bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemical Weapons: The United Nations Team of Experts in the Iran-Iraq War
Authors: Imobersteg U. 
Published: July 2016

AbstractThis report from a member of the United Nations (UN) team of experts describes the investigations of the use of chemical weapons during the Iran-Iraq War. The UN-sponsored team of experts discovered evidence that clearly showed the use of three chemical weapon substances during that conflict—Yperite (Mustard Gas), Tabun (nerve gas), and Phosgene (respiratory irritant). The effects of these chemical agents and some means of treatment for victims are described.
A Method to Reduce Rural EMS Response Times
Authors: Johnson David R. , Maggiore W. Ann , Davis David Ralph 
Published: July 2016

AbstractProlonged EMS response times are a significant problem in rural areas. In this study, VHF radios and personal medical kits were placed in the private vehicles of rescue squad members. By coordinating the responses using radios, higher level EMTs were sent directly to the scene to initiate patient assessment and other procedures while others proceeded to an unstaffed station to pick up the rescue truck.Using this response system, EMTs arrived at the scene prior to the rescue vehicle on 30 of 35 calls (85.7%). In 25 of 35 calls (71.4%), the first person at the scene was at an advanced EMT level even though the majority of responses (56%) were made by Basic EMTs (p<0.001). The mean response time for EMTs using privately owned vehicles was 9±4 minutes (means±SD) compared with 16±9 minutes for the rescue truck (p<0.01). There also was a significant difference in response times between the privately owned vehicles and the rescue truck when the time between the receipt of the call and the initial acknowledgement of response was measured (1±1 minutes vs. 7±3 minutes; p<0.01).An effective EMS response can be made in rural areas by sending EMTs directly to a scene in private vehicles. Providing EMTs with VHF radios and personal medical kits enhances this response.
Air Force Rescue at the MGM Hotel Fire in Las Vegas
Authors: Wallace David M. 
Published: July 2016

One of the worst hotel fires in the USA occurred at the MGM Grand Hotel in Las Vegas, Nevada, on November 21, 1980. This tragedy claimed 84 lives and injured 300 others. The toll might have been higher were it not for Air Force assistance.Nine U.S. Air Force helicopters responded swiftly to the scene in answer to the city of Las Vegas plea for help. The call came from the Metropolitan Police Department at 7:38 a.m. and got an immediate response from the Nellis Air Force Base (AFB) Consolidated Command Post. By 7:55 a.m., the first Huey helicopter was airborne. Less than 20 minutes later it was hovering over the MGM Grand Hotel. Evacuation of survivors began immediately, according to Major Larry B. Doege, commander of Detachment 1, 57th Fighter Weapons Wing.
Helicopter Ambulance Missions in Stockholm, Sweden
Authors: Brismar Bo , Alveryd Alv 
Published: July 2016

In the county of Stockholm with 2 million inhabitants and an area of 6,500 km2 , a trial project with a helicopter ambulance, staffed by physicians, was carried out during the summer seasons of 1978 to 1980. A total of 507 missions were accomplished.The Trial Project. During the summer a large number of tourists visit the Stockholm archipelago. For these people there is a problem in the event of acute illness or accident to get qualified medical care without delay. A Bell 206 Long Ranger was based at Barkarby airport just outside the city of Stockholm. This was manned by doctors, ambulance personnel and a pilot, and was supplied with an emergency kit, intubation equipment, a portable ECG apparatus and a defibrillator.
Medical Attendance in Air Transportation of Patients
Authors: Durner Peter , Frey Rudolf , Kassuhlke M. 
Published: July 2016

SummaryAir transportation missions of seriously ill or injured patients are subdivided into rescue missions and medical evacuation missions. In 1981, for rescue missions, 29 stationed rescue helicopters were available with an operation radius of 50 km. Their task consisted of securing the primary care for vital risk patients as soon as possible. Medical evacuation missions were realized by helicopter, ambulance aircraft, and airliner. Before take-off a medical briefing was held to diminish the transport-trauma. Patients with cardiopulmonary insufficiency are at risk as simultaneous appearance of acceleration, climbing rate, falling cabin pressure and emotional stress may produce serious complications. Additional education of the medical crew is required.
Airborne Field Hospital in Disaster Area: Lessons from Armenia (1988) and Rwanda (1994)
Authors: Heyman Samuel N. , Eldad Arie , Wiener Michael 
Published: July 2016

