trained paramedical personnel in the field and may actually delay care in rural areas where a physician may not be readily available or may be the only physician at the hospital.It is our hypothesis that properly trained Advanced Emergency Medical Technicians (AEMT's) may serve as triage officers for rural disasters with little difference, and perhaps improvement, in the outcomes of medical care. AEMT's are among the first responders to arrive at scenes of accidents and often triage from three to five trauma patients in multiple victim accidents on the highway. They are on duty, available and strategically located both day and night. The AEMT's are familiar with working under field conditions, i.e. at night by headlight, in rain, snow, and darkness, and know extrication procedures. They are aware of environmental hazards. They have radio and telemetry communication with a physician when needed.
A Review of Pulmonary Barotrauma in Scuba Diving Accidents
Authors: Mathew B.G. 
Published: July 2016

The increasing popularity of scuba diving as a sport necessitates that emergency personnel become familiar with medical diving problems. It is important to understand that pulmonary barotrauma can be sustained with an uncontrolled ascent of little more than 1 meter. This can occur under any circumstance in which compressed air is breathed under water. The most common is scuba diving or submarine escape training, but it may also be encountered when a person escapes from a submerged car or a child surfaces after breathing from an inverted bucket in a swimming pool. Two cases of pulmonary barotrauma are reported and the spectrum of presentation of this condition is discussed.Knowledge of this condition increases clinical awareness resulting in early diagnosis and effective treatment. It will be shown that it is better to over treat this condition, as the side effects of treatment are minimal and the results of failure to treat can be disastrous.
Military-Civilian Collaboration for Disaster Medicine in Canada (Discussion Comment)
Authors: Armstrong Barry 
Published: July 2016

Besides defense, a military organization can protect a country in two ways: (1) Ensure the integrity of a country despite internal disasters and disturbances; military aid can have a humanitarian role. (2) International responsibilities.The Canadian Forces participate in peacekeeping and disaster relief all over the globe. This international military job results in increased prestige for Canada and security for Canadians.
Health Care for South Lebanon's Civilian Population Following the June 1982 War
Authors: Tulchinsky T.H. , Adler Yakov 
Published: July 2016

AbstractFollowing the June 1982 war in South Lebanon, the Israel Ministry of Health sent a medical team to assess health conditions in the area, to assist in the restoration of local health services, and to provide additional medical assistance as needed in public health and specialized medical services. For the approximately 600,000 population of the area, public health sanitary conditions were restored by local authorities, with some external assistance. Sanitation and housing for the refugee camp populations were difficult to solve because of extensive damage in the camps; but United Nations activities, supported by international and Israeli sources, were effective. Epidemic conditions did not occur. Monitoring for specific infectious diseases showed increases not exceeding usual summer conditions. Child nutrition status was satisfactory. Medical needs for specialty services, not available in South Lebanon, were arranged through screening and referral to Israeli hospitals. Renal dialysis needs were met by establishing a dialysis unit using local personnel in a damaged and non-functioning government hospital. Private medical and hospital services, the bulk of health care in the area, functioned except for minor dislocations throughout the war and post-war period. Israeli medical aid, managed by a small multidisciplinary team, was designed to assist and, where necessary, augment rather than replace local health services.
Lung Function During Hoist Rescue Operations
Authors: Haagensen Rolf E. , Sjöborg Karl-Ake , Mjelstad Stig , man Rescue , Steen Petter A. 
Published: July 2016

AbstractIntroduction: A case is presented in which a 43-year-old man suffering from a severe asthma attack, had ventilatory arrest during a hoisting procedure. Based on this experience, the influence of three hoisting techniques on lung function was tested.Methods: The ventilatory capacity of 12 healthy volunteers was tested during three commonly used hoisting techniques: 1) single sling; 2) double sling; or 3) strapped to a stretcher.Results: The vital capacity (VC) and the one-second, forced expiratory volume (FEV1) were reduced significantly during all hoisting techniques compared to the standing position. The reduction was significantly more pronounced on a stretcher than in either sling position. There were no differences in the FEV1 to VC ratio between the positions.Conclusion: The small reduction in ventilatory capacity during hoisting procedures is tolerated easily by healthy individuals, but should be taken into account when planning such procedures on patients with severe pulmonary disease.
Privatization and Emergency Medical Services
Authors: Reissman Stephan G. 
Published: July 2016

