bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paramedic On Scene Time for Patients Initially Refusing Treatment or Transport
Authors: Heiser John M. , Norton Robert L. , Neely Keith W. , Acker Joe , Hedges Jerris R. 
Published: July 2016

AbstractIntroduction:Patients initially refusing care (PIRC) place their health in jeopardy and consume paramedic and base-station physician time. This study quantifies the time spent on-scene related to PIRC cases.Methods:A retrospective analysis of 128 PIRC cases was performed in the Multomah County EMS system.Results:The PIRC cases had a significantly longer mean on-scene time than did non-refusal cases (30.3 vs 14.6 min; p<.001). Medication administration by paramedics (14% of patients) significantly increased the on-scene time. Overall, the mean time on-scene was not affected by age, gender, vital signs (pulse, blood pressure, respiratory rate), police involvement, and whether the patient was transported. The type of call had limited influence on on-scene time, although mean on-scene time was significantly longer for altered mental status cases than for trauma related cases (35.6 vs 22.4 min; p<.03).Conclusions:PIRC cases create a burden on the EMS system by consuming paramedic and base-station physician time and by preventing these personnel from responding to other calls.
Medical Coverage of a Marathon: Establishing Guidelines for Deployment of Health Care Resources
Authors: Ellis David G. , Verdile Vincent P. , Paris Paul M. , Heller Michael B. , Kennedy Robert , Cox Roy , Irrgang James , Fu Freddie 
Published: July 2016

AbstractIntroduction:Few prearranged events provide better opportunities for emergency health system coordination and planned disaster management than does medical coverage of a major city marathon. No guidelines exist as to the appropriate level of care that should be provided for such an event.Methods:The medical coverage for 2,900 marathon runners and an estimated 500,000 spectators along a 26.2-mile course over city streets for the 1986 Pittsburgh Marathon was examined prospectively. Support groups included physicians, nurses, and medical students from area hospitals and emergency departments and podiatrists, physical therapists, athletic trainers, and massage therapists from the Pittsburgh area. Emergency medical services were provided by city and county advanced life support (ALS) and basic life support (BLS) units, the American Red Cross, and the Salvation Army. A total of 641 medical volunteers participated in the coverage. Data were collected by volunteers as to acute medical and sports medical complaints of all patients, their vital signs, and the treatment provided. Medical care was provided at 20 field aid-stations along the race route (including a station every mile afier the 12-mile mark, and at four stations at the finish line).Results:Race day weather conditions were unusually warm with a high temperature of 86°F (30°C), relative humidity of 64%, partly sunny with little ambient wind, and a high wet bulb-globe temperature of 78°F (25.6°C). Records were obtained on 658/2,900 (25%) runner-patients of which 52 (8%) required transportation to area hospitals after evaluation at aid-stations: three were admitted to intensive care units. Analysis showed that 379/658 (58%) of the patients were treated at the finish line medical areas, and of the remaining 279 patients treated on the course, 218/279 (78%) were seen at seven, mile-aid-stations between 16.2 and 22.8 miles. The conditions of heat and humidity constitute a near “worst-case” scenario and the numbers of medical personnel that should be available to deliver acute care of hyperthermia/hypothermia and fluid/electrolyte disorders are recommended. Also it is recommended that approximately 50% of medical personnel and equipment should be deployed in the finish line area and that 80% of the remaining resources on the race course be deployed in aid-stations located every mile between miles 16 and 23.
Thoraco-Lumbar Spinal Instability during Variations of the Log-Roll Maneuver
Authors: Suter Robert E. , Tighe Thomas V. , Sartori John , Reed Kendell 
Published: July 2016

AbstractIntroduction:The “log-roll” maneuver is a common method of moving patients with suspected spinal injuries despite the fact that there is very little published information concerning its effectiveness.Methods:Lateral thoraco-lumbar motion and rotation during five variations of the log-roll maneuver were examined radiographically in fourteen healthy adults. Variations included the addition of axial traction and alterations in subject arm position.Results:While no rotational differences were noted between variations, substantial differences in lateral displacement were identified between individual subjects and techniques. This variability seemed to be due to differences in individual body habitus, particularly the shoulder/thorax to pelvis proportions and the amount of periabdominal fat. The addition of traction decreased motion in 59% of attempts but increased motion in 18%. While definitive recommendations cannot be made based upon these data, only one variation of the log-roll techniques examined consistently minimized lateral spinal motion in subjects tested. This variation involved positioning the subject with arms fully extended at their sides with palms resting on the lateral portion of their thighs and maintaining this position throughout the procedure.Conclusions:Pending further studies, it may be advisable to utilize this variation in patients with suspected thoraco-lumbar trauma.
Survey of Emergency Medical Technicians' Ability to Cope with the Deaths of Patients During Prehospital Care
Authors: Norton Robert L. , Bartkus Edward A. , Schmidt Terri A. , Paquette Jan D. , Moorhead John C. , Hedges Jerris R. 
Published: July 2016