AbstractThe outcome of survivors within disaster areas largely depends upon the quick reallocation and operation of logistic and medical support systems. Enthusiastic media equipped with advanced communication systems, reveal mass human suffering in real time. But, the response period required for the organization of rescue systems is much slower and is most frustrating. In this article, we present our experience in quick deployment and operation of airborne field hospitals gained following the earthquake disaster in Armenia in 1988 and the civil war in Rwanda in 1994.Deployment of improvised, volunteer-based, military field hospitals was feasible within 24 hours after the decision was made. A multi-disciplinary structure enabled an effective, flexible mode of operation and reduced the dependency on meticulous, time-consuming assessments of requirements prior to deployment.These missions are a paradigm for the successful incorporation and integration within the capabilities of military infrastructure of volunteer professionals drafted from civil medical facilities. Such field hospitals could provide backup for primary care medical systems in disaster areas and substitute or take some pressure off of local hospitals, particularly when evacuation systems are insufficient.
Portable, but Suitable: Devices in Prehospital Care Might Be Hazardous to Patient or to Aviation Safety
Authors: Dahlgren Bengt-Einar , Hogberg Raul , Nilsson Hans G 
Published: July 2016

AbstractIntroduction:Devices used for support of patients requiring air rescue or conveyance are subjected to severe environments that may affect their ability to function when needed or may affect other systems within the transporting vehicle.Methods:The ability of four portable ventilators, a suction device, and plastic and rubber tracheal tubes to withstand changes in temperature, vibration, sudden deceleration, and electromagnetic fields was studied in the laboratory setting. In addition, the effects of the operation of these devices on the flight instrumentation was investigated.Results:All of the ventilators tested delivered stable minute volumes at temperatures above zero, but in sub-zero temperatures problems were encountered with the driving gas. Vibrations produced alterations in the performance of two of the ventilators, and resonant frequencies were detected that are identical to those produced by the rotors of the helicopter used.Suctioning became difficult at temperatures below −5° C as the mucus froze in the collecting tubing. The motor produced electromagnetic fields that interfered with the aircraft instrumentation, and resonant frequencies had a deleterious effect on the circuit boards. Plastic tubes were adversely affected by cold, and these chilled tubes were excessively sensitive to vibration and shocks.Conclusion:The devices used in various aircraft influence certain vital maneuver systems of the craft. Studies on portable ventilators, a suction device, and tracheal tubes showed that, under specific conditions, the equipment was safe to patients and was not hazardous to the aviation safety. However, under certain conditions commonly encountered during air rescue operations, the equipment became dys-functional or presented safety hazards to the aircraft, and, hence, the crew. The Swedish Air Force has adopted three different criteria constellations: 1) operative; 2) storing; and 3) transport environment.
Emergency Medical Services System in Hong Kong: A Pearl in the South China Sea
Authors: Kalinowski Edward , Burkle Frederick M. 
Published: July 2016

AbstractEach Emergency Medical Services (EMS) system is unique in its development and scope of practice. In many instances, incorporates components of other models, It is important to the intellectual growth of the Emergency Medical Technicians that they visualize EMS design from an international perspective. This article describes the EMS system that exists in Hong Kong. It explores the changes that are occurring, defines the relationship between Hong Kong and China, and considers the influence that this evolving model might have on China after 1997.
Relationship Between Battery Capacity and the Delivery of Shocks in Prehospital Defibrillators
Authors: Cleland Mark J. , Maloney Justin P. , Hay James L. , Rowe Brian H. 
Published: July 2016

