bluuebunny/crossref_metadata_2025_split huggingface dataset:
AIDS and Prehospital Personnel: Knowledge and Prevention of Occupational Exposure
Authors: Gellert George A. , Maxwell Roberta M. , Higgins Kathleen V. , Barnard Rebecca , Page Brandon 
Published: July 2016

AbstractObjectives:Prehospital personnel, including law enforcement officers, paramedics, and fire-fighters, may be exposed to the human immunodeficiency virus (HIV) while working. This study of prehospital personnel sought to determine: 1) their knowledge of the acquired immune syndrome (AIDS) and HIV transmission; 2) the extent of AIDS training received; 3) self-assessment of risk for HIV infection; and 4) precautions adopted to reduce occupational risk of exposure to HIV.Methods:A survey was administered to prehospital personnel in a large Southern California jurisdiction. The response rate was 41% (n = 1,756) in 10 city and county departments where respondents were employed. Law enforcement officers (44%), firefighters (44%), and paramedics (12%) comprised the sample.Results:Respondents had accurate knowledge about AIDS, but incorrect perceptions about HIV transmission. A minority believed that HIV could be contracted from casual contact. Training relating to AIDS was not frequent. Preventive practices were infrequent in the work setting, with precautions used less than 50% of the time on eight of 10 measures. One-third of these prehospital personnel assessed their risk for HIV infection as medium to high, largely attributable to fear of occupational exposure.Conclusions:Improved educational programs regarding HIV/AIDS are needed for prehospital personnel to increase the use of preventive occupational practices in the field.
Disaster Triage: START, then SAVE—A New Method of Dynamic Triage for Victims of a Catastrophic Earthquake
Authors: Benson Mark , Koenig Kristi L. , Schultz Carl H. 
Published: July 2016

AbstractTriage of mass casualties in situations in which patients must remain on-scene for prolonged periods of lime, such as after a catastrophic earthquake, differs from traditional triage. Often there are multiple scenes (sectors), and the infrastructure is damaged. Available medical resources are limited, and the time to definitive care is uncertain. Early evacuation is not possible, and local initial responders cannot expect significant outside assistance for at least 49–72 hours. Current triage systems are based either on a shorter time to definitive care or on a longer time to initial triage.The Medical Disaster Response (MDR) project deals with the scenario in which specially trained, local health-care providers evaluate patients immediately after the event, but cannot evacuate patients to definitive care. For this type of scenario, a dynamic triage methodology was developed that permits the triage process to evolve over hours or even days, thereby maximizing patient survival and resulting in a more efficient use of resources. This MDR system incorporates a modified version of “Simple Triage and Rapid Treatment” (START) that substitutes radial pulse for capillary refill, coupled with a system of secondary triage termed, “Secondary Assessment of Victim Endpoint” (SAVE).The SAVE triage was developed to direct limited resources to the subgroup of patients expected to benefit most from their use. The SAVE assesses survivability of patients with various injuries and, on the basis of trauma statistics, uses this information to describe the relationship between expected benefits and resources consumed. Because early transport to an intact medical system is unavailable, this information guides treatment priorities in the field to a level beyond the scope of the START methodology.Pre-existing disease and age are factored into the triage decisions. An elderly patient with burns to 70% of body surface area is unsalvageable under austere field conditions and would require the use of significant medical resources—both personnel and equipment—and would be triaged to an “expectant area.” Conversely, a young adult with a Glasgow Coma Scale score of 12 who requires only airway maintenance would use few resources and would have a reasonable chance for survival with the interventions available in the field, and would be triaged to a “treatment” area.The START and SAVE triage techniques are used in situations in which triage is dynamic, occurs over many hours to days, and only limited, austere, field, advanced life support equipment is readily available. The MDR-SAVE methodology is the first systematic attempt to use triage as a tool to maximize patient benefit in the immediate aftermath of a catastrophic disaster.
An Attempt at More Accurate Estimation of the Number of Ambulances Needed at Disasters in The Netherlands
Authors: de Boer Jan 
Published: July 2016

AbstractA more accurate estimate of the number of ambulances needed at disasters prevents vehicles from being withdrawn unnecessarily from their “normal” duties, thereby curtailing needless expense and helping to ensure that disaster sites are not overcrowded with emergency workers impeding each other's effectiveness. This article discusses a formula for determining the number of ambulances needed at a disaster.
A Decentralized Trauma System Design for a Rural Area
Authors: Narad Richard A. , Becker Jack L. , Frecceri Christy 
Published: July 2016

