bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of the Prehospital Index in Identifying Major Hemorrhage in Trauma Victims
Authors: Jones Jeffrey , Newman Carol , Krohmer Jon , Mattice Connie 
Published: July 2016

AbstractPurpose:To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.Methods:The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requiremets for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severityscore.Results:Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI >3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI ≤3; 86% (102/119) of these patients did not require transfusion.Conclusion:The data suggest that patients with PHI scores >3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.
Urban Search and Rescue Medical Teams: FEMA Task Force System
Authors: Barbera Joseph A. , Lozano Michael 
Published: July 2016

AbstractRecent national and international disasters involving collapsed structures and trapped casualties (Mexico City; Armenia; Iran; Philippines; Charleston, South Carolina; Loma Prieta, California; and others) have provoked a heightened national concern for the development of an adequate capability to respond quickly and effectively to this type of calamity. The Federal Emergency Management Agency (FEMA) has responded to this need by developing an Urban Search and Rescue (US&R) Response System, a national system of multi-disciplinary task forces for rapid deployment to the site of a collapsed structure incident. Each 56person task force includes a medical team capable of providing advanced emergency medical care both for task force members and for victims located and reached by the sophisticated search, rescue, and technical components of the task force. This paper reviews the background and development of urban search and rescue, and describes the make-up and function of the Federal Emergency Management Agency (FEMA) Task Force medical teams.
Comparison of Delivered Volumes and Airway Pressures when Ventilating Through an Endotracheal Tube with Bag-Valve Versus Demand-Valve
Authors: Mosesso Vincent N. , Lukitsch Karen , Menegazzi James , Mosesso Janet 
Published: July 2016

AbstractIntroduction:Use of an oxygen-powered demand-valve to ventilate through an endotracheal tube is considered inappropriate due to concern regarding excessive airway pressure.Hypothesis:It was hypothesized that ventilation through an endotracheal tube using a bag-valve (BV) device and the recently modified demand-valve (DV) would produce similar tidal volumes (Vt), minute ventilation (MV), and peak airway pressures (PAP).Methods:This is a prospective, randomized vitro experimental model. Subjects were blinded to volume and pressure gauges. Thirty-nine EMTs (mean age 27 years with mean experience five years) volunteered to ventilate a mechanical test lung through an endotracheal tube for 10 minutes. Each subject was randomized to BV or DV and to either normal (0.1 L/cm H2O) or poor (0.04 L/cm H2O) lung compliance. This DV delivers set flow of 40 L/min at maximum 50±5 cm H2O. Subjects were instructed to use their “usual” technique for an average size adult in respiratory arrest with normal heart rate and blood pressure. The Vt and PAP were recorded for each breat; the MV and maximum PAP (PAP-max) for each minute was noted. Data were analyzed using repeated measures ANOVA and Tuke multiple comparisons with alpha set at 0.05.Results:Overall average tidal volumes and minute ventilations were acceptable with both ventilalory devices at both normal and poor compliance for the first, fifth, and 10th minute of continuous ventilation. Average airway pressures and peak airway pressures during the first, fifth, and 10th minute of ventilation all were significantly higher with those of the bag-valve than with the use of the demandvalve at both normal and poor compliance.Conclusion:In this model, ventilation with bag-valve and demand-valve both provided more than adequate Vt and MV; values wer similar except for higher Vt with BV at normal compliance. However, DV yielded significantly lower PAP and PAPmax at both poor and normal compliance. These findings need corrobration in an in vivo model, but suggest that with proper training, demand-valve ventilation through an endotracheal tube may be preferable.
Improvised Purification Methods for Obtaining Individual Drinking Water Supply Under War and Extreme Shortage Conditions
Authors: Kozlicic Abdulah , Hadzic Abdulfetah , Bevanda Hrvoje 
Published: July 2016

AbstractBackground:Supplying an adequate amount of drinking water to a population is a complex problem that becomes an extremely difficult task in war conditions. In this paper, several simple methods for obtaining individual supplies of drinking water by filtration of atmospheric water with common household items are reported.Methods:Samples of atmospheric water (rain and snow) were collected, filtered, and analyzed for bacteriological and chemical content. The ability of commonly available household materials (newspaper, filter paper, gauze, cotton, and white cotton cloth) to filter water from the environmental sources was compared.Results:According to chemical and biological analysis, the best results were obtained by filtering melted snow from the ground through white cotton cloth.Conclusions:Atmospheric water collected during war or in extreme shortage conditions can be purified with simple improvised filtering techniques and, if chlorinated, used as an emergency potable water source.
Effectiveness of Interactive Videodisc Instruction for the Continuing Education of Paramedics
Authors: Heller Michael , Stoy Walt A. , Shuman Larry J. , Wolfe Harvey , Zavada Chalice A. 
Published: July 2016

