bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and Surgical Management of Abdominal War Injuries in Sarajevo: State Hospital of Sarajevo Experience
Authors: Vujovic Branko , Mazlagic Damir 
Published: July 2016

AbstractBackground:In war, abdominal injuries constitute a significant proportion of the total injuries. These injuries are associated with high mortality and their treatment poses dianostic, surgical, and therapeutic dilemmas. This article presents the epidemiology of abdominal war injuries during the siege of Sarajevo, and briefly describes the surgical techniques and therapeutic practices used in their treatment.Methods:A retrospective medical record review was performed of 273 war casualties with trauma to visceral and vascular structures in the abdomen inflicted during a 7.5 month period in 1992.Results:Most patients underwent exploratory laparotomy. Six percent had negative laparotomies, and there were no deaths in this group. In 18.3%, injuries were limited to one organ system, while 81.7% sustained combined injuries to multiple-organ systems. The crude mortality rate was 26.0%. Mortality rate excluding deaths within 24 hours of injury was 10.3%. Injuries were caused by metal fragments from artillery shrapnel, mortar and contact mines, or hand grenades. Because of a shortage of colostomy bags, resections of the colon with primary end-to-end anastomoses rather than colostomy were performed in 72% of the cases.Conclusions:Mortality was highest in those victims with four or more injured organ systems (81.3%) or with major vascular injuries (64.7%). The primary cause of death within the first 24 hours was prolonged hemorrhagic shock.
Hospital Disaster Operations During the 1989 Loma Prieta Earthquake
Authors: Martchenke Julie , Pointer James E. 
Published: July 2016

AbstractObjective:To study hospital disaster operations following a major United States disaster.Design:Researchers interviewed all 51 hospital administrators and 49 of 51 emergency department (ED) charge nurses and emergency physicians who were on duty at the study hospitals during the 13-hour period immediately following the 1989 Loma Prieta earthquake.Setting:The 51 acute-care hospitals in the six northern California counties most affected by the Loma Prieta earthquake.Measurements:Questionnaires and inperson interviews.Results:The most frequently noted problem was lack of communications within and among organizations. Hospitals received inadequate information about the disaster from local governmental agencies. Forty-three percent of hospitals had inadequate back-up power configurations, and five hospitals sustained total back-up generator failures. Twenty hospitals performed partial evacuations.Conclusions:The Loma Prieta earthquake did not cause total disruption of hospital services. Hospitals need to work with local governmental agencies and internal hospital departments to improve disaster communications.
Comparison of Interventions in Prehospital Care by Standing Orders Versus Interventions Ordered by Direct [On-line] Medical Command
Authors: Holliman C. James , Wuerz Richard C. , Miguel Gaspar Vazquez-de , Meador Steven A. 
Published: July 2016

AbstractObjective:The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders.Design:Prospective identification of patient care measures done as part of a prehospital quality assurance program.Setting:An urban paramedic service in the northeast United States with direct medical command from three local hospitals.Participants:One thousand eight paramedic reports from October 1992 through March 1993.Interventions:All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the prior two studies of the same system.Results:Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1 %), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system).Conclusion:Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed.
Disabling Job Injuries Among Urban EMS Providers
Authors: Tortella Bartholomew J. , Lavery Robert F. 
Published: July 2016

AbstractObjective:Nationwide data were collected concerning serious, disabling injuries requiring hospitalization (SDIH) or deaths among urban emergency medical services (EMS) providers.Design and Setting:A mail survey of EMS systems was conducted among the 200 most populated U.S. cities.Participants:Participants were training and operations officers of urban EMS systems.Measurements and Main Results:Ninety forms (45%) were returned with 88 evaluable (44%). There were 81 SDIHs for a rate of one in 31,616 dispatches. No deaths were reported. Body parts most frequently injured were the hand (22%), head (19%), foot (16%), and eye (14%). Although 90% of fire-based EMS systems (fire-EMS) provided helmets, eye protection, safety shoes, and gloves, less than half (45%) of nonfire-EMS did so. Three (4%) SDIHs resulted from acts of violence.Conclusion:Occupational injuries of EMS personnel are at a serious level. Fire-based EMS systems experienced a higher rate of hand SDIHs despite the provision of protective equipment. Few nonfire-EMS staff are provided with safety equipment, which may have resulted in a relatively high number of head and hand SDIHs. Fire-EMS medical directors need to take an active role in verifying that protective equipment is adequate and appropriate to allow the performance of field EMS duties without being too cumbersome. Medical directors of nonfire-EMS must be advocates for the provision of basic protective equipment aimed at mitigating SDIHs of EMS staff.
Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care
Authors: VanRooyen Michael J. , Sloan Edward P. , Barrett John A. , Smith Robert F. , Reyes Hernan M. 
Published: July 2016