AbstractStudy Objective:Automatic external defibrillators (AED) have enabled the medical act of defibrillation to be performed in the community by a number of non-physician providers. However, these portable, battery-powered units are costly to maintain and service. This study examines the life of AED batteries and provides a battery replacement protocol.Design:Prospective diagnostic testing of 191 field batteries to determine their ability to deliver shocks at 360 joule.Setting:Ottawa General Hospital Paramedic Program.Outcomes:Using a battery analyzer, battery capacity and the number of shocks delivered were determined for each battery (at room temperature and in a controlled, refrigerated setting). In addition, the reliability of the testing method was assessed using the interclass correlation coefficient (ICC).Results:High reliability of blinded technical assessment of the batteries was achieved (ICC = 0.85). A strong correlation between the battery's capacity and the number of shocks it can deliver was obtained. For example, a battery with a measured capacity of 75% is capable of delivering more than 30 consecutive 360 joule shocks. This compares to a battery with a capacity of 20%, which is capable of delivering only 12 consecutive 360 joule shocks.Conclusion:While manufacturers' recommendations on battery replacement always have been based on an assumed technical threshold, these recommendations are not based on individual battery performance. The system for testing batteries described in this paper, should provide significant cost savings and improve quality assurance within a prehospital AED program.
Computerized Hospital On-Line Resources Allocation Link (CHORAL): A Mechanism to Monitor and Establish Policy for Hospital Ambulance Diversions
Authors: Neely Keith W. , Bennison Alice , Acker Joe , Long David , Norton Robert L. , Schriver John A. 
Published: July 2016

AbstractOngoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy.In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base-station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn is transmitted automatically to all other CHORAL computers.Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours). Using this system, the paramedics know the resource status of destination hospitals immediately, resource information monitored at base-stations and 911 centre is accurate, and data are available for use in establishing policy.
Emergency Medical Services for Collegiate Football Games: A Six and One-Half Year Review
Authors: Rose William D. , Laird Sherry L. , Prescott John E. , Kuhns Gerald B. 
Published: July 2016

AbstractAn emergency medical services (EMS) system involving paramedic and physician coverage at collegiate football games is described. Injury data for six and one-half years were reviewed. During this period, the data indicated that 313 patients sought medical care, either at the first-aid stations on-scene or at a local hospital emergency department. Lacerations and abrasions were the most common presenting complaints, totaling 20%. Bee stings were the second most common injury. One paramedic per 5,000 and one physician per 30,000 spectators appear to be adequate coverage for this type of event, although preplanning for a mass influx of patients is a necessity. Recommendations are provided for some basic personal and health needs of spectators at mass gatherings.
The Role of Pulse Oximetry in the Initial Airway Management of Helicopter Transported, Trauma Victims
Authors: Carol Ross S. , Renzi Francis P. 
Published: July 2016

AbstractIntroduction:Circumstances surrounding the prehospital management of trauma patients may mask clinical signs of inadequate oxygenation. Pulse oximetry (PO) may influence airway management prior to helicopter transport by helping to identify patients with occult hypoxemia.Methods:Patients were enrolled in a prospective study. Initially, the flight physician clinically decided how best to manage the patient's airway prior to helicopter transport. The patient's oxygenation saturation (O2at), was determined by PO. Then, the physician reassessed the initial airway management decision based on clinical assessment and knowledge of the O2Sat. All patients had an arterial blood gas (ABG) measurement taken after completion of transport.Results:Sixty patients were enrolled. Knowledge of the O2Sat, as determined by pulse oximetry, did not influence airway management. No patients with occult hypoxemia were identified.Conclusion:The use of PO in the initial evaluation of trauma patients prior to helicopter transport did not influence the flight physician's initial management of the airway.
Seroconversion by EMS Personnel Vaccinated with HBV Recombinant DNA
Authors: Koenigsberg Max D. , Ward Sharon , Herman Linda , McDonald Cary , Feldman Richard M. 
Published: July 2016

AbstractObjective:To evaluate the seroconversion rate of EMS personnel given the hepatitis B virus (HBV) recombinant deoxyribonucleic acid (DNA) vaccine series.Design:Retrospective review of paramedics and firefighters consecutively completing the HBV recombinant DNA vaccine program.Setting:Urban, non-prof it, private, regional EMS Resource Hospital. The Chicago North EMS System is under contract with the Chicago Fire Department. This contract allows for the voluntary vaccination of EMS personnel with recombinant DNA-HBV vaccine and treatment and follow-up of paramedics and firefighters possibly exposed to HBV.Population:Initial 68 EMS personnel completing HBV recombinant DNA vaccine program (48 primary prophylaxis and 20 post-exposure prophylaxis).Intervention:HBV recombinant DNA vaccine series was administered voluntarily to Chicago EMS System paramedics and firefighters per manufacturers recommendations. Two weeks after completion of the vaccination series, blood samples for HBV antibody titres were drawn to determine reactivity and the need for further immunization.Results:Of the 68 vaccinated individuals, only two had negative titres (3%). These two individuals were given a fourth dose of vaccine with successful seroconversion.Conclusions:Prehospital care personnel are known highrisk, health-care workers for acquiring HBV and should be vaccinated prophylactically. There is a high seroconversion rate (97%) utilizing HBV recombinant DNA vaccine. However, post-vaccination antibody titres must be performed to identify those rare individuals that do not seroconvert.
SARA Three Years Later: Emergency Physician's Knowledge, Beliefs, and Actions
Authors: Landesman Linda Y. , Leonard Ralph B. 
Published: July 2016