AbstractObjectives:To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets.Design/Setting:Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS).Interventions:All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using “Student's“ t-test and Chi-square with alpha set at 0.05.Exclusions:Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15).Results:Overall the mean compliance score of the pre-IVD group was 0.65 ±0.19 (±SD). The post-IVD group score was 0.65 ±0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030.Conclusion:Eight hours of IVD instruction did not result in improved paramedic performance as judged by computer analysis of trip sheets.
Evolution of Rescue Systems: A Comparison between Cologne and Cleveland
Authors: Lechleuthner Alex , Emerman Charles , Dauber Andreas , Bouillon Bertil , Kubincanek John A. 
Published: July 2016

AbstractIntroduction:Comparisons of different emergency medical services (EMS) systems often are reduced to simple comparisons between distinct facilities or strategies (e.g., prehospital physician versus paramedic, “scoop and run” versus “stay and play”).Methods:The EMS systems of similar cities (Cologne and Cleveland) in two different countries (Germany and the United States) are compared. The comparison is seen from the perspective of an evolutionary standpoint that reflects the development of the EMS system in connection with the special environments. Data on rescue times, facilities, and (trauma) outcomes are compared.Results:No statistically significant differences in outcome between the systems were detected.Conclusion:Both systems are developed in special environments and are optimized over decades, which explains the similarities in outcome.
System Implications of the Ambulance Arrival-to-Patient Contact Interval on Response Interval Compliance
Authors: Campbell Jack P. , Gratton Matthew C. , Salomone Joseph A. , Lindholm Daniel J. , Watson William A. 
Published: July 2016

AbstractBackground:Background: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.Purpose:To determine the effect of the VSPA interval on the mandated code 1 (<9 min) and code 2 (<13 min) response time interval compliance in an urban, public-utility model system.Methods:A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the man dated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.Results:Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p<0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).Conclusion:The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.
Sources of Disagreement Among Public and Private Agency Paramedics
Authors: Federiuk Carol S. , O'Brien Kerth 
Published: July 2016

AbstractIntroduction:The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system.Methods:This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics.Results:On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment.Conclusion:A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.
To Report or Not to Report: Emergency Services Response to Elder Abuse
Authors: Jones Jeffrey S. , Walker George , Krohmer Jon R. 
Published: July 2016

AbstractPurpose:Prehospital emergency medical services (EMS) personnel, as initial responders to calls for assistance, are in an ideal position to identify abused or neglected elderly. A survey of prehospital personnel in Michigan was conducted to determine the scope of this problem, levels of awareness, and willingness to report cases of elder abuse.Methods:The study population was a random sample of 500 prehospital personnel throughout one state. A blinded, self-administered survey was completed by emergency medical technicians (EMTs) and paramedics outlining their practice characteristics, prevalence of abuse in their community, and training available specific to elder abuse. Attitudes concerning the understanding and reporting of geriatric abuse were measured using a Likert-type scale.Results:A total of 156 surveys (31%) was completed; 68% of the respondents were paramedics. Respondents had an average of 8.7 years (range: 9 months-30 years) of prehospital emergency-care experience, and evaluated an average of 11 patients (range: 1–59) older than 65 years of age each week. Seventy-eight percent had seen a suspected case of elder abuse or negligence during their careers; 68% had seen a case during the past 12 months (mean: 2.3 cases/yr; range: 0–24 cases/yr). However, surveyed personnel reported only 27% of suspected cases to authorities last year (mean: 0.62 cases/yr). Reasons for not reporting included 1) unsure which authorities take reports; 2) unclear definitions; 3) unaware of mandatory reporting laws; and 4) lack of anonymity. Ninety-five percent of respondents stated that training related to elder abuse was not available through their EMS agency.Conclusion:Paramedics and EMTs lack complete understanding of their role in the identification and reporting of elder abuse. This information should be emphasized during EMS training and reinforced through continuing education.
A Comparative Analysis of the Emergency Medical Services and Rescue Responses to Eight Airliner Crashes in the United States, 1987–1991
Authors: Anderson Paul B. 
Published: July 2016