AbstractHypothesis:Emergency medical technicians (EMTs) find that the death of patients in their care is stressful.Population:Random sample of certified EMTs in one state (Levels I–IV).Methods:A blinded, self-administered survey was sent to a random sample of 2,500 EMTs. Demographic data obtained were: level of training; hours worked each month; population of area served; age; gender; number of deaths per year; training for coping prehospital deaths; and availability of protocols and on-line medical advice for out-of-hospital deaths. A five-point, Likert scale was used to rate the frequency of perceived stress experienced by EMTs in specific situations and the routine practice for notification of survivors. Univariable analysis was performed using Spearman's Rank correlation, Kruskal-Wallis test, and Mann-Whitney U-test. Multivariable correlations were performed using forward and backward step-wise logistic regression analysis. A significance level of 0.05 was used throughout.Results:There were 654 respondents with a mean age of 35.5±8.3 yr; 83% were men. Their highest level of training was: 4% EMT-I, 43% EMT-II, 18% EMT-III, 33% EMT-IV. They saw an average of 9.6 deaths/year and spent an average of 20±17 minutes with survivors. 62 % found treatment of a patient that was dying or died in their care was commonly a stressful experience. Factors that made notification of the family about the prehospital death emotionally difficult included: fewer hours worked/month; working in a smaller community; lower level of EMT training; female gender; and fewer deaths seen during the previous year. The same factors were associated with general emotional difficulty in treatment of a patient who died during prehospital care. Online [direct] medical direction by physicians was common (73%), but did not lessen the difficulty of notification. It did reduce the emotional difficulty for specific clinical situations. Written protocols for not attempting resuscitation were common (66%), but only 44% had protocols for termination of resuscitation. Resuscitation of the clearly dead for the benefit of the family (10%) or for the EMT (5%) was practiced infrequently. Most (67%) respondents had some formal training in dealing with death and the dying patient. Such training did not correlate with less difficulty in notification of survivors or in coping with the deaths of patients in their care.Conclusion:EMTs perceive they have emotional difficulty when prehospital deaths occur and survivors must be notified. Less experience and a lower level of EMT training correlate with more difficulty in coping with patient death. Protocols and on-line [direct] medical control can provide support for the EMT in coping with out-of-hospital deaths. Most notification of survivors is handled by EMTs with formal training to cope with patients that are dying or who die during prehospital care.
9-1-1 EMS Process in the Loma Prieta Earthquake
Authors: Thiel Charles C. , Schneider James E. , Hiatt Donald , Durkin Michael E. 
Published: July 2016

AbstractThe Santa Cruz County 9-1-1 emergency response system was taxed severely with over 1,000 calls during the first seven hours following the Loma Prieta earthquake. It remained functional and responsive, making 229 ambulance runs in the 72-hour period following the earthquake. Initially, the demand was very high compared to normal, but decreased to slightly greater than normal levels during the second day. A fewer than normal number of advanced life support transports were required, and the number of vehicular accident cases were fewer than normal following the earthquake. The 9-1-1 center adopted an abbreviated procedure and only attempted to determine if the call was a medical emergency and the location for dispatch. During the initial emergency period, there were an unusually low proportion of transports and an unusually high number of cases in which the patient was not located. The medical system in Santa Cruz County was able to accommodate the injury load: the health care system was extensive; its three community hospitals were not damaged severely; and there was light demand.Based on this experience, a revised 9-1-1 emergency medical services (EMS) procedure is recommended for disaster periods: 1) the dispatcher inquires whether the patient can be transported by other means; 2) the caller is asked to explain the need for an ambulance in order to assign a priority to the request; and 3) the caller is asked to cancel the call if there no longer is a need. This procedure is expected to improve disaster management of limited ambulance resources during and following a disaster, while maintaining rapid call processing.
Follow-up and Outcome of Patients Who Decline or Are Denied Transport by EMS
Authors: Zachariah Brian S. , Bryan David , Pepe Paul E. , Griffin Monica 
Published: July 2016

