bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital Use of a Prototype Esophageal Detection Device: A Word of Caution!
Authors: Marley Charles D. , Eitel David R. , Koch Mark F. , Hess Dean R. , Taigman Michael A. 
Published: July 2016

AbstractObjective:To determine the effectiveness of a prototype esophageal detection device (EDD) during use in the prehospital setting.Design/Setting:Prospective convenience sample in a prehospital setting.Population:Intubated adult patients.Interventions:The study device was used to determine esophageal or endotracheal placement of endotracheal tubes in intubated patients. Clinical means were used to confirm tube location. A data sheet was completed for each patient.Results:Of 105 uses of the device, 17 of 17 esophageal tubes were identified correctly (100% sensitivity). Sixty-five of 88 tracheal tubes were correctly identified (78% specificity). There was intermediate reinflation of the device on 13 of the 65 tracheal tubes. Five tests were indeterminate. There were no false negatives (negative predictive value 100%), but 18 false positives (positive predictive value 48%).Conclusion:This prototype EDD adequately identifies esophageally placed endotracheal tubes. Correct identification of endotracheally placed tubes was less sensitive. Much work needs to be done regarding the use of negative aspiration devices to identify placement of endotracheal tubes.
Evaluation of Agricultural Rescue Course by Providers
Authors: Stueland Dean T. , McCarty John E. , Stamas Peter , Gunderson Paul D. 
Published: July 2016

AbstractStudy objective:To assess the characteristics of rural emergency medical services providers involved in the prehospital care of victims of agricultural injuries and determine which aspects of an agricultural rescue course were perceived as most useful.Design:A questionnaire was sent to participants of a course designed for agricultural prehospital providers who had attended a farm accident rescue course between 1986 and 1993.Setting:A rural referral center in central Wisconsin.Participants:The questionnaire was sent to all persons who had participated in the course. Respondents to the questionnaire characterized their service experience and rated the topic areas in usefulness and whether the subject should be included in future courses.Results:A total of 459 surveys (44% of potential respondents) was returned. Of the respondents, 316 (74.4%) were men, and the mean age was 39.4 years. There were 247 (60.8%) who were volunteers, and an additional 126 (31%) were paid, on-call workers. There were 232 (56.4%) basic providers, and 365 (87.5%) were from a rural area. Many (n = 149; 36.9%) had not responded to farm accidents during the past year. Training course topics rated most useful were machinery extrication, tractor overturn, and enclosed-space rescue.Conclusions:Respondents to an evaluation of an agricultural rescue course primarily were rural, basic providers. Future development of courses for emergency medical technicians involved in agriculture rescue must account for this level of training. Such courses should be short and modular with an emphasis on continuing education, practice, and focus on the identified needs of the participants.
Does Basic life Support in a Rural EMS System Influence the Outcome of Patients with Respiratory Distress?
Authors: Brown Lawrence H. , Prasad N. Heramba , Whitley Theodore W. , Benson Nicholas H. , Corlette Adrian 
Published: July 2016

AbstractPurpose:The purpose of this study was to determine whether basic life support, prehospital emergency medical care in a rural area affects the hospital course of patients with respiratory distress.Methods:Medical records for patients admitted from the emergency department with a discharge diagnosis related to respiratory disease were reviewed. Data collected included: 1) mode of arrival; 2) initial symptom; 3) vital signs; 4) prehospital interventions applied; 5) hospital days; 6) discharge status; and 7) principal diagnosis. Multiple logistic regression analysis was used to predict length of hospital stay.Results:Charts for 603 patients were reviewed. Complete data for all variables included in the logistic regression analysis were available for 471 patients (78.1%). Because 55 patients died, only 416 (69.0%) were included in the multiple regression analysis conducted to predict length of hospital stay. Logistic regression analysis demonstrated that patients who arrived by ambulance and older patients were more likely to die; patients with higher systolic blood pressures were more likely to survive. Only patient age predicted length of hospital stay, with older patients having longer stays.Conclusions:Basic life support prehospital care in this rural emergency medical services system does not result in a lower mortality rate or a shorter hospital stay for a broad group of patients with respiratory distress who require hospital admission. Although this study is limited to a single population and a single emergency medical services system, it is one of only a few studies of outcome in basic life support systems.
Design of Clinical Trials
Authors: Detre Katherine M. 
Published: July 2016

