bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Mortality Rates Among Trauma Patients Transported by Helicopter and Ambulance in Maryland
Authors: Kerr Walter A. , Kerns Timothy J. , Bissell Richard A. 
Published: July 2016

AbstractIntroduction:A comprehensive state wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient out comes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (Maryland State Police) Aviation Division contribute to an improved trauma patient survival rate in Maryland.Methods:A retrospective study was conducted on the records of all patients transported by helicopter or ground ambulance and admitted to the R Adams Cowley Shock Trauma Center (R Adams Cowley Shock Trauma Center of the University of Maryland Medical System) of the University of Maryland Medical System. Data were obtained from the Maryland Institute of Emergency Medical Services Systems (Maryland Institute for Emergency Medical Services Systems) Shock Trauma Clinical Registry for the period January 1988 through July 1995, covering 23,002 patients. Patients included those transported directly from the scene of injury to the Maryland Institute for Emergency Medical Services Systems as well as those from interfacility transfers. All patients were stratified by injury severity and compared by outcome (mortality) using Mantel-Haenszel statistics.Results:During the study period, 11,379 patients were transported by ground and 11,623 were transported by Maryland State Police helicopter. The mean Injury Severity Score (Maryland State Police) for patients transported by ground was 12.7 (standard deviation = 12.52) and the mean Injury Severity Score for patients transported by air was 14.6 (Injury Severity Score = 13.42), p <0.001. Among patients classified as having a high index of injury severity, the mortality rate was lower among those transported by Maryland State Police helicopter than among those transported by ambulance. The mortality rate was significantly lower for air transported patient with an Injury Severity Score higher than 31.Conclusion:The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.
The National (United States) Disaster Medical System: A Survey and Analysis
Authors: Clark William D. , Moskop John C. , Whitley Theodore W. 
Published: July 2016

AbstractThe National Disaster Medical System (NDMS) was formulated to provide medical care for casualties of future large-scale natural disasters and military conflicts. We sent questionnaires to the 59 emergency medical directors of North Carolina's participating hospitals in order to assess their views regarding the need for NDMS and the level of their hospital's preparedness. Responses were received from 78% (46) of the physicians surveyed. Of those responding, an overwhelming majority supported the need for a national plan like NDMS to treat casualties of a natural disaster or an overseas military conflict. Respondents also agreed that the participation of emergency department personnel, other physicians, and support personnel is essential for successful activation of NDMS. Responses to questions regarding level of preparedness, however, suggested that there is less than an optimal degree of preparedness for participation in NDMS.
International Emergency Health Care Systems Survey
Authors: Bissell Richard A. , Conover Jean 
Published: July 2016

AbstractMedical emergencies occur in every country regardless of its level of socio-economic development. Little comparative data are available which define the characteristics of the system by which some emergencies are managed. Without such comparisons, it is difficult for countries to establish appropriate priorities within their geographic, cultural, and economic constraints. In an effort to gather some of these needed data, a survey was distributed to the participants in an International Conference on Emergency Health Care (EHC) Development convened in Washington, D. C, in August 1989. Each country participating was classified as Industrialized (INDUS), Developing (DC), or Least Developed (LDC) in accordance with World Health Organization definitions. Responses are expressed as proportion of total participants.There were 450 participants from 74 countries. Only 17% of the surveys were returned. The sample included 78 participants from 40 (57%) countries. (INDUS: 30%; DC: 48%; LDC: 22%). All showed considerable dependence on ambulance services, but DC and LDC indicated substantial reliance on friends, neighbors, community health workers, and physician's offices. Prehospital EHC services were available to 93% of INDUS, 63% of DC, and possibly one-third of the LDC. Emergency Health Care is taken to the patients in the same proportions as noted above. The types of manpower dispatched varied widely with a great proportion of the respondents from DC and LDC indicating that care was delivered by non-professionally trained individuals. Interestingly, INDUS had the greatest proportion of volunteers. Response and transport times were shorter for INDUS than for DC. When no prehospital EHC services were available, patients reached the receiving facilities by alternate means such as walking (33%), private automobile (48%), or public transportation (33%). Central emergency access was available for 80%. Considerable variation exists as to the mechanisms by which such services are financed: poorer countries depend more on government support than do INDUS who rely heavily on donations and fee-for-service. Lastly, regardless of level of economic development, cardiovascular disease, trauma, and medical illness comprise the most important reasons for accessing the EHC systems.This preliminary study points to the need for individualizing EHC systems in concert with the priorities of the country for which they are designed. Direct application of operational systems across countries does not seem an appropriate mechanism for the development of EHC. However, the delivery of EHC must be made an important element of overall health care in all the countries of the world.
Countermeasures Against Earthquake Disasters in Relation to Medical Treatment in Japan
Authors: Osawa Yutaka 
Published: July 2016