AbstractIntroduction:In recent years, several authors have begun to address the medical and legal risks associated with patients refusing or being refused transport by emergency medical services (EMS) systems. However, data regarding patient outcomes still are lacking.Purpose:The purpose of this study was to determine: 1) why patients are not transported; and 2) the subsequent outcome of these patients.Setting:A busy, suburban, volunteer EMS service with indirect medical control, but no guidelines for non-transport of patients.Methods:A retrospective review of the records of 158 consecutive EMS incidents in which an ambulance was called, but the patient was not transported. Follow-up was attempted by telephone contact with the patient and/or family.Results:Telephone follow-up was established successfully for 93 cases (59%). Of the 93 patients, 60 (64.5%) subsequently sought care from a physician, 15 of whom (25%) later were admitted. The mean hospital stay was 6.6±7.9 days (median=3 days) with a range of 1–30 days. Two were admitted to an intensive care unit (ICU) and two others died. Of the 93 study cases, 43 (46%) involved situations in which the patient refused transport. Paramedics declined transport or mutually agreed not to transport in 50 cases (54%). This latter category accounted for 11 (73%) of the 15 hospitalizations. Ten percent of patients (or their families) stated that they were dissatisfied with the non-transport decisions.Conclusions:Serious, even fatal outcomes were identified in the follow-up of patients not transported by EMS. Although a direct causal relationship was not established within the context of this study, situations in which EMS personnel either denied transport (or mutually agreed with the patient not to transport by ambulance) were twice as likely to result in hospitalization than were those cases in which the patients declined transportation against the advice of the EMS personnel.
Who Calls the Shots? EMS Operations Control and the Role of the Communications Center
Authors: Suter Robert E. 
Published: July 2016

Once ignored by health care and management theorists, emergency medical service (EMS) has begun to attract attention to its traditional policies and practices. Long-standing notions about job qualifications, job responsibilities, organizational structure, and operations control are being challenged by alternative approaches such as System Status Management (SSM), Computer-Aided Dispatch (CAD), and Emergency Medical Dispatch (EMD). One important characteristic of these new models is their emphasis on the role of the communications center in controlling operations. Convincing arguments for these systems have been advanced, and they have been implemented successfully in many areas.Despite these developments, variations of the traditional model which minimizes the importance of the communications center and emphasizes control by field supervisors still characterize many, if not most, EMS systems in the United States. While this probably is due to a natural resistance to change and local political concerns, data supporting the new systems unfortunately are only anecdotal. Except for superficial comparisons, the traditional and alternative approaches have not been examined in light of accepted management theory and principles. Therefore, this paper will analyze the communications center and operations control from a theoretical standpoint to determine where in an EMS organization, control is exercised most naturally, and how these findings could impact on management effectiveness.
Recommendations for Life-Supporting First-Aid Training of the Lay Public for Disaster Preparedness
Authors: Angus Derek C. , Pretto Ernesto A. , Abrams Joel I. , Safar Peter 
Published: July 2016

AbstractIn catastrophic disasters such as major earthquakes in densely populated regions, effective Life-Supporting First-Aid (LSFA) and basic rescue can be administered to the injured by previously trained, uninjured survivors (co victims). Administration of LSFA immediately after disaster strikes can add to the overall medical response and help to diminish the morbidity and mortality that result from these events. Widespread training of the lay public also may improve bystander responses in everyday emergencies. However, for this scheme to be effective, a significant percentage of the lay population must learn the eight basic steps of LSFA. These have been developed by the International Resuscitation Research Center in collaboration with the World Association for Emergency and Disaster Medicine, the City of Pittsburgh Department of Public Safety, and the American Red Cross (Pennsylvania chapter). They include: 1) scene survey; 2) airway control; 3) rescue breathing (mouth-to-mouth); 4) circulation (chest compressions; may be omitted for disasters, but should be retained for everyday bystander response); 5) abdominal thrusts for choking (may be omitted for disasters, but retained for everyday bystander response); 6) control of external bleeding; 7) positioning for shock; and 8) call for help.
Factors Influencing Treatment of Asthma in Children in the Prehospital Setting
Authors: Tortella Bartholomew J. , Marrocco Annicol D. , Lavery Robert F. , Killeen Noel 
Published: July 2016