A Controlled Clinical Trial is the formal experimental approach to treatment evaluation. In such a trial, the investigator controls the assignment of treatments—ideally by randomization— to experimental groups. When well executed, such a trial provides the strongest evidence for the relative effectiveness of the different therapeutic interventions. Some people, myself among them, believe that the clinical trial approach should be used early when a new therapeutic modality is first introduced.The purpose of a controlled clinical trial is to answer the question of whether the new therapy is preferable to standard therapies. If no standard therapy exists, then new therapy has to compete either with no treatment or placebo.
Measuring the Impact of Various Dispatching Procedures on Response Time, Backlog, Availability and Patient Care in an Urban Setting
Authors: DeLucia David , Pascarelli Emil 
Published: July 2016

A study conducted by the Massachusetts Institute of Technology concluded that in a large city, a minimum of eight ambulances per 500,000 population was desirable to assure a reasonable response time.How does a large city with less than this suggested minimum make best use of its available ambulance units ?A three week study was conducted in New York City to examine the impact of various dispatching procedures on response time, “backlog”, availability of “back-up” units and patient care.
Operational Medicine: Specialized Emergency Medicine Training
Authors: Vaughn Prentis B. 
Published: July 2016

The discipline of emergency medicine includes the field of disaster medicine. Unfortunately, little actual emphasis is placed upon this vital area of training in emergency medical residency programs aside from nominal involvement in mock hospital-community disaster drills and triage exercises. In addition to these important areas of disaster medicine, physicians must be knowledgeable in field medical sanitation, environmental illnesses, ground and aero-medical evacuation, epidemiology and logistics in addition to hands on emergency medical casualty care. To better serve this important neglected area of the emergency medicine residency curriculum, we developed a one-month block of instruction.The operational medicine course is composed of separate instructional modules. The emphasis of the field medical training is obviously a military one; however, that emphasis is easily translated into a field medical environment, one that is commonly employed in military disaster relief operations. The American armed forces, particularly the US Army, frequently come to the aid of victims of both civil and natural disasters. This humanitarian assistance also serves the readiness training goals of the Army Medical Department during peacetime.
Physician Leadership of Emergency Medical Services (EMS)
Authors: Nagel Eugene 
Published: July 2016

I would hope that there is no question regarding the need for physician leadership in an EMS system; and that the question, if there is any, concerns the amount required, where it is to be applied, and its quality. EMS, I would remind you, stands for emergencymedicalservices. Medical delivery systems, in my opinion, require physicians for their design and implementation. That does not mean that all the services have to be delivered by physicians, but they need physician leadership.If this outlines the area of physician authority, then there is by definition a concomitant responsibility—authority without responsibility would be tyranny. The responsibility should provide an appropriate level of medical care that is current in concept, appropriate to the needs, considerate of the resources available, and coherent with the overall health care system. It must not be just an isolated EMS system.
Burn Mass Casualty Management: Lessons Learned
Authors: McManus William F. 
Published: July 2016

Successful management of a mass casualty situation involving 45 injured marines following a fire in Japan demonstrates the important principles of triage, patient movement, quality patient care, logistics, communication and medical direction.Following the accident, the US Army Institute of Surgical Research assembled a burn team consisting of three surgeons, three nurses, one microbiologist and eleven clinical specialists (three of whom were inhalation therapy technicians) and the equipment and supplies necessary to treat and transport these patients. The US Air Force Military Airlift Command transported the team and equipment to Japan in a C–141 Starlifter Medevac plane and pre-positioned a second C–141 in Japan for the return flight. Additional ventilators and supplies were mobilized from Japan, Okinawa, the Philippines and Alaska.
Chilean-Pan American Project of Emergency and Critical Care for Infants (Progressive Care)
Authors: Caballero Rodrigo Miranda 
Published: July 2016