Planning of earthquake disaster prevention is of great concern in Japan, since we have frequently been subjected to serious damage due to severe earthquakes. The medical treatment after a disastrous earthquake is undoubtedly one of the most serious items to be considered.The countermeasures against earthquake disasters, in relation to medical treatment, may be divided into two categories; a) prevention of damage to medical facilities and instruments, b) planning for emergency and disaster medicine. This paper introduces the countermeasures against earthquake disasters in relation to medical treatment in Japan.
The Need for a Global Health Disaster Network
Authors: Libman Ingrid M. , LaPorte Ronald E. , Akazawa Shunichi , Boostrom Eugene , Glosser Caryle , Marler Eric , Pretto Ernesto , Sauer Francois , Villasenor Anthony , Young Frank , Ochi Genro 
Published: July 2016

AbstractWhen a disaster occurs, a major difficulty is knowing where to find accurate information, and how to help coordinate efforts to share accurate information in a quick and organized manner. The establishment of a global information network, that is in place before a disaster occurs, could link all the communication efforts for relief. We propose that a Global Health Unit for Disaster and Relief Coordination be set up as part of the Global Health Network, utilizing the Internet as its backbone. This Unit would establish the links for the disaster information mosaic.
The Flight from Rwanda in 1994: What Were (Are) the Priorities?
Authors: Domres Bernd , Mang Andreas 
Published: July 2016

AbstractExtent of the Catastrophe:More than 2 million refugees, 2–3 million displaced persons internally, thousands of unaccompanied children, and a total number of reported fatalities of 48,347 in Goma, Zaire.Priorities for International Relief:International relief support started with coordination provided by the United Nations High Commissioner for Refugees (UNHCR). In the first phase, availability of potable water was the highest priority. Current priorities are to intensify repatriation of Rwandan refugees under conditions that will guarantee human rights and allow for dignified daily living.Conclusion:Education beginning at childhood, to overcome conflicts, social inequality, and overpopulation should be promoted by assisting governments, instead of pursuing policies aimed largely at forwarding their own national interests.
How to Cope with a Visit from the Pope
Authors: Federman Jane H. , Giordano Lorraine M. 
Published: July 2016

AbstractA mass gathering always presents a challenge to the medical providers of a city since preparations must be made to cover any potential disasters, big or small. With a prediction of several hundred thousand people coming to the New York City area to participate in the Papal Masses, the New York City-Emergency Medical Services readied its forces of physicians, paramedics, and emergency medical technicians from throughout the region. Extensive multiagency planning involving a Total Quality Management process was integral to the success of covering the events.
Triage By Emergency Medical Dispatchers
Authors: Stratton Samuel J. 
Published: July 2016

AbstractPurpose:This study is an evaluation of the ability of medically trained and controlled emergency medical dispatchers to use telephone triage techniques to direct the appropriate prehospital unit to an emergency scene.Methods:Emergency dispatchers, educated in a formal emergency medical dispatch program, were assigned one of four triage priorities to incoming 9-1-1 calls. The actual field management delivered for each patient was compared with the dispatcher's triage to determine the appropriateness of triage.Results:A total of 1,045 consecutive calls were reviewed with 74.4% sorted as needing advanced life support (ALS) units on scene; 65.3% (95% CI, 61.9 to 68.6%) of these calls required ALS intervention. A total of 3.4% of the runs sorted to the non-ALS response groups were identified to have required ALS intervention. Comparing the need for ALS intervention, a significant difference was found between the triage groups.Conclusion:Emergency medical dispatchers, using a formal system for telephone triage, are able to direct appropriate prehospital resources to the emergency scene.
Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge
Authors: Houtchens Bruce A. , Clemmer Terry P. , Holloway Harry C. , Kiselev Alexander A. , Logan James S. , Merrell Ronald C. , Nicogossian Arnauld E. , Nikogossian Haik A. , Rayman Russell B. , Sarkisian Ashot E. , Siegel John H. 
Published: July 2016