AbstractStudy Objective:The purpose of this study is to describe treatment of asthma in children by paramedics.Design:Retrospective review of an advanced life support (ALS) run reports over a one-year period.Setting:Review of paramedic response to pediatric respiratory emergencies in an urban, primarily inner-city, prioritized, dual-response emergency medical services (EMS) system.Participants:Patients < 19 years of age complaining of shortness of breath, paramedics, pediatric residents, and attending physicians.Measurements and Main Results:The medical records of 383 patients were reviewed for demographic and medical information. The population was separated into an ALS treatment group (received ALS) and a NO-ALS group (evaluation and/or oxygen only). Sixty percent of the patients (n = 231) were classified into the ALS group; 89% received epinephrine. Sixty-six percent (n = 101) of the NO-ALS patients received evaluation only, and the remaining 34% (n = 51) were evaluated and received oxygen. The ALS patients were older and had significantly higher respiratory rates and accessory muscle use than did the NO-ALS patients. Relief was reported in 66 % of ALS patients. No adverse reactions were reported in the ALS group. Determining factors influencing ALS treatment included age, the use of medications at home, wheezing, accessory muscle use, respiratory rate, and presence or absence of upper respiratory infection (URI) symptoms.Conclusions:This study demonstrates that asthma constitutes the majority of pediatric emergencies in the prehospital setting in this inner-city EMS system. The ALS treatment of pediatric asthma improves patient status. Factors which may influence paramedic judgment in treating asthma in children may be inappropriate. There is a critical need for further research in the prehospital treatment of pediatric asthma and in developing education interventions directed at the entire spectrum of prehospital care of pediatric emergencies.
The Effect of a Quality Improvement Feedback Loop on Paramedic Skills, Charting, and Behavior
Authors: O'Connor Robert E. , Megargel Ross E. 
Published: July 2016

AbstractObjective:A mechanism was initiated for conveying quality improvement (QI) results to paramedics as a means of improving chart documentation in difficult-to-correct areas. This study examines the impact of this QI feedback loop on charting, resuscitation rates from cardiac arrest, endotracheal intubation (ETI) success rates, and trauma scene times.Design:Paramedic trip sheets were reviewed before and after the institution of the QI feedback hop in this interrupted time series design.Setting:The New Castle County, Delaware, Paramedic Program.Participants:All New Castle County paramedics participated in the study.Interventions:In January 1990, the medical director began to circulate a QI summary among the paramedics in an effort to improve performance and chart documentation. The summary focused on the management of respiratory distress or arrest, cardiac arrest, and major trauma. The success rate for ETI was compared with the rate of field resuscitation from cardiac arrest, the percentage of unjustified prolonged trauma scene times (longer than 10 minutes), and the percent compliance with minimum endotracheal intubation documetation (ETID) requirements from a six-month period before institution of the QI feedback mechanism with data obtained from a six-month period after the program had been operational for one year.Results:Comparing results from before with after the initiation of the QI program, the ETI success rate was 273 of 295 (92.5%) before and 300 of 340 (88.2%) after (X2= 3.04, p <.1, ns); field resuscitations totaled 26 of 187 (13.9%) before and 44 of 237 (18.6) after (X2= 1.40, p <.25, ns); ETID rate was 249 of 295 (84.4%) before and 336 of 340 (98.8%) after (X2= 44.24, p <.001), and unjustified prolonged trauma scene times were 69 of 278 (24.8%) before and seven of 501 (1.4%) after (X2= 320.5, p <.001).Conclusion:The use of QI feedback had little effect on psychomotor skills such as the ETI success rate or resuscitation rate, but had a dramatic effect on chart documentation, as evidenced by ETID rate, and behavior, as evidenced by the reduction in prolonged trauma scene times. The use of QI feedback is recommended as a means of correcting charting deficiencies or modifying behavior.
Paramedic Documentation of Indicators for Cervical Spine Injury
Authors: Pennardt Andre M. , Zehner Wm. John 
Published: July 2016

AbstractIntroduction:Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should “wear that collar and be strapped to that board.” Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.Hypothesis:Algorithms exist for physicians to “clear” the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.Methods:A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.Results:All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).Conclusion:Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.
Experiences from the World Health Organization Missions in Sarajevo, 1992–1993
Authors: Rubin Margareta 
Published: July 2016

As a physician and aid worker for the World Health Organization (WHO), I spent some months during the winter (1992-1993) in the besieged city of Sarajevo and another month during the spring (1993) in northeastern Bosnia.Impressions from such an experience, in the middle of a war in Europe, naturally mark one's mind. As one who has seen Sarajevo's people desperately fight to survive the winter, during constant bombardment, and with lack of everything associated with basic needs such as fuel, food, water, and drugs, I will never forget. I could speak a long time about the hardship, as well as the helpfulness, friendship, and even happiness amid grief and misery. There were joyful parties with Bosnian songs and music, dinners with food made of almost nothing at all and held in homes seriously damaged by shelling. Sarajevo, that magic city, became a mysterious attraction to us foreigners. Once we had been there, we had to go back to see how the city was surviving. We all had the “Sarajevo Syndrome.”