AbstractIntroduction:Crashes involving commercial airliners stress emergency medical services (EMS) and rescue operations to performance far in excess of everyday activities, and special adaptations of everyday responses need to be implemented. Fortunately, these events are infrequent and usually do not occur more than once in any location. The responses that occur must be highly coordinated and efficient. Little is known about the responses to such events. This study examines the EMS and rescue responses associated with eight recent crashes involving commercial airliners in the United States.Objective:To identify common factors for which alterations in responses may enhance the survival and decrease the morbidity to victims involved in commercial aviation crashes.Study population:Eight commercial airliner crashes in the United States from 1987 through 1991.Methods:Case review using: 1) press and media accounts; 2) U.S. National Transportation and Safety Board testimony and reports; and 3) structured interviews with airport, fire, EMS, and hospital personnel. Data were collated and common factors identified for the cases. Findings are classified into: 1) conditions at the crash sites; 2) initial responses; 3) scene management; 4) scene status; 5) patient transport; 6) hospital responses; and 7) preplanning exercises.Results:Common factors that impaired responses for which some remediation is possible include: 1) new methods for training including computerized simulations; 2) improvements in rescue-extrication equipment and supplies; 3) stored caches of EMS equipment and supplies at airports; 4) ambulance transport capabilities; and 5) augmentation of patient transport capabilities.Conclusions:Many lessons can be learned through structured studies of commercial aircraft crashes. These findings suggest that simple and relatively inexpensive modifications may enhance all levels of emergency response to such events.
On-line Medical Direction: A Prospective Study
Authors: Wuerz Richard C. , Swope Gregory E. , Holliman C. James , Miguel Gaspar Vazquez-de 
Published: July 2016

AbstractObjectives:To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.Methods:Blinded, prospective study.Setting:A university hospital base-station resource center.Participants:Ten emergency physicians, 50 advanced life support providers.Interventions:Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.Results:Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ± 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ± 439 sec). Mean transport time in this system was 13 minutes.Conclusion:Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.
Safe Out-of-Hospital Treatment of Chest Pain Without Direct Medical Control
Authors: McErlean Mara , Raccio-Robak Nancy , Bartfield Joel M. , Hermes Daniel 
Published: July 2016

AbstractIntroduction:The use of direct medical control (DMC) in the out-of-hospital setting often is beneficial, but has the disadvantage of consuming emergency medical services (EMS) resources.Hypothesis:Uncomplicated, nontrauma, adult patients with chest pain can be treated safely and transported by paramedics without DMC.Methods:Retrospective chart review of all nontrauma, adult patients with chest pain treated in a combined rural and suburban EMS system during a 2-year period (December 1990 through November 1992) was conducted. Before November 1991, DMC was mandatory for all patients with chest pain. Beginning 01 November 1991, if a patient had resolution of pain either spontaneously, with administration of oxygen, or after a single dose of nitroglycerin, DMC was at the discretion of the paramedic. Using the above criteria for inclusion, three study groups were defined: Group 1, before protocol change; Group 2, after protocol change without DMC; and Group 3, after protocol change when physician contact was obtained, but not required. These groups were compared for the following parameters: 1) scene time; 2) time to administration of first dose of nitroglycerin; 3) time interval between measurement of vital signs; 4) oxygen use; 5) intravenous access; and 6) electrocardiographic monitoring. Continuous and categorical variables were analyzed by multivariate and univariate analysis of variance and chi-square tests, respectively.Results:Of 308 nontrauma, adult patients with chest pain, 71 met inclusion criteria in Group 1, 40 in Group 2, and 34 in Group 3. No statistically significant differences were identified in any of the study parameters.Conclusion:Adult patients with chest pain who have no other symptoms or complicating conditions can be treated appropriately by paramedics without DMC.
Early Predictors of Sepsis in the Motor-Vehicle Crash Trauma Victim
Authors: Previdi Jeanette K. , Cayten C. Gene , Byrne Daniel W. 
Published: July 2016

AbstractIntroduction:Sepsis is a major cause of late morbidity and mortality in the victim of trauma. Currently, there is no method that is clinically practical and accurate for predicting the occurrence of sepsis in trauma victims.Methods:Data were collected on 3,759 motor-vehicle crash victims from 16 hospitals during a 4 1/2 year period. Retrospective analysis was done to examine the relationship of patient and injury factors known within the first 24 hours of admission on the development of sepsis.Results:Sepsis developed in 154 patients (4.1%) who had a mortality rate of 17.5% Significant early predictors of sepsis included: 1) certain pre-existing conditions; 2) blood transfusion required; 3) seven or more injuries; 4) Glasgow Coma Scale score <10 and hypertension; 5) major blood vessel injury; 6) head trauma; 7) internal injury of the chest or abdomen; 8) spinal-cord injury; and 9) certain fracture types.Conclusions:These predictors might help target high-risk patients and, thus, promote earlier and more effective treatment for those patients.
Anaphylactoid Reaction to Adenosine
Authors: Fata John G. , Roth Ronald N. , Carpenter Linda 
Published: July 2016

AbstractAdenosine (Adenocard) is an endogenous purine nucleoside that has been approved recently for intravenous treatment of paroxysmal supraventricular tachycardia. With a serum half-life of 10 seconds, reported side effects including facial flushing, dyspnea, and chest pressure are common, but very transient. An elderly woman who received adenosine for paroxysmal supraventricular tachycardia had a prolonged anaphylactoid reaction that required pharmacological treatment. This is the first reported case of prolonged anaphylactoid reaction to adenosine.