AbstractIntroduction:The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa.Methods:During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas.Results:Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47 and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent.Conclusion:These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.
Joint Position Statement on Emergency Medical Services and Emergency Medical Services Systems
Authors:   National Association of State EMS Directors and National Association of EMS Physicians
Published: July 2016

In 1966, a National Academy of Science's National Research Council white paper described inadequacies in the emergency health care available in the United States. Entitled “Accidental Death and Disability: The Neglected Disease of Modern Society,” this paper cited a diversity or lack of standards for many aspects of emergency medical services (EMS) and a general absence of a systemized approach.Federal response in the early 1970s, through the National Highway Traffic Safety Administration and the EMS System Act of 1973, addressed the fragmented delivery of EMS, and set standards for planning and developing such services within the context of an EMS system. The System Act addressed the primary prevention of injury and acute, critical illness as well as methods for comprehensive intervention, from system access and prehospital care through stabilization and rehabilitation, in those cases where primary prevention fails.
The Emergency Medical Response to the Cantara Hazardous Materials Incident
Authors: Koehler Gus A. , Van Ness Carol 
Published: July 2016

AbstractOn 14 July 1991, at 2150 h, a train derailment occurred near the Cantara rail curve about six miles above Dunsmuir in Northern California. The derailment spilled approximately 19,000 gallons of metam-sodium into the Sacramento River. When mixed with loater, metam-sodium degrades to methylisothiocyanate (MITC) and other gases. The contaminated river water passed the town of Dunsmuir and other occupied areas exposing residents to MITC gas.From 15 July to 20 July (five days), a total of 360 people underwent triage. The majority of patients displayed minor exposure symptoms that did not require hospital care. Mercy Mt. Shasta Hospital, a small rural hospital close to Dunsmuir, received the majority of patients. As of 29 July, 15 days after the incident, Mercy Mt. Shasta Hospital had seen 244 exposed patients in its emergency department, and had admitted five. Three had symptoms that could have been spill-related. Three Regional Poison Control Centers provided medical toxicology advice.Medical management of the emergency medical services (EMS) response to the event was piecemeal and weak. There did not appear to be a medical operations component at local Emergency Operations Centers (EOC). Most health care personnel interviewed complained about inadequate information about the substance and the situation. Local fire service mutual- aid agreements to obtain additional fire service and ambulance personnel worked well. It is important to emphasize that everyone who believed they had been exposed to the chemical underwent triage and received appropriate acute medical care.
Airway Control in Trauma Patients with Cervical Spine Fractures
Authors: Lord S. Alan , Boswell William C. , Williams James S. , Odom John W. , Boyd Carl R. 
Published: July 2016