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.
Pedestrian Intoxication and Fatal Traffic Accident Injury Patterns
Authors: Williams James S. , Graff Jonathan A. , Uku Justin M. 
Published: July 2016

AbstractIntroduction:Sixteen percent of all motor-vehicle fatalities are pedestrian, and accidents involving pedestrians are associated with the highest morbidity and mortality rates. Classic pedestrian injury patterns have been described. However, it has been suggested that the pattern may differ if the pedestrian is intoxicated. The role of pedestrian intoxication on motor-vehicle accident injury patterns has not been well-delineated.Hypothesis:Intoxicated pedestrian traffic victims have an injury pattern that is more serious and more rapidly fatal than is the pattern for nondrinking victims.Methods:Autopsies of 223 consecutive pedestrian victims were reviewed and grouped according to the presence of alcohol in the blood: Group I, Negative (n = 165); Group II, Positive (n = 58). Gender, age, anatomic injuries, survival time, time of day, and year also were examined.Results:Results indicated that there were more males in Group II (79%) than in Group I (64%); younger victims, younger than 40 years old, in Group II (70%) than in Group I (34%); fewer victims older than 60 years old in Group II (8%) than in Group I (38%). Group II sustained more frequent and more severe injuries—two times the frequency of the cervical spine, liver, upper and lower extremity, pelvic and rib fractures and thoracolumbar spine injuries; three times more aortic injuries; five times more heart injuries. Death occurred within 24 hours in 95% of those in Group II and in 67% of those in Group I. Accidents occurred from 1500h to 2300h in 67% of Group II and in 53% of Group I victims.Conclusion:Intoxicated pedestrian accident victims are predominantly young men, struck between 1500h and 0700h; they have an injury pattern that is two to five times more serious than is the pattern for the sober victims.
Liability Immunity as a Legal Defense for Recent Emergency Medical Services System Litigation
Authors: Morgan David L. , Trail William R. , Trompler Vicky A. 
Published: July 2016

AbstractBackground:Although many emergency medical services (EMS) providers are concerned about liability litigation, no comprehensive, national studies of EMS appelate cases have been published. Information about these cases and the use of liability immunity (sovereign immunity, emergency medical care immunity, or Good Samaritan immunity) as a defense could be used for EMS risk management and better patient care.Objective:To review recent EMS system civil litigation cases to determine their common characteristics and the number that used liability immunity as a legal defense.Methods:An observational study of the WESTLAW computerized database of legal cases from all state and federal appellate courts. All legal cases that named a member of the EMS system as a defendant, involved either a patient-care incident or ambulance collision, and received an appellate court opinion from 1987 through 1992, were studied.Results:Eighty-six cases were identified and analyzed. Most cases (85%) were related to a patient-care incident, and 71 % of the cases involved a death or significant physical injury. More than 49% of the patient cases alleged inadequate assessment or treatment, and 27% alleged delay in ambulance arrival or no ambulance arrival. There were 11 cases (15%) that alleged no transport of the patient to the hospital. Liability immunity was used as a defense in 53% of the cases. The appellate courts ruled in favor of 68% of the defendants that did not use an immunity defense and in favor of 72% of those that did use liability immunity.Conclusion:There have been a large number of recent appellate cases involving EMS systems. The common characteristics of many of these cases demonstrate the need for providing rapid ambulance arrival, proper assessment and treatment, and rapid patient transportation to a hospital. Although liability immunity was used as a legal defense by most EMS system defendants, the appellate court outcome was similar regardless of its use.
Paramedic Field Instructors: An Approach to Training the Newest Paramedics While Maintaining the Interest of the Most Successful Senior Paramedics
Authors: Krochmal Paul , Moore Jessie , Shea Kathleen , Kiessling Mark , Blaustein David , Schriver John 
Published: July 2016

