bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compliance with Closest Hospital Transport Protocol
Authors: Norton Robert L. , Bartkus Edward A. , Neely Keith W. , Schriver John A. , Hedges Jerris R. 
Published: July 2016

AbstractHypothesis:Paramedics accurately estimate the closest trauma hospital for ground transport.Population:Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded.Methods:A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “closest” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 = 0.924). Chisquare analysis was used to analyze hospital bypasses to specific hospitals.Results:Of the 1193 eligible patients entered into the trauma system, 160 (13%; 95% CI = 11–15%) transports bypassed the closest available hospital for a receiving hospital ≥1 mile more distant. There were 11 (1%; 0–2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS) <12, 15 (11%; 6–18%) were taken to a hospital one mile or further beyond the closest hospital. None (0%; 0–2%) were transported more than five miles past the closest hospital. Of the six hospitals, three were bypassed more than one mile significantly more often then they received bypass patients. One hospital received such patients four times more than it was bypassed (p <.001).Conclusion:While paramedics generally can identify the closest hospital for trauma patient transport, some systematic hospital bypass errors occur. If a community wants assurance of an equitable patient distribution among participating trauma hospitals and assignment of the closest geographic hospital for injured patients, then map vector distance determination to identify the closest available hospital should supplement paramedic dispatching.
Standing Orders for Field Intravenous Lines Do Not Shorten Prehospital Time in Trauma Patients
Authors: Tortella Bartholomew J. , Lavery Robert F. , Cody Ronald P. , Salant Mindi 
Published: July 2016

AbstractStudy Objective:No randomized, prospective studies have been conducted that examine how standing orders for establishing intravenous (IV) lines in trauma patients affect prehospital time. The purpose of this randomized, prospective study was to determine if standing orders for IV lines in the field shorten prehospital time.Design:A prospective, randomized study was conducted.Setting:Trauma patients (n = 521) were randomized prospectively on an even-/odd-day basis over a one-year period from 1 April 1988 to 1 April 1989. Patients were sorted into an IV Standing Orders (SO) arm (n = 258) and a No Standing Orders (NO) arm (n = 263) in which On-Line [Direct] Medical Command (OLMC) was required before IV initiation.Participants:Trauma patients, paramedics in a high-volume, urban, EMS system, and medical-command physicians on the trauma team at a Level 1 trauma center.Results:No significant differences were found in demographics, prehospital vital signs, mechanism of injury, or trauma severity scores between the two treatment arms. Scene times were similar for the two groups (IV SO = 11.4 minutes, and NO = 10.6 minutes, p = .1675) as was IV success rate (92% vs. 88%, p = .1729).Conclusion:When compared to OLMC in this EMS system, IV standing orders did not affect scene time. This supports the concept that only spinal stabilization and airway management be performed at the scene and other ALS maneuvers (e.g., IVs) be performed in the ambulance, preferably en route to a Trauma Center. Since IV standing orders had no documented, adverse effects and led to focused, concise radio telemetry reports, this EMS system adopted their use on a permanent basis.
The Prehospital Use of Nitroglycerin According to Standing Medical Orders in an Urban EMS System
Authors: Herman Linda L. , Koenigsberg Max , Ward Sharon , Sloan Edward P. 
Published: July 2016

AbstractPurpose:The purposes of this study are to quantify the use of nitroglycerin (NTG) in prehospital care, to detect deviations from the Standing Medical Orders (SMO), to determin the effectiveness of its administration, and the incidence of clinically significant adverse reactions (hypotension, bradycardia).Method:Retrospective review of 7683 Advanced Life Support (ALS) telemetry, base-station contacts over a three month period (June, July, Auguest 1990) to identify all prehospital patient contacts in which NTG was utilized.Setting:The Resource Hospital/Telemetry Base-Station a two community hospitals/Telemetry Base-Stations for the Chicago North EMS System.Results:There were 445 runs in which NTG was indicated as per SMO. Two hundred eighty-eight patients (64.7%) received NTG for appropriate indications as per SMO, 203 for ischemic chest pain (45.6%), 79 for pulmonary edema (17.7%), and six for both (1.3%). There were 157 (35.5%) runs in which NTG was indicated, but not administered. There were 22 patients who received NTG for indications that deviated from the SMO. Reassessment data concerning the subjective symptom was completed on 118 patients (40.9%), 92 (45.3%) patients with chest pain and 26 with dyspnea (32.9%). Following the administration of NTG, 21 patients (10.1%) with chest pain were unchanged, while 13 with dyspnea (15.3%) improved, 13 patients (15.3%) were unchanged, and none worsened. In 121 patients, the systolic blood pressure (SBP) decreased, while 24 were unchanged (5.4%), and 28 had an increase (6.3%). The mean initial value SBP was 176±44 mmHg and the repeat mean SBP was 164±41 mmHg with a mean decrease of 12±22 mmHg. The diastolic blood pressure (DBP) decreased in 87 patients, was unchanged in 53 (11.9%), and increased in 33 (7.4%). The initial mean DBP was 97±24 mmHg, the repeat mean DBP was 92±23 mmHg, a mean decrease of 5±15 mmHg. Only one patient became hypotensive with the administration of NTG and was successfully resusticated with a fluid bolus of 300 ml normal saline.Conclusions:In this EMS system, NTG is under-utilized based on the indications delineated by this system's SMOs. Reassessment is documented infrequently, but when completed, clinically significant adverse reactions are rare. Since the incidence of hypotension and bradycardia are rare, the inability to establish an IV line should not preclude the administration of NTG.
Reporting of Child Abuse by Prehospital Personnel
Authors: King Brent R. , Baker M. Douglas , Ludwig Stephen 
Published: July 2016