The following papers, submitted in Spanish, may be obtained directly from the author (Telephone: 258458):1. Manejo de Emergencias y Accidentes en el nino. Reanimacion Cardiopulmonar Cerebral en un Sistema de Cuidado Progressivo.2. Programma Asistencial Docente de Medicina Urgencia-Primeros Auxilios y Cuidado Intensivo.3. Proyecio Chileno-Panamericano Sobre Prevencion y Manejo de Emergencias y Accidentes en la Infancia. Sistema de Atencion Progresiva.
Irreversible Hemorrhagic Shock Model in the Monkey
Authors: Bar-Joseph Gad , Safar Peter , Stezoski William S. 
Published: July 2016

In spite of extensive research, the question of fluid therapy for hemorrhagic shock is still controversial. Certain drawbacks in the experimental models are among the reasons for this controversy. These drawbacks are mainly related to the animal species used, to the way the shock insult is initiated and to the effects of deep anesthesia on the response to shock.Dogs were used in more than 90% of shock studies—although their response to bleeding is different from the human response. The dog has a large, contractile spleen, which can modify its cardiovascular response to bleeding.
Total Parenteral Nutrition in Critical Polytrauma Patients. Effects of Essential Aminoacid Distribution.
Authors: Magalini Sergio I. , Proietti Rodolfo , Pelosi Giuliano 
Published: July 2016

Previous work of our group and data from the literature show that in the polytraumatic patient the metabolic status is characterized by a severe and persistent catabolic situation involving carbohydrate, protein, lipid, mineral metabolism and hormonal and chemical mediators. This situation is clinically expressed by the so-called “post stress syndrome.”Total parenteral nutrition has assumed a major role in the treatment of polytrauma patients and its application has produced a significant modification of the physiopathological evolution and improvement of the clinical outcome.
Heimlich's Maneuver — Pros and Cons
Authors: Wedel Karl-Wilhelm 
Published: July 2016

In early 1975, H.J. Heimlich demonstrated external compression of the diaphragm as a first-aid measure in the event of threatening death by suffocation.A controversial debate developed in the ensuing years. What speaks infavorof the so-called “Heimlich Maneuver,” which should be applied only when:• the foreign substance sits too deep or too tight to be removed by other means; and• the trachea is completely closed by the foreign substance and breathing has ceased entirely,is the dramatic situation which leaves a helper only a few minutes to save life in view of imminent unconsciousness and threatening hypoxic cardiac arrest.What speaksagainstapplying the maneuver are possible lesions of the intrathoracic organs (including fractures of the osseous thorax) and ruptures of internal organs, also the application without an existing indication or inadequate mastery of the manipulation.
High Frequency Jet Ventilation Versus IPPV for CPR in Dogs
Authors: Brader Eric , Klain Miroslav , Safar Peter , Bircher Nicholas 
Published: July 2016

Investigation of High Frequency Jet Ventilation (HFJV) for cardiopulmonary resuscitation (CPR) was initiated to determine whether HFJV may be used as an alternative to conventional intermittent positive pressure ventilation (IPPV) and also to determine whether HFJV may be employed in CPR if cardiac arrest should occur during use of HFJV.The novel method of HFJV has several advantages over conventional ventilation, namely low airway pressure, no hemodynamic impairment and no need for muscle paralysis. Transtracheal HFJV offers in addition cricothyroid membrane puncture as a fast alternative to tracheal intubation in cases of difficult airway control. It is able to prevent aspiration, and allows direct intrapulmonary drug administration.
Intrapulmonary Drug Administration during High Frequency Jet Ventilation
Authors: Klain M. , Keszler H. , Nordin U. , Kalla R. 
Published: July 2016