AbstractA unique approach to providing orientation and supervised field experience for newly graduated paramedics and for the continuing education and recognition of experienced, skilled, operational paramedics is described. A group of 30 paramedic field instructors (PFI) was selected following application, development of criteria for selection, and interviews. This program had a positive effect in both realms during its first year of operation in the emergency medical services system in which it was implemented.
Mobile Medical Relief and Military Assistance in Somalia
Authors: VanRooyen Michael J. , VanRooyen Julia B. , Sloan Edward P. , Ward Edward 
Published: July 2016

AbstractIntroduction:Mobile medical clinics were established by an international medical relief organization to provide health care to victims of the war in Somalia. The study's purpose was to examine the prevalence of diseases seen and the effectiveness of mobile medical clinics, and to evaluate military support in security and care provisions.Methods:This is a descriptive case series conducted over a 6-month period. Physicians determined clinical diagnoses, and clinic personnel assigned security scores (one to five) based on: 1) crowd control; 2) the incidence of looting; and 3) threats of violence by individuals demanding treatment.Setting:Mobile medical teams that provided health care to regions in urban and rural Somalia assisted by United States and Italian military forces.Participants:At 149 mobile clinics, 25,265 patients were treated.Interventions:Medical treatment included dispensing medications, intravenous rehydration, and minor surgical procedures. The effectiveness of security measures was scored based on: 1) effective crowd control; 2) the lack of theft or threats of violence; and 3) the unimpaired operation of the clinic.Results:Medical teams treated 25,265 patients. The most common medical problems encountered were skin infections (19.5%), upper and lower respiratory tract infections (16.1%), and gastroenteritis with dehydration (7.1%). Malnutrition was seen in 4.7% of cases, and trauma accounted for only 0.7% of complaints. When military escorts were provided, the mean security score was 43% higher (4.85 ±0.46) as compared to the absence of a military escort (3.40 ±0.60) (p <0.001).Conclusions:Mobile medical clinics were found to be effective in this setting despite difficult conditions, limited therapeutic modalities, and few in-patient facilities. Infectious diseases were most common, while malnutrition and trauma were less commonly seen. The cooperation of United States and Italian military forces facilitated relief efforts by maintaining security, particularly in unstable areas.
Prehospital Communications During the Loma Prieta Earthquake
Authors: Martchenke Julie , Rusteen Jeff , Pointer James E. 
Published: July 2016

AbstractIntroduction:On 17 October 1989, the Loma Prieta Earthquake shook the San Francisco Bay area, home to more than 6 million people. This study examined the effectiveness and function of emergency medical services (EMS) communications after this event.Methods:The six Bay area counties most affected by the Loma Prieta Earthquake were surveyed using a 156-part questionnaire. This study examined the functioning of the primary 9-1-1 county dispatch centers. Paramedics involved in a set of defined activities during the period after the earthquake also were surveyed. Emergency medical services directors also were questioned by telephone using an interview tool developed for this purpose. All areas concerning disaster response were not queried. Ten specific areas were considered, including: 1) preparation for disaster; 2) the impact of the earthquake; 3) reconnaissance; 4) call volume; and 5) others.Results:Coordination among the various agencies responsible for disaster response and mitigation needs more study. Uniform response plans for medical mutual aid need development. Government support similar to police and fire department arrangements for mutual aid are not in place. Additional planning and training for disasters at all levels need reassessment. The communication-center personnel indicated that they did not call for more resources, but instead accepted volunteers at dispatch centers and extra assistance. Once engaged, however, most communications centers (CCs) had great difficulty tracking and controlling all the units under their jurisdiction. In some large urban counties, some ambulances were idled awaiting calls but lost their communications centers, while other ambulance personnel were trying to handle multiple patients and requests for services.Conclusions:Significant help from a state or federal agency likely will be unavailable for a substantial period after a catastrophic regional event. Important coordination among EMS agencies for disaster response is poor or absent. Although fatalities and casualties were limited compared to what could have occurred, great confusion reigned for varying periods of time after the earthquake. Communications among local agencies, counties, and the state were problematic. Information flow to hospitals was cited frequently as a problem, making it difficult for hospitals to prepare adequately. Medical mutual-aid help was disorganized and inadequately controlled. The training of personnel and the method of recall for disaster response need to be examined.
Survey of Medical Services at Major League Baseball Stadiums
Authors: Ma O. John , Pirrallo Ronald G. , Rubin Jonathan M. 
Published: July 2016