AbstractObjective:Investigate Emergency Physicians' knowledge about the Superfund Amendments and Reauthorization Act (SARA) Title III legislation, passed by the United States Congress in 1986, and to determine the factors contributing to their level of preparedness in dealing with patients exposed to toxic chemicals.Methods:A 115-item questionnaire was mailed to the medical directors of all emergency departments (EDs) in the State of New York. The results of the cross-sectional survey were analyzed using standard statistical methods.Results:One hundred and eighty-seven (72%) of the directors of EDs in New York State responded to the survey. Three years after SARA was enacted, only 33% of the directors had heard about this legislation. Only 18% had been invited to attend the meetings of the Local Emergency Planning Committees (LEPC). Sixty percent of the directors knew whether or not the LEPC had devised plans that defined a role for their EDs in responding to environmental emergencies. This knowledge about community planning mainly had an effect on preparedness of the EDs. Preparedness also was predicted by how recently the EDs had treated patients exposed to toxic chemicals, the perception that emergency physicians had a legitimate role in planning for and responding to chemical emergencies, and how often emergency physicians had attended continuing education courses about hazardous materials.Conclusion:Despite the finding that some emergency physicians are involved in community preparations, two main problems persist in planning a medical response to environmental emergencies. First, the ED directors generally are unaware of the legislation that mandates these preparations and are not interacting with community planners. Second, there is not full involvement by the local EDs in the LEPC planning efforts.Recommendations:A procedure is needed to disseminate information about legislation which affects emergency physicians, such as SARA, and about regional planning for environmental emergencies. Dissemination should include education about the professions' role in planning for and providing care for patients exposed to toxic chemicals.
Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13
Authors: Hsiao Albert K. , Michelson Stuart P. , Hedges Jerris R. 
Published: July 2016

AbstractIntroduction:Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).Methods:A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of ≤13 was performed. A total of 120 patients met the inclusion and exclusion criteria.Results:A significant number of patients presenting with a GCS score of ≤9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10–13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.Conclusion:Patients with a presenting GCS score of ≤9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10–13 is problematic. Patients with a presenting GCS score of 10–13 must be evaluated individually and closely monitored. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.
Comparison of Two Systems for Quality Assurance of Prehospital Advanced Life Support Services
Authors: Holliman C. James , Swope Gregory , Mauger Lisa , Wuerz Richard C. , Meador Steven A. 
Published: July 2016

AbstractIntroduction:The need for quality assurance (QA) systems for review of prehospital advanced life support (ALS) care has long been recognized. However, there only have been limited published studies on the operation and cost of QA systems for prehospital care. A number of different systems currently are in use, and the relative effectiveness of different QA systems has not been well determined.Objective:The aim of this study was to compare the personnel work-time and costs of two different systems of QA for prehospital ALS services, and thereby determine which type of system was more cost-effective in the generation of QA reports.Methods:The quality assurance program (System 1) for three independent ALS services in a rural/suburban area and the QA program (System 2) for a nearby urban ALS service were compared. Data recorded included the training level and number of hours per year devoted exclusively to QA activities by different personnel. The annual costs for other aspects of the QA systems and apportioned salary costs for time spent on QA work were recorded.Results:System 1, a computer-based system, utilized 1,116 hours per year of personnel time and required [US]$17,662 in total costs per year (average cost per run reviewed of $4.38). System 2 (a manual system) utilized 569 hours per year of personnel time and had an annual cost of [US]$8,361 (or $2.15 per run reviewed). System 1 generated 852 reports per year (21 % of runs) about non-compliance with protocols or charting deficiencies. System 2 generated 284 reports per year (7.3% of runs) for similar events.Conclusions:Either a computer-based or “manual” system for QA of prehospital ALS services can be utilized. A computer-based system requires more personnel time and is more expensive, but generates more reports per year than does the manual system. A computer-based system more readily can retrieve run report data for further review.