It has previously been demonstrated that high frequency jet ventilation, via transtracheal cricothyroid membrane puncture, can maintain good gas exchange even during cardiopulmonary resuscitation. When the upper airways were filled with fluid, aspiration could be prevented without a cuffed endotracheal tube when respiratory rates of 100/min or higher and an inspiratory time of at least 50% were used. We have also shown that cricothyroid membrane puncture is relatively easy to perform and produces less tracheal damage than a cuffed endotracheal tube.In one of our studies, cardio-green dye was mixed into the jet using a Y-connector on the proximal end of the angiocath cannula (Figure 1). In two dogs, the distribution of the dye in the lungs was investigated. It was found that nebulized dye was transported by the jet stream to the most distant bronchi which could be observed. On subsequent autopsy, the dye was found in the most peripheral airways.
A Comparison of Standard and “New” Cardiopulmonary Resuscitation (CPR) in Dogs
Authors: Bircher Nicholas G. , Safar Peter 
Published: July 2016

Standard CPR, consisting of 60 chest compressions per min with a ventilation interposed after every fifth compression, often allows restoration of spontaneous circulation but cannot be relied upon to preserve the brain during resuscitation attempts. In experimental models, it produces only one-third to one-half of normal cerebral blood flow and cannot sustain EEG activity. Many attempts have been made to augment overall cardiac output during CPR and presumably thereby increase cerebral blood flow. Crile used a pneumatic pressure suit to bind the abdomen and legs, but subsequent investigations found a high risk of hepatic trauma with abdominal binding. Both Wilder and Harris showed in dogs that simultaneous ventilation and compression augment carotid flow. Birch showed in an animal model that prolonged compression increased mean arterial pressure during CPR. Weisfeldt and colleagues of Baltimore have recently extended these findings to man, and combined them into a so-called “New” CPR, which consists of:a) high pressure ventilation simultaneous with sternal compression;b) 40 compressions per min;c) 60% compression duration; andd) abdominal binding.
A New Automatic Resuscitator for Hospital and Emergency
Authors: Tonczar Laszlo 
Published: July 2016

We could obtain good results similar to other groups with a device for cardiac compression and automatic ventilation during CPR. The following paper will not discuss the experience with such a device, but the further development and improvement of a device already used and found to be useful.The further development seemed to be necessary since we tried to utilize new hemodynamic results important for external cardiac compression and ventilation. Other reasons were problems occurring with its practical use.
Automatic Implanted Defibrillator — Initial Clinical Experience
Authors: Mirowski M. , Reid Philip R. , Mower Morton M. , Langer Alois , Heilman M. S. , Kolenik Steve A. 
Published: July 2016

The automatic implantable defibrillator is an electronic device designed to continuously monitor cardiac rhythm, identify ventricular fibrillation and deliver corrective defibrillatory discharges, when indicated. Physically similar to early pacemakers, it weights 250 grams and has a volume of 145 cc (Figure 1). All materials in contact with body tissue are biocompatible. The defibrillating electrodes are made from titanium and silicone rubber. One electrode, designed for placement in the superior vena cava near the right atrial junction, is located on the distal end of an intravascular catheter. The second electrode, in the form of a flexible rectangular patch, is placed extrapericardially over the apex of the heart. The outside surface of the apical electrode is insulated to achieve optimal current distribution.The device is powered by lithium batteries having a projected monitoring life of approximately 3 years or a discharge capability of approximately 100 shocks. The sensing system detects ventricular fibrillation by monitoring a sampled probability density function of ventricular electrical activity.
Development of a Coma Scale for Emergency Care
Authors: Marsden Andrew K. , Staniland John R. , Price David J.E. 
Published: July 2016