AbstractIntroduction:Prehospital (EMS) personnel routinely enter patient's homes and often are the first trained persons to evaluate an ill or injured child. Therefore, it is vital for these individuals to recognize child abuse (CA), and to understand the proper procedures for reporting suspected cases.Methods:A questionnaire was administered to prehospital care-givers participating in a seminar on pediatric emergencies. Questions were designed to test factual knowledge of CA and the correct reporting procedures, as well as to evaluate attitudes toward CA.Results:There were 48 responses to the questionnaire; 34 (71%) were paramedics, the remainder were emergency medical technicians (EMTs) and/or registered nurses (RNs). Thirty-three (69%) practiced either in a rural or suburban setting. Subjects had an average of 10.8 years of prehospital emergency-care experience. Twenty-eight (58%) reported no previous training in CA. All participants understood the nature of CA, were able to identify the various forms of CA, and believed CA to be a significant problem. However, 33 (69%) did not understand the legislation that mandates reporter status, and while 27 (56%) claimed to have reported CA, only 16 (33%) had made a report either to police or to children's services workers. Of the 21 who never had reported a case of CA, 14 (67%) believed that they never had encountered an abused child. The remainder were not certain, and therefore, did not report, or thought that the hospital staff would report.Conclusions:While this subject deserves further study, it seems that many EMTs and paramedics lack a complete understanding of their role in the identification and reporting of CA. This information should be emphasized further in EMT and paramedic education, and should be reinforced through continuing education.
Devices for Expired Air Resuscitation
Authors: Rossi Rolando , Lindner Karl Heinz , Ahnefeld Friedrich Wilhelm 
Published: July 2016

AbstractObjectives:Expired air resuscitation is an essential part of first-aid and cannot be replaced by other measures. Because of the risk of transmitting infectious diseases, the use of devices is recommended. Three types are available—masks, tubes, and foils.Participants:Six masks (Air-Vita Bi-Protect, Laerdal Pocket-mask, Dräger Hivita Mask E, Rescue-Med De-vice, Resuscitator, SealEasy Resuscitation Kit), five tube instruments (Dr. Brook Airway, Dual-Aid, Goettinger Tubus, Lifeway, Sussex Valve Airway), and two foils (Ambu Life-Key, Laerdal ResusdFace Shield) were studied.Measurements:Inspiratory and expiratory resistance, valve leakage, ability to protect against infection transmission, and practicability (e.g., possibility of training on standard mannequins, seal) were measured and tested in the laboratory.Results:Only a few of the mask and tube devices had low inspiratory and expiratory resistances. Some of the one-way valves failed. There were definite risks of provoking complications (vomiting, lacerations) when using tube instruments.Conclusions:Devices consisting of a foil have definite advantages, and seem to be more appropriate for the use by first-aiders [first responders].
The Utilization of Quality Assurance Methods in Emergency Medical Services
Authors: Davis Eric A. , Billitier Anthony J. 
Published: July 2016

AbstractObjective:The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.Methods:A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.Results:Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.Conclusion:This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.
Prehospital Care of Agricultural Injuries
Authors: Stueland Dean , McCarty John , Stamas Peter 
Published: July 2016

AbstractIn the United States, farming has become one of the most dangerous occupations. There are unique challenges for the providers of prehospital care to victims of agricultural trauma. The machinery and the work environment associated with agricultural trauma are different from those encountered in other occupations. The unique features of the machinery and risks are discussed. In addition, solutions unique to the problems of agricultural prehospital care are discussed. Effective care of the victims of agricultural trauma has a potential to reduce morbidity.
Pediatric Casualties during the Civil Conflict in the Republic of Georgia 22 November–5 December 1991
Authors: Metreveli Irakli T. , Vosk Arno 
Published: July 2016

The Civil War in GeorgiaOn 9 April 1991, the Republic of Georgia proclaimed its independence from the Soviet Union. Sviat Gamsakhurdia, an anti-communist leader of the Georgian Nationalist movement, was elected President by an overwhelming majority. Soon after the election, however, Gamsakhurdia's popularity began to plummet. He was accused of suppressing any opposition, and he and his supporters accused the opposition of being in league with Moscow and seeking to sabotage Georgian independence. Demonstrators in Tbilisi, the capital city, demanded the resignation of the new government, and the government relied increasingly upon armed forces to maintain power.
Epidemic of Surgical Wound Infections in Wartime Sarajevo
Authors: Ler Zeljko , Vujovic Branko , Jazic Sead 
Published: July 2016