AbstractObjective:To analyze the availability and level of medical services for fans at major league baseball games in the United States.Methods:A 10-item questionnaire was sent to the operations managers of each of 28 major league baseball stadiums. The survey was distributed in cooperation with a major league baseball club. Telephone follow-up was used to complete missing responses. The survey addressed five areas of fan medical services: 1) health-care provider availability and compensation; 2) advanced cardiac life support (ACLS) capabilities, including equipment; 3) presence of on-site ambulance(s); 4) fan fatalities; and 5) alcohol consumption limitations.Results:Survey response was 100%. Healthcare providers are on-site at all stadiums: nurses (86%), physicians (75%), emergency medical technicians (EMTs, [68%]), and paramedics (50%). Ninety-six percent use a combination of health-care providers. The most common medical teams are nurse + EMT + physician (25 %) and nurse + EMT + paramedic + physician (18%). All health-care providers receive some form of compensation. All stadiums have at least one ACLS-certified provider; 96% have ACLS equipment. Ambulances are on-site 75% of the time. Sixty-eight percent of the clubs reported at least one fan fatality through the 1992 and 1993 seasons (mean 1.1, range 0–4). All clubs limit alcohol consumption; 96% use multiple approaches. The various approaches include: 1) specific inning discontinuation (86%); 2) maximum purchase (68%); 3) restricted sale locations (64%); and 4) crowd conduct (57%). Advertisement for responsible alcohol consumption is displayed at 75% of the stadiums; designateddriver programs exist at 46%.Conclusions:All major league baseball clubs provide medical services for fans. Furthermore, almost all stadiums have ACLS capabilities. Responsible alcohol consumption also is a recognized priority for fan safety.
Epidemiology of Pediatric EMS Practice: A Multistate Analysis
Authors: Joyce Steven M. , Brown Douglas E. , Nelson Elizabeth A. 
Published: July 2016

AbstractObjective:To describe the epidemiology of pediatric emergency medical services (EMS) practice in a large patient population from several geographic areas.Design:Retrospective computer analysis of EMS databases from four states using a common data set and analysis system.Setting:Pennsylvania, Tennessee, Mississippi, and Nevada (except Clark County), 1990 through 1992.Methods:All patient-care reports of patients 14 years old and younger were extracted from the EMS databases and analyzed for the following factors: age, gender, date, elapsed pre-hospital times, incident type, mechanism of injury, call disposition, illness or injuries encountered, severity of illness/injury (by abnormal vital signs), and basic life support (BLS) and advanced life support (ALS) treatment delivered.Results:A total of 1,512,907 patient care reports were reviewed. Those of 61,132 children were extracted for analysis. These children comprised about 4% of prehospital responses. Male subjects predominated (56%), and children aged 7 through 14 years represented 46% of cases. Most calls occurred in the evening and daylight hours. Children were transported by ambulance in 89% of cases, and care was refused in 7.7%. Mean response time was 9±16 minutes, mean scene time 12±14 minutes, and mean transport time 14±20 minutes. Traumatic incidents predominated at 42%, with motor vehicle accidents and falls the most common mechanisms. Blunt injuries accounted for 94% of trauma, whereas respiratory problems, seizures, and poisoning/overdose were the most common medical problems. Vital signs were obtained in 56% of cases. Abnormal vital signs were noted in 21% of these, and the presumptive causes were similar in distribution to those of the general population, with the addition of cardiac arrest. The most commonly used treatments were spinal immobilization, oxygen administration, intravenous access and several ALS medications. An ALS capability was available in more than half the runs, but ALS treatment was delivered in only 14% of those cases. Outcome data were not available.Conclusion:This multistate analysis of pediatric EMS epidemiology confirms findings reported in smaller regional studies, with several exceptions. Excessive scene times were not noted. Few children had serious disorders as evidenced by abnormal vital signs. An ALS treatment, when available, was used infrequently. These findings have implications for EMS planners and educators.