Monitoring of the level of neurological response is an essential component of the diagnostic and therapeutic process in the management of craniocervical injury and neurological catastrophes. When Hippocrates reminded us that “No Head Injury is so mild that it can be neglected,” he cannot have been aware of the significance of the lethal factors of cerebral swelling and intracranial hematoma contributing to poor survival. Neither can he have known how these factors could be detected. Coma scales have evolved to indicate when deterioration is likely and intervention indicated.Many hospitals use simple grades of responsiveness for their unconscious patients, but the widespread habit of recording the level of response in an abstract manner is as meaningless as measuring temperature in units of feverishness. There is a requirement for a device which can be expressed in numerical terms and, when necessary, related to an analogue or graphical mode.
Psychometric Testing and Carbon Monoxide Poisoning
Authors: Myers Roy A. M. , Mitchell Jeffrey T. , Cowley R. Adams 
Published: July 2016

The Maryland Institute for Emergency Medical Services Systems (MIEMSS) is the smoke and carbon monoxide (CO) inhalation referral center for Maryland, particularly Baltimore City and the five surrounding counties. The majority of our patients are from the Baltimore/Washington corridor.The use of a short screening battery of psychometric tests is an important method for improving the clinical approach to the diagnosis of CO poisoning. Our own experience and a literature survey have shown how poorly the CO level correlates with clinical signs and symptoms. We have reported on six patients who were unconscious from CO poisoning but had a carboxyhemoglobin (HbCO) level of under 1%, and we have seen apparently well oriented patients with HbCO levels of 45%. From these experiences, we have concluded that the HbCO level is only an indicator of exposure to CO, not necessarily of the severity of poisoning. These large discrepancies have necessitated the development of a supplemental test, such as the psychometric battery, to determine generalized cerebral dysfunction.
The Importance of Ketamine and Gamma-Hydroxy-Butyric-Acid as Anesthetics under Disaster Conditions
Authors: Madjidi A. 
Published: July 2016

Extensive experiments in animals and humans, as well as clinical experience in disaster areas, have shown that expensive devices and complicated inhalation narcotics are not suited for anesthesia under disaster conditions. Today, the most important drugs are intravenous and, in emergencies, also intramuscular preparations which do not cause any significant central respiratory depression:1. Ketamine, suited for routine anesthesia under disaster conditions; and2. Gamma-Hydroxy-Butyric-Acid (Somsanit), suited for poor risk patients with hypoxic injuries and/or shock.
The Red Cross Role in Disaster Preparedness
Authors: Weyand Jürgen 
Published: July 2016

We recognize that priorities in disasters are most often the supply of shelter, water and food, but to streamline this paper we have limited ourselves to aspects of Disaster Preparedness pertaining to medical intervention.It is essential to understand that the overall responsibility in disaster preparedness and for coordination in case of disaster remains under all circumstances with public authorities. National Red Cross Societies, being auxiliary to their governments, are usually given a clearly defined role in disaster. In many cases the tasks assigned to the Red Cross include medical, paramedical and welfare assistance in varying degrees.The activities described hereafter are therefore not necessarily to be seen as a standard applied to all National Red Cross Societies.
Emergency Preparedness and Disaster Relief Coordination Program of the World Health Organization (Pan American Health Organization, PAHO)
Authors: de Goyet Claude De Ville 
Published: July 2016

The Pan American Health Organization (PAHO) has two components: (1) The Pan American Sanitary Bureau (PASB), founded in 1902, serves as the health agency affiliated with the Organization of the American States (OAS); in 1947, the PASB became the Regional office of the World Health Organization for the Americas. (2) The Emergency Preparedness and Disaster Relief Coordination office.In October 1976, the Directing Council of PAHO, “anxious that the international assistance given to countries affected by natural disasters should be better coordinated, rational, and more effective”, requested that the Director set up a “disaster unit with instructions to define the policy of the Organization, to formulate a plan of action for the various types of disasters, to make an inventory of the human and other resources available, to train the necessary personnel, to prepare and disseminate the appropriate guidelines and manuals, and to promote operational research.” In March 1977, a permanent office for Emergency Preparedness and Disaster Relief Coordination was established at PAHO Headquarters in Washington, D.C.