AbstractIntroduction:Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial.Purpose:This study was undertaken to survey the preferred methods of airway management in cervical spine fracture (CSF) patients, to evaluate the experience of handling such patients at a level-I trauma center, and to contrast the findings with recommendations of the American College of Surgeons Committee on Trauma.Hypothesis:The methods used for control of the airway in patients with fractures of their cervical spine support the recommendation of the American College of Surgeons (ACS) Committee on Trauma.Methods:The study consisted of two parts: 1) a survey; and 2) a retrospective study. Survey questionnaires were sent to 199 members of the Eastern Association for the Surgery of Trauma and to 161 anesthesiology training programs throughout the United States. Three resuscitation scenarios were posed: 1) Elective airway—CSF—breathing spontaneously, stable vital signs; 2) Urgent airway—CSF—breathing spontaneously, unstable vital signs; and 3) Emergent airway—CSF—apneic, unstable. In addition, a three-year retrospective study was conducted at a level-I trauma center to determine the method of airway control in patients with cervical spine fractures.Results:Responses to the questionnaires were received from 101 trauma surgeons (TS) and 58 anesthesiologists (ANESTH). Respondents indicated their preference of airway methods: Elective airway: Nasotracheal intubation: TS 69%, ANESTH 53%. Orotracheal intubation: TS and ANESTH 27%. Surgical airway: TS 4%. Intubation with fiberoptic bronchoscope (FOB): ANESTH 20%. Urgent airway: Nasotracheal intubation: TS 48%, ANESTH 38%. Orotracheal intubation: TS 47%, ANESTH 45%. Surgical airway: TS 4%. FOB: ANESTH 16%. Emergent airway: Orotracheal intubation: TS 81 %, ANESTH 78%. Surgical Airway: TS 19%, ANESTH 7%. FOB: ANESTH 15%.The retrospective review at the trauma center indicated that 102 patients with CSF were admitted; 62 required intubation: four (6%) on the scene, seven (11%) en route, five (8%) in the emergency department, 42 (67%) in the operating room, and four (6%) on the general surgery floor. Airway control methods used were nasotracheal: 14 (22%); orotracheal: 27 (43%); FOB: 17 (27%); tracheostomy: one (2%); unknown: three (4%). No progression of the neurological status resulted from intubation.Conclusion:The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.
Agreement Between Paramedic-Estimated Weights and Subsequent Hospital Measurements in Adults with Out-of-Hospital Cardiac Arrest
Authors: Martin Daniel R. , Soria David M. , Brown Charles G. , Pepe Paul E. , Gonzalez Edgar , Jastremski Michael , Stueven Harlan , Cummins Richard O. 
Published: July 2016

AbstractObjective:To assess the accuracy of paramedic estimates of adult body weights in cardiac arrest cases.Hypothesis:Paramedics could accurately estimate the weights of out-of-hospital cardiac arrest patients.Design:Retrospective data analysis of a 15-month, multicenter study involving nontraumatic out-of-hospital cardiac arrest patients. Paramedic estimates of body weights were compared to weights measured in the hospital. Patients were included in the analysis only if both a paramedic weight and a measured in-hospital weight were recorded.Setting:Six urban emergency medical services systems.Participants:The study population included adults with return of spontaneous circulation who subsequently were admitted to the hospital.Measurements:Pearson correlation analysis of paramedic-estimated weights and measured weights.Results:Among the 133 study patients, the correlation coefficient (R) for paramedic estimates and the actual measured weight was 0.93. Paramedic estimates of weight were within 10% of the measured weights in 74% of the patients, and within 20% of measured weights in 93% of the patients.Conclusion:Paramedic weight estimates correlated well with measured weights.
Intravenous Maintenance with a Saline Lock Intermittent Infusion Device in the Prehospital Environment
Authors: Carducci Bryan , Stein Kurt 
Published: July 2016

AbstractIntroduction:A study was done with EMS personnel to determine the ease of use and accetance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance.Study Hypotheses:Saline lock, intermittent infusion device use in specific clinical scenaios is easier, less expensive, and as effective traditional TV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical servics (EMS) system.Methods:This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlin Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects.Results:There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four-month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65 %) and facilitated patient transportation (73 of 79 or 92%). Medications were administered according to protocol or command dirtion in the prehospital setting through 20 (25%) SL. Intravenous access was maintained by 52 of 79 SL (65 %), and seven (9%) SL were converted to fluid infusions in the prehospital setting after contact with the medical command physician. In the ED, two (3%) SL were judged by nurses to be nonpatent and 17 (22 %) were converted to maintenance fluid infusions. Systemwide use of SL was favored by 73 of 79 (92.4%) EMS providers. Each device and 2 ml 0.9% saline flush carpuject cost [U.S.]$1.62 versus the cost of IV tubing and a 250 cc bag of lactated Ringer's at $2.11, resulting in a cost savings of 23.2%.Conclusion:The saline lock, intermittent infusion device is an effective method of maintaining prehospital IV access. When compared to traditional IV fluid bags, EMT-Ps judged the device to be easier and less time-consuming to initiate, and facilitated patient transportation. A cost savings was realized when SL usage was compared to traditional IV fluid bag infusion. Systemwide implementation of the saline lock was desired.