AbstractBackground:An epidemic of surgical wound infections observed at the State Hospital of Sarajevo during June-September 1992 is reported.Methods:A cross-sectional survey of 138 surgical patients with wound infection treated by the Department of Surgery of the State Hospital of Sarajevo was performed in mid-September and again in mid-November 1992. A preliminary evaluation of the bactericidal effectiveness of a new antiseptic preparation called DI-ASEPT also was done.Results:The frequency of wound infection was 24.4% in September and 19.2% in November. Pseudomonas species was the primary etiologic agent in this epidemic. DI-ASEPT was as effective as povidone-iodine in producing wound asepsis.Conclusions:Because of limited resources large numbers of casualties, and an extremely adverse environment as a result of war that has affected hygienic conditions at the State Hospital of Sarajevo, a high frequency of contaminated or dirty operations were performed. This was the primary reason for the observed increase in wound infections. After hygienic conditions were restored, the epidemic of wound infections was terminated.
Hospital Preparedness for Chemical Accidents: The Effect of Environmental Legislation on Health Care Services
Authors: Landesman Linda Y. , Markowitz Steven B. , Rosenberg Stephen N. 
Published: July 2016

AbstractBackground:Chemical accidents occur often across the United States, endangering the health and safety of many people. The Super fund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents.Methods:A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Timel), and in 1989 after its implementation (Time2).Results:Ninety-four percent of the directors responded at Timel and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk.Conclusion:Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.
Critical Thinking: Incorporation into the Paramedic Curriculum
Authors: Janing Judy 
Published: July 2016

AbstractThe purpose of this paper is to present approaches to foster critical thinking skills within the context of the current paramedic curriculum. It reviews some of the definitions and concepts of critical thinking from selected adult education and nursing literature in an attempt to formulate a workable definition as it applies to paramedics. From that definition, elements are identified and incorporated to form a teaching model for use in presenting the curriculum content. Some sample teaching strategies based on revised objectives of the airway/ventilation section also are included.
Complex, Humanitarian Emergencies: II. Medical Liaison and Training
Authors: Burkle Frederick M. 
Published: July 2016

AbstractIn complex, humanitarian emergencies, professional liaison roles are just one of many that evolve from the coordination of United Nations agencies, the International Committee of the Red Cross, international and national non-governmental relief organizations, and coalition military forces. Liaison is crucial to the humanitarian relief process. Decision makers benefit from liaisons' professional experience, their knowledge of the characteristics, missions, and capabilities of each major participant in the relief process, and in their ability to coordinate and clarify professional issues in meeting the goals of a mission. Medical liaison roles develop from the awareness that complex emergencies primarily are catastrophic public-health emergencies. Unfortunately, education and training of the medical liaison currently are ill-defined. However, limited experience suggests that skills should be broadly based in principles of disaster epidemiology, assessment and management, knowledge of contributing relief resources, agencies and the military, and international humanitarian law and the Geneva Conventions.
Post-Disaster Malaria in Costa Rica
Authors: Sáenz Rocio , Bissell Richard A. , Paniagua Francisco 
Published: July 2016

AbstractIntroduction:In recent years, controversy has surrounded the issue of whether infectious disease should be considered a serious potential consequence of natural disasters. This article contributes to this debate with evidence of a significant outbreak of malaria in Costa Rica's Atlantic region after the 1991 earthquake and subsequent floods.Methods:This study is an epidemiologic investigation of the incidence of malaria for the periods of 22 months before the April 1991 Limon earthquake and for 13 months afterward. Data were obtained from the Costa Rican Ministry of Health's malaria control program.Results:Some of the cantons in the region experienced increases in the incidence of malaria as high as 1,600% and 4,700% above the average monthly rate for the pre-earthquake period (p ≤0.01). Causal mechanisms are postulated as relating to changes in human behavior (increased exposure to mosquitoes while sleeping outside, and a temporary pause in malaria control activities), changes in the habitat that were beneficial to mosquito breeding (landslide deforestation, river damming, and rerouting), and the floods of August 1991.Conclusions:It is recommended that there be enhanced awareness of the potential consequences of disaster-wrought environmental changes.Date of Event: 22 April 1991; Type: Earthquake, 7.4 Richter scale; Location: Costa Rica; Number of deaths and casualties: 54 deaths and 505 moderate to severe injuries.
Incorporating Drugs and Devices into Emergency Medical Services Systems
Authors: Wolfberg Douglas M. , Verdile Vincent P. , Flinn Richard D. 
Published: July 2016

AbstractThe proliferation of new medical technology and pharmacology forces the medical community to ensure the efficacy and safety of new drugs and devices before their use in patient care. Although traditional medical practices have a fairly consistent means to achieve this end, prehospital medical practice often does not. In addition, it often appears that the emergency medical services marketplace does not always follow conventional supply/demand and cost/quality paradigms. This article describes a process implemented in Pennsylvania to standardize the mechanism by which new drugs and devices are introduced into prehospital medical practice.
Factors Influencing Successful Intubation in the Prehospital Setting
Authors: Doran James V. , Tortella Bartholomew J. , Drivet Walter J. , Lavery Robert F. 
Published: July 2016

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.