AbstractIntroduction:Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, “It is not government's obligation to provide services, but to see that they're provided.” Even in the area of public safety, privatization has found a “market.”In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. Privately owned ambulance services staff and respond to medical emergencies in a given community as part of the 9–1–1 emergency response system. Regulations for acceptable response times, equipment, and other essential components of EMS systems are specified by contract. This allows the municipality oversight of the service provided, but it does not provide the service directly. As will be discussed, this “contracting-out” model has many benefits.Privatizing EMS services is a decision based not only on cost-savings, but on accountability. A thorough evaluation must be utilized in the selection process. Issues of efficiency, effectiveness, quality, customer service, responsiveness, and equity must be considered by the government, in addition to cost of service.The uncertain future of health care in the United States has led those in EMS to look beyond the field's internal market to explore additional opportunities for expanding and redefining its roles beyond emergency care. It is important, however, to consider how emergency medical care, the original role of EMS, can be best delivered. Responding to emergencies is not just one of the functions involved in this field, it is the principal function from which public perception of EMS is formed, and from which support for entering other markets can be fostered.The purpose of this paper is to present several important concepts and considerations that public officials, medical directors, and the public must be aware of when contemplating the possibility of privatizing their Emergency Medical Services. A review of the general concepts of privatization and issues of accountability will be presented, referencing policy experts, followed by an examination of how advocates of privatization might see these issues as they relate to providing EMS. The conclusion will present prescriptions for both municipal and commercial ambulance providers.
Medical and Surgical Issues in the Persian Gulf War
Authors: Adler Jacov 
Published: July 2016

AbstractThis report includes the preparations for and the medical impact of the missile attacks launched by Iraq on Israel. It includes the authorization language for the preparations, the preparations undertaken, the perceived threat to the civilian population of Israel, the operational plans activated, the attacks and the medical impact of these attacks, the number and types of casualties, the damage to property, and the initial and subsequent protection times. There occurred a total of 18 missile attacks with 40 conventional missiles launched against Israeli civilians. They resulted in an 4.4 times overall increase in the number of ambulance responses, 228 civilians injured; and two deaths. In addition, five persons died of myocardial infarction related to these attacks. Eight persons died of suffocation due to use of the gas masks.
The EMS Response to the Oklahoma City Bombing
Authors: Maningas Peter A. , Robison Mark , Mallonee Sue 
Published: July 2016

AbstractThis is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion.The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.
The Efficacy of Integrating “Smart Simulated Casualties” in Hospital Disaster Drills
Authors: Gofrit Ofer N. , Leibovici Dan , Shemer Joshua , Henig Avinoam , Shapira Shmuel C. 
Published: July 2016

AbstractIntroduction:Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill.Objective:To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill.Methods:A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as “Smart Victims.” The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill.Results:The “smart casualties” made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The “smart casualties” were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals.Conclusion:Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.
Prehospital Treatment of Patients with IV Heroin Overdose: What Are We Treating?
Authors: Pedersen Carsten Boe , Steentoft Anni , Worm Karen , Sprehn Michael , Mogensen Torben , Sørensen Mogens Bredgaard 
Published: July 2016

AbstractObjective:To measure blood levels of morphine and additional drugs in patients suspected of intravenous (IV) heroin abuse and to evaluate the effects of antidote treatment.Design:Prehospital blood sampling in 52 patients.Results:Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses.Conclusion:This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.
Medical Outreach After Hurricane Marilyn
Authors: Leonard Ralph B. , Spangler Harold M. , Stringer Lew W. 
Published: July 2016

AbstractIntroduction:Many geographical areas are subject to devastating disasters that leave the citizens not only without homes, but also without their local medical systems. Now medical-aid stations consisting of personnel, supplies, and equipment quickly can be deployed when needed to such areas under the aegis of the National Disaster Medical System (NDMS). Such teams can provide emergent medical care as well as daily medical care. However, these aid stations are of no help for the home–bound or nursing home patients too infirm to reach them. Thus, these citizens only can obtain medical care if medical teams make planned outreach excursions to reach them.Objective:To describe a planned outreach program that was implemented for such patients on St. Thomas Island after it was devastated by Hurricane Marilyn in 1995.Results:Over a five-day period, the out-reach team provided medical care for 67 patients ranging in age from 11 days to 90 years. Play and art therapy was provided for non-injured children. The most common needs in the elderly were anti-hypertensive medications and insulin-loaded syringes.Conclusion:For outreach efforts of this nature, membership of the team should include a registered nurse, a paramedic, a respiratory therapist, a public health specialist, and a local authority familiar both with the area and its inhabitants. A physician does not need to be assigned to the team, but should be available by radio.
Identifying Victims of Elder Abuse and Neglect: A Training Video for Prehospital Personnel
Authors: Seamon Jason P. , Jones Jeffrey S. , Chun Eric , Krohmer Jon R. 
Published: July 2016