AbstractMost trauma-care systems are based on an urban model in which patients are found in sufficient proximity to the trauma center to allow preferential triage. The roles of other hospitals in the community are limited. In rural areas, patients may be remote from the trauma center and may require initial stabilization at a closer, nontrauma “center” designated hospital. An inclusive trauma system design is more appropriate in such situations.The Emergency Department Approved for Trauma (EDAT) is a program implemented in a rural area of northeastern California that establishes minimum standards for non-trauma center designated hospitals in remote areas. It integrates these hospitals into the trauma system through transfer guidelines and agreements and participation in systemwide quality assurance/improvement programs. The EDAT program promotes both improved initial treatment of rural trauma patients and appropriate transfer of patients to designated trauma centers.
Relevant in Times of Turmoil: WHO and Public Health in Unstable Situations
Authors: Loretti Alessandro , Leus Xavier , Van Holsteijn Bart 
Published: July 2016

AbstractFor millions of people world-wide, surviving the pressure of extreme events is the predominant objective in daily existence. The distinction between natural and human-induced disasters is becoming more and more blurred. Some countries have known only armed conflict for the last 25 years, and their number is increasing. Recently, humanitarian sources reported 24 ongoing emergencies, each of them involving at least 300,000 people “requiring international assistance to avoid malnutrition or death”. All together, including the countries still only at risk and those emerging from armed conflicts, 73 countries, i.e., almost 1.8 trillion people, were undergoing differing degrees of instability.Instability must be envisioned as a spectrum extending between “Utopia” and “Chaos”. As emergencies bring forward extreme challenges to human life, medical and public health ethics make it imperative for the World Health Organisation (WHO) to be involved. As such, WHO must enhance its presence and effectiveness in its capacity as a universally accepted advocate for public health. Furthermore, as crises become more enmeshed with the legitimacy of the State, and armed conflicts become more directed against countries' social capital, they impinge more on WHO's work, and WHO must reconcile its unique responsibility in the health sector, the humanitarian imperative and the mandate to assist its primary constituents.Health can be viewed as a bridge to peace. The Organization specifically has recognised that disasters can and do affect the achievement of health and health system objectives. Within WHO, the Department of Emergency and Humanitarian Action (EHA) is the instrument for intervention in such situations. The scope of EHA is defined in terms of humanitarian action, emergency preparedness, national capacity building, and advocacy for humanitarian ^principles. The WHO's role is changing from ensuring a two-way flow of information on new scientific developments in public health in the ideal all-stable, all-equitable, well-resourced state, to dealing with sheer survival when the state is shattered or is part of the problem. The WHO poses itself the explicit goals to reduce avoidable loss of life, burden of disease and disability in emergencies and post-crisis transitions, and to ensure that the Humanitarian Health Assistance is in-line with international standards and local priorities and does not compromise future health development. A planning tree is presented.The World Health Organization must improve its own performance. This requires three key pre-conditions: 1) presence, 2) surge capacity, and 3) institutional support, knowledge, and competencies. Thus, in order to be effective, WHO's presence and surge capacity in emergencies must integrate the institutional knowledge, the competencies, and the managerial set-up of the Organization.
Post-War Kosovo: Part 3. Development and Rehabilitation of Emergency Services
Authors: Lis Julian , Eliades M. James , Benishi Dukagjin , Koci Bajram , Gettle David , VanRooyen Michael J. 
Published: July 2016

AbstractThe recent crisis in Kosovo led to nearly complete destruction of a healthcare system serving the needs of approximately 2 million people. Even prior to the crisis, the pre-existing healthcare system had inadequate provisions for the delivery of Emergency Medical Services. More than 440 diverse governmental and non-governmental organizations (NGOs) arrived to assist (and often compete) in the rehabilitation of Kosovo's healthcare needs. Each brought with them individual biases and strategies for how this rehabilitation should occur, and each faced numerous unforeseen barriers to the implementation of its programs.The authors used a four-step, multi-modal, needs assessment to gather information on the needs and potential barriers to the implementation of a program to rehabilitate emergency services as discussed in Part II. This paper chronicles the phases of the Emergency Medicine program development and the process of responding to barriers and changing needs. The program's successes and failures are noted, and the actual barriers encountered are reviewed. Overall, the needs assessment tool employed in this program was useful in the implementation of a program to restore and rehabilitate Emergency Services in Kosovo. The authors recommend the use of combined quantitative and qualitative methods for developing priorities for interventions in post-conflict settings following complex emergencies.
Complex Emergencies in Indonesia
Authors: Bradt David A. , Drummond Christina M. , Richman Mark 
Published: July 2016

AbstractRecently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of >1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies.Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late.The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.
Principles of Disaster Management Lesson 14. Criteria for Assessing a Program
Authors: Cuny Fred C. 
Published: July 2016