AbstractIntroduction:The majority of prehospital emergency medical services (EMS) personnel lack specific training relating to elder abuse and neglect.Objectives:To develop and test an audio visual training program that focuses on the identification and reporting of domestic violence in the elderly.Methods:A videotape was designed to be used as a 45-minute training course for prehospital personnel using one-half inch, super-VHS recording. A convenience sample of 60 EMS personnel working in Kent County then were asked to evaluate the videotape program. Each volunteer completed a pre-test on elder abuse and neglect, watched the 45-minute videotape, and then answered 12 questions on a post-test.Results:Participants had an average of 12.4 years (range: 1–30 years) prehospita emergency-care experience. Only four (7%) could recall any previous training relating to elder abuse or neglect during their career. Although the prevalence of elder abuse in their community was described as “rather rare” by most (60%) of the subjects, 85% (51/60) had seen a suspected case of elder abuse or neglect during their careers; 47% (28/60) had seen a case during the past six months. Only 29% of these suspected cases were reported to county authorities. Approximately 40% of the questions on the pre-test were answered correctly (mean score, 4.8 ± 3.0). In comparison, 83% of the questions on the post-test were answered correctly (10.0 ± 3.0). Although participants had a number of suggestions to improve the video program, 78% (47/60) expected this material to change the way they will evaluate elderly patients in the future.Conclusion:Prehospital personnel do not feel confident identifying or reporting victims of elder abuse or neglect. A videotape training program may be an effective way of presenting this information as a means of continuing education.
Automatic External Defibrillation and Its Effects on Neurologic Outcome in Cardiac Arrest Patients in an Urban, Two-Tiered EMS System
Authors: Ho Jeffrey , Held Timothy , Heegaard William , Crimmins Timothy 
Published: July 2016

AbstractObjective:To describe the use of the Automatic External Defibrillation (AED) device in an urban, two-tiered Emergency Medical Service (EMS) response setting with regard to its potential effects on cardiac arrest patient survival and neurologic outcome.Methods:A retrospective and descriptive design was utilized to study all cardiac arrest patients that had resuscitations attempted in the prehospital environment over a 30-month period. The study took place in a two-tiered EMS system serving an urban population of 368,383 persons. The first tier of EMS response is provided by the City Fire Department, which is equipped with a standard AED device. All first-tier personnel are trained to the level of Emergency Medical Technician-Basic. The second tier of EMS response is provided by personnel from one of two ambulance services. All second-tier personnel are trained to the level of Emergency Medical Technician-Paramedic.Results:271 cardiac arrest patients were identified for inclusion. One-hundred nine of these patients (40.2%) had an initial rhythm of either ventricular fibrillation or pulseless ventricular tachycardia and were shocked using the AED upon the arrival of first-tier personnel. Forty-two patients (38.5%) in this group had a return of spontaneous circulation in the field and 22 (20.2%) survived to hospital discharge. Of the survivors, 17 (77.3%) had moderate to good neurologic function at discharge base on the Glasgow-Pittsburgh Cerebral Performance Categories. Faster response times by the first-tier personnel appeared to correlate with better neurologic outcomes.Conclusion:First responder-based AED usage on patients in ventricular fibrillation or pulseless ventricular tachycardia can be applied successfully in an urban setting utilizing a two-tiered EMS response. In this study, a 20.2% survival to hospital discharge rate was obtained. Seventy-seven percent of these survivors had a moderate to good neurologic outcome based on the Glasgow-Pittsburgh Cerebral Performance Categories.
Medical Disaster Preparedness of Rotterdam Europort: An Application of Methodology for Assessing Disaster Preparedness
Authors: de Boer Jan 
Published: July 2016

AbstractMedical disaster preparedness (MDP) of Rotterdam-Europort has been estimated by grading personnel, materials, and methods utilized in the chain of medical care, from the disaster site to the hospital. On a scale from 1 to 5, this MDP was set at 2.8: the disaster site is the weakest link, which determines the strength of the whole chain. This, in turn, was the result mainly of the methods utilized for which the personnel were not properly educated and trained.By applying the methodology as described in an earlier paper, the MDP of cities, airports, harbors, industrial plants, etc. can be determined in a standardized way. This methodology should facilitate epidemiologic research in the public health aspects of disaster preparedness.
Nitroglycerine Lingual Aerosol in Prehospital Emergency Care,
Authors: Rottman Steven J. , Larmon Baxter 
Published: July 2016

Nitroglycerine (NTG) commonly is used in the prehospital emergency care setting for the treatment of chest pain suggestive of myocardial ischemia or infarction or for cardiac unloading in patients with presumed pulmonary edema. The usual form of this drug is as a 400 mcg tablet administered sublingually. Recently, NTG has become available as an aerosolized form (NTGA) in a multiple dose, pressurized canister containing 200 metered doses of 400 meg of NTG each. In this form, the drug is purported to be absorbed rapidly from the surface of the tongue.In the field, we have noted that the sublingual tablet form of NTG occasionally remains undissolved following administration to patients complaining of chest pain. In each of these cases, clinically, the patients were unchanged on arrival at the receiving hospital and an intact tablet was discovered properly placed under the tongue. In an attempt to evaluate the ease of administration and clinical responses of patients with chest pain to the aerosolized form of the drug, we replaced NTG sublingual tablets on paramedic units in the Burbank system with the NTGA form.