AbstractThis lesson examines mechanisms that can be used for the evaluation of a program or project. The principal concern raised is whether the project has met its stated goals and objectives and whether the project has resulted in producing benefits to the affected society. Short-term (immediate) and long-term (developmental) contributions are discussed. The importance of projects contributing to increasing the absorbing capacity of the affected community for the next event is stressed. Twelve problems commonly encountered in program execution are defined. Optimal management attempts to identify potential pitfalls in advance, designing and implementing mechanisms to avoid them, and to deal with them if they should become manifest. Simply meeting the goals and objectives of the sponsoring organization is inadequate, as all responses must be coordinated and approved by the national coordinating agency. Thus, not only is the effectiveness of the project in meeting the defined goals and objectives important, but the project must be assessed in terms of the overall impact of the project on the society. Reference is made to using the structure provided by the Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style as promulgated by the Task Force on Quality Control of the World Association for Disaster and Emergency Medicine and the Nordic Society of Disaster Medicine.
The League of Red Cross and Red Crescent Societies (1983)
Authors: Kisselev Andrei K. 
Published: July 2016

The League of Red Cross Societies is the international federation of the 130 National Red Cross and Red Crescent Societies, which together have a membership of more than 230,000,000. The League is one of the three components of the International Red Cross, the others being the International Committee of the Red Cross (ICRC) and the National Red Cross/Red Crescent Societies.The ICRC acts as a neutral intermediary in humanitarian matters during international conflicts, civil wars and internal disturbances, providing protection and assistance to victims, prisoners of war and civilian detainees. The League objective is to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world.
In Memoriam, Rudolf Frey
Authors: Safar Peter , Kirimli Nancy 
Published: July 2016

Rudolf Frey, known as “Rolf“ in Europe and “Rudi” in America — a leading star of anesthesiology, emergency medicine and disaster medicine — has ended his life's struggles. He influenced many lives positively. His years were rich with experiences and contributions.Surgery and anesthesiology were his base specialties. Alone, these fields would have been too narrow for him. He initiated the first professorship of anesthesiology in Germany at the University of Heidelberg in the 1950's; the first autonomous university department of anesthesiology in Germany at the Gutenberg University of Mainz in 1960; the journalDer Anaesthesist, the first textbook of anesthesiology in German; one of the first physician-staffed advanced life support ambulance and ambulance helicopter services in Europe; numerous training programs, symposia and congresses; and theClub of Mainzand its associated monograph seriesDisaster Medicine, originally published by Springer-Verlag.
Introduction to Emergency Medical Services (EMS) Organization
Authors: Stewart Ronald D. 
Published: July 2016

Experience and history have taught us that much can be done for the sick and injured before such patients reach the hospital. From the legacy of the Good Samaritan to the modern day organization of emergency medical services, the immediate care of those stricken has undergone significant change in both philosophy and practice. While many prehospital care organizations with roots established deeply in the past still flourish, modern emergency care, in the new world at least, has developed rapidly only over the past ten years.In the United States, a concerted effort to improve the care of the wounded during the Civil War led to the introduction of the “flying ambulances” used earlier by Napoleon's Chief Surgeon, Larrey. Americans made significant contributions to acute care with the work of such noted men as Crile, with his form of external pneumatic counterpressure; Kouwenhoven, Knickerbocker and Jude at lohns Hopkins; Beck and the first reported defibrillation in a patient; Safar and his co-workers with the rediscovery of mouth-to-mouth; and many others.
Simplified Triage and Registration in Disasters
Authors: Schinke Lutz 
Published: July 2016

The triage (i.e., sorting) of casualties is the most important task of a physician in a disaster. This function is so extensive that only an experienced doctor can fulfill it satisfactorily. To do so, he needs comprehensive information. This article will demonstrate a time-saving method of receiving and giving information for triage in connection with the registration of casualties.The immediate situation determines classification. A rigid pattern cannot be applied. The doctor must know the number of casualties and helpers, transportation facilities, hospital capacities, and medical supplies. To help him assemble these data, the doctor has at his disposal an assistant registrar. This assistant is equipped with a walkietalkie to communicate with ambulance control. He also has a registration list and can enter important data concerning the patients clearly thereon (Figures 1 A, B).
Critical Care Medicine (CCM) in Czechoslovakia (CSSR): Present State and Its Development
Authors: Pokorny Jiri 
Published: July 2016

Due to the development of modern resuscitation during anesthesia and surgical operations, methods of intensive therapy have been introduced in clinical medicine. Efforts, through cardiopulmonary resuscitation (CPR), to give any patient in need the chance to survive resulted in systems of emergency medical services (EMS). A short account of the present state of CCM in the CSSR is given here. The principle of “differentiated patient care” is outlined, with accepted definitions of resuscitative and intensive care. The terminology of different steps in CCM is offered for discussion.In Czechoslovakia, the Constitution of 1960 proclaims the right to health care for every citizen. Medical care is provided to all citizens free of charge by the State. The State took over the responsibility for planning, organizing and providing medical care on the highest attainable contemporary level. In the last ten years, special programs have been launched in order to cover most actual health areas such as neonatal and maternal health care, cardiovascular disease programs, oncology, geriatric care, and, last but not least, the care of patients with acute organ systems' failure.
Role of Anesthesiology in Emergency Medical Services (EMS) in Poland
Authors: Rondio Zdzislaw , Jurczyk Witold 
Published: July 2016

Improvements of results in emergency care of critically ill patients can be realized if EMS organizations are properly based on local conditions. The Emergency Medical Unit is the first of three parts of the Integrated Health Service in Poland. The second part is in-hospital treatment. The third part is outpatient care. In most hospitals, the head of the department of anesthesiology and intensive therapy coordinates each emergency medical unit. Each unit consists of ambulances (mobile intensive care units), admission (emergency) rooms, and an intensive medical care unit (ICU). A specialization program was created and physicians who complete this type of training obtain the title “specialist in anesthesiology and intensive therapy.”This four year specialization program contains the educational elements necessary to administer all types of modern anesthesia, and provides full preparation for work in mobile and stationary intensive medical care units as well. Such training has also given these specialists the chance to initiate treatment methods for chronic pain. An examination consisting of practical tests, multiple choice written knowledge tests, and oral tests completes the program. The latter is a conversation with a commission, consisting of full professors and associate professors in anesthesiology and intensive therapy.
Medicalization (Physician-Staffing) of Extra-Hospital First Aid
Authors: Margenet Alain , Desfemmes Catherine , Dufeu Nicolas , Huguenard Pierre 
Published: July 2016

All requests for medical assistance need to be answered. In France, the public “Service d'Aide Medicale d'Urgence” (SAMU) receives the calls and can send, if necessary, mobile physician-staffed ambulances. SAMU works in coordination with the police, the fire brigade and general practitioners.Response to the request for medical assistance from the public has been solved in different ways, such as agreement on a single call number for certain countries, and whether or not to use a physician-staffed system. In France, the first mobile emergency and resuscitation units (SMUR) were created in 1967. This initiative was taken by anesthesiologists, some surgeons, and military physicians belonging especially to the fire brigade of Paris, and to the seafaring-men of Marseille. The necessity of centralizing coordinating calls and radio controlling the public means of assistance has led to the creation of the Emergency Aid Services or SAMU.
Shock Complicating Acute Myocardial Infarction during Hot Weather
Authors: Kolar Jiri , Bhatnagar Sudhir K. , Al-Yusuf Abdul Razak 
Published: July 2016

Shock appears to complicate acute myocardial infarction (AMI) more often during the hot summer in Kuwait, than it does in winter. The aim of this study was to define the forms of shock, investigate its frequency, and evaluate the effects of fluid therapy.Material and MethodsIn a 3 month period during the hot summer of 1980, 21 shock patients (pts.) (18 male, 3 female) with AMI were studied. Their average age was 55 years (yrs.) (range 30–82), all had definite AMI (18 anterior, 3 inferior) and at least 3 known criteria of shock. Observations were made for 24 hours (hrs.) in the CCU, within one hour of admission. Initial hemodynamic pressures were obtained and hemoglobin (Hb), hematocrit (Hct) and serum glutamic oxaloacetic transaminase (SGOT) on blood samples were estimated.
Animal Experiments on the Effects of PEEP and Different Ventilation-Compression Ratios in Neonatal Cardiopulmonary Resuscitation
Authors: Dick W. F. , Traub E. , Engels K. , Lindner K. -H. 
Published: July 2016

The physiological range of respiratory rates and heart rates in neonates is approximately 40 per min and 120 per min, respectively, which yields a theoretical ventilation-compression ratio of 1:3ratherthan 1:5.Thirty-six anesthetized pigs with an average body weight of 4–5 kg were used in the study. After establishing a steady state by artificial ventilation with 100% oxygen, a cardiac arrest was induced by an intravenous injection of potassium chloride. Following the cardiac arrest, the animals were resuscitated with ventilation rates of 30 and 40 per min, respectively, while external cardiac compression was performed at rates between 60 and 160 per min. Randomly selected animals were resuscitated with ventilation-compression ratios of 1:2, 1:3 and 1:4 for 10 min each, 6 animals each were ventilated using a ventilation rate of 30 per min, 40 per min, or positive end-